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Stringfield SB, Waddimba AC, Criss KM, Burgess B, Dosselman LJ, Fichera A, Wells KO, Fleshman J. Ketamine intolerance in patients on enhanced recovery after surgery protocols undergoing colorectal operations. J Gastrointest Surg 2024:S1091-255X(24)00342-1. [PMID: 38523035 DOI: 10.1016/j.gassur.2024.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/12/2024] [Accepted: 02/24/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Ketamine is used in enhanced recovery after surgery (ERAS) protocols because of its beneficial antihyperalgesic and antitolerance effects. However, adverse effects such as hallucinations, sedation, and diplopia could limit ketamine's utility. The main objective of this study was to identify rates of ketamine side effects in postoperative patients after colorectal surgery and, secondarily, to compare short-term outcomes between patients receiving ketamine analgesia and controls. METHODS This was a retrospective observational cohort study. Subjects were adults who underwent ERAS protocol-guided colorectal surgery at a large, integrated health system. Patients were grouped into ketamine-receiving and preketamine cohorts. Patients receiving ketamine were divided into tolerant and intolerant groups. Propensity score-adjusted models tested multivariate associations of ketamine tolerance/intolerance vs control group. RESULTS A total of 732 patients underwent colorectal surgery within the ERAS program before ketamine's introduction (control). After ketamine's introduction, 467 patients received the medication. Intolerance was seen in 29% of ketamine recipients, and the most common side effect was diplopia. Demographics and surgical variables did not differ between cohorts. Multivariate models revealed no significant differences in hospital stays. Pain scores in the first 24 hours after surgery were slightly higher in patients receiving ketamine. Opiate consumption after surgery was lower for both ketamine tolerant and ketamine intolerant cohorts than for controls. CONCLUSION Rates of ketamine intolerance are high, which can limit its use and potential effectiveness. Ketamine analgesia significantly reduced opiate consumption without increasing hospital stays after colorectal surgery, regardless of whether it was tolerated.
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Affiliation(s)
- Sarah B Stringfield
- Department of Surgery, Baylor University Medical Center, Dallas, Texas, United States.
| | - Anthony C Waddimba
- Department of Surgery, Baylor University Medical Center, Dallas, Texas, United States; Baylor Scott and White Research Institute, Dallas, Texas, United States
| | - Keirsyn M Criss
- College of Medicine, Texas A & M University Health Science Center, Dallas, Texas, United States
| | - Brooke Burgess
- College of Medicine, Texas A & M University Health Science Center, Dallas, Texas, United States
| | - Luke J Dosselman
- University of Texas (UT) Southwestern Medical School, Dallas, Texas, United States
| | - Alessandro Fichera
- Department of Surgery, Baylor University Medical Center, Dallas, Texas, United States
| | - Katerina O Wells
- Department of Surgery, Baylor University Medical Center, Dallas, Texas, United States
| | - James Fleshman
- Department of Surgery, Baylor University Medical Center, Dallas, Texas, United States
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2
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Waddimba AC, DeSpain S, Bennett MM, Douglas ME, Warren AM. Longitudinal validation of the Fear of COVID-19 Scale in a nationwide United States sample: An item response theory model across three inflection points of the pandemic. Stress Health 2023; 39:1157-1170. [PMID: 37158412 DOI: 10.1002/smi.3259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/11/2023] [Accepted: 04/20/2023] [Indexed: 05/10/2023]
Abstract
The COVID-19 pandemic's global emergence/spread caused widespread fear. Measurement/tracking of COVID-19 fear could facilitate remediation. Despite the Fear of COVID-19 Scale (FCV-19S)'s validation in multiple languages/countries, nationwide United States (U.S.) studies are scarce. Cross-sectional classical test theory-based validation studies predominate. Our longitudinal study sampled respondents to a 3-wave, nationwide, online survey. We calibrated the FCV-19S using a unidimensional graded response model. Item/scale monotonicity, discrimination, informativeness, goodness-of-fit, criterion validity, internal consistency, and test-retest reliability were assessed. Items 7, 6, and 3 consistently displayed very high discrimination. Other items had moderate-to-high discrimination. Items 3, 6, and 7 were most (items 1 and 5 the least) informative. [Correction added on 18 May 2023, after first online publication: In the preceding sentence, the term 'items one-fifth least' has been changed to 'items 1 and 5 the least'.] Item scalability was 0.62-0.69; full-scale scalability 0.65-0.67. Ordinal reliability coefficient was 0.94; test-retest intraclass correlation coefficient 0.84. Positive correlations with posttraumatic stress/anxiety/depression, and negative correlations with emotional stability/resilience supported convergent/divergent validity. The FCV-19S validly/reliably captures temporal variation in COVID-19 fear across the U.S.
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Affiliation(s)
- Anthony C Waddimba
- Division of Surgical Research, Department of Surgery, Baylor University Medical Center, Dallas, Texas, USA
- Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Sydney DeSpain
- Arkansas College of Osteopathic Medicine, Arkansas Colleges of Health Education, Fort Smith, Arkansas, USA
| | | | - Megan E Douglas
- Baylor Scott and White Research Institute, Dallas, Texas, USA
| | - Ann Marie Warren
- Baylor Scott and White Research Institute, Dallas, Texas, USA
- Division of Trauma & Critical Care Surgery, Department of Surgery, Baylor University Medical Center, Dallas, Texas, USA
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3
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Fair L, Waddimba AC, Strothman P, Dwyer D, Anderton P, Bittle A, Ogola GO, Leeds S, Davis D. The use of a total bowel length measurement protocol may reduce reoperations and complications after single-anastomosis duodenal switch. Surg Endosc 2023; 37:9310-9317. [PMID: 37884731 DOI: 10.1007/s00464-023-10505-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/24/2023] [Indexed: 10/28/2023]
Abstract
INTRODUCTION Most surgeons who perform single-anastomosis duodeno-ileal switches (SADI-S) use a pre-determined common channel length without measuring total bowel length (TBL). However, TBL varies between patients, and a standardized common channel length could contribute to malabsorptive complications and reoperations following SADI-S. The purpose of this study was to determine whether using a TBL measurement protocol to individualize common channel length would be associated with reduced reoperations and complications. METHODS A prospectively maintained data registry was retrospectively reviewed to identify all patients who underwent SADI-S between September 2017 and February 2022. In April 2021, we began using TBL measurements during SADI-S with 40% of the TBL used as the length for the common channel. Outcomes pre-TBL and post-TBL measurement protocol were compared. RESULTS A total of 119 SADI-S recipients (59 pre-TBL; 60 post-TBL) were included. The pre-TBL group had a higher frequency of reoperations (23.7% vs 1.7%, p < 0.001) and late complications (29.3% vs 3.3%, p < 0.001). The mean time to reoperation was 13.7 months in the pre-TBL group and 6.7 months in the post-TBL group (p = 0.347). Patients in the post-TBL group had significantly higher serum albumin levels at 3 months (4.2 g/dL vs 3.5 g/dL, p < 0.001), 6 months (4.1 g/dL vs 3.6 g/dL, p < 0.001), and 12 months (4.2 g/dL vs 3.8 g/dL, p = 0.023) postoperatively when compared to the pre-TBL group. CONCLUSION Using TBL measurements to individualize common channel length was associated with a significant reduction in reoperations and late complications following SADI-S.
