Watts B.V.,National Center for Patient Safety |
Schnurr P.P.,VA National Center for PTSD |
Zayed M.,White River Junction Medical Center |
Young-Xu Y.,National Center for Patient Safety |
And 2 more authors.
Psychiatric Services | Year: 2015
Objective: Patient decision aids have been used in many clinical situations to improve the patient centeredness of care. A patient decision aid for patients with posttraumatic stress disorder (PTSD) has not been developed or tested. The authors evaluated the effects of a patient decision aid on the patient centeredness of PTSD treatment. Methods: The study was a randomized trial of a patient decision aid for PTSD versus treatment as usual (control group). The participants were 132 male and female veterans who presented to a single U.S. Department of Veterans Affairs hospital with a new diagnosis of PTSD. Patient centeredness was assessed by knowledge of PTSD and its treatment, level of decisional uncertainty, and ability to state a preferred treatment option. Secondary outcomes included treatments received and PTSD symptoms in the six months after study entry. Results: Compared with the control group (N=65), participants who reviewed the patient decision aid (N=63) had higher scores for PTSD knowledge (p=.002) and less conflict about their choice of treatment (p=.003). In addition, participants who reviewed the patient decision aid were more likely to select and receive an evidence-based treatment for PTSD (p=.04) and had superior PTSD outcomes (p=.004) compared with the control group. Conclusions: Use of a patient decision aid was associated with improvements in patient-centered PTSD treatment. The patient decision aid was also associated with greater use of evidence-based treatments and improvement of PTSD symptoms. This study suggests that clinics should consider using a patient decision aid for patients with PTSD. © 2015, American Psychiatric Association. All rights reserved.
Pomerantz A.S.,White River Junction Medical Center |
Sayers S.L.,Philadelphia Medical Center |
Sayers S.L.,University of Pennsylvania
Families, Systems and Health | Year: 2010
The U.S. Department of Veterans Affairs (VA) has been undergoing tremendous transformation in the past 15 years with regard to the delivery of health care. This special issue describes one aspect of this transformation of the largest health system in the U.S.; the system-wide efforts to integrate mental health treatment into the primary care setting in VA. This primary care-mental health integration (PC-MHI) is being accomplished through the central VA system support and implementation of three primary models developed in the field: the White River Colocated models, the Behavioral Health Laboratory, and TIDES (Translating Initiatives in Depression into Effective Solutions). The papers in this special issue describe the development of these models, local and regional efforts to prepare medical centers to adapt and implement PC-MHI, and the impact of the integration on mental health care in these settings. These efforts could represent a national model of PC-MHI implementation for health care systems throughout the U.S. © 2010 American Psychological Association.
Glasziou P.,Bond University |
Ogrinc G.,White River Junction Medical Center |
Goodman S.,Johns Hopkins Schools of Medicine and Public Health
BMJ Quality and Safety | Year: 2011
The considerable gap between what we know from research and what is done in clinical practice is well known. Proposed responses include the Evidence-Based Medicine (EBM) and Clinical Quality Improvement. EBM has focused more on 'doing the right things' - based on external research evidence - whereas Quality Improvement (QI) has focused more on 'doing things right' - based on local processes. However, these are complementary and in combination direct us how to 'do the right things right'. This article examines the differences and similarities in the two approaches and proposes that by integrating the bedside application, the methodological development and the training of these complementary disciplines both would gain.
Giardiello F.M.,Johns Hopkins University |
Allen J.I.,Yale University |
Axilbund J.E.,Johns Hopkins University |
Boland C.R.,Baylor University |
And 14 more authors.
Gastroenterology | Year: 2014
The Multi-Society Task Force, in collaboration with invited experts, developed guidelines to assist health care providers with the appropriate provision of genetic testing and management of patients at risk for and affected with Lynch syndrome as follows: Figure 1 provides a colorectal cancer risk assessment tool to screen individuals in the office or endoscopy setting; Figure 2 illustrates a strategy for universal screening for Lynch syndrome by tumor testing of patients diagnosed with colorectal cancer; Figures 3-6 provide algorithms for genetic evaluation of affected and at-risk family members of pedigrees with Lynch syndrome; Table 10 provides guidelines for screening at-risk and affected persons with Lynch syndrome; and Table 12 lists the guidelines for the management of patients with Lynch syndrome. A detailed explanation of Lynch syndrome and the methodology utilized to derive these guidelines, as well as an explanation of, and supporting literature for, these guidelines are provided. © 2014 by the AGA Institute.
