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Udo T, Roberts PC, Dyett J, Mullin S, Cummings D, Morano C. Opportunities and Challenges to Build Behavioral Health Crisis Capacity in Rural America. Psychiatr Serv 2024:appips20230111. [PMID: 38650491 DOI: 10.1176/appi.ps.20230111] [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] [Indexed: 04/25/2024]
Abstract
This column shares lessons learned from a 1-year pilot implementation of a crisis response program deploying crisis professionals to rural parts of Albany County, New York. The data (325 crisis interventions for 191 unique individuals, 57% of cases resolved on the scene) suggest that the program helps fill the crisis services gap in these communities. Police were present on 80% of cases. Educating police to build confidence in the program and providing clearer guidelines on the triage process for dispatchers may be important strategies to continue shifting crisis response duties from traditional first responders to crisis professionals.
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Affiliation(s)
- Tomoko Udo
- Department of Health Policy, Management and Behavior (Udo, Mullin, Cummings) and Department of Epidemiology and Biostatistics (Udo), School of Public Health, University at Albany, Rensselaer, New York; School of Criminal Justice (Roberts) and School of Social Welfare (Dyett, Morano), University at Albany, Albany, New York
| | - Preston Cody Roberts
- Department of Health Policy, Management and Behavior (Udo, Mullin, Cummings) and Department of Epidemiology and Biostatistics (Udo), School of Public Health, University at Albany, Rensselaer, New York; School of Criminal Justice (Roberts) and School of Social Welfare (Dyett, Morano), University at Albany, Albany, New York
| | - Jordan Dyett
- Department of Health Policy, Management and Behavior (Udo, Mullin, Cummings) and Department of Epidemiology and Biostatistics (Udo), School of Public Health, University at Albany, Rensselaer, New York; School of Criminal Justice (Roberts) and School of Social Welfare (Dyett, Morano), University at Albany, Albany, New York
| | - Shannon Mullin
- Department of Health Policy, Management and Behavior (Udo, Mullin, Cummings) and Department of Epidemiology and Biostatistics (Udo), School of Public Health, University at Albany, Rensselaer, New York; School of Criminal Justice (Roberts) and School of Social Welfare (Dyett, Morano), University at Albany, Albany, New York
| | - Denard Cummings
- Department of Health Policy, Management and Behavior (Udo, Mullin, Cummings) and Department of Epidemiology and Biostatistics (Udo), School of Public Health, University at Albany, Rensselaer, New York; School of Criminal Justice (Roberts) and School of Social Welfare (Dyett, Morano), University at Albany, Albany, New York
| | - Carmen Morano
- Department of Health Policy, Management and Behavior (Udo, Mullin, Cummings) and Department of Epidemiology and Biostatistics (Udo), School of Public Health, University at Albany, Rensselaer, New York; School of Criminal Justice (Roberts) and School of Social Welfare (Dyett, Morano), University at Albany, Albany, New York
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Pica S, Morano C, Díez LR. A role for the diabetes nurse educator to telemedically support children with type 1 diabetes on continuous glucose monitoring? The COVID-19 lockdown experience. Prim Care Diabetes 2022; 16:365-367. [PMID: 35351390 DOI: 10.1016/j.pcd.2022.03.011] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/17/2022] [Accepted: 03/22/2022] [Indexed: 11/25/2022]
Abstract
The role of diabetes nurse educators during the COVID-19 lockdown to telematically provide routine reviews of glycaemic control in children with type 1 diabetes (T1D) using continuous glucose monitoring systems is evaluated. Implementing these routines in the day-to-day clinical practice could reduce in-person clinic visits and improve glucose control.
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Affiliation(s)
- Susana Pica
- Pediatrics Clinical Management Unit, University Hospital of Jerez de la Frontera, Andalucía, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Spain.
| | - Carmen Morano
- Pediatrics Clinical Management Unit, University Hospital of Jerez de la Frontera, Andalucía, Spain; Biomedical Research and Innovation Institute of Cadiz (INiBICA), Spain.
| | - Luis-Rogelio Díez
- Pediatrics Clinical Management Unit, University Hospital of Jerez de la Frontera, Andalucía, Spain.
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Morano C, Berical E. Evaluating a Multidisciplinary Team Approach to Elder Abuse. Innov Aging 2021. [PMCID: PMC8679291 DOI: 10.1093/geroni/igab046.1057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This paper presents findings from a University and Community-based Agency collaboration to design and implement a preliminary evaluation of the Elder Abuse Multidisciplinary Team (E-MDT) Intervention. This intervention brings professionals from a variety of fields to investigate and respond to elder abuse. Data from 22 Interviews with staff along with anonymous survey data from E-MDT team members/staff (n=312) sought to establish team successes, challenges in implementation, and ongoing functioning. Themes that emerged in creating successful teams include: Establishing Buy-In and Trust of the team members, The Benefit of sharing experience and practical knowledge with other program sites; and Recognizing the Differences related to Onboarding and Sustaining New programs versus Sustaining Existing Programs. Themes related to responding during COVID revealed challenges such as Adapting to Technology and Inconsistent Access to the Internet. It was noted that remote meetings were easier to attend than face-to-face meetings. Data from the survey found the vast majority of respondents view the E-MDTs as having a positive impact on Clients (93%); while 93% of respondents indicated a positive impact on their Approach to Practice and the service area of their agency. Approximately 80% of the respondents indicated their multidisciplinary teams were Effective. Responses to 3-Open Ended questions included in the survey echoed similar themes from the interviews, as well as comments about their Professional Development and the complexity of responding to elder abuse. The paper will close with a discussion of the strategies used to facilitate the collaboration and complete the evaluation during the COVID-19 pandemic.
