1
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Swann-Thomsen HE, Tivis R, Sitts C, Hanks J. An innovative approach for coordinating multiple sedated procedures in medically complex pediatric patients. Soc Work Health Care 2024; 63:237-247. [PMID: 38354742 DOI: 10.1080/00981389.2024.2316706] [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: 06/20/2023] [Accepted: 11/28/2023] [Indexed: 02/16/2024]
Abstract
Children and youth with special health care needs often undergo a higher frequency of sedated procedures, increasing their risk for complications, prolonged hospitalizations, as well as increased time and cost burdens. By consolidating multiple procedures requiring anesthetic sedation, the risk and cost can be reduced for both families and health care systems. In this paper, we discuss an innovative model to coordinate procedures across internal and external providers to improve quality of care for this vulnerable patient population. Although preliminary, our findings suggest this approach may be beneficial to both the patient, family, and health system.
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Affiliation(s)
| | - Rick Tivis
- Applied Research Division, St. Luke's Health System, Boise, Idaho, USA
| | - Claire Sitts
- St. Luke's Children's Hospital, Boise, Idaho, USA
| | - John Hanks
- St. Luke's Children's Hospital, Boise, Idaho, USA
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2
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Swann-Thomsen HE, Sitts C, Hanks J, Tivis R. Implementing a social work care coordination model for children and youth with special health care needs in a rural-urban health system. Soc Work Health Care 2024; 63:188-204. [PMID: 38217440 DOI: 10.1080/00981389.2024.2304010] [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: 09/01/2022] [Accepted: 01/05/2024] [Indexed: 01/15/2024]
Abstract
This retrospective chart review examined care coordination among pediatric patients with varying levels of medical complexity who received care in a rural-urban health system. Care coordination utilization across patient acuity levels was examined for meaningful differences in frequency and duration of care coordination services. Results indicated that patients with more severe medical complexity had increased frequency and duration of care coordination services, as well as different patterns of care coordination activity utilization. This model of pediatric outpatient care coordination provides a flexible and highly targeted approach for stratification of care and services based on the needs of the individual patient.
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Affiliation(s)
| | - Claire Sitts
- St. Luke's Children's Hospital, Boise, Idaho, USA
| | - John Hanks
- St. Luke's Children's Hospital, Boise, Idaho, USA
| | - Rick Tivis
- Applied Research Division, St. Luke's Health System, Boise, Idaho, USA
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3
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Mussarat N, Biggio J, Martin J, Morgan J, Tivis R, Elmayan A, Williams FB. Masked pregnancy-associated hypertension as a predictor of adverse outcomes. Am J Obstet Gynecol MFM 2023; 5:100976. [PMID: 37098390 DOI: 10.1016/j.ajogmf.2023.100976] [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: 03/03/2023] [Revised: 04/12/2023] [Accepted: 04/18/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND Masked hypertension has been described in nonpregnant populations as elevated blood pressure in the home setting that is not reproduced on clinical assessment. Patients with masked hypertension have a greater risk of cardiovascular morbidity than patients who have blood pressures within normal range or those with white coat hypertension. OBJECTIVE This study aimed to determine whether masked pregnancy-associated hypertension detected on Connected Maternity Online Monitoring, a remote home blood pressure monitoring system, is associated with higher rates of hypertensive disorders of pregnancy during delivery admission and maternal and neonatal morbidities. STUDY DESIGN This was a retrospective cohort study of all patients on Connected Maternity Online Monitoring who delivered at 6 hospitals in a single healthcare system between October 2016 and December 2020. Patients were classified as having either normal blood pressure or masked pregnancy-associated hypertension. Masked pregnancy-associated hypertension was defined as remotely detected systolic blood pressure of ≥140 mm Hg or diastolic blood pressure of ≥90 mm Hg after 20 weeks of gestation on 2 occasions before diagnosis in a clinical setting. The chi-square test and Student t test were used for demographic and outcomes comparisons. Logistic regression was used to adjust outcomes by race, insurance, and body mass index. RESULTS A total of 2430 deliveries were included in our analysis, including 165 deliveries that met the criteria for masked pregnancy-associated hypertension. Clinically established pregnancy-associated hypertension, defined at the time of delivery, was more common in the masked pregnancy-associated hypertension group than in the normotensive group (66% vs 10%; adjusted odds ratio, 17.2; 95% confidence interval, 11.91-24.81). Patients with masked pregnancy-associated hypertension had higher rates of preeclampsia with severe features on delivery admission than normotensive patients (28% vs 2%; adjusted odds ratio, 23.35; 95% confidence interval, 14.25-38.26). Preterm delivery (16% vs 7%; adjusted odds ratio, 2.47; 95% confidence interval, 1.55-3.94), cesarean delivery(38% vs 26%; adjusted odds ratio, 1.58; 95% confidence interval, 1.13-2.23), small for gestational age (11% vs 5%; adjusted odds ratio, 2.27; 95% confidence interval, 1.31-3.94), and neonatal intensive care unit admission (8% vs 4%; adjusted odds ratio, 2.20; 95% confidence interval, 1.18-4.09) were more common among patients with masked pregnancy-associated hypertension than among normotensive patients. CONCLUSION With more outcomes research, remote blood pressure monitoring may prove to be an important tool in identifying pregnancies at risk of complications related to masked hypertension.