Cavanagh M.F.,Northport Veterans Affairs Medical Center |
Lane D.S.,Stony Brook University Medical Center |
Messina C.R.,Stony Brook University Medical Center |
Anderson J.C.,White River Junction Medical Center
Cancer | Year: 2013
BACKGROUND One of 5 nationally funded Centers for Disease Control and Prevention Colorectal Cancer (CRC) Screening Demonstration Programs, Project SCOPE, was conducted at an academic medical center and provided colonoscopy screening at no cost to underserved minority patients from local community health centers. METHODS Established barriers to CRC screening (eg, financial, language, transportation) among the target population were addressed through clinical coordination of care by key project staff. The use of a clinician with a patient navigator allowed for the performance of precolonoscopy "telephone visits" instead of office visits to the gastroenterologist in virtually all patients. The clinician elicited information relevant to making screening decisions (eg, past medical and surgical history, focused review of systems, medication/supplement use, CRC screening history). The patient navigator reduced barriers, including, but not limited to, scheduling, transportation, and physical navigation of the medical center on the day of colonoscopy. RESULTS Preprogram preparation was vital in laying groundwork for the project, yet enhancements to the program were ongoing throughout the screening period. Detailed referral forms from primary care physicians, coupled with information obtained during telephone interviews, facilitated high colonoscopy completion rates and excellent patient satisfaction. Similarly valuable was the employment of a bilingual patient navigator, who provided practical and emotional patient support. CONCLUSIONS Academic medical centers can be efficient models for providing CRC screening to disadvantaged populations. Coordination of care by a preventive medicine department, directing the recruitment, scheduling, prescreening education, and the evaluation and preparation of target populations had an overall positive effect on CRC screening with colonoscopy among patients from a community health center. Cancer 2013;119(15 suppl):2894-904. © 2013 American Cancer Society.
Shiner B.,Dartmouth College |
Watts B.V.,White River Junction Medical Center |
Pomerantz A.,White River Junction Medical Center |
Young-Xu Y.,Dartmouth College |
Schnurr P.P.,VA National Center for PTSD
Journal of Traumatic Stress | Year: 2011
The authors examined the relationship between changes in symptoms of posttraumatic stress disorder (PTSD) and functioning as measured by the Medical Outcomes Study Short Form-36 (SF-36) among 167 veterans in a primary care clinic. Those who reported at least moderate baseline symptoms were categorized as better, unchanged, or worse at reassessment. The SF-36 was used to examine concordance between change in functioning and symptoms. Veterans with reliable changes in symptoms of PTSD showed corresponding statistically significant changes in functioning across health domains. Moreover, these changes in functioning were clinically significant on several SF-36 subscales and on one summary scale. Copyright © 2011 International Society for Traumatic Stress Studies.
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.
Dominitz J.A.,University of Washington |
Robertson D.J.,White River Junction Medical Center
American Journal of Gastroenterology | Year: 2013
While colonoscopy is the gold standard for the evaluation of the colon, research on post-colonoscopy colorectal cancers has increased our awareness of its limitations. In this issue of the Journal, Erichsen et al. provide evidence to suggest that post-colonoscopy colorectal cancers are most likely due to missed cancers at the time of the index colonoscopy, rather than due to aggressive tumor biology. Ultimately, studies demonstrating the shortcomings of colonoscopy are a call to action for the gastroenterology community to develop strategies and new technologies to improve the effectiveness of colonoscopy. © 2013 by the American College of Gastroenterology.
MacPhee E.,White River Junction Medical Center
Current Psychiatry Reports | Year: 2013
Despite the challenges of conducting research on dissociation and the dissociative disorders, our understanding has grown greatly over the past three decades, including our knowledge of the often overlooked sensorimotor manifestations of dissociation, more commonly referred to as somatoform dissociation. This article will first review the definitions and presentations of dissociation in general along with recent research on the concept of somatoform dissociation. Then, each of the dissociative disorders and conversion disorder will be discussed in further detail as well as how they might present in a medical setting. Current recommendations for diagnosis and treatment will also be provided. © 2013 Springer Science+Business Media New York (outside the USA).
MacPhee E.,White River Junction Medical Center
Current psychiatry reports | Year: 2013
Despite the challenges of conducting research on dissociation and the dissociative disorders, our understanding has grown greatly over the past three decades, including our knowledge of the often overlooked sensorimotor manifestations of dissociation, more commonly referred to as somatoform dissociation. This article will first review the definitions and presentations of dissociation in general along with recent research on the concept of somatoform dissociation. Then, each of the dissociative disorders and conversion disorder will be discussed in further detail as well as how they might present in a medical setting. Current recommendations for diagnosis and treatment will also be provided.