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Affiliation(s)
| | - Erin Berical
- University at Albany, Albany, New York, United States
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Gettel CJ, Voils CI, Bristol AA, Richardson LD, Hogan TM, Brody AA, Gladney MN, Suyama J, Ragsdale LC, Binkley CL, Morano CL, Seidenfeld J, Hammouda N, Ko KJ, Hwang U, Hastings SN, Bellolio MF, Biese K, Binkley C, Bott N, Brody A, Carpenter C, Clark S, Dresden MS, Forrester S, Gerson L, Gettel C, Goldberg E, Greenberg A, Hammouda N, Han J, Hastings SN, Hogan T, Hung W, Hwang U, Kayser J, Kennedy M, Ko K, Lesser A, Linton E, Liu S, Malsch A, Matlock D, McFarland F, Melady D, Morano C, Morrow‐Howell N, Nassisi D, Nerbonne L, Nyamu S, Ohuabunwa U, Platts‐Mills T, Ragsdale L, Richardson L, Ringer T, Rosen A, Rosenberg M, Shah M, Skains R, Skees S, Souffront K, Stabler L, Sullivan C, Suyama J, Vargas S, Camille Vaughan E, Voils C, Wei D, Wexler N. Care transitions and social needs: A Geriatric Emergency care Applied Research (GEAR) Network scoping review and consensus statement. Acad Emerg Med 2021; 28:1430-1439. [PMID: 34328674 DOI: 10.1111/acem.14360] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 04/29/2021] [Revised: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Individual-level social needs have been shown to substantially impact emergency department (ED) care transitions of older adults. The Geriatric Emergency care Applied Research (GEAR) Network aimed to identify care transition interventions, particularly addressing social needs, and prioritize future research questions. METHODS GEAR engaged 49 interdisciplinary stakeholders, derived clinical questions, and conducted searches of electronic databases to identify ED discharge care transition interventions in older adult populations. Informed by the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) framework, data extraction and synthesis of included studies included the degree that intervention components addressed social needs and their association with patient outcomes. GEAR convened a consensus conference to identify topics of highest priority for future care transitions research. RESULTS Our search identified 248 unique articles addressing care transition interventions in older adult populations. Of these, 17 individual care transition intervention studies were included in the current literature synthesis. Overall, common care transition interventions included coordination efforts, comprehensive geriatric assessments, discharge planning, and telephone or in-person follow-up. Fourteen of the 17 care transition intervention studies in older adults specifically addressed at least one social need within the PRAPARE framework, most commonly related to access to food, medicine, or health care. No care transition intervention addressing social needs in older adult populations consistently reduced subsequent health care utilization or other patient-centered outcomes. GEAR stakeholders identified that determining optimal outcome measures for ED-home transition interventions was the highest priority area for future care transitions research. CONCLUSIONS ED care transition intervention studies in older adults frequently address at least one social need component and exhibit variation in the degree of success on a wide array of health care utilization outcomes.