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Affiliation(s)
- Lucas Fair
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Anthony C Waddimba
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Phillip Strothman
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Darby Dwyer
- Health Sciences Center, College of Medicine, Texas A&M University, Dallas, TX, USA
| | - Priscilla Anderton
- Health Sciences Center, College of Medicine, Texas A&M University, Dallas, TX, USA
| | - Anella Bittle
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Gerald O Ogola
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Steven Leeds
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA
- Health Sciences Center, College of Medicine, Texas A&M University, Dallas, TX, USA
- Center for Advanced Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Daniel Davis
- Department of Minimally Invasive Surgery, Baylor University Medical Center, Dallas, TX, USA.
- Center for Medical and Weight Loss Management, Baylor University Medical Center, Dallas, TX, USA.
- Health Sciences Center, College of Medicine, Texas A&M University, Dallas, TX, USA.
- Center for Metabolic and Weight Loss Surgery, Baylor University Medical Center at Dallas, Dallas, TX, USA.
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4
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Warren AM, Bennett MM, da Graca B, Waddimba AC, Gottlieb RL, Douglas ME, Powers MB. Intentions to receive COVID-19 vaccines in the united states: Sociodemographic factors and personal experiences with COVID-19. Health Psychol 2023; 42:531-540. [PMID: 36066860 DOI: 10.1037/hea0001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Information regarding vaccination and the association with individuals' characteristics, experiences, and information sources is important for crafting public health campaigns to maximize uptake. Our objective was to investigate factors associated with intentions for COVID-19 vaccination among a sample of U.S. adults using a population-based cross-sectional survey. METHOD Data were collected via an online questionnaire administered nationwide from January 4, to January 7, 2021 following the emergency use authorization for two SARS-CoV-2 mRNA-based vaccines. RESULTS Of 936 U.S. adult respondents, 66% stated an intention to be vaccinated once a COVID-19 vaccine was available to them; 14.7% responded "maybe" and 19.6% "no." Unadjusted and multivariate associations revealed "no/maybe" vaccination intentions were associated with younger age, female, Black race, lower income, history of not receiving the influenza vaccine, lower fear of COVID-19, suffering moderate to severe reduction in access to food/nutrition, and lower trust in health care authorities, personal health care providers, and/or traditional news media as sources of COVID-19 information. Of respondents "maybe" intending to be vaccinated, 65% reported "a lot" of trust in personal health care providers as sources of COVID-19 information. Respondents stating "no" intention to be vaccinated were skeptical of all COVID-19 information sources considered. CONCLUSIONS Our findings confirm observations predating COVID-19 vaccine availability regarding sociodemographic characteristics associated with vaccine hesitancy in the United States. We further identify personal health care providers as the most trusted information source among people who "maybe" intend to get vaccinated and demonstrate the challenge in reaching people not intending to be vaccinated. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | - Mark B Powers
- Baylor Scott & White, Baylor University Medical Center
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5
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Woitowich NC, Waddimba AC, Yeh C, Muhammad LN, Warren AM, Wood CV. Evaluation of Professional Setbacks and Resilience in Biomedical Scientists During the COVID-19 Pandemic. JAMA Netw Open 2023; 6:e2328027. [PMID: 37556144 PMCID: PMC10413169 DOI: 10.1001/jamanetworkopen.2023.28027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/29/2023] [Indexed: 08/10/2023] Open
Abstract
This survey study evaluates whether resilience was associated with professional and career setbacks among biomedical scientists during the COVID-19 pandemic.
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Affiliation(s)
- Nicole C. Woitowich
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anthony C. Waddimba
- Division of Surgical Research, Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Chen Yeh
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lutfiyya N. Muhammad
- Division of Biostatistics, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Ann Marie Warren
- Division of Trauma, Acute Care, and Critical Care Surgery, Baylor University Medical Center, Dallas, Texas
| | - Christine V. Wood
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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6
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Al-Temimi MH, Waddimba AC, Ogola GO, Ilanga MAP, Peters WR, Fleshman JW, Wells KO. Does Small Bowel Adenocarcinoma Have a Worse Prognosis than Colonic Adenocarcinoma? A Propensity Score-matched Comparison Using the National Cancer Database. J Gastrointest Surg 2023; 27:1723-1726. [PMID: 36971953 DOI: 10.1007/s11605-023-05632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 02/09/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Mohammed H Al-Temimi
- Department of Surgery, Kaiser Permanente San Francisco Medical Center, San Francisco, CA, USA
| | - Anthony C Waddimba
- Department of Surgery, Division of Surgical Research, Baylor University Medical Center, Dallas, TX, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Gerald O Ogola
- Department of Surgery, Division of Surgical Research, Baylor University Medical Center, Dallas, TX, USA
- Baylor Scott and White Research Institute, Dallas, TX, USA
| | - Malynn Anne P Ilanga
- Department of Surgery, General Medical Education, University of Oklahoma College of Medicine, Tulsa, OK, USA
| | | | - James W Fleshman
- Department of Surgery, Division of Colon and Rectal Surgery, Baylor University Medical Center, 3409 Worth Street, Suite 600, TX, 75246, Dallas, USA
| | - Katerina O Wells
- Department of Surgery, Division of Surgical Research, Baylor University Medical Center, Dallas, TX, USA.
- Department of Surgery, Division of Colon and Rectal Surgery, Baylor University Medical Center, 3409 Worth Street, Suite 600, TX, 75246, Dallas, USA.
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7
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Fauveau LR, Dao TN, Wallace LB, Mamawala MK, Obaid A, Waddimba AC, Grant MD. Positive surgical margins after breast-conserving surgery for ductal carcinoma in-situ: does histologic grade or estrogen receptor status matter? Breast Cancer Res Treat 2023; 199:215-220. [PMID: 37027122 DOI: 10.1007/s10549-023-06905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 02/24/2023] [Indexed: 04/08/2023]
Abstract
PURPOSE DCIS has been shown to have a higher rate of positive margins following breast-conserving surgery (BCS) than invasive breast cancer. We aim to analyze certain factors of DCIS, specifically histologic grade and estrogen receptor (ER) status, in patients with positive surgical margins following BCS to determine if there is an association. METHODS A retrospective review of our institutional patient registry was performed to identify women with DCIS and microinvasive DCIS who underwent BCS by a single surgeon from 1999 to 2021. Demographics and clinicopathologic characteristics between patients with and without positive surgical margins were compared using chi-square or Student's t-test. We assessed factors associated with positive margins using univariate and multivariable logistic regression. RESULTS Of the 615 patients evaluated, there was no significant difference in demographics between the patients with and without positive surgical margins. Increasing tumor size was an independent risk factor for margin positivity (P = < 0.001). On univariate analysis both high histologic grade (P = 0.009) and negative ER status (P = < 0.001) were significantly associated with positive surgical margins. However, when adjusted in multivariable analysis, only negative ER status remained significantly associated with margin positivity (OR = 0.39 [95% CI 0.20-0.77]; P = 0.006). CONCLUSION The study confirms increased tumor size as a risk factor for positive surgical margins. We also demonstrated that ER negative DCIS was independently associated with a higher rate of positive margins after BCS. Given this information, we can modify our surgical approach to reduce rate of positive margins in patients with large-sized ER negative DCIS.