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Affiliation(s)
- Naiha Mussarat
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA.
| | - Joseph Biggio
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - Jane Martin
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - John Morgan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - Rick Tivis
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - Ardem Elmayan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
| | - Frank B Williams
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Ochsner Health Center - New Orleans, New Orleans, LA
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4
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Jenkins C, Bob-Manuel T, Kelly J, Tivis R, Effron MB. Abstract 227: Long Term Outcomes In Patients With Type 2 Myocardial Infarction With And Without Significant Change In Troponin Levels. Circ Cardiovasc Qual Outcomes 2022. [DOI: 10.1161/circoutcomes.15.suppl_1.227] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
It is well known that morbidity and mortality are higher in patients with Type 2 Myocardial Infarction (T2MI) compared to Type 1 MI. Few studies have compared outcomes in T2MI patients with significant increase in troponins (Tpn) (Myocardial infarction [Inf]) vs Tpn elevation with no or an insignificant Tpn increase (Myocardial Injury [Inj]).
Method:
Single center retrospective observational study evaluating patients admitted with an elevated Tpn-I and no evidence of obstructive coronary artery disease. Inj was defined as <50% increase if Tpn-I ≤ 1.0 ng/mL or <20% increase if Tpn-I > 1.0 ng/mL. Inf was defined as Tpn increase ≥ 50% if Tpn-I ≤ 1.0 ng/mL or ≥ 20% increase if Tpn-I > 1.0 ng/mL. Primary outcome was a composite of all-cause mortality, coronary revascularization, or admission for heart failure within 1 year.
Results:
The study included 3,123 patients with a hospital admission between March 2019 to September 2019: 1609 patients with Inj and 1514 patients with Inf. Adjusted primary outcome was higher with Inf than Inj (p=0.02), as was revascularization (p=0.0017). Readmission for heart failure was not significantly different (p=0.26). Risk factors for primary outcomes (history of stroke, diabetes, ESRD, hypertension, and heart failure) were higher in the Inj group with lower primary outcomes. (Table)
Conclusion:
Patients with T2MI (Inf pattern of Tpn) are more likely to have an adverse outcome within 1 year than patients with Inj.
Clinical Implications:
True T2MI (rise in Tpn) are more likely to have an adverse outcome and require catherization than patients with flat Tpn elevation who are more likely to have heart failure.
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Affiliation(s)
| | | | | | - Rick Tivis
- Ochsner Cntr for Outcomes Rsch, New Orleans, LA
| | - Mark B Effron
- Univ of Queensland-Ochsner Clinical Sch, New Orleans, LA
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5
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Mussarat N, Biggio JR, Tivis R, Elmayan A, Williams F. Masked Pregnancy Associated Hypertension as a Predictor of Adverse Outcomes. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.143] [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: 11/01/2022]
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6
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Toppin JD, Long M, Tivis R, Biggio J, Williams F. Early-onset fetal growth restriction defined by only abdominal circumference is associated with perinatal mortality. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.289] [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: 11/30/2022]
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7
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Long M, Nakahara A, Elmayan A, Tivis R, Biggio J, Williams F. Fetal growth restriction defined by abdominal circumference alone predicts perinatal mortality. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.11.312] [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: 11/25/2022]
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8
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Bareiss AK, Kattar N, Tivis R, Unis G, Do T, Montelibano L, Price-Haywood EG, McCoul E. Healthcare utilization for sinusitis after pneumococcal vaccination in patients with low antibody titers. Int Forum Allergy Rhinol 2021; 12:1018-1024. [PMID: 34962358 DOI: 10.1002/alr.22954] [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: 09/26/2021] [Revised: 11/29/2021] [Accepted: 12/15/2021] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pneumococcal antibody deficiency has been the subject of limited study in chronic rhinosinusitis (CRS) and has not been studied in recurrent acute rhinosinusitis (RARS). The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is considered for patients with non-protective Streptococcus pneumoniae titers. We hypothesized that both RARS and CRS patients with deficient S. pneumoniae titers and subsequent PPSV23 vaccination would have reduced healthcare encounters for sinusitis and fewer prescriptions for antibiotics or steroids. METHODS A retrospective cohort study was performed of patient encounters between January 2011 and December 2019. All patients included were ≥18 and ≤65 years old with a diagnosis of CRS or RARS and pneumococcal titer data. Patients with immunodeficiency and comorbid conditions requiring PPSV23 vaccination prior to the age of 65 were excluded. RESULTS A total of 938 patients were included. Non-protective antibody titers were present in 75.8% of CRS and 74.8% of RARS patients. 306 patients with deficient antibody titers received the PPSV23 vaccine. 89% of CRS and 90.1% of RARS patients had protective responses. Among 217 patients with continuous data from 2 years before through 2 years after PPSV23 vaccination, a decrease in the number of encounter diagnoses of CRS (p<0.0001) and RARS (p = 0.0006) was observed. Decreases in the frequency of antibiotic (p = 0.002) and corticosteroid (p = 0.04) prescriptions were also appreciated. CONCLUSIONS Most patients with CRS and RARS have non-protective antibody titers. PPSV23 administration significantly decreases healthcare utilization. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Anna K Bareiss
