Palo Alto VA Healthcare System

Palo Alto, CA, United States

Palo Alto VA Healthcare System

Palo Alto, CA, United States
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Rhode P.C.,Tulane University | Froehlich-Grobe K.,University of Texas at Dallas | Hockemeyer J.R.,Palo Alto VA Healthcare System | Carlson J.A.,San Diego State University | Lee J.,University of Kansas
Disability and Health Journal | Year: 2012

Background: Stress negatively influences health, but few scales capture unique stressors encountered by people with physical disability. Objective/Hypothesis: Conduct a pilot study to develop and evaluate the factor structure of a stress measure targeting unique stressors facing people with physical limitations due to impaired movement of the upper and lower extremities. Methods: Development of the Disability Related Stress Scale (DRSS) included: (1) obtaining input regarding content and items from focus groups and outside experts and (2) piloting the instrument. Participants recruited from an independent living center attended a focus group or completed the pilot survey. The piloted measure was a 107 item two-part survey. Part 1 assessed stressors encountered over the past week and Part 2 assessed stressors encountered over the past six months. Participants included a convenience sample of 143 adults who experienced a physical limitation; 26 attended focus groups and 117 completed the instrument. Respondents were predominantly women (60%), Caucasian (58%), and unemployed (92%). Respondents were 50.51 6 14.46 years old and had lived with their disability for 15.64 6 13.04 years. Results: Exploratory factor analyses revealed a 4-factor solution for Part 1 and a 2-factor solution for Part 2 of the DRSS. Estimates of internal consistency (Part 1 Cronbach's α 5 .78-84; Part 2 Cronbach's α 5 .72) and factor loadings (.40-1.00 for Part 1; .43-.87 for Part 2) indicate adequate reliability for all subscales. Conclusions: Preliminary results provide initial support for the instrument's reliability and factor structure although further validation studies are warranted. © 2012 Elsevier Inc.


Judge K.S.,Cleveland State University | Judge K.S.,Margaret Blenkner Research Institute | Yarry S.J.,Case Western Reserve University | Yarry S.J.,Palo Alto VA Healthcare System | Orsulic-Jeras S.,Margaret Blenkner Research Institute
Gerontologist | Year: 2010

Purpose: The current article provides an in-depth description of a dyadic intervention for individuals with dementia and their family caregivers. Using a strength-based approach, caregiving dyads received skills training across 5 key areas: (a) education regarding dementia and memory loss, (b) effective communication, (c) managing memory loss, (d) staying active, and (e) recognizing emotions and behaviors. Results of the acceptability and feasibility of the intervention protocols are also presented.Design and Methods: Caregiving dyads were randomly assigned to participate in the intervention. Participants in the treatment condition were asked to complete a series of evaluation questions after each intervention session and an overall evaluation of the program. Data were also collected from the intervention specialists who implemented the protocols.Results: Overall, the evaluation data indicated that the content and process of the intervention were viewed as highly acceptable and feasible by both participants and intervention specialists.Implications: This article highlights the merit of using a strength-based approach for working with caregiving dyads with dementia and how a single intervention protocol can be used to address the goals of both care partners. Furthermore, the intervention program was found to be highly acceptable and feasible, which is an important aspect of developing dyadic protocols. © The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved.


O'Dell J.R.,University of Western Ontario | Mikuls T.R.,University of Western Ontario | Taylor T.H.,White River Junction Medical Center | Ahluwalia V.,Brampton Civic Hospital | And 12 more authors.
New England Journal of Medicine | Year: 2013

Background: Few blinded trials have compared conventional therapy consisting of a combination of disease-modifying antirheumatic drugs with biologic agents in patients with rheumatoid arthritis who have active disease despite treatment with methotrexate - a common scenario in the management of rheumatoid arthritis. Methods: We conducted a 48-week, double-blind, noninferiority trial in which we randomly assigned 353 participants with rheumatoid arthritis who had active disease despite methotrexate therapy to a triple regimen of disease-modifying antirheumatic drugs (methotrexate, sulfasalazine, and hydroxychloroquine) or etanercept plus methotrexate. Patients who did not have an improvement at 24 weeks according to a prespecified threshold were switched in a blinded fashion to the other therapy. The primary outcome was improvement in the Disease Activity Score for 28-joint counts (DAS28, with scores ranging from 2 to 10 and higher scores indicating more disease activity) at week 48. Results: Both groups had significant improvement over the course of the first 24 weeks (P = 0.001 for the comparison with baseline). A total of 27% of participants in each group required a switch in treatment at 24 weeks. Participants in both groups who switched therapies had improvement after switching (P<0.001), and the response after switching did not differ significantly between the two groups (P = 0.08). The change between baseline and 48 weeks in the DAS28 was similar in the two groups (-2.1 with triple therapy and -2.3 with etanercept and methotrexate, P = 0.26); triple therapy was noninferior to etanercept and methotrexate, since the 95% upper confidence limit of 0.41 for the difference in change in DAS28 was below the margin for noninferiority of 0.6 (P = 0.002). There were no significant between-group differences in secondary outcomes, including radiographic progression, pain, and healthrelated quality of life, or in major adverse events associated with the medications. Conclusions: With respect to clinical benefit, triple therapy, with sulfasalazine and hydroxychloroquine added to methotrexate, was noninferior to etanercept plus methotrexate in patients with rheumatoid arthritis who had active disease despite methotrexate therapy. Copyright © 2013 Massachusetts Medical Society.