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Affiliation(s)
- Cameron J. Gettel
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- National Clinician Scholars Program Department of Internal Medicine Yale School of Medicine New Haven Connecticut USA
| | - Corrine I. Voils
- William S. Middleton Memorial Veterans Hospital Madison Wisconsin USA
- Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | | | - Lynne D. Richardson
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
- Department of Population Health Science & Policy Icahn School of Medicine at Mount Sinai New York New York USA
- Institute for Health Equity Research Icahn School of Medicine at Mount Sinai New York New York USA
| | - Teresita M. Hogan
- Department of Medicine Section of Emergency Medicine The University of Chicago School of Medicine Chicago Illinois USA
| | - Abraham A. Brody
- Hartford Institute for Geriatric Nursing New York University Rory Meyers College of Nursing New York New York USA
| | - Micaela N. Gladney
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
| | - Joe Suyama
- Department of Emergency Medicine University of Pittsburgh Pittsburgh Pennsylvania USA
| | - Luna C. Ragsdale
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
- Department of Emergency Medicine Durham VA Health Care System Durham North Carolina USA
| | - Christine L. Binkley
- Department of Emergency Medicine University of North Carolina School of Medicine Chapel Hill North Carolina USA
| | - Carmen L. Morano
- School of Social Welfare University at AlbanyState University of New York Albany New York USA
| | - Justine Seidenfeld
- Department of Surgery Division of Emergency Medicine Duke University School of Medicine Durham North Carolina USA
| | - Nada Hammouda
- Department of Emergency Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Kelly J. Ko
- West Health Institute La Jolla California USA
| | - Ula Hwang
- Department of Emergency Medicine Yale School of Medicine New Haven Connecticut USA
- Geriatrics Research, Education, and Clinical Center James J. Peters VAMC Bronx New York USA
| | - Susan N. Hastings
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) Durham VA Health Care System Durham North Carolina USA
- Department of Medicine Duke University School of Medicine Durham NC USA
- Geriatric Research, Education, and Clinical Center Durham VA Health Care System Durham North Carolina USA
- Center for the Study of Human Aging and Development Duke University School of Medicine Durham North Carolina USA
- Department of Population Health Sciences Duke University School of Medicine Durham North Carolina USA
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Park D, Morano C, Savage A. Understanding the role of social support and social support network for depression among informal dementia caregivers: a pilot clinical project on caregivers in NYC. Soc Work Health Care 2021; 60:599-613. [PMID: 34651558 DOI: 10.1080/00981389.2021.1987374] [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] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 08/23/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
This study aims to explore the association of depressive symptoms with the informal social support network reported by dementia caregivers participating in a community-based caregiver support program. Caregivers in a community-based dementia caregiver program completed an intake assessment, including the social support network instrument. Measures were completed for caregivers' social support network, using the social support network instrument (SSNI). Measures also included depression, caregiver strain, basic activities of daily living, instrumental activities of daily living, and demographics. Findings suggest the effects of social supports and social network on caregivers' depressive symptoms. Caregivers who had financial supports were less likely to have depressive symptoms. Also, the frequency of contact among social network variables predicted the decrease of depressive symptoms.
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Affiliation(s)
- Daejun Park
- Department of Social Work, Ohio University, Athens, OH, USA
| | - Carmen Morano
- School of Social Welfare, University at Albany, SUNY, Albany, NY, USA
| | - Andrea Savage
- Silberman School of Social Work, Hunter College, CUNY, New York, NY, USA
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Pascucci D, Sassano M, Nurchis MC, Cicconi M, Acampora A, Park D, Morano C, Damiani G. Impact of interprofessional collaboration on chronic disease management: Findings from a systematic review of clinical trial and meta-analysis. Health Policy 2020; 125:191-202. [PMID: 33388157 DOI: 10.1016/j.healthpol.2020.12.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/21/2020] [Accepted: 12/11/2020] [Indexed: 01/06/2023]
Abstract
Improvement of chronic disease management demands effective collaborative relationships between health and social-care which is achieved through teamwork. Interprofessional Education (IPE) and Interprofessional Collaboration (IPC) are recognized as essential for the delivery of effective and efficient healthcare. Although IPC and IPE are key components of primary care, evidence of studies evaluating how an IPE intervention prior to IPC improved chronic patient outcomes remains scarce. The aim of this study was to assess the impact of IPC interventions on the management of chronic patients compared to usual care. A systematic review and meta-analysis of Randomized Controlled Trials (RCTs) on IPC interventions on chronicity management and their impact on clinical and process outcomes was conducted. Of the 11,128 papers initially retrieved, 23 met the inclusion criteria. Meta-analyses results showed the reduction of systolic blood pressure (Mean Difference (MD) -3.70; 95 % CI -7.39, -0.01), glycosylated hemoglobin (MD -0.20; 95 % CI -0.47, -0.07), LDL cholesterol (MD -5.74; 95 % CI -9.34, -2.14), diastolic blood pressure (MD -1.95; 95 % CI -3.18, -0.72), days of hospitalization (MD -2.22; 95 % CI -4.30, -0.140). A number of positive findings for outcomes related to IPC were found reflecting an improvement of quality of care and an enhancement in the delivery of patient-centered and coordinated care. Moreover, the need for a purposeful systemic approach linking interprofessional education with interprofessional collaboration and patient health and wellbeing is necessary.
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Affiliation(s)
- Domenico Pascucci
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Michele Sassano
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Mario Cesare Nurchis
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Michela Cicconi
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Anna Acampora
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy; Dipartimento di Epidemiologia del Servizio Sanitario Regionale-Regione Lazio, ASL Roma 1, Via Cristoforo Colombo 112, 00147, Rome, Italy
| | - Daejun Park
- Department of Social Work, Ohio University, Athens, OH, 45701, USA
| | - Carmen Morano
- University at Albany, State University of New York, 135 Western Ave RI 221, Albany, NY, 12222, USA
| | - Gianfranco Damiani
- Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
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Morano C, park D, Savage A. UNDERSTANDING THE ROLE OF SOCIAL SUPPORTS AND SOCIAL NETWORK FOR DEMENTIA CAREGIVERS’ MENTAL HEALTH. Innov Aging 2019. [PMCID: PMC6847484 DOI: 10.1093/geroni/igz038.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This paper explores the associations of depressive symptoms with social supports and social networks among dementia caregivers. It has been well documented that dementia caregivers are at greater risk of experiencing negative mental health and poorer physical health than non-caregivers. This paper describes a collaborative process between two universities and a community-based provider in designing a Social Network Analyses to examine the network structures used by dementia caregivers participating in a community-based support program. The relationship between the caregiver support networks and depressive symptoms, were analyzed using multivariate regression models. Given the small sample size and missing data multiple imputation was applied to the data. The findings suggest the effects of a variety of supports in the caregiver network on mental health and depressive symptoms. Among the findings it was found that the presence of financial support (B= - 0.58; p = .01) and frequency of contacts (B = -0.58; p = .01) support resulted in a decrease in depressive symptoms and better mental health than for caregivers without similar supports in their networks. This paper will conclude with a discussion of potential uses of social network analysis to better understand how the structure of caregivers’ network can address the concrete physical, emotional and financial needs of dementia caregivers.
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Affiliation(s)
- Carmen Morano
- School of Social Welfare, University of Albany, State University of New York, Albany, New York, United States
| | - daejun park
- University at Albany, School of Social Welfare, Albany, New York, United States
| | - Andrea Savage
- Silberman School of Social Work, New York, United States
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Mahoney KJ, Mahoney EK, Morano C, DeVellis A. UNMET NEEDS IN SELF-DIRECTED HCBS PROGRAMS. Innov Aging 2019. [PMCID: PMC6844805 DOI: 10.1093/geroni/igz038.859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Unmet Need for long-term services and supports has been linked to a variety of harmful health outcomes. One suggested strategy for ameliorating unmet need is to give participants control of the budget and let them construct individualized plans. The evaluation of the Cash and Counseling controlled experiment documented a marked reduction in unmet need when compared to traditional agency-based solutions, but it also showed significant unmet needs remained. This paper, drawing from 76 ethnographic case studies of Cash and Counseling participants, gives us an understanding of what those unmet needs are, who sees them, and what participants and their family caregivers see as possible remedies. Certain areas of unmet need identified in this study stand out. These included health-related problems, environmental issues, and the caregivers’ need for relied. The paper concludes with implications for care integration and the training of support brokers as warnings about reducing budgets.
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Affiliation(s)
- Kevin J Mahoney
- Boston College School of Social Work National Resource Center (NRCPDS), Chestnut Hill, Massachusetts, United States
| | - Ellen k Mahoney
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, United States
| | - Carmen Morano
- School of Social Welfare, University at Albany, State University of New York, Albany, New York, United States
| | - Andrew DeVellis
- Simmons School of Social Work, Boston, Massachusetts, United States
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Mahoney EK, Oh G, Morano C, Mahoney KJ, DeVellis A. PARTICIPANT VIEWS OF THE TASKS AND CHARACTERISTICS OF SUPPORTIVE SUPPORT BROKERS IN SELF-DIRECTION PROGRAMS. Innov Aging 2019. [PMCID: PMC6846264 DOI: 10.1093/geroni/igz038.860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This qualitative study draws on 76 ethnographic case studies with Cash and Counseling participants, examines what participants and their caregivers saw the support broker doing, and looks at what the participants found helpful and less than helpful. Participants and their caregivers saw support broker duties as Coaching, Problem Solving, Advocacy and Monitoring. Equally important was how the support broker performed these roles. Six attributes that mattered to participants were: Familiarity, Supportive Relationship, Proactive Engagement, Responsiveness, Knowldge and Cultural Friendliness. These findings from the participant and caregiver perspective have great import for the training of present and future care managers and support broker, and have implications for regulatory and even licensure requirements. These results can be a first step in constructing a quality framework for self-directed supports and services.
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Affiliation(s)
- Ellen K Mahoney
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, United States
| | - Grace Oh
- Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts, United States
| | - Carmen Morano
- School of Social Welfare, University at Albany, State University of New York, Albany, New York, United States
| | - Kevin J Mahoney
- Boston College School of Social Work National Resource Center (NRCPDS), Lauderdale-by-the-Sea, Florida, United States
| | - Andrew DeVellis
- Simmons School of Social Work, Boston, Massachusetts, United States
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Schroepfer T, Berg-Weger M, Morano C. Training the Next Generation of Gerontological Social Worker Scholars. J Gerontol Soc Work 2019; 62:823-827. [PMID: 31809685 DOI: 10.1080/01634372.2019.1663461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 08/30/2019] [Accepted: 08/30/2019] [Indexed: 06/10/2023]
Abstract
The rapid growth of the aging population in the United States has produced concern over whether the social work profession will be able to meet the needs of elders and their caregivers. Currently, a shortage of gerontological social workers trained specifically to work with this population exists, and based on projections, this shortage will only become more critical over the next few decades. In order to address this shortage, one approach has been adopted that seeks to increase the number of gerontological social work faculty, who can then encourage Bachelor and Master of Social Work students to consider working with older adults, and prepare them with the knowledge and skills necessary for doing so. In this commentary, we describe a program that adopts this approach and the measures used to determine its success, and conclude with a brief description of three articles included in this issue of the JGSW that analyze and report the results of these measures.
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Affiliation(s)
- Tracy Schroepfer
- School of Social Work, University of Wisconsin-Madison, Madison, USA
| | | | - Carmen Morano
- School of Social Welfare, University at Albany, Albany, NY, USA
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Mahoney E, Oh G, Morano C, Mahoney K, DeVellis A. The Tasks and Characteristics of Supportive Support Brokers. J Gerontol Soc Work 2019; 62:216-235. [PMID: 30614409 DOI: 10.1080/01634372.2018.1561585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 12/17/2018] [Accepted: 12/18/2018] [Indexed: 06/09/2023]
Abstract
In the United States, under the Cash and Counseling or budget authority model of self-directed personal assistance where the participant manages his or her own services and supports, the Support Broker role was established to assist and coach the participant. The support broker role grew out of a person-centered planning process where focus groups and surveys helped ascertain what potential participants wanted to help them establish a self-directed alternative. But, despite this role being described in policy guidance from the Center for Medicare and Medicaid, little research has been conducted examining the functions, activities and usefulness of this position. This study draws on 76 ethnographic case studies with early Cash and Counseling participants, examines what participants and their caregivers actually saw the support broker doing, and looks at what the participants found helpful and less than helpful. Participants and family caregivers saw support broker duties as falling into four areas: Coaching, Problem Solving, Advocacy and Monitoring. Equally important was how the support broker performed these duties. Key aspects of quality included: Familiarity, Supportive Relationship, Proactive Engagement, Responsiveness, Knowledge and Cultural Friendliness. These findings can provide the basis for establishing quality indicators for self-direction.
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Affiliation(s)
- Ellen Mahoney
- a William F. Connell School of Nursing , Boston College , USA
| | - Grace Oh
- a William F. Connell School of Nursing , Boston College , USA
| | - Carmen Morano
- b School of Social Welfare , University at Albany , Albany , NY , USA
| | - Kevin Mahoney
- c University at Albany, School of Social Welfare , Boston College , Boston , USA
| | - Andrew DeVellis
- d School of Social Work , Wayside Youth and Family Support Network , Boston , MA , USA
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12
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Mahoney KJ, Mahoney EK, Morano C, DeVellis A. Unmet needs in self-directed HCBS programs. J Gerontol Soc Work 2019; 62:195-215. [PMID: 29558342 DOI: 10.1080/01634372.2018.1451421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 03/08/2018] [Indexed: 06/08/2023]
Abstract
Unmet need for long-term services and supports has been linked to a variety of harmful health outcomes. One suggested strategy for ameliorating unmet need is to give participants control of a budget and let them construct individualized plans. The evaluation of the Cash and Counseling controlled experiment (CCDE) documented a marked reduction in unmet need when compared to traditional agency-based solutions, but it also showed significant unmet needs remained. This paper reanalyzes 76 case studies from the CCDE to, for the first time gain an understanding of what those unmet needs are, who sees them, and what participants, caregivers and support brokers think might reduce this problem. Using a collective or multiple case study approach to understand this phenomenon, unmet needs were sorted into five categories using real life experiences of respondents. Unmet needs for assistance in managing the employer and budget tasks of self-direction were also captured.This paper discusses situations where the clinician researchers documented needs that were not expressed by the care recipients and provides a picture of where and why unmet needs remain.The paper concludes with strategies for reducing unmet needs and training future social workers.
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Affiliation(s)
- Kevin J Mahoney
- a School of Social Work Boston College , Chestnut Hill , Massachusetts , USA
| | - Ellen K Mahoney
- b William F. Connell School of Nursing Boston College , Chestnut Hill , Massachusetts , USA
| | - Carmen Morano
- c Silberman School of Social Work, Hunter College , New York , New York , USA
| | - Andrew DeVellis
- d Wayside Youth and Family Support Network , Framingham , Massachusetts Institute for Psychoanalysis, Boston, MA , USA
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Morano C, Damiani G. Interprofessional education at the meso level: taking the next step in IPE. Gerontol Geriatr Educ 2019; 40:43-54. [PMID: 30321121 DOI: 10.1080/02701960.2018.1515739] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The downstream demand for professionals with competence in Interprofessional Collaboration (IPC) has contributed to the substantial growth in the upstream demand for interprofessional education (IPE). The majority of IPE programs focuses exclusively on direct care practitioners and seldom include those responsible for the administration and management of care. Unfortunately, complex reimbursement mechanisms along with the multiple agencies and departments regulating the delivery, evaluation, and reimbursement of care can result in unintended barriers to IPC and eventually IPE. The Healthcare Services Planning and Management Program (HSPMP) is an innovative model of IPE that was designed to improve system wide collaboration among those responsible for the reimbursement, management and administration of the delivery of care. Although HSPMP was not developed in the US, this innovative model has the potential to develop the systemic integration needed to break down the barriers to the delivery and evaluation of IPE and IPC. The aim of this article is to introduce HSPMP to the US as a model of IPE that could help facilitate better integration of the US health care system and help to reduce some of the consequences resulting from the current fragmented system of care.
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Affiliation(s)
- Carmen Morano
- School of Social Welfare, University at Albany, State University of New York, Albany, NY, USA
| | - Gianfranco Damiani
- Unità Organizzativa Complessa Igiene Ospedaliera, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Roma, Italia
- Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Roma, Italia
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Morano C, Savage A, Rees C. USING NETWORK ANALYSIS TO EXAMINE DEMENTIA CARE REFERRALS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C. Morano
- Silberman School of Social Work at Hunter College, City University of New York, New York, New York,
| | - A. Savage
- Silberman School of Social Work at Hunter College, City University of New York, New York, New York,
| | - C. Rees
- State University of New York – Albany, Center for Human Services Research, Albany, New York
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15
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Morano C, Giunta N, Parikh NS, Panuska S, Fahs MC, Gallo WT. Mind-body techniques, race-ethnicity, and depression among urban senior center participants. Health Soc Work 2013; 38:167-172. [PMID: 24437022 DOI: 10.1093/hsw/hlt010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
As the older adult population grows and becomes more diverse, more of its members are turning to complementary and alternative medicine (CAM). There are mixed findings regarding racial and ethnic differences in the use of CAM. This article explores racial and ethnic differences in use of a category of CAM known as mind-body techniques (MBT) among senior center participants with symptoms of depression. It also examines the relationship between use of MBT and depression severity. A cross-sectional survey was conducted with a representative sample of senior center participants in New York City, from which a subsample of those with depressive symptoms was drawn. Racial and ethnic differences in MBT use were identified, as was a significant negative relationship between MBT use and depression severity. African American elders were more likely to have used MBT than other racial or ethnic groups. When controlling for race or ethnicity, health status, and barriers to medical care, predictors of depression severity included health status, experiencing barriers to medical care, and Hispanic identity. Findings suggest that being female or younger is associated with a higher likelihood of using CAM. Contrary to some prior research, education level was not associated with use of MBT.
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Affiliation(s)
- Carmen Morano
- Silberman School of Social Work, New York, NY 10024, USA.
| | - Nancy Giunta
- Silberman School of Social Work, New York, NY 10024, USA
| | - Nina S Parikh
- Brookdale Center for Healthy Aging, New York, NY, USA
| | | | - Miriam C Fahs
- School of Public Health, Hunter College, City University of New York, USA
| | - William T Gallo
- School of Public Health, Hunter College, City University of New York, USA
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16
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Giunta N, Morano C, Parikh NS, Friedman D, Fahs MC, Gallo WT. Racial and ethnic diversity in senior centers: comparing participant characteristics in more and less multicultural settings. J Gerontol Soc Work 2012; 55:467-483. [PMID: 22852991 DOI: 10.1080/01634372.2011.653519] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The 2008 Health Indicators Project surveyed a probability sample (N = 1,870) of New York City senior center participants. Attendees of racially and ethnically diverse and nondiverse senior centers were compared across 5 domains: demographics; health and quality of life; social support networks; neighborhood perceptions and engagement; health service access/utilization. Although homogeneous and diverse center participants demonstrate similar health and quality-of-life outcomes, those from diverse centers demonstrate greater risk of social isolation, receive less family support, and more likely seek medical care from hospitals or community clinics. Implications and future directions for research, practice and policy are discussed.
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Affiliation(s)
- Nancy Giunta
- Silberman School of Social Work at Hunter College, City University of New York, New York, NY 10035, USA.
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17
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Sacks D, Das D, Romanick R, Caron M, Morano C, Fahs MC. The value of daily money management: an analysis of outcomes and costs. J Evid Based Soc Work 2012; 9:498-511. [PMID: 23092378 DOI: 10.1080/15433714.2011.581530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
For vulnerable and frail older adults, management of daily financial obligations can become an overwhelming burden spiraling into at-risk situations. Social service agencies have developed community-based Daily Money Management programs to assist these adults in protecting their financial security. Through this study the authors present the first economic estimates of the costs of Daily Money Management programs which, along with case management programs, save $60,000 per individual when compared with the cost of nursing home placement, making them highly cost effective. Most importantly, individuals are able to remain in their homes. The authors address the current gap between cost-effective community-based practice and public policy support.
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Affiliation(s)
- Debra Sacks
- The Brookdale Center for Healthy Aging, Hunter College, New York, NY 10035, USA.
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18
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Dente M, Cilurso F, Fornari L, Morano C, Moretti M, Neri T, Solinas L, Tiberi R, Anastasio G, Santi F, Bagarani M. [Intestinal perforation due to accidental ingestion of foreign bodies]. G Chir 2010; 31:38-41. [PMID: 20298665] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Usually the ingested foreign bodies (IFB) pass the gastrointestinal tract making no lesions. Sometimes IFB could lead to a gastrointestinal perforation. The most frequently perforating IFB are chicken or fish bones and toothpicks, while risks factors are mental retardation, alcohol or drug abuse, denture usage, quick eating or habitual chewing of toothpicks. The accidentally ingestion in a high risk patient with unclear symptoms, added to a low sensitive diagnostic imaging, lead to intraoperative diagnosis in one half cases of gastrointestinal perforation by IFB. Furthermore the surgical treatment range between the less minimal invasive laparoscopic IFB extraction and intraabdominal hole suture to a laparotomic bowel or colic resection. Herein we describe our experience in 3 cases of gastrointestinal perforation by IFB have been diagnosed at surgery and treated by IFB extraction and hole suture (in 2 patients; 1 laparoscopy, 1 laparotomy) or open right emicolectomy (1 patient).
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Affiliation(s)
- M Dente
- Dipartimento di Chirurgia Digestiva ed Endocrina, Ospedale Regina Apostolorum, Albano, Roma
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Abstract
For a growing number of older adults, a day outing to a local casino has become one of the more enjoyable and accessible opportunities for socialization and entertainment. Unfortunately, for some older adults this growing pastime increases their risk for developing a gambling problem or, worse yet, a gambling addiction. The consequences of problematic gambling behaviors for individuals living on a fixed income require greater attention by social work researchers, practitioners, and providers of senior services. The development and implementation of a Gambling Education Workshop for older adults attending senior centers in a large metropolitan area, along with qualitative interviews with a sample of workshop participants, are reported in this article. Among the findings from this project are the needs for greater awareness of the risk factors associated with problematic gambling, as well as greater awareness among older adults about the consequences associated with gambling.
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Affiliation(s)
- Rupal Parekh
- Brookdale Center for Healthy Aging and Longevity, City University of New York, New York, NY 10010, USA
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20
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Abstract
The number of individuals with Alzheimer's disease or a related dementia is growing at a staggering rate. Thus, it is essential that social workers in geriatric settings are knowledgeable about this disorder and the appropriate interventions to use at all stages of the disease. The purpose of this article is to examine the types of non-pharmacological, psychosocial treatments that are used to manage the behavioral manifestations and changes in the mood of individuals with Alzheimer's disease or a related dementia. While great strides have been made in pharmacological treatments of Alzheimer's disease, less attention has been given to the types of psychosocial interventions that are readily employed in community-based and long-term care settings to assist in the care of these individuals. This article provides an overview of psychosocial interventions, as well as identifies the direction for future evidence-based treatment studies, for individuals with Alzheimer's disease and related dementia.
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Affiliation(s)
- Sara Sanders
- University of Iowa, School of Social Work, 308 North Hall, Iowa City, IA 52242, USA
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Fazii P, Calella G, Cosentino L, Pelatti A, Stella M, Crescenzi C, Pistola F, Russi C, Gattone M, Morano C, Riario Sforza G. VALUTAZIONE DELLE ANTIBIOTICO-RESISTENZE IN CEPPI DI STREPTOCOCCUS PYOGENES ISOLATI NELLA ZONA DI PESCARA. Microbiol Med 2004. [DOI: 10.4081/mm.2004.3851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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22
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Fazii P, Cosentino L, Carusi T, Maroli M, De Cono P, Clerico L, Morano C, Riario Sforza G. DESCRIZIONE DI UN CASO DI OFTALMOMIASI ESTERNA CAUSATA DA OESTRUS OVIS. Microbiol Med 2003. [DOI: 10.4081/mm.2003.4346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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23
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Morano C. Identifying the special needs of male caregivers. Continuum 1998; 18:8-13. [PMID: 10185903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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24
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Romeo MG, Tina LG, Cilauro S, Morano C, Virzì G, Rodonò A, Betta P, Saporito A, Distefano G. [The importance of using the cerebral function monitor (CFM) in the neurological prognosis of neonates in intensive care]. Pediatr Med Chir 1998; 20:197-9. [PMID: 9744012] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Cerebral function monitor (CFM), unlike traditional EEG, allows a long-term evaluation of electric brain activity, without interfering with the nursing of the newborn in the intensive care unit. Our aim was to evaluate the prognostic value of CFM for neurological outcome. We studied 102 newborns (gestational age 34.5 +/- 4.36 weeks; weight 1980 +/- 720 grams) by Multitrace CFM (Lectromed) 5 hours daily in the first week following admission. The patients also underwent cerebral echography, EEG and neurological follow-up to the 24th month. CFM was found to correlate well with the EEG recorded 3 months later. The persistence for at least one week of an I.C. tracing or the normalization of initial tracing have a good prognostic value (positive predictive value 95.23%), a persistently pathologic registration has a negative prognostic value (negative predictive value 85.18%), that even increases if cerebral echographic alterations are demonstrated (98.57%). The association of CFM and ultrasound abnormalities determines a relative risk for neurological motor impairment of 69.14, whereas CFM alone gives a relative risk of 6.4.
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Affiliation(s)
- M G Romeo
- Clinica Pediatrica II, Università di Catania, Italia
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25
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Trombini R, Morano C, Perisco Stella L, Alibrandi M, Picucci L, De Nuntis S, Bevilacqua M, De Petris U. [Paraesophageal hiatal hernia]. MINERVA CHIR 1998; 53:411-7. [PMID: 9780633] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Paraesophageal hiatal hernia is an uncommon disease but it frequently presents in aged people, causing chronic vague abdominal symptoms up to surgical emergencies from incarceration, strangulation or obstruction. The authors describe the physiopathology and clinical anatomical features of paraesophageal hiatal hernia. Important diagnostic radiological and instrumental aspects are then illustrated, versus sliding esophageal hiatal hernia. There are followed by a description of possible complications of this lesion and therapeutic implications.
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Affiliation(s)
- R Trombini
- Divisione di Chirurgia, Ospedale Generale di Zona, Regina Apostolorum, Albano Laziale, Roma
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26
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Picucci L, Persico Stella L, Alibrandi M, Cardillo L, Trombini R, Morano C. [Postoperative complications after thyroid surgery. Review of the literature and personal experience]. MINERVA CHIR 1997; 52:901-12. [PMID: 9411291] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The authors make a review of the literature on the complications which occur after thyroidectomy. They report, moreover, a study carried out on 192 thyroidectomy performed between January 1992 and May 1995. The surgical technique employed foresees the systematic search for and saving of laryngeal nerves fibers and the parathyroid gland. Results were the incidence of postoperative hypocalcemia and of permanent hypocalcemia. The authors also analyse problems related to laryngeal nerves in matters of thyroid surgery. After a short introduction on surgical anatomy, attention is drawn to the "recurrent nerve risk" but also the superior laryngeal nerve too, often injured with modifications of the vocal tone and serious consequences for particular professional groups.
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Affiliation(s)
- L Picucci
- Divisione di Chirurgia, Ospedale Generale di Zona, Regina Apostolorum Albano Laziale, Roma
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27
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Persico Stella L, Alibrandi M, Morano C, Picucci L. [Postoperative pain control]. MINERVA CHIR 1997; 52:69-74. [PMID: 9102616] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Pain was and in part still is a constant feature of surgical practice: before, during and after surgery. To start with painful symptoms represent a fundamental diagnostic element, given that in over 60% of cases pain is the primary indication for surgery. During the operation, pain used to constitute the main impediment to the surgeon's activities, until the introduction of ether and the birth of modern anesthesia. Lastly, the postoperative period is also painful so much so that whereas until fifty years ago patients were above all afraid of the operation, patients nowadays are concerned about the pain during the days after the operation. Moreover, over 50% of patients undergoing surgery are unsatisfied with the treatment of postoperative pain, in spite of the fact that drugs are available which enable us to control it. The authors studied the quality of postoperative analgesia in 357 patients, who received treatment with ketorolac tromethamine 30 mg i.v. on leaving the operating theatre, and subsequently i.m. every 8 hours starting from 3 hours after surgery. The use of ketorolac tromethanine demonstrated effective analgesia and was well accepted by patients, without revealing any particular collateral effects.
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Affiliation(s)
- L Persico Stella
- Divisione di Chirurgia, Ospedale Generale di Zona Regina Apostolorum, Roma
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28
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D'Agata A, Betta P, Sciacca P, Morano C, Praticò G, Curreri R, Quattrocchi O, Sciacca F. [Role of dietary prevention in newborns at risk for atopy. Results of a follow-up study]. Pediatr Med Chir 1996; 18:469-72. [PMID: 9053884] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
The Authors have studied the role of various preventing diet for a primary prophylaxis of allergy in 125 newborns at risk of atopy: 30 exclusively breast-fed, 50 hypoallergenic milk fed, 30 soy milk fed, and 15 with conventional milk formula. IgE values were determined at 5 days, 6 months, and 12 months of age, IgE values at 5 days were compared to newborns not at atopic risk. The clinical follow-up lasted 4 years. Total IgE values at 5 days were significantly higher in new-born at atopic risk. Only breast-feeding subjects had IgE normal values at six months. Allergic symptoms were observed in 14% of infants with a guided diet and in 53% of infants with a conventional diet. Breast fed subjects had atopic disorders in only 8% of cases, subjects with hypoallergenic formula in 12% while soja milk fed in 25%. The Authors stress the role of breast feeding in preventing allergic disorders in subjects at atopic risk or, when human milk misses, of a hypoallergenic formula, more than soy milk and conventional formula and confirm the possibility of diet and ambiental prophylaxis of allergy.
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Affiliation(s)
- A D'Agata
- Clinica Pediatrica II, Università di Catania, Italia
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29
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Morano C, Fornari L, Persico Stella L. [Acute abdomen caused by the rupture of a solitary non-parasitic cyst of the liver]. MINERVA CHIR 1996; 51:713-6. [PMID: 9082237] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A rare case of acute abdomen caused by the rupture of a solitary, non-parasitic cyst of the liver is reported. Considering the rarity of the event, it was considered interesting to examine the anatomo-pathological, clinical and diagnostic aspects as well as the various surgical and other treatment possibilities for these conditions. Stress is also laid on the fact that surgical treatment is only indicated in the case of complications, while in uncomplicated forms the treatment of choice of alcoholisation.
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Affiliation(s)
- C Morano
- Divisione di Chirurgia, Ospedale Generale di Zona, Regina Apostolorum, Albano Laziale, Roma
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