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Affiliation(s)
- Lindsey R Fauveau
- Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, 3410 Worth Street, Suite 235, Dallas, TX, 75246, USA.
- Baylor Scott and White Research Institute, 3500 Gaston Ave, Dallas, TX, 75246, USA.
- Department of Surgery, Health Systems Science, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX, 75246, USA.
- Division of Breast Surgical Oncology, Department of Surgery, Ochsner Health, 10310 The Grove Boulevard, Baton Rouge, LA, 70836, USA.
| | - Tuoc N Dao
- Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, 3410 Worth Street, Suite 235, Dallas, TX, 75246, USA
| | - Lucy B Wallace
- Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, 3410 Worth Street, Suite 235, Dallas, TX, 75246, USA
| | - Mufaddal K Mamawala
- Baylor Scott and White Research Institute, 3500 Gaston Ave, Dallas, TX, 75246, USA
| | - Ala Obaid
- Baylor Scott and White Research Institute, 3500 Gaston Ave, Dallas, TX, 75246, USA
| | - Anthony C Waddimba
- Baylor Scott and White Research Institute, 3500 Gaston Ave, Dallas, TX, 75246, USA
- Department of Surgery, Health Systems Science, Baylor University Medical Center, 3500 Gaston Ave, Dallas, TX, 75246, USA
| | - Michael D Grant
- Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, 3410 Worth Street, Suite 235, Dallas, TX, 75246, USA
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Carter BD, Badejo MA, Ogola GO, Waddimba AC, Fleshman JW, Harrington MA. National trends in distribution of underrepresented minorities within United States general surgery residency programs: A longitudinal panel study. Am J Surg 2023; 225:1000-1008. [PMID: 36646598 DOI: 10.1016/j.amjsurg.2023.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 12/25/2022] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Abstract
BACKGROUND Cultural affinity with a provider improves satisfactoriness of healthcare. We examined 2005-2019 trends in racial/ethnic diversity/inclusion within general surgery residency programs. METHODS We triangulated 2005-2019 race/ethnicity data from Association of American Medical Colleges surveys of 4th-year medical students, the Electronic Residency Application Service, and Accreditation Council for Graduate Medical Education-affiliated general surgery residencies. Temporal trends in minority representation were tested for significance. RESULTS Underrepresented racial/ethnic minorities in medicine (URiMs) increased among graduating MDs from 7.6% in 2005 to 11.8% in 2019 (p < 0.0001), as did their proportion among surgery residency applicants during 2005-2019 (p < 0.0001). However, proportions of URiMs among general surgery residents (≈8.5%), and of programs without URiMs (≈18.8%), stagnated. CONCLUSIONS Growing URiM proportions among medical school graduates and surgery residency applicants did not improve URiM representation among surgery trainees nor shrink the percentage of programs without URiMs. Deeper research into motivators underlying URiMs' residency program preferences is warranted.
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Affiliation(s)
- Brittany D Carter
- General Medical Education, Department of Surgery, Baylor University Medical Center, Dallas, TX, USA.
| | - Megan A Badejo
- College of Medicine, Texas A & M University Health Science Center, Dallas Campus, Texas, USA.
| | - Gerald O Ogola
- Division of Surgical Research, Department of Surgery, Baylor University Medical Center, Dallas, Texas, USA; Baylor Scott and White Research Institute, Dallas, Texas, USA.
| | - Anthony C Waddimba
- Division of Surgical Research, Department of Surgery, Baylor University Medical Center, Dallas, Texas, USA; Baylor Scott and White Research Institute, Dallas, Texas, USA.
| | - James W Fleshman
- Division of Colorectal Surgery, Department of Surgery, Baylor University Medical Center, Dallas, Texas, USA.
| | - Melvyn A Harrington
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas, USA.
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9
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Waddimba AC, Baker BM, Pogue JR, McAuliffe MP, Bennett MM, Baxter RD, Mohr DC, Warren AM. Psychometric validity and reliability of the 10- and 2-item Connor-Davidson resilience scales among a national sample of Americans responding to the Covid-19 pandemic: an item response theory analysis. Qual Life Res 2022; 31:2819-2836. [PMID: 35366196 PMCID: PMC8976171 DOI: 10.1007/s11136-022-03125-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/27/2022]
Abstract
Purpose Psychometric validity/reliability of 10-item and 2-item abbreviations of the Connor–Davidson Resilience Scale (CD-RISC-10; CD-RISC-2) was investigated via item response theory and classic approaches. Methods We sampled 5023 adult American participants in a June/July 2020 survey on the COVID-19 pandemic’s psychological effects. Our questionnaire incorporated the CD-RISC-10 with other validated measures. CD-RISC-10 items were ranked on item-to-scale correlations, loadings on a one-factor confirmatory factor analysis model, and item slope/threshold parameters plus information curves from a unidimensional graded response model. Concurrent validity of the highest ranked item pair was evaluated vis-à-vis the CD-RISC-10 and CD-RISC−2. Internal consistency, based on average variance extracted (AVE) and multiple reliability coefficients, was also compared. Convergent/divergent validity was tested by correlating anxiety, depression, fear of COVID-19, anxiety sensitivity, coping, and personality measures with both scales and the highest ranked item pair. Binary agreement/classification indexes assessed inter-rater reliability. Results Items 2 and 9 from CD-RISC-10 ranked the highest. Reliability coefficients were > 0.93, > 0.72, and > 0.82 for the CD-RISC-10, CD-RISC-2, vs summation of items 2 and 9. AVEs were 0.66, 0.67, and 0.77. CD-RISC abbreviations and the summation of items 2 and 9 correlated negatively with anxiety (> − 0.43), depression (> − 0.42), and fear of COVID-19 (> − 0.34); positively with emotional stability (> 0.53) and conscientiousness (> 0.40). Compared to the CD-RISC-2, summative scores of items 2 and 9 more efficiently classified/discriminated high resilience on the CD-RISC-10. Conclusion We confirmed construct validity/reliability of copyrighted CD-RISC abbreviations. The CD-RISC-10’s items 2 and 9 were psychometrically more salient than the CD-RISC−2. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-022-03125-y.
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Affiliation(s)
- Anthony C Waddimba
- Baylor Scott and White Research Institute, Dallas, TX, USA.
- Department of Surgery, Health Systems Science, Baylor University Medical Center, Dallas, TX, USA.
| | - Bailey M Baker
- College of Medicine, Texas A&M University Health Science Center, Dallas Campus, Dallas, TX, USA
| | - Jamie R Pogue
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Division of Trauma, Acute Care, & Critical Care Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Madison P McAuliffe
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Division of Trauma, Acute Care, & Critical Care Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Monica M Bennett
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Division of Trauma, Acute Care, & Critical Care Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Ronald D Baxter
- General Medical Education, Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Ann Marie Warren
- Baylor Scott and White Research Institute, Dallas, TX, USA
- Division of Trauma, Acute Care, & Critical Care Surgery, Baylor University Medical Center, Dallas, TX, USA
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10
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da Graca B, Bennett MM, Powers MB, Gottlieb RL, Waddimba AC, Warren AM. Psychological differences in adults with and without a COVID-19 diagnosis. J Ment Health 2022; 31:560-567. [PMID: 35000538 DOI: 10.1080/09638237.2021.2022617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Substantial evidence is emerging regarding the broad societal and psychological impacts of the COVID-19 pandemic, but little is known about whether infected individuals are differently affected. AIM We evaluated psychological differences between individuals who do vs. do not report testing positive for COVID-19. METHODS An online survey was offered to adults (≥18 years) who were diagnosed with COVID-19 by a provider within a large integrated-delivery healthcare system, enrolled in COVID-19-related clinical trials at the healthcare system, or responded to targeted local distribution. Measures assessed included the 8-item Patient Health Questionnaire depression scale, Generalized Anxiety Disorder 7-item Scale, and Posttraumatic Diagnostic Scale for DSM-5. RESULTS Of 487 respondents, 43% reported testing positive for COVID-19, including 11% requiring hospitalization. Overall rates of general anxiety disorder and posttraumatic stress were 34% and 16%, respectively, with no significant differences between groups. Prevalence of depression was higher among respondents reporting a positive COVID-19 test (52% vs. 31%). This difference persisted after controlling for respondent characteristics (odds ratio = 3.7, p < 0.01). CONCLUSIONS People who report testing positive for COVID-19, even those not requiring hospitalization, have increased risk for depression. Mental health care screening and services should be offered to individuals testing positive, facilitating early intervention.
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Affiliation(s)
| | | | - Mark B Powers
- Baylor University Medical Center, Dallas, TX, USA.,Texas A&M University - College of Medicine, Dallas, TX, USA
| | - Robert L Gottlieb
- Baylor Scott and White Research Institute, Dallas, TX, USA.,Baylor University Medical Center, Dallas, TX, USA.,Texas A&M University - College of Medicine, Dallas, TX, USA
| | - Anthony C Waddimba
- Baylor Scott and White Research Institute, Dallas, TX, USA.,Baylor University Medical Center, Dallas, TX, USA
| | - Ann Marie Warren
- Baylor Scott and White Research Institute, Dallas, TX, USA.,Baylor University Medical Center, Dallas, TX, USA.,Texas A&M University - College of Medicine, Dallas, TX, USA
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11
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Warren AM, McMinn K, Testa G, Wall AE, Saracino G, Waddimba AC, Johannesson L. Psychological Characteristics of Recipients Pretransplantation in the Dallas UtErus Transplant Study (DUETS). Prog Transplant 2021; 31:330-336. [PMID: 34704857 DOI: 10.1177/15269248211046002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Uterus transplantation is now a viable option for fertility treatment for women with absolute uterine factor infertility. Psychological assessment is recommended as a part of the perioperative evaluation process. RESEARCH OBJECTIVE The purpose of this study was to examine the psychological characteristics and mental health history of the 20 women who participated in the Dallas UtErus Transplant Study (DUETS) trial. DESIGN This retrospective observational descriptive study was part of a prospective clinical trial. Prior to transplant, 20 women completed a clinical psychological interview, 19 of whom also completed psychological assessment measures including the Hospital Anxiety and Depression Scale, Patient Health Questionnaire 9 item, Generalized Anxiety Disorder 7 item, PTSD Checklist for DSM-5, 36-Item Short Form, Connor-Davidson Resilience Scale 10 item, and Dyadic Adjustment Scale. RESULTS Women who participated in the trial had high health-related quality of life and minimal psychological history, with most reporting psychological distress associated with their initial infertility diagnosis (N = 13). None of the participants endorsed psychological distress to meet clinical concerns on the psychological measures used. Satisfaction with relationship adjustment with their partners was also high. CONCLUSIONS Women with absolute uterine factor infertility who underwent uterus transplant demonstrated low psychological distress on assessment measures, were resilient, had high health related quality of life, and strong satisfaction with the quality of relationships with their partners. Although some women reported either current or past psychological diagnosis, most reported psychological distress that occurred at the time of the infertility diagnosis and appeared to resolve over time.
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Affiliation(s)
- Ann Marie Warren
- 466551Baylor Scott & White Research Institute, Dallas, TX, USA.,Division of Trauma, Acute Care, and Critical Care Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Kenleigh McMinn
- Division of Trauma, Acute Care, and Critical Care Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Giuliano Testa
- Annette C. and Harold Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Anji E Wall
- Annette C. and Harold Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Giovanna Saracino
- Annette C. and Harold Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
| | - Anthony C Waddimba
- 466551Baylor Scott & White Research Institute, Dallas, TX, USA.,Health Systems Science, Department of Surgery, Baylor University Medical Center, Dallas, TX, USA
| | - Liza Johannesson
- Annette C. and Harold Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX, USA
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Waddimba AC, Bennett MM, Fresnedo M, Ledbetter TG, Warren AM. Resilience, Well-being, and Empathy Among Private Practice Physicians and Advanced Practice Providers in Texas: A Structural Equation Model Study. Mayo Clin Proc Innov Qual Outcomes 2021; 5:928-945. [PMID: 34585086 PMCID: PMC8456060 DOI: 10.1016/j.mayocpiqo.2021.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective To investigate structural relationships of latent constructs such as occupational wellbeing, resilience, work meaningfulness, and psychological empowerment with affective and cognitive clinical empathy among a community of physicians and advanced practice providers. Methods We conducted a cross-sectional observational study. We gathered data by an anonymous self-administered multidimensional questionnaire disseminated electronically between March and May 2016. Participants were physicians and advanced practice providers belonging to the Health Texas Provider Network, a group private practice affiliated with the Baylor Scott and White Health system. We excluded allied health care staff (eg, nurses) and trainees (eg, residents, medical students). We pursued a 3-step strategy: (1) confirmatory factor analysis of a theory-driven measurement model, (2) a modified structural equation model from which pathways with nonsignificant path coefficients were deleted, and (3) multigroup analyses of the modified model. Results Cognitive empathy was the strongest predictor of affective empathy. We observed modest positive associations of resilience with cognitive and affective empathy and of well-being and meaning with affective but not with cognitive empathy. Resilience, meaning, and psychological empowerment were surprisingly negatively associated with well-being, suggesting diminished self-care among practitioners. Effects of psychological empowerment on empathy and well-being were mediated by resilience and meaning. Conclusion Cognitive empathy directly influenced affective empathy; well-being and meaningfulness exerted direct positive effects on affective but not on cognitive empathy, whereas resilience had direct positive associations with both empathy dimensions. Resilience and meaning manifested direct, negative associations with well-being, revealing clinicians’ disproportionate focus on patient care at the expense of self-care.