- Department of Otolaryngology - Head and Neck Surgery, Tulane University
| | - Nrusheel Kattar
- Department of Otorhinolaryngology, Ochsner Clinic Foundation
| | - Rick Tivis
- Center for Outcomes Research, Ochsner Clinic Foundation
| | - Graham Unis
- Department of Otorhinolaryngology, Ochsner Clinic Foundation
| | - Triet Do
- Department of Otolaryngology - Head and Neck Surgery, Tulane University
| | | | - Eboni G Price-Haywood
- Center for Outcomes Research, Ochsner Clinic Foundation.,Ochsner Clinical School, University of Queensland
| | - Edward McCoul
- Department of Otolaryngology - Head and Neck Surgery, Tulane University.,Department of Otorhinolaryngology, Ochsner Clinic Foundation.,Ochsner Clinical School, University of Queensland
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9
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King I, Christopher A, Hansen A, Student A, Sordahl J, Naidoo S, Nguyen E, Ambert-Pompey S, Fisher A, Tivis R, Smith CS. Interprofessional grant writing seminar for early career faculty in a small, isolated teaching center. F1000Res 2021; 9:1208. [PMID: 34527221 PMCID: PMC8366299 DOI: 10.12688/f1000research.26092.2] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/20/2022] Open
Abstract
Small, isolated teaching centers have difficulty mentoring interprofessional junior faculty in research methods and grant writing. Peer mentoring programs for grant writing at larger institutions have been successful. In this short report, we describe our program that leveraged mentor experience using four framing seminars followed by project refinement in three-person peer groups and monthly mentored works in progress meetings. In its first year, ten faculty from medicine, psychology, and pharmacy completed the program and successfully obtained six funded grants. Five of the projects transitioned from single profession applications to interprofessional applications as participants connected and profession-specific expertise was identified. Refinements for future cohorts are discussed.
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Affiliation(s)
- India King
- Department of Psychology, Family Medicine Residency of Idaho, Nampa, ID, 83704, USA.,Department of Psychology, Boise VA Medical Center, Boise, ID, 83702, USA
| | - Andrea Christopher
- Department of Medicine, Boise VA Medical Center, Boise, ID, 83702, USA.,Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Ann Hansen
- Department of Medicine, Boise VA Medical Center, Boise, ID, 83702, USA
| | - Ami Student
- Department of Psychology, Boise VA Medical Center, Boise, ID, 83702, USA
| | - Jeff Sordahl
- Department of Psychology, Boise VA Medical Center, Boise, ID, 83702, USA
| | - Sarah Naidoo
- Department of Pharmacy, Boise VA Medical Center, Boise, ID, 83702, USA
| | - Elaine Nguyen
- Department of Pharmacy, Boise VA Medical Center, Boise, ID, 83702, USA
| | | | - Amber Fisher
- Department of Pharmacy, Boise VA Medical Center, Boise, ID, 83702, USA
| | - Rick Tivis
- Department of Medicine, Boise VA Medical Center, Boise, ID, 83702, USA
| | - C Scott Smith
- Department of Medicine, Boise VA Medical Center, Boise, ID, 83702, USA.,Department of Medicine, University of Washington, Seattle, WA, 98195, USA
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10
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Doxey RS, Krug MF, Tivis R. The Lunch Conference Diet: Fostering Resident Engagement in Culinary Medicine Through a Curriculum Centered on Changes to Provided Conference Food. Am J Lifestyle Med 2021; 15:249-255. [PMID: 34025315 DOI: 10.1177/1559827621994499] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Despite the burden of chronic disease attributable to lifestyle, most internal medicine residents do not receive adequate training in nutrition and nutrition counseling. METHODS We held a culinary medicine workshop in September 2018, followed by didactic sessions throughout the academic year. Changes were made to lunch conference food to more closely follow the Mediterranean diet and to encourage healthy eating. With a modified NUTCOMP (Nutrition Competence Questionnaire) instrument, we assesses residents' perceived competence with nutrition counseling before and after the curriculum. RESULTS Twenty-six of 30 residents completed the pre-curriculum and post-curriculum surveys (not the same 26). The mean NUTCOMP score increased from 3.5 to 4.0 (P < .0001), indicating an increased perceived competence with nutritional counseling. Residents felt that nutritional counseling was important before and after the curriculum (4.2 to 4.3, P = .48). Conference food was more nutritious at the end of the intervention (Mediterranean diet score range 1-4 to 4-7) and residents enjoyed the food more. CONCLUSIONS An innovative, multimodal nutrition curriculum centered on changes to catered lunch conference food improved resident's confidence with nutritional counseling. This could feasibly be integrated into other residency programs with supportive leadership and adequate training.
