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Ogden, UT, United States

Yaish H.M.,University of Utah | Christensen R.D.,y Dee Hospital Center | Agarwal A.,University of Utah
Journal of Perinatology | Year: 2013

The diagnosis of hereditary spherocytosis (HS) in a newborn infant is generally made on the basis of a positive family history, spherocytes on blood film and Coombs-negative hemolytic jaundice of variable severity with an elevated mean corpuscular hemoglobin concentration (MCHC) and a low mean corpuscular volume (MCV). In general, sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE) quantification of erythrocyte membrane proteins is not needed to make the clinical diagnosis of HS. However, we observed that a neonate with no family history of HS, but with abundant spherocytosis on repeated blood films, Coombs-negative hemolytic jaundice and normal MCHC and MCV measurements, where SDS-PAGE revealed alpha-spectrin deficiency, a rare autosomal-recessive variety of HS that generally has a severe clinical phenotype. © 2013 Nature America, Inc. All rights reserved.

Miser W.F.,Ohio State University | Jeppesen K.M.,y Dee Hospital Center | Wallace L.S.,Ohio State University
Family Medicine | Year: 2013

BACKGROUND AND OBJECTIVES: Our objectives were to (1) compare Newest Vital Sign (NVS) scores and administration characteristics with the short (S) version of the Test of Functional Health Literacy in Adults (S-TOFHLA) and Spoken Knowledge in Low-Literacy Diabetes (SKILLD) tool and (2) gather information from research assistants (RAs) regarding their perceptions of patient understanding of NVS items. METHODS: Adults, age ≥ 18 years, with diabetes mellitus visiting a primary care clinic were recruited to participate. An RA orally administered a sociodemographic questionnaire. Patients completed, in random order, the NVS, S-TOFHLA, and SKILLD. Completion time for each tool was electronically recorded, while patients assessed tool difficulty using a 5-point Likert-type scale. RAs' comments regarding patients' understanding of individual NVS items were tallied. RESULTS: A total of 226 patients (mean age=53.8 years, 31% male, 45.1% African American, 28.8% high school graduate) participated. African Americans were signifcantly less likely to score ≥4 on the NVS (adjusted OR=0.23, 95% CI=0.13, 0.42) as compared to Caucasians. NVS scores were highly correlated with S-TOFHLA scores, rho=0.62, and moderately correlated with SKILLD scores, rho=0.39. NVS scores were inversely correlated with completion time, rho=-0.25 and diffculty rating, rho=-0.37. CONCLUSIONS: Related to the care of patients with diabetes, the most important feature of the NVS is that it can quickly provide a clinician with valuable insight regarding their patients' ability to complete a practical skill (i.e., interpreting a food label) needed to achieve tight blood glucose control.

Christensen R.D.,The Women and Newborns Program | Christensen R.D.,y Dee Hospital Center
Clinics in Perinatology | Year: 2012

This article focuses on the use of rEpo, IVIG, and rG-CSF in the NICU. It discusses the most recent studies and the most definitive and clinically relevant evidence, rather than summarizing all published studies. The last section was written for NICU practice groups that choose to use any of these medications and are seeking a consistent approach for doing so. The section provides the author's approach to the use of rEpo, IVIG, and rG-CSF, revealing personal preferences, interpretations, and experiences, and is based on the dictum, "if you are going to use it, use it the same way each time." © 2012 Elsevier Inc.

Jeppesen K.M.,y Dee Hospital Center | Hull B.P.,Ohio State University | Raines M.,Ohio State University | Miser W.F.,Ohio State University
Journal of General Internal Medicine | Year: 2012

BACKGROUND: In 2005 the Spoken Knowledge in Low Literacy in Diabetes scale (SKILLD) was introduced as a diabetes knowledge test. The SKILLD has not been validated since its introduction. OBJECTIVE: To perform a validation analysis on the SKILLD. DESIGN AND PARTICIPANTS: Cross-sectional observational study of 240 patients with diabetes at an academic family practice center. MAIN MEASURES: SKILLD's correlation with an oral form of the Diabetes Knowledge Test (DKT) was used to assess criterion validity. A regression model tested construct validity, hypothesizing that SKILLD score was independently related to health literacy and education level. Content validity was tested using Cronbach's Alpha for inter-item relatedness and by comparing SKILLD items with the content of a National Institutes of Health (NIH) diabetes education website. We assessed inter-rater reliability and bias using Spearman correlation coefficients and sign-rank tests between interviewers scoring the same interview. KEY RESULTS: The SKILLD demonstrated fair correlation with the DKT (Pearson's coefficient 0.54, 95% CI = 0.49 to 0.66, p < 0.001). Health literacy, education level, male gender, household income, and years with diabetes were independent predictors of SKILLD score in the regression model. Cronbach's Alpha for inter-item relatedness was 0.54. There were some topics on the NIH website not addressed by the SKILLD. The inter-rater correlation coefficient was 0.79 (95% CI 0.56 to 0.91, p < 0.001). CONCLUSIONS: The SKILLD is an adequate diabetes knowledge test and is appropriate for people of all literacy levels. However, it should be expanded to more completely evaluate diabetes knowledge. © 2011 Society of General Internal Medicine.

Jeppesen K.M.,y Dee Hospital Center | Bahner D.P.,Ohio State University
Journal of Ultrasound in Medicine | Year: 2012

Objectives-Bedside sonography is a growing field of medicine, but there is little evidence about how to teach it to medical students. A peer-mentoring system may help preclinical medical students learn bedside sonography. Methods-In 2008 and 2009, participating first-year medical students completed an image recognition test at 0, 2, and 4 months and were randomized to an early or a late intervention group. In hands-on sessions, senior medical students taught the early intervention group how to perform a Trinity hypotensive ultrasound protocol between months 0 and 2 and then taught the late intervention group the Trinity protocol between months 2 and 4. Participants completed a practical examination at month 4. We measured the improvement in knowledge after the intervention and retention of knowledge and skills in the early intervention group at month 4. First-year medical students completed precourse and postcourse surveys about comfort and skills with sonography. Results-Eighty-six first-year medical students enrolled; 79 completed the precourse survey; 54 completed all knowledge tests; 52 completed the practical examination; and 49 completed the postcourse survey. Of the 125 nonparticipants, 109 completed the precourse survey, and 25 completed the postcourse survey. Participants' knowledge scores increased by 30% after the intervention. The early intervention group retained 92% of the knowledge gained. Thirty-six percent of participants were able to complete the Trinity protocol in 15 minutes during the practical examination, with no significant difference between the early and late intervention groups. Participants responded positively about the experience and indicated that hands-on sessions were helpful. Conclusions-Peer mentoring is a useful method for teaching sonography to preclinical medical students. © 2012 by the American Institute of Ultrasound in Medicine.

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