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Key Words
- APP, advanced practice provider
- AVE, average variance extracted
- BIC, Bayesian information criterion
- CD-RISC, Connor-Davidson Resilience Scale
- CD-RISC-10, 10-item short form of the Connor-Davidson Resilience Scale
- CFA, confirmatory factor analysis
- CFI, comparative fit index
- GFI, goodness of fit index
- HTPN, Health Texas Provider Network
- IRI, Interpersonal Reactivity Index
- LPA, latent profile analysis
- MCPWBI, Mayo Clinic Physician Well-being Index
- PEI, Psychological Empowerment Instrument
- RMSEA, root mean square error of approximation
- SE, standard error
- SRMR, standardized root mean square residual
- TIPI, 10-Item Personality Inventory
- TLI, Tucker-Lewis Index
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Affiliation(s)
- Anthony C Waddimba
- Baylor Scott and White Research Institute, Dallas, TX.,Health Systems Science, Department of Surgery, Baylor University Medical Center, Dallas, TX
| | | | - Michelle Fresnedo
- Baylor Scott and White Research Institute, Dallas, TX.,Division of Trauma, Acute Care, and Critical Care Surgery, Baylor University Medical Center, Dallas, TX
| | - Thomas G Ledbetter
- Chief Medical Office, Baylor Scott and White Medical Center, Waxahachie, TX
| | - Ann Marie Warren
- Baylor Scott and White Research Institute, Dallas, TX.,Division of Trauma, Acute Care, and Critical Care Surgery, Baylor University Medical Center, Dallas, TX
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Waddimba AC, Newman P, Shelley JK, McShan EE, Cheung ZO, Gibson JN, Bennett MM, Petrey LB. Pain management after laparoscopic appendectomy: Comparative effectiveness of innovative pre-emptive analgesia using liposomal bupivacaine. Am J Surg 2021; 223:832-838. [PMID: 34610868 DOI: 10.1016/j.amjsurg.2021.09.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/06/2021] [Accepted: 09/20/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Laparoscopic appendectomy is standard of care for appendicitis in the US. Pain control that limits opioids is an important area of research given the opioid epidemic. This study examined post-appendectomy inpatient opioid use and pain scores following intraoperative use of liposomal bupivacaine (LB) versus non-liposomal bupivacaine. METHODS This was a retrospective cohort study of 155 adults who underwent laparoscopic appendectomy for acute appendicitis. Patients were divided into four cohorts based on the analgesia administered: (i) bupivacaine hydrochloride (BH)± epinephrine; (ii) undiluted LB; (iii) LB diluted with normal saline; and (iv) LB diluted with BH. RESULTS Baseline demographic/clinical attributes, intra-operative findings, and post-operative pain scores were equivalent across cohorts. Post-operative pre-discharge opioid use was higher in the BH vs. LB cohorts (mean 60.4 vs. 46.0, 35.5, and 30.4 morphine milligram equivalents, respectively; p < 0.001). CONCLUSIONS Pre-emptive analgesia with LB during laparoscopic appendectomy can reduce inpatient opioid use without significantly increasing post-operative pain scores.
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Affiliation(s)
- Anthony C Waddimba
- Health Systems Science; Department of Surgery; Baylor University Medical Center; Dallas, TX, United States; Baylor Scott & White Research Institute; Dallas, TX, United States.
| | - Pete Newman
- Division of Trauma, Critical Care, & Acute Care Surgery; Department of Surgery; Baylor University Medical Center; Dallas, TX, United States; Texas College of Osteopathic Medicine; University of North Texas Health Science Center; Fort Worth, TX, United States
| | - Jordin K Shelley
- Division of Trauma, Critical Care, & Acute Care Surgery; Department of Surgery; Baylor University Medical Center; Dallas, TX, United States; Texas College of Osteopathic Medicine; University of North Texas Health Science Center; Fort Worth, TX, United States
| | - Evan E McShan
- Baylor Scott & White Rehabilitation Institute; Dallas, TX, United States
| | - Zi-On Cheung
- College of Medicine; Texas A & M University Health Science Center; Dallas Campus, TX, United States
| | - Jennifer N Gibson
- General Medical Education; Department of Surgery; Baylor University Medical Center; Dallas, TX, United States
| | - Monica M Bennett
- Baylor Scott & White Research Institute; Dallas, TX, United States
| | - Laura B Petrey
- Division of Trauma, Critical Care, & Acute Care Surgery; Department of Surgery; Baylor University Medical Center; Dallas, TX, United States.
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Johnson BA, Waddimba AC, Ogola GO, Fleshman JW, Preskitt JT. A systematic review and meta-analysis of surgery delays and survival in breast, lung and colon cancers: Implication for surgical triage during the COVID-19 pandemic. Am J Surg 2020; 222:311-318. [PMID: 33317814 PMCID: PMC7834494 DOI: 10.1016/j.amjsurg.2020.12.015] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 02/08/2023]
Abstract
Background Thousands of cancer surgeries were delayed during the peak of the COVID-19 pandemic. This study examines if surgical delays impact survival for breast, lung and colon cancers. Methods PubMed/MEDLINE, EMBASE, Cochrane Library and Web of Science were searched. Articles evaluating the relationship between delays in surgery and overall survival (OS), disease-free survival (DFS) or cancer-specific survival (CSS) were included. Results Of the 14,422 articles screened, 25 were included in the review and 18 (totaling 2,533,355 patients) were pooled for meta-analyses. Delaying surgery for 12 weeks may decrease OS in breast (HR 1.46, 95%CI 1.28–1.65), lung (HR 1.04, 95%CI 1.02–1.06) and colon (HR 1.24, 95%CI 1.12–1.38) cancers. When breast cancers were analyzed by stage, OS was decreased in stages I (HR 1.27, 95%CI 1.16–1.40) and II (HR 1.13, 95%CI 1.02–1.24) but not in stage III (HR 1.20, 95%CI 0.94–1.53). Conclusion Delaying breast, lung and colon cancer surgeries during the COVID-19 pandemic may decrease survival. Delaying cancer surgeries during the COVID-19 pandemic may impact survival. Surgical delays of 12 weeks decreases survival in breast, lung and colon cancers. Surgical delays worsen survival in stage I and II breast cancers but not stage III. Triage recommendations for future waves of COVID-19 should consider this evidence.
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Affiliation(s)
- Brett A Johnson
- College of Medicine, Texas A&M Health Science Center, Dallas Campus, Texas, United States; Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
| | - Anthony C Waddimba
- Health Systems Science, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States; Baylor Scott and White Research Institute, Dallas, TX, United States.
| | - Gerald O Ogola
- Baylor Scott and White Research Institute, Dallas, TX, United States; Biostatistics, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
| | - James W Fleshman
- Division of Colon and Rectal Surgery, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
| | - John T Preskitt
- Division of Surgical Oncology, Department of Surgery, Baylor University Medical Center, Dallas, TX, United States.