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Affiliation(s)
- Richmond S Doxey
- University of Washington-Boise VA Internal Medicine Residency, Boise, Idaho
| | - Michael F Krug
- University of Washington-Boise VA Internal Medicine Residency, Boise, Idaho
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11
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Swann-Thomsen HE, Vineyard J, Hanks J, Hofacer R, Sitts C, Flint H, Tivis R. Pediatric care coordination and risk tiering: Moving beyond claims data. J Pediatr Rehabil Med 2021; 14:485-493. [PMID: 33935117 DOI: 10.3233/prm-200694] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE The goal of this study was to evaluate the performance of a pediatric stratification tool that incorporates health and non-medical determinants to identify children and youth with special health care needs (CYSHCN) patients according to increasing levels of complexity and compare this method to existing tools for pediatric populations. METHODS This retrospective cohort study examined pediatric patients aged 0 to 21 years who received care at our institution between 2012 and 2015. We used the St. Luke's Children's Acuity Tool (SLCAT) to evaluate mean differences in dollars billed, number of encounters, and number of problems on the problem list and compared the SLCAT to the Pediatric Chronic Conditions Classification System version2 (CCCv2). RESULTS Results indicate that the SLCAT assigned pediatric patients into levels reflective of resource utilization and found that children with highly complex chronic conditions had significantly higher utilization than those with mild and/or moderate complex conditions. The SLCAT found 515 patients not identified by the CCCv2. Nearly half of those patients had a mental/behavioral health diagnosis. CONCLUSIONS The findings of this study provide evidence that a tiered classification model that incorporates all aspects of a child's care may result in more accurate identification of CYSHCN. This would allow for primary care provider and care coordination teams to match patients and families with the appropriate amount and type of care coordination services.
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Affiliation(s)
- Hillary E Swann-Thomsen
- Idaho Center for Health Research, Idaho State University, Meridian, ID, USA.,St. Luke's Applied Research Division, Boise, ID, USA
| | - Jared Vineyard
- Idaho Center for Health Research, Idaho State University, Meridian, ID, USA.,St. Luke's Applied Research Division, Boise, ID, USA
| | - John Hanks
- St. Luke's Children's Hospital, Boise, ID, USA
| | - Rylon Hofacer
- Idaho Center for Health Research, Idaho State University, Meridian, ID, USA.,St. Luke's Applied Research Division, Boise, ID, USA
| | | | - Hilary Flint
- St. Luke's Applied Research Division, Boise, ID, USA
| | - Rick Tivis
- Idaho Center for Health Research, Idaho State University, Meridian, ID, USA.,St. Luke's Applied Research Division, Boise, ID, USA
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12
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King I, Christopher A, Hansen A, Student A, Sordahl J, Naidoo S, Nguyen E, Ambert-Pompey S, Fisher A, Tivis R, Smith CS. Interprofessional grant writing seminar for early career faculty in a small, isolated teaching center. F1000Res 2020; 9:1208. [PMID: 34527221 PMCID: PMC8366299 DOI: 10.12688/f1000research.26092.1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/23/2023] Open
Abstract
Small, isolated teaching centers have difficulty mentoring interprofessional junior faculty in research methods and grant writing. Peer mentoring programs for grant writing at larger institutions have been successful. In this short report, we describe our program that leveraged mentor experience using four framing seminars followed by project refinement in three-person peer groups and monthly mentored works in progress meetings. In its first year, ten faculty from medicine, psychology, and pharmacy completed the program and successfully obtained six funded grants. Five of the projects transitioned from single profession applications to interprofessional applications as participants connected and profession-specific expertise was identified. Refinements for future cohorts are discussed.
