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Smeltz L, Carpenter S, Benedetto L, Newcomb N, Rubenstein D, King T, Lunsford C, Shaw T, DeWaters AL. Introduction to Disability and Antiableist Health Care: A Pilot, Student-Led Module for Preclinical Medical Students. Am J Phys Med Rehabil 2024; 103:e54-e57. [PMID: 38261784 PMCID: PMC11031297 DOI: 10.1097/phm.0000000000002399] [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] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
ABSTRACT Physical medicine and rehabilitation physicians often care for disabled patients, who comprise America's largest marginalized population. Despite medical students' and physicians' discomfort with caring for disabled patients and the pervasiveness of ableism in health care, medical education lacks disability-focused education. Kern's approach to curriculum development and disability community input were used to design a three-part, elective curriculum for first-year medical students. Part one introduced disability models and language. Part two described how to perform a comprehensive history and physical examination for a disabled patient using ADEPT-CARE. Part three provided an overview of disability history and the disability rights movement. The curriculum's goal was to improve students' attitudes regarding disability health and self-perceived knowledge and confidence in caring for patients with disabilities. The curriculum was evaluated through presurvey and postsurvey. Students favorably reviewed the curriculum. One hundred percent of students ( n = 21) agreed or strongly agreed that the curriculum improved their knowledge of disability health, increased their perceived confidence in caring for patients with disabilities, and enhanced their medical education. There were no statistically significant differences in students' attitudes toward patients with disabilities after curriculum completion. Our asynchronous module provides one potential curriculum for increasing preclinical medical students' self-perceived knowledge of disability health.
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Affiliation(s)
- Lydia Smeltz
- Medical Student, Penn State College of Medicine, Hershey, PA
| | | | | | - Nora Newcomb
- Medical Student, University of South Florida Morsani College of Medicine
| | | | - Tonya King
- Adjunct Professor of Biostatistics within the Division of Biostatistics & Bioinformatics, Department of Public Health Sciences at Penn State College of Medicine, Hershey, PA
| | - Christopher Lunsford
- Assistant Professor of Orthopaedics and Pediatrics, Duke University School of Medicine
| | - Tanya Shaw
- Curriculum Manager, Penn State College of Medicine
| | - Ami L. DeWaters
- Associate Professor of Medicine, Interim Director of Health Systems Science at Penn State College of Medicine, Hershey, PA
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Keim-Malpass J, Lunsford C, Letzkus LC, Scheer E, Valdez RS. Establishing the Need for Anticipatory Symptom Guidance and Networked Models of Disease in Adaptive Family Management Among Children With Medical Complexity: Qualitative Study. JMIR Form Res 2023; 7:e52454. [PMID: 37801346 DOI: 10.2196/52454] [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: 09/04/2023] [Revised: 10/04/2023] [Accepted: 10/06/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Caregivers of children with medical complexity navigate complex family management tasks for their child both in the hospital and home-based setting. The roles and relationships of members of their social network and the dynamic evolution of these family management tasks have been underexamined. OBJECTIVE The purpose of this study was to explore the structures and processes of family management among caregivers of children with medical complexity, with a focus on the underlying dynamic nature of family management practices and the role of members of their social network. METHODS This study used a qualitative approach to interview caregivers of children with medical complexity and members of their social network. Caregivers of children with medical complexity were recruited through an academic Children's Hospital Complex Care Clinic in the mid-Atlantic region and interviewed over a period of 1 to 3 days. Responses were analyzed using constructivist grounded theory and situational analysis to construct a new conceptual model. Only caregiver responses are reported here. RESULTS In total, 20 caregivers were included in this analysis. Caregiver perspectives revealed the contextual processes that allowed for practices of family management within the setting of rapidly evolving symptoms and health concerns. The dynamic and adaptive nature of this process is a key underlying action supporting this novel conceptual model. The central themes underpinning the adaptive family management model include symptom cues, ongoing surveillance, information gathering, and acute on chronic health concerns. The model also highlights facilitators and threats to successful family management among children with medical complexity and the networked relationship among the structures and processes. CONCLUSIONS The adaptive family management model provides a basis for further quantitative operationalization and study. Previously described self- or family management frameworks do not account for the underlying dynamic nature of the disease trajectory and the developmental stage progression of the child or adolescent, and our work extends existing work. For future work, there is a defined role for technology-enhanced personalized approaches to home-based monitoring. Due to the disparities caregivers and the children in this population already experience, technology-enhanced approaches must be built alongside key stakeholders with an equity orientation to technology co-development. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/14810.
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Affiliation(s)
- Jessica Keim-Malpass
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Christopher Lunsford
- Department of Physical Medicine and Rehabilitation, Duke University School of Medicine, Durham, NC, United States
| | - Lisa C Letzkus
- Division of Developmental Pediatrics, Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Eleanore Scheer
- Department of Systems and Information Engineering, University of Virginia School of Engineering and Applied Sciences, Charlottesville, VA, United States
| | - Rupa S Valdez
- Department of Systems and Information Engineering, University of Virginia School of Engineering and Applied Sciences, Charlottesville, VA, United States
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, United States
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Smeltz L, Carpenter S, Benedetto L, Newcomb N, Rubenstein D, King T, Lunsford C, DeWaters AL. ADEPT-CARE: A Pilot, Student-Led Initiative to Improve Care for Persons with Disabilities via a Novel Teaching Tool. Disabil Health J 2023:101462. [PMID: 37061363 DOI: 10.1016/j.dhjo.2023.101462] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/28/2023] [Accepted: 03/05/2023] [Indexed: 04/08/2023]
Abstract
BACKGROUND Over one-quarter of United States adults live with a disability. Despite persistent ableism, defined as discrimination and prejudice against people with disabilities, in healthcare, disability-focused training remains largely absent from medical education. OBJECTIVE The aim of this study was to pilot and evaluate a novel teaching mnemonic (ADEPT-CARE) for performing a comprehensive history and physical exam for disabled patients. METHODS In Spring 2022, first-year medical students at a suburban Mid-Atlantic institution could electively participate in a learning module that included ADEPT-CARE. Surveys were administered to students before and following exposure to the ADEPT-CARE protocol. RESULTS Of 142 eligible students, 33 and 21 completed the pre- and post-surveys, respectively. The ADEPT-CARE protocol made sense to 95.2% of students. All (100%) students reported that they will use the ADEPT-CARE protocol in the assessment of patients with disabilities. Students were more likely to agree or strongly agree that they had a consistent approach or strategy in mind when assessing a patient with a disability after exposure to ADEPT-CARE (85.7% vs. 39.4%, respectively, p = 0.002). There was no statistically significant difference in students' perceived confidence in their ability to assess a patient with a disability after curriculum completion compared to before (85.7% vs. 81.8%, respectively, p = 1.0). CONCLUSIONS The ADEPT-CARE protocol has the potential to be an effective teaching tool by providing a framework to equitably care for disabled patients. Future research should assess whether students' self-reported increased confidence and intention to utilize ADEPT-CARE translates into the clinical setting.
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Affiliation(s)
- Lydia Smeltz
- Penn State College of Medicine, 700 HMC Cres Road, Hershey, 17033, PA, USA.
| | - Sandra Carpenter
- Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, 02215, MA, USA
| | - Lauren Benedetto
- Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, 90027, CA, USA
| | - Nora Newcomb
- University of South Florida Morsani College of Medicine, 560 Channelside Dr, Tampa, 33602, FL, USA
| | - Dana Rubenstein
- Duke University School of Medicine, 40 Duke Medicine Circle, 124 Davison Building, Durham, 27710, NC, USA
| | - Tonya King
- Penn State College of Medicine, 700 HMC Cres Road, Hershey, 17033, PA, USA
| | - Christopher Lunsford
- Duke University School of Medicine, 40 Duke Medicine Circle, 124 Davison Building, Durham, 27710, NC, USA
| | - Ami L DeWaters
- Penn State College of Medicine, 700 HMC Cres Road, Hershey, 17033, PA, USA
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Valdez RS, Lunsford C, Bae J, Letzkus LC, Keim-Malpass J. Self-Management Characterization for Families of Children With Medical Complexity and Their Social Networks: Protocol for a Qualitative Assessment. JMIR Res Protoc 2020; 9:e14810. [PMID: 32012094 PMCID: PMC7005691 DOI: 10.2196/14810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 10/31/2019] [Accepted: 12/16/2019] [Indexed: 11/13/2022] Open
Abstract
Background Children with medical complexity (CMC) present rewarding but complex challenges for the health care system. Transforming high-quality care practices for this population requires multiple stakeholders and development of innovative models of care. Importantly, care coordination requires significant self-management by families in home- and community-based settings. Self-management often requires that families of CMC rely on vast and diverse social networks, encompassing both online and offline social relationships with individuals and groups. The result is a support network surrounding the family to help accomplish self-management of medical tasks and care coordination. Objective The goal of this study is to use a theoretically driven perspective to systematically elucidate the range of self-management experiences across families of CMC embedded in diverse social networks and contextual environments. This approach will allow for characterization of the structure and process of self-management of CMC with respect to social networks, both in person and digitally. This research proposal aims to address the significant gaps in the self-management literature surrounding CMC, including the following: (1) how self-management responsibilities are distributed and negotiated among the social network and (2) how individual-, family-, and system-level factors influence self-management approaches for CMC from a theoretically driven perspective. Methods This study will encompass a qualitative descriptive approach to understand self-management practices among CMC and their social networks. Data collection and analysis will be guided by a theoretical and methodological framework, which synthesizes perspectives from nursing, human factors engineering, public health, and family counseling. Data collection will consist of semistructured interviews with children, parents, and social network