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Waddimba AC, Mohr DC, Beckman HB, Meterko MM. Physicians' perceptions of autonomy support during transition to value-based reimbursement: A multi-center psychometric evaluation of six-item and three-item measures. PLoS One 2020; 15:e0230907. [PMID: 32236139 PMCID: PMC7112234 DOI: 10.1371/journal.pone.0230907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/12/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Successive health system reforms have steadily eroded physician autonomy. Escalating accountability demands placed on physicians concurrent with diminishing autonomy plus widespread "cost cutting" endanger clinical work-life quality and, in turn, threaten patient-care quality, safety, and continuity. This has engendered a renewed emphasis on bettering physician work-life to safeguard patient care. Research indicates that autonomy support could be an effective intervention point in this dynamic, and that improving healthcare practitioners' experience of autonomy can promote better patient outcomes. New measures of autonomy support towards physicians during systemic/organizational transformation are thus needed. OBJECTIVE We investigated the validity and reliability of two versions of a brief measure of physicians' perceptions of autonomy support. DESIGN Psychometric evaluation of practitioners' responses to a theory-based, pilot-tested, multi-center, cross-sectional survey-questionnaire. PARTICIPANTS Physicians serving in California, Massachusetts, or upstate New York clinical practices implementing pay-for-performance incentives were eligible. We obtained responses from 1,534 (35.14%) of 4,365 physicians surveyed. ANALYSIS We randomly partitioned the study sample equitably into derivation and validation subsamples. We conducted parallel analysis, inter-item/point-biserial correlations, and item-response-theory-based graded response modeling on six autonomy support items. Three items with the highest (a) point-biserial correlations, (b) item-level discrimination and (c) information capture were used to construct a short-form (3-item) version of the full (6-item) autonomy scale. We utilized exploratory structural equation modeling and confirmatory factor analysis to establish the factor structure and construct validity of the full-length and short-form scales before comparing their factor invariance, reliability and interrater agreement across physician subgroups. FINDINGS All six autonomy support items loaded highly onto one factor accounting for the majority of variance and demonstrating good data fit. The three most discriminating and informative items loaded equally well onto a single factor with similar goodness-of-fit to the data. The three-item scale correlated highly with its six-item parent, showing equally high sensitivity and specificity in discriminating high autonomy support. Variability in scores nested predominantly at within- rather than between-subgroup levels. CONCLUSIONS AND IMPLICATIONS Our data supported the factor structure, construct validity, internal consistency, and reliability of six- and three-item autonomy support scales. These brief tools are easily incorporated into multi-dimensional questionnaires at relatively low cost.
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Affiliation(s)
- Anthony C Waddimba
- Baylor Scott and White Research Institute, Dallas, Texas, United States of America
- Department of Surgery, Health Systems Science, Baylor University Medical Center, Dallas, Texas, United States of America
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, Massachusetts, United States of America
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Howard B Beckman
- Departments of Family Medicine, Internal Medicine & Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Common Ground Health, Rochester, New York, United States of America
| | - Mark M Meterko
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Performance Measurement, VA Office of Analytics and Business Intelligence (OABI), Washington, D.C., United States of America
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Riley MR, Mohr DC, Waddimba AC. The reliability and validity of three-item screening measures for burnout: Evidence from group-employed health care practitioners in upstate New York. Stress Health 2018; 34:187-193. [PMID: 28524379 DOI: 10.1002/smi.2762] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 03/01/2017] [Accepted: 04/19/2017] [Indexed: 11/06/2022]
Abstract
We investigate the psychometric validity and reliability of three-item screening measures for emotional exhaustion, depersonalization, and personal achievement comprising an abbreviated version of the Maslach Burnout Inventory®. Despite its utilization in multiple studies, the shortened instrument has not been sufficiently validated in diverse settings, populations, and organizational contexts. We examine its ability to assess burnout accruing from patient care practice in a rural, underserved area. Utilizing data from a cross-sectional survey of 308 rural-based medical professionals, we investigate how the three short-form subscales of the nine-item abbreviated inventory compare with their gold-standard parent subscales from the original 22-item human services scale in measuring corresponding dimensions of burnout. The findings provide significant evidence that the three-item measures are valid and reliable proxies for the long-form subscales. The short-form measures are highly correlated with the original subscales and display high convergent and discriminant validity. Each of the abbreviated subscales manifests the kind of high sensitivity with adequate specificity that one would expect to see in a good screening instrument. We conclude that the short-form measures can be utilized to rapidly screen human service professionals such as rural health care practitioners for symptoms of each of the three dimensions of burnout.
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Affiliation(s)
- Moira R Riley
- Bassett Healthcare Network, Research Institute, Cooperstown, NY, USA
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, MA, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA, USA
| | - Anthony C Waddimba
- Center for Clinical Innovation, Parkland Health and Hospital System, Dallas, TX, USA
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Hasbrouck MA, Waddimba AC. The work-related stressors and coping strategies of group-employed rural health care practitioners: A qualitative study. Am J Ind Med 2017; 60:867-878. [PMID: 28833294 DOI: 10.1002/ajim.22753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Escalating demands on practitioners, stagnating/dwindling resources, and diminishing autonomy have heightened patient-care work-related stress. Using qualitative content/thematic analysis of responses to open-ended survey questions, plus spontaneous comments, we sought to identify rural clinicians' subjective perceptions of their workplace stressors and typical adaptive/coping strategies. METHODS Within a hybrid inductive-deductive approach, we framed empirical themes (derived by consensus, corroborated with text segments, and extant literature) into theory-based coding templates by which we analyzed the data. RESULTS Of 308 (65.1% of) recipients completing questionnaires, 290 (94%) answered open-ended questions and/or provided comments. Categorizing stressors by socio-ecology, they cited four themes: Organizational, practitioner/staff-related, patient-related, and third party-induced stressors. Organizational stressors were referenced most conspicuously. How respondents described their coping fitted the Stress, Appraisal and Coping. [Lazarus and Folkman (1984): New York, NY: Springer Publishing Company, Inc] model. Emotion-focused were referenced more than problem-focused approaches. Themes scarcely differed by demographics, except for marital status. CONCLUSIONS Findings highlight needs for resilience coaching, rekindling work meaningfulness, mentorship in work-home balance/limit-setting, supportive peer networks, and deeper teamwork.
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Affiliation(s)
| | - Anthony C. Waddimba
- Parkland Health and Hospital System; Center for Clinical Innovation; Dallas Texas
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Waddimba AC, Scribani M, Krupa N, May JJ, Jenkins P. Frequency of satisfaction and dissatisfaction with practice among rural-based, group-employed physicians and non-physician practitioners. BMC Health Serv Res 2016; 16:613. [PMID: 27770772 PMCID: PMC5075400 DOI: 10.1186/s12913-016-1777-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 09/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Widespread dissatisfaction among United States (U.S.) clinicians could endanger ongoing reforms. Practitioners in rural/underserved areas withstand stressors that are unique to or accentuated in those settings. Medical professionals employed by integrating delivery systems are often distressed by the cacophony of organizational change(s) that such consolidation portends. We investigated the factors associated with dis/satisfaction with rural practice among doctors/non-physician practitioners employed by an integrated healthcare delivery network serving 9 counties of upstate New York, during a time of organizational transition. METHODS We linked administrative data about practice units with cross-sectional data from a self-administered multi-dimensional questionnaire that contained practitioner demographics plus valid scales assessing autonomy/relatedness needs, risk aversion, tolerance for uncertainty/ambiguity, meaningfulness of patient care, and workload. We targeted medical professionals on the institutional payroll for inclusion. We excluded those who retired, resigned or were fired during the study launch, plus members of the advisory board and research team. Fixed-effects beta regressions were performed to test univariate associations between each factor and the percent of time a provider was dis/satisfied. Factors that manifested significant fixed effects were entered into multivariate, inflated beta regression models of the proportion of time that practitioners were dis/satisfied, incorporating clustering by practice unit as a random effect. RESULTS Of the 473 eligible participants. 308 (65.1 %) completed the questionnaire. 59.1 % of respondents were doctoral-level; 40.9 % mid-level practitioners. Practitioners with heavier workloads and/or greater uncertainty intolerance were less likely to enjoy top-quintile satisfaction; those deriving greater meaning from practice were more likely. Higher meaningfulness and gratified relational needs increased one's likelihood of being in the lowest quintile of dissatisfaction; heavier workload and greater intolerance of uncertainty reduced that likelihood. Practitioner demographics and most practice unit characteristics did not manifest any independent effect. CONCLUSIONS Mutable factors, such as workload, work meaningfulness, relational needs, uncertainty/ambiguity tolerance, and risk-taking attitudes displayed the strongest association with practitioner satisfaction/dissatisfaction, independent of demographics and practice unit characteristics. Organizational efforts should be dedicated to a redesign of group-employment models, including more equitable division of clinical labor, building supportive peer networks, and uncertainty/risk tolerance coaching, to improve the quality of work life among rural practitioners.
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Affiliation(s)
- Anthony C Waddimba
- Bassett Healthcare Network, Research Institute, 1 Atwell Road, Cooperstown, NY, 13326, USA. .,Columbia University College of Physicians and Surgeons, 630 West 168th St, New York, NY, 10032, USA.
| | - Melissa Scribani
- Bassett Healthcare Network, Research Institute, 1 Atwell Road, Cooperstown, NY, 13326, USA
| | - Nicole Krupa
- Bassett Healthcare Network, Research Institute, 1 Atwell Road, Cooperstown, NY, 13326, USA
| | - John J May
- Bassett Healthcare Network, Research Institute, 1 Atwell Road, Cooperstown, NY, 13326, USA.,Columbia University Mailman School of Public Health, 722 West 168th St, New York, NY, 10032, USA
| | - Paul Jenkins
- Bassett Healthcare Network, Research Institute, 1 Atwell Road, Cooperstown, NY, 13326, USA
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Waddimba AC, Scribani M, Hasbrouck MA, Krupa N, Jenkins P, May JJ. Resilience among Employed Physicians and Mid-Level Practitioners in Upstate New York. Health Serv Res 2016; 51:1706-34. [PMID: 27620116 DOI: 10.1111/1475-6773.12499] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To investigate the factors associated with resilience among medical professionals. DATA SOURCES/STUDY SETTING Administrative information from a rural health care network (1 academic medical center, 6 hospitals, 31 clinics, and 20 school health centers) was triangulated with self-report data from 308 respondents (response rate = 65.1 percent) to a 9/2013-1/2014 survey among practitioners serving a nine-county 5,600-square-mile area. STUDY DESIGN A cross-sectional questionnaire survey comprising valid measures of resilience, practice meaningfulness, satisfaction, and risk/uncertainty intolerance, nested within a prospective, community-based project. DATA COLLECTION/EXTRACTION METHODS The sampling frame included practitioners on institutional payroll, excluding voluntary/involuntary attritions and advisory board/research team members. In multivariable mixed-effects models, we regressed full-range and high-/low-resilience scores on demographics, professional satisfaction, workplace needs, risk/uncertainty intolerance, and service unit characteristics. PRINCIPAL FINDINGS Relational needs, uncertainty intolerance, satisfaction ≥75 percent of the time, number of practitioners on a unit, and workload were significantly associated with resilience. Higher scores were most strongly associated with uncertainty tolerance, satisfaction, and practitioner numbers. Practitioner/unit demographics were mostly nonsignificant. CONCLUSIONS More resilient practitioners experienced frequent satisfaction, relational needs gratification, better uncertainty tolerance, lighter workloads, and practiced on units with more colleagues. Further studies should investigate well-being interventions based on these mutable factors.
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Affiliation(s)
- Anthony C Waddimba
- Health Services Research Scientist, Bassett Healthcare Network, Research Institute, Cooperstown, NY. .,Assistant Professor of Pediatrics, Columbia University College of Physicians & Surgeons, Cooperstown, NY.
| | - Melissa Scribani
- Biostatistics and Computing Center, Bassett Healthcare Network, Research Institute, Cooperstown, NY
| | - Melinda A Hasbrouck
- Health Services Research Scientist, Bassett Healthcare Network, Research Institute, Cooperstown, NY
| | - Nicole Krupa
- Biostatistics and Computing Center, Bassett Healthcare Network, Research Institute, Cooperstown, NY
| | - Paul Jenkins
- Biostatistics and Computing Center, Bassett Healthcare Network, Research Institute, Cooperstown, NY
| | - John J May
- Health Services Research Scientist, Bassett Healthcare Network, Research Institute, Cooperstown, NY.,Department of Epidemiology, Columbia University Mailman School of Public Health, Cooperstown, New York
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Waddimba AC, Beckman HB, Mahoney TL, Burgess JF. The Moderating Effect of Job Satisfaction on Physicians' Motivation to Adhere to Financially Incentivized Clinical Practice Guidelines. Med Care Res Rev 2016; 74:148-177. [PMID: 26860890 DOI: 10.1177/1077558716628354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We examined moderating effects of professional satisfaction on physicians' motivation to adhere to diabetes guidelines associated with pay-for-performance incentives. We merged cross-sectional survey data on attitudes, from 156 primary physicians, with prospective medical record-sourced data on guideline adherence and census data on ambulatory-care population characteristics. We examined moderating effects by testing theory-driven models for satisfied versus discontented physicians, using partial least squares structural equation modeling. Results show that attitudes motivated, while norms suppressed, adherence to guidelines among discontented physicians. Separate models for satisfied versus discontented physicians revealed motivational differences. Satisfied physicians disregarded intrinsic and extrinsic influences and biases. Discontented physicians, alienated by social pressure, favored personal inclinations. To improve adherence to guidelines among discontented physicians, incentives should align with personal attitudes and incorporate promotional campaigns countering resentment of peer and organizational pressure.
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Affiliation(s)
- Anthony C Waddimba
- 1 Bassett Healthcare Network Research Institute, Cooperstown, NY, USA.,2 Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Howard B Beckman
- 3 EagleDream Health, Inc., Rochester, NY, USA.,4 University of Rochester Medical Center/University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Thomas L Mahoney
- 4 University of Rochester Medical Center/University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.,5 Finger Lakes Health Systems Agency, Rochester, NY, USA
| | - James F Burgess
- 6 Center for Healthcare Organization and Implementation Research, Veterans Affairs Boston Healthcare System, Boston, MA, USA.,7 Boston University School of Public Health, Boston, MA, USA
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Waddimba AC, Nieves MA, Scribani M, Krupa N, Jenkins P, May JJ. Predictors of burnout among physicians and advanced-practice clinicians in central New York. ACTA ACUST UNITED AC 2015. [DOI: 10.5430/jha.v4n6p21] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Provider wellbeing is a barometer of the strength of healthcare systems/organizations. Burnout prevalence among physicians exceeds that among other adult workers in the United States. Rural-based practitioners might be at greater risk.Objective: We investigated predictors of burnout among group employed providers within an integrated healthcare network.Methods: In a prospective observational study of physicians/advanced-practice clinicians serving an 8-county region of central New York, we linked administrative practice-setting data with responses to a questionnaire-survey comprising validated measures of burnout, resilience, work meaningfulness, satisfaction, risk aversion, and uncertainty/ambiguity tolerance. We included providers on the official payroll, excepting advisory board and/or research team members plus those who retired, resigned or were fired. 308 (65.1%) of 473 eligible clinicians completed the survey. 59.1% of these were physicians/doctoral-level practitioners; 40.9% advanced-practice clinicians. We assessed burnout using a validated 5-level single-item measure formatted as a binary outcome of “burned out/burning out” (levels 3–5) versus not. We derived a parsimonious generalized linear mixed-effects regression of this outcome on provider demographics, work-related needs, risk aversion, satisfaction, and unit characteristics.Results: Perceived workload, relatedness needs, practice satisfaction 75% of the time, dissatisfaction 50%, resilience, and practicing on a small unit were the significant, independent predictors.Conclusions: Heavy workloads, unmet relational needs, frequent dissatisfaction, low resilience, and serving on a small unit were most significantly associated with being “burned out/burning out”. Feeling satisfied most of the time and high resilience were protective. Profession, specialty, autonomy, and support staffing were not statistically significant.
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Waddimba AC, Scribani M, Nieves MA, Krupa N, May JJ, Jenkins P. Validation of Single-Item Screening Measures for Provider Burnout in a Rural Health Care Network. Eval Health Prof 2015; 39:215-25. [DOI: 10.1177/0163278715573866] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We validated three single-item measures for emotional exhaustion (EE) and depersonalization (DP) among rural physician/nonphysician practitioners. We linked cross-sectional survey data (on provider demographics, satisfaction, resilience, and burnout) with administrative information from an integrated health care network (1 academic medical center, 6 community hospitals, 31 clinics, and 19 school-based health centers) in an eight-county underserved area of upstate New York. In total, 308 physicians and advanced-practice clinicians completed a self-administered, multi-instrument questionnaire (65.1% response rate). Significant proportions of respondents reported high EE (36.1%) and DP (9.9%). In multivariable linear mixed models, scores on EE/DP subscales of the Maslach Burnout Inventory were regressed on each single-item measure. The Physician Work-Life Study’s single-item measure (classifying 32.8% of respondents as burning out/completely burned out) was correlated with EE and DP (Spearman’s ρ = .72 and .41, p < .0001; Kruskal-Wallis χ2 = 149.9 and 56.5, p < .0001, respectively). In multivariable models, it predicted high EE (but neither low EE nor low/high DP). EE/DP single items were correlated with parent subscales (Spearman’s ρ = .89 and .81, p < .0001; Kruskal-Wallis χ2 = 230.98 and 197.84, p < .0001, respectively). In multivariable models, the EE item predicted high/low EE, whereas the DP item predicted only low DP. Therefore, the three single-item measures tested varied in effectiveness as screeners for EE/DP dimensions of burnout.
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Affiliation(s)
- Anthony C. Waddimba
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Melissa Scribani
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
| | | | - Nicole Krupa
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
| | - John J. May
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
- Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York Center for Agricultural Medicine and Health, Cooperstown, NY, USA
| | - Paul Jenkins
- Bassett Healthcare Network Research Institute, Cooperstown, NY, USA
- New York Center for Agricultural Medicine and Health, Cooperstown, NY, USA
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Waddimba AC, Burgess JF, Young GJ, Beckman HB, Meterko M. Motivators and Hygiene Factors Among Physicians Responding to Explicit Incentives to Improve the Value of Care. Qual Manag Health Care 2013; 22:276-92. [DOI: 10.1097/qmh.0000000000000006] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Waddimba AC, Meterko M, Beckman HB, Young GJ, Burgess JF. Provider Attitudes Associated With Adherence to Evidence-Based Clinical Guidelines in a Managed Care Setting. Med Care Res Rev 2009; 67:93-116. [DOI: 10.1177/1077558709342882] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In a cross-sectional observational study of Rochester (New York) primary care physicians (PCPs) enrolled in a pay-for-performance (P4P) collaboration, the authors investigated attitudinal factors associated with provider adherence to evidence-based clinical guidelines targeted by explicit incentives. The multivariable adherence model linked guideline adherence rates to provider attitudes among 186 survey respondents, adjusting for individual, practice, and community characteristics. Adherence was defined as the percentage of expected services that were delivered. Attitudes associated with adherence, independent of specialty and prior behavior, were financial salience (adjusted odds ratio [OR] = 3.6; 95% confidence interval [CI] = 1.7-8.4), peer cooperation (OR = 2.0; 95% CI = 1.0-4.0), control (OR = 0.5; 95% CI = 0.3-1.0), and autonomy regarding the health plan (OR = 0.3; 95% CI = 0.1-0.6). The most adherent providers perceived P4P as financially salient and felt supported by peers. Some PCPs might have perceived P4P and external interventions as challenging their autonomy and “crowding out” their intrinsic motivation, leading them to reduce efforts aimed at guideline adherence.
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Affiliation(s)
| | - Mark Meterko
- Veterans Affairs Boston Healthcare System, Massachusetts, Boston University, Massachusetts
| | - Howard B. Beckman
- University of Rochester, New York, Rochester Individual Practice Association, New York
| | - Gary J. Young
- Veterans Affairs Boston Healthcare System, Massachusetts, Boston University, Massachusetts
| | - James F. Burgess
- Veterans Affairs Boston Healthcare System, Massachusetts, Boston University, Massachusetts
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Waddimba AC, Jain NB, Stolzmann K, Gagnon DR, Burgess JF, Kazis LE, Garshick E. Predictors of cardiopulmonary hospitalization in chronic spinal cord injury. Arch Phys Med Rehabil 2009; 90:193-200. [PMID: 19236973 DOI: 10.1016/j.apmr.2008.07.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2008] [Revised: 07/21/2008] [Accepted: 07/27/2008] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate longitudinal risk factors of hospitalization for circulatory and pulmonary diseases among veterans with chronic spinal cord injury (SCI). Circulatory and respiratory system illnesses are leading causes of death in patients with chronic SCI, yet risk factors for related hospitalizations have not been characterized. DESIGN Prospective cohort study. SETTING Veterans Affairs (VA) Boston Healthcare System, Boston, Massachusetts. PARTICIPANTS/DATA SOURCES: Veterans (N=309) greater than or equal to 1 year post-SCI from the VA Boston Chronic SCI cohort who completed a health questionnaire and underwent spirometry at study entry. Baseline data were linked to 1996 through 2003 hospitalization records from the VA National Patient Care Database. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Cardiopulmonary hospital admissions, the predictors of which were assessed by multivariate Cox regression. RESULTS Of 1478 admissions observed, 143 were a result of cardiopulmonary (77 circulatory and 66 respiratory) illnesses. Independent predictors were greater age (3% increase/y), hypertension, and the lowest body mass index quintile (<22.4 kg/m2). A greater percentage-predicted forced expiratory volume in 1 second was associated with reduced risk. SCI level and completeness of injury were not statistically significant after adjusting for these risk factors. CONCLUSIONS Cardiopulmonary hospitalization risk in persons with chronic SCI is related to greater age and medical factors that, if recognized, may result in strategies for reducing future hospitalizations.
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Affiliation(s)
- Anthony C Waddimba
- Research and Development Service, VA Boston Healthcare System, Boston, MA
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