Newman M.,Northwestern University | Ravindranath D.,Palo Alto VA Healthcare System | Figueroa S.,University of Michigan | Jibson M.D.,University of Michigan
Academic Psychiatry | Year: 2016

Objectives: There is little guidance regarding best practices in supervision of psychiatric residents. As a result, expectations for both supervisors and trainees are often unclear. This study explored the experiences of trainees and supervisors in outpatient supervision, in order to identify areas for potential improvement. Methods: The authors conducted focus groups of residents and faculty members. The sessions were transcribed and analyzed via established methods of qualitative data analysis. Results: A number of themes emerged. In general, residents desire an explicit structure to supervisory sessions, with more specific and concrete instruction. Attendings prefer to let residents lead discussion in supervision and focus on interpersonal aspects, such as the mentor-mentee relationship. Findings were situated within an established model of skill acquisition, the five-stage progression described by Dreyfus and Dreyfus. Conclusions: The differing experiences of trainees and supervisors reflect their respective stages of skill development as ambulatory psychiatrists. Potential interventions to improve the educational value of supervision include explicit agenda-setting at the beginning of supervision, regular bidirectional feedback, and more frequent opportunities for residents to observe attending interviews with patients. © 2014 Academic Psychiatry.


Bertaccini E.J.,Palo Alto VA Healthcare System | Trudell J.R.,Stanford University
Current Opinion in Anaesthesiology | Year: 2012

PURPOSE OF REVIEW: Although general anesthetics have been provided effectively for many years, their exact molecular underpinnings remain relatively unknown. In this article, we discuss the recent findings associated with resistance to anesthetic effects as a way of shedding light on these mechanisms. RECENT FINDINGS: The original theories of anesthetic action based upon their effects on cellular membranes have given way to specific theories concerning direct effects on ion channel proteins. These molecular targets are intimately involved in the conduct of neuronal signaling within the central nervous system and are thought to be essential in the modulation of conscious states. It is the lack of a thorough understanding of unperturbed consciousness that fosters great difficulty in understanding how anesthetics alter this conscious state. However, one very fruitful line of analysis in the quest for such answers lies in the examination of both in-vitro and in-vivo ion channel systems that seem to maintain variable levels of resistance to anesthetics. SUMMARY: Information about the possible targets and molecular nature of anesthetic action is being derived from studies of anesthetic resistance in γ aminobutyric acid receptors, tandem pore potassium channels, and an apparently wide variety of protein systems within the nematode, Caenorhabditis elegans. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


PubMed | University of Michigan, Palo Alto VA Healthcare System and Northwestern University
Type: Journal Article | Journal: Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry | Year: 2016

There is little guidance regarding best practices in supervision of psychiatric residents. As a result, expectations for both supervisors and trainees are often unclear. This study explored the experiences of trainees and supervisors in outpatient supervision, in order to identify areas for potential improvement.The authors conducted focus groups of residents and faculty members. The sessions were transcribed and analyzed via established methods of qualitative data analysis.A number of themes emerged. In general, residents desire an explicit structure to supervisory sessions, with more specific and concrete instruction. Attendings prefer to let residents lead discussion in supervision and focus on interpersonal aspects, such as the mentor-mentee relationship. Findings were situated within an established model of skill acquisition, the five-stage progression described by Dreyfus and Dreyfus.The differing experiences of trainees and supervisors reflect their respective stages of skill development as ambulatory psychiatrists. Potential interventions to improve the educational value of supervision include explicit agenda-setting at the beginning of supervision, regular bidirectional feedback, and more frequent opportunities for residents to observe attending interviews with patients.

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