members, inclusive of individuals such as friends, neighbors, and community members, as well as online communities and individuals. Data analysis will consist of a combination of inductive and deductive methods of qualitative content analysis, which will be analyzed at both individual and multiadic levels, where interview data from two or more individuals, focused on the same experience, will be comparatively analyzed. Results This study will take approximately 18 months to complete. Our long-term goals are to translate the qualitative analysis into (1) health IT design guidance for innovative approaches to self-management and (2) direct policy guidance for families of CMC enrolled in Medicaid and private insurance. Conclusions Multiple innovative components of this study will enable us to gain a comprehensive and nuanced understanding of the lived experience of self-management of CMC. In particular, by synthesizing and applying theoretical and methodological approaches from multiple disciplines, we plan to create novel informatics and policy solutions to support their care within home and community settings. International Registered Report Identifier (IRRID) PRR1-10.2196/14810
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Affiliation(s)
- Rupa S Valdez
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Christopher Lunsford
- Department of Orthopaedics, School of Medicine, Duke University, Durham, NC, United States
| | - Jiwoon Bae
- Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, United States
| | - Lisa C Letzkus
- School of Nursing, University of Virginia, Charlottesville, VA, United States
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Abstract
The COVID-19 era exposes what was already a crisis in the medical profession: structural racism, ageism, sexism, classism, and ableism resulting in healthcare disparities for Persons with Disabilities (PWD). Early research highlights these disparities, but we do not yet know the full impact of this pandemic on PWD. Over the last 20 years, many medical schools have attempted to develop disability competency trainings, but discrimination and inequities remain, resulting in a pervasive distrust of medicine by the disability community at large. In this commentary, we suggest that disability competency is insufficient because the healthcare disparities experienced by PWD are not simply a matter of individual biases, but structural and systemic factors requiring a culture shift in the healthcare professions. Recognizing that disability is a form of diversity that is experienced alongside other systemic disadvantages like social class, race, age, sex, gender identity, and geographic location, we explore the transformative potential of disability conscious medical education, training, and practice that draws on insights from intersectional disability justice activism. Disability conscious medicine is a novel approach, which improves upon competency programs by utilizing disability studies and the principles of disability justice to guide us in the critique of norms, traditions, and institutions to more fully promote the respect, beneficence, and justice that patients deserve.
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Affiliation(s)
- Adrienne Doebrich
- School of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Marion Quirici
- Thompson Writing Program, Duke University, Durham, NC, USA
| | - Christopher Lunsford
- Pediatric Rehabilitation Medicine, Department of Orthopaedics and Department of Pediatrics, Duke University, Durham, NC, USA
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Lunsford C, Rosen L, Biffl S, Ramsey J, Edinger J, Pierce W, Houtrow A. Gaps in the delivery of rehabilitation medical equipment in the digital age. J Pediatr Rehabil Med 2019; 12:227-234. [PMID: 31609713 DOI: 10.3233/prm-190012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Lauren Rosen
- St. Joseph's Childrens Hospital of Tampa, Tampa, FL, USA
| | - Susan Biffl
- Rady Children's Hospital-San Diego, San Diego, CA, USA
| | | | - Jason Edinger
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Wendy Pierce
- University of Colorado School of Medicine, Colorado, CO, USA
| | - Amy Houtrow
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Thode AM, Wild L, Mathias D, Straley J, Lunsford C. A comparison of acoustic and visual metrics of sperm whale longline depredation. J Acoust Soc Am 2014; 135:3086-3100. [PMID: 24926504 DOI: 10.1121/1.4869853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Annual federal stock assessment surveys for Alaskan sablefish also attempt to measure sperm whale depredation by quantifying visual evidence of depredation, including lip remains and damaged fish. A complementary passive acoustic method for quantifying depredation was investigated during the 2011 and 2012 survey hauls. A combination of machine-aided and human analysis counted the number of distinct “creak” sounds detected on autonomous recorders deployed during the survey, emphasizing sounds that are followed by silence (“creak-pauses”), a possible indication of prey capture. These raw counts were then adjusted for variations in background noise levels between deployments. Both a randomized Pearson correlation analysis and a generalized linear model found that noise-adjusted counts of “creak-pauses” were highly correlated with survey counts of lip remains during both years (2012: r(10) = 0.89, p = 1e-3; 2011: r(39) = 0.72, p = 4e-3) and somewhat correlated with observed sablefish damage in 2011 [r(39) = 0.37, p = 0.03], but uncorrelated with other species depredation. The acoustic depredation count was anywhere from 10% to 80% higher than the visual counts, depending on the survey year and assumptions employed. The results suggest that passive acoustics can provide upper bounds on depredation rates; however, the observed correlation breaks down whenever three or more whales are present.
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Lunsford C, Ashraf H, Suskauer SJ. Poster 426 Benefits of Intensive Rehabilitation Boosts During Late Recovery for Children with Severe Traumatic Brain Injury: A Case Series. PM R 2012. [DOI: 10.1016/j.pmrj.2012.09.1036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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