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Affiliation(s)
- India King
- Department of Psychology, Family Medicine Residency of Idaho, Nampa, ID, 83704, USA
- Department of Psychology, Boise VA Medical Center, Boise, ID, 83702, USA
| | - Andrea Christopher
- Department of Medicine, Boise VA Medical Center, Boise, ID, 83702, USA
- Department of Medicine, University of Washington, Seattle, WA, 98195, USA
| | - Ann Hansen
- Department of Medicine, Boise VA Medical Center, Boise, ID, 83702, USA
| | - Ami Student
- Department of Psychology, Boise VA Medical Center, Boise, ID, 83702, USA
| | - Jeff Sordahl
- Department of Psychology, Boise VA Medical Center, Boise, ID, 83702, USA
| | - Sarah Naidoo
- Department of Pharmacy, Boise VA Medical Center, Boise, ID, 83702, USA
| | - Elaine Nguyen
- Department of Pharmacy, Boise VA Medical Center, Boise, ID, 83702, USA
| | | | - Amber Fisher
- Department of Pharmacy, Boise VA Medical Center, Boise, ID, 83702, USA
| | - Rick Tivis
- Department of Medicine, Boise VA Medical Center, Boise, ID, 83702, USA
| | - C. Scott Smith
- Department of Medicine, Boise VA Medical Center, Boise, ID, 83702, USA
- Department of Medicine, University of Washington, Seattle, WA, 98195, USA
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13
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Grassley JS, Ward M, Tivis R. Development and Psychometric Testing of the Nurses' Confidence Scale: Unique Families. J Obstet Gynecol Neonatal Nurs 2019; 49:101-112. [PMID: 31758912 DOI: 10.1016/j.jogn.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To develop and evaluate an instrument designed to measure the confidence of nurses in their ability to provide neutral, compassionate care to unique families in perinatal settings: the Nurses' Confidence Scale: Unique Families. DESIGN Prospective instrument development and psychometric study. SETTING Health system in the U.S. Mountain West region. PARTICIPANTS Convenience sample of 62 perinatal/neonatal nurses. METHODS We developed a two-part scale to measure the confidence of nurses in their ability to care for complex/nontraditional families, termed unique families. Part A was focused on nursing care behaviors for any unique family; Part B was focused on providing care to seven specific unique family populations. Five experts in perinatal nursing or adoption evaluated the scale's content validity. To test the psychometric properties of the scale, we used item analysis, reliability analysis, and exploratory factor analysis. RESULTS The content validity index was 0.82. The Cronbach's alpha coefficient estimate of internal consistency for Part A was .92. Principal component analysis resulted in two factors that explained 64% of the total variance: skills and resources (Cronbach's alpha coefficient = .89) and awareness and sensitivity (Cronbach's alpha coefficient = .87). Part B had a Cronbach's alpha coefficient of .90. Parts A and B showed a strong positive relationship with one another (r = .77). The general self-efficacy measure was strongly and positively correlated with Part A (r = .81) and moderately and positively correlated with Part B (r = .48). CONCLUSION The Nurses' Confidence Scale: Unique Families is a new tool with which to measure the confidence of perinatal/neonatal nurses in providing sensitive, specific care to complex/nontraditional families. Results of our psychometric evaluation supported initial acceptable reliability and validity of the scale.
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14
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Hofacer RD, Panatopoulos A, Vineyard J, Tivis R, Nguyen E, Jingjing N, Lindsay RP. Clinical Care Coordination in Medically Complex Pediatric Cases: Results From the National Survey of Children With Special Health Care Needs. Glob Pediatr Health 2019; 6:2333794X19847911. [PMID: 31106248 PMCID: PMC6506911 DOI: 10.1177/2333794x19847911] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 03/27/2019] [Revised: 04/02/2019] [Accepted: 04/05/2019] [Indexed: 12/01/2022] Open
Abstract
This study uses a secondary analysis of the 2009-2010 National Survey of Children
with Special Health Care Needs (NS-CSHCN) to describe care coordination (CC) for
children with medical complexity (CMC). Chi-square test, t
test, and multivariate logistic regression statistical tests are used to
determine the relationships and differences between sources of CC and factors
associated with receiving clinic-based CC for CMC and their family. Among CMC,
66.47% received no CC support and 25.73% received clinic-based CC. In
multivariate models, families reporting dissatisfaction with communication
between health care providers or reporting family-centered care were less likely
to receive clinic-based CC. Families were more likely to receive clinic-based CC
if they had younger children, lower household income, and greater school
absenteeism. Clinic-based CC is associated with improved communication between
health providers but must become more family-centered and minimize student
absenteeism for the CMC population.
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Affiliation(s)
| | | | | | - Rick Tivis
- Idaho State University, Meridian, ID,
USA
| | | | | | - Ryan P. Lindsay
- Idaho State University, Meridian, ID,
USA
- Ryan P. Lindsay, Idaho State University,
Kasiska Division of Health Sciences, 1311 East Central Drive, Meridian, ID
83642, USA.
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15
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Lambertz CK, Tivis R, Hansen K. NO SToPS: Assessment of a Supportive Care Program to Reduce Treatment Breaks in Patients With Head and Neck Cancer. Clin J Oncol Nurs 2018; 22:666-668. [PMID: 30452009 DOI: 10.1188/18.cjon.666-668] [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
NO SToPS is an interprofessional supportive care program implemented in 2008 for patients with head and neck cancer undergoing chemoradiation. The goals of the program are to reduce radiation treatment breaks and hospitalizations related to toxicity from this difficult treatment. Breaks lead to lower locoregional control and survival rates in this population. This article describes the effect of the NO SToPS program.
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16
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Xu X, Tupy S, Robertson S, Miller AL, Correll D, Tivis R, Nigg CR. Successful adherence and retention to daily monitoring of physical activity: Lessons learned. PLoS One 2018; 13:e0199838. [PMID: 30235221 PMCID: PMC6147478 DOI: 10.1371/journal.pone.0199838] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 06/14/2018] [Indexed: 11/30/2022] Open
Abstract
Research utilizing repeated-measures such as daily assessments with self-report and/or objective measures [e.g., physical activity (PA) monitors] are important in understanding health behaviors and informing practice and policy. However, studies that utilize daily assessment often encounter issues with attrition and non-compliance. The current research yielded high levels of retention and adherence with both self-report and objective daily measures. The purpose of this paper is to highlight and discuss strategies utilized in maximizing retention, minimizing missing data, and some lessons learned from the research experience. Fifty community participants took part in a 4-week study utilizing both daily self-report questionnaires and daily use of PA monitors (Fitbit One™). This study focused on typical daily PA and was not an intervention study (e.g., participants were not randomized nor asked to change their PA behavior). Participants completed the study in two waves (wave 1 n = 10, wave 2 n = 40). The research team utilized several retention strategies including automating the data collection process, a prorated incentive structure, having a dedicated and responsive study staff, and utilizing the 2-wave process to optimize data collection during the 2nd wave. The study had 100% retention and generally positive anonymous feedback post-study. Overall, participants completed the vast majority of daily surveys (97%) and wore their Fitbits (for at least part of the day) on almost all days (99.57%) of the study, although there were individual differences. The strategies discussed and lessons learned may be useful to other researchers using daily measurements for whom adherence and retention are important issues. Future research employing these strategies in different populations, with different measurements, and for longer durations is warranted to determine generalizability.
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Affiliation(s)
- Xiaomeng Xu
- Department of Psychology, Idaho State University, Pocatello, Idaho, United States of America
- * E-mail:
| | - Samantha Tupy
- Department of Psychology, Idaho State University, Pocatello, Idaho, United States of America
| | - Stephen Robertson
- Department of Psychology, Idaho State University, Pocatello, Idaho, United States of America
| | - Ashley L. Miller
- Department of Psychology, University of Oregon, Eugene, Oregon, United State of America
| | - Danielle Correll
- Department of Psychology, University of Colorado Colorado Springs, Colorado Springs, Colorado, United States of America
| | - Rick Tivis
- Idaho Center for Health Research, Idaho State University, Meridian, Idaho, United States of America
- Boise VA Medical Center of Excellence for Primary Care Education, Boise, Idaho, United States of America
| | - Claudio R. Nigg
- Office of Public Health Studies, University of Hawai’i at Manoa, Honolulu, Hawaii, United States of America
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Grassley JS, Tivis R, Finney J, Chapman S, Bennett S. Evaluation of a Designated Family Bonding Time to Decrease Interruptions and Increase Exclusive Breastfeeding. Nurs Womens Health 2018; 22:219-227. [PMID: 29885710 DOI: 10.1016/j.nwh.2018.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE The purpose of this quality improvement project was to plan and implement a daily family bonding time on our mother/baby care unit and evaluate its effect on interruptions, mothers' perceptions of interruptions, and exclusive breastfeeding rates. DESIGN A separate sample pre-/postintervention design conducted in three phases. SETTING/LOCAL PROBLEM Healthy breastfeeding newborns had double the odds of receiving supplementation before discharge if they stayed more than 1 night or were born at night. Night nurses suggested implementing a daily quiet time as a strategy for limiting interruptions. PARTICIPANTS A convenience sample of 60 postpartum women. INTERVENTION/MEASURES During Phases 1 and 3, data were collected on interruptions (number, duration, and by whom), women's perceptions of interruptions, and exclusive breastfeeding rates. Family bonding time was launched in Phase 2 during the hours of 2 p.m. to 4 p.m. Women were encouraged to rest with their newborns in their rooms; interruptions were limited to those that were urgent, medically necessary, or requested by the women. RESULTS Outcome data were analyzed using descriptive statistics, a repeated-measures analysis of variance, t test, and chi-square test. Analysis of interruptions by the unit nursing staff indicated a decrease in interruptions between 2 p.m. and 4 p.m. that could be attributed to family bonding time (F(1, 58) = 7.50, p = .008). Analysis of interruptions by other hospital staff and visitors indicated a significant interaction of time with interruptions; interruptions decreased in both phases between 2 p.m. and 4 p.m. (F(3, 174) = 4.83, p = .0029; F(3, 174) = 2.95, p = .034). Exclusive breastfeeding rates increased significantly (χ2(4) = 21.27, p = .0003); there were no significant differences in women's perceptions of interruptions. CONCLUSION New mothers experience many interruptions during their hospital stays, particularly when visitors arrive in large groups and stay more than 60 minutes. Documenting sources of interruptions before launching family bonding time helps identify hospital staff who need to be informed. Addressing their concerns before implementation can facilitate project sustainability.
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Weppner WG, Davis K, Tivis R, Willis J, Fisher A, King I, Smith CS. Impact of a complex chronic care patient case conference on quality and utilization. Transl Behav Med 2018; 8:366-374. [DOI: 10.1093/tbm/ibx082] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- William G Weppner
- Boise VAMC Center of Excellence in Primary Care Education, , Medical Service, Boise, ID, USA
- University of Washington School of Medicine, Department of Medicine, Seattle, WA, USA
| | - Kyle Davis
- St. Luke’s Health System, Behavioral Health Department, Boise, ID, USA
| | - Rick Tivis
- Boise VAMC Center of Excellence in Primary Care Education, , Medical Service, Boise, ID, USA
- Idaho State University, Division of Health Sciences, Meridian, ID, USA
| | - Janet Willis
- Boise VAMC Center of Excellence in Primary Care Education, , Medical Service, Boise, ID, USA
| | - Amber Fisher
- Boise VAMC Center of Excellence in Primary Care Education, , Medical Service, Boise, ID, USA
- Idaho State University, Division of Health Sciences, Meridian, ID, USA
| | - India King
- Boise VAMC Center of Excellence in Primary Care Education, , Medical Service, Boise, ID, USA
- Idaho State University, Division of Health Sciences, Meridian, ID, USA
| | - C Scott Smith
- Boise VAMC Center of Excellence in Primary Care Education, , Medical Service, Boise, ID, USA
- University of Washington School of Medicine, Department of Medicine, Seattle, WA, USA
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Sordahl J, King IC, Davis K, Tivis R, Smith SC, Fisher A, Willis J, Gordon T, Weppner WG. Interprofessional case conference: impact on learner outcomes. Transl Behav Med 2018; 8:927-931. [DOI: 10.1093/tbm/ibx018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - India C King
- Psychology Faculty, Boise VA Medical Center of Excellence for Primary Care Education, VISN 20 Virtual IMPACT HUB, Boise, ID, USA
- Idaho State University, School of Pharmacy, Meridian, ID, USA
| | - Kyle Davis
- St. Luke’s Health System, Boise, ID, USA
| | - Rick Tivis
- Boise VA Medical Center of Excellence for Primary Care Education, Boise, ID, USA
- Idaho State University, Meridian, ID, USA
| | - Scott C Smith
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
- Department of Veterans Affairs, Office of Academic Affiliations, Centers of Excellence in Primary Care Education, Washington, DC, USA
| | - Amber Fisher
- Idaho State University, School of Pharmacy, Meridian, ID, USA
- Boise VA Medical Center of Excellence for Primary Care Education, Boise, ID, USA
| | - Janet Willis
- Boise VA Medical Center of Excellence for Primary Care Education, Boise, ID, USA
- Northwest Nazarene University, Nampa, ID, USA
| | - Timothy Gordon
- Boise VA Medical Center of Excellence for Primary Care Education, Boise, ID, USA
| | - William G Weppner
- Boise VA Medical Center of Excellence for Primary Care Education, Boise, ID, USA
- Division of General Internal Medicine, University of Washington, Seattle, WA, USA
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Weppner WG, Davis K, Sordahl J, Willis J, Fisher A, Brotman A, Tivis R, Gordon T, Smith CS. Interprofessional Care Conferences for High-Risk Primary Care Patients. Acad Med 2016; 91:798-802. [PMID: 27008359 DOI: 10.1097/acm.0000000000001151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
PROBLEM As health care systems convert to team-based care, the need to improve interprofessional education is tremendous. In addition to formal instruction, trainees need authentic team-based workplace learning experiences. APPROACH The authors designed the PACT-ICU (Patient-Aligned Care Team Interprofessional Care Update) conference to provide team-based care to high-risk patients while teaching trainees principles of interprofessionalism and modeling relevant behaviors. Trainees, supervisors, and affiliated support staff from the fields of internal medicine, nurse practitioner, pharmacy, psychology, and nursing all participate in this conference. During the conference, each participant focuses on the narrative of the patient's illness from his/her own professional perspective. A multifaceted care plan with specific action items is the product of the conference. To evaluate this workplace learning opportunity, the authors recorded patient characteristics, plus trainees' participation and satisfaction. OUTCOMES Over the first 16 months (2013-2014) of the PACT-ICU, 33 trainees presented 79 patients. Each trainee presented two or three times each academic year. Patients were 90% male; their mean age was 64.5 years (SD 9.3, range 28-92), and their mean calculated 90-day risk of death or hospitalization was 22% (SD 14%, range 1%-45%).Overall, all surveyed trainees (n = 32; 97% response rate) expressed satisfaction, reporting that the conference was "helpful" or "very helpful" in developing treatment plans. NEXT STEPS Further assessment of change in trainee behavior related to interprofessional team care, patient-level outcomes (e.g., quality of care and utilization), and factors facilitating dissemination of the model to other academic clinic settings is necessary.
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Affiliation(s)
- William G Weppner
- W.G. Weppner is codirector and physician associate director, Boise VA Center of Excellence for Primary Care Education, Boise, Idaho, and assistant professor, Division of General Internal Medicine, University of Washington, Seattle, Washington. K. Davis is clinical psychologist, Saint Luke's Mountain States Tumor Institute, Boise, Idaho. J. Sordahl is neuropsychology postdoctoral fellow, South Texas Veterans Health Care System, San Antonio, Texas. J. Willis is nursing associate director, Boise VA Center of Excellence for Primary Care Education, Boise, Idaho. A. Fisher is codirector and pharmacy associate director, Boise VA Center of Excellence for Primary Care Education, Boise, Idaho. A. Brotman is psychology associate director, Boise VA Center of Excellence for Primary Care Education, Boise, Idaho. R. Tivis is statistician, Boise VA Center of Excellence for Primary Care Education, Boise, Idaho. T. Gordon is data manager, Boise VA Center of Excellence for Primary Care Education, Boise, Idaho. C.S. Smith is national physician consultant, VA Centers of Excellence for Primary Care Education, and professor, Division of General Internal Medicine and Medical Education, University of Washington, Seattle, Washington
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Christopher AS, Smith CS, Tivis R, Wilper AP. Trends in United States physician work hours and career satisfaction. Am J Med 2014; 127:674-80. [PMID: 24713209 DOI: 10.1016/j.amjmed.2014.03.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 01/06/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Affiliation(s)
| | - C Scott Smith
- Department of Medicine, Boise Veterans Affairs Medical Center, Boise, Idaho
| | - Rick Tivis
- Department of Medicine, Boise Veterans Affairs Medical Center, Boise, Idaho
| | - Andrew P Wilper
- Department of Medicine, Boise Veterans Affairs Medical Center, Boise, Idaho
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Eichmeyer JN, Burnham C, Sproat P, Tivis R, Beck TM. The value of a genetic counselor: improving identification of cancer genetic counseling patients with chart review. J Genet Couns 2013; 23:323-9. [PMID: 24155015 DOI: 10.1007/s10897-013-9664-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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] [Received: 04/10/2013] [Accepted: 10/02/2013] [Indexed: 11/26/2022]
Abstract
Advances in genetics are changing cancer care and requiring institutions to maximize the unique skills of genetics professionals. The identification of genetic syndromes is vital for prevention and management of families with high cancer risks. Despite this, high risk individuals who qualify are often not referred. Genetic counselors could review oncology charts to improve identification. A genetics assessment tool developed by NCI Community Cancer Centers Program was used to perform self-assessment of the genetics program. A weekly report of all new oncology patients was provided to a genetic counselor for chart review. In 2010, 58 % of all eligible patients (n = 152) were offered a genetics evaluation. In 2011 this improved to 70 % (n = 167), which was a statistically significant difference, X (2)(1) = 5.13, p = 0.02. By cancer site, ovarian cancer referrals also showed statistically significant improvement, X (2)(1) = 6.36, p = 0.01. Breast and colon referrals were improved but not significant. Over 10 months, 129 patients were identified through the chart review program. Three were confirmed to have a genetic mutation for a hereditary cancer syndrome. An average week included review of 73 charts for 10 medical oncologists, 4 radiation oncologists, and 4 pediatric oncologists which generated 60-80 min of work for the genetic counselor. This program improved patient identification and quality, and allowed physicians to become more aware of opportunities for genetic counseling and more patients to receive genetic counseling and testing.
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Affiliation(s)
- Jennifer N Eichmeyer
- St. Luke's Mountain States Tumor Institute, 100 E. Idaho, Boise, ID, 83712, USA,
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Smith CS, Morris M, Francovich C, Tivis R, Bush R, Sanders SS, Graham J, Niven A, Kai M, Knight C, Hardman J, Caverzagie K, Iobst W. A multisite, multistakeholder validation of the Accreditation Council for Graduate Medical Education competencies. Acad Med 2013; 88:997-1001. [PMID: 23702529 DOI: 10.1097/acm.0b013e3182951efc] [Citation(s) in RCA: 5] [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: 06/02/2023]
Abstract
PURPOSE The Accreditation Council for Graduate Medical Education's (ACGME's) six-competency framework has not been validated across multiple stakeholders and sites. The objective of this study was to perform a multisite validation with five stakeholder groups. METHOD This was a cross-sectional, observational study carried out from October to December, 2011, in the internal medicine residency continuity clinics of eight internal medicine residency programs in the Pacific Northwest, including a VA, two academic medical centers, a military medical center, and four private hospitals. The authors performed a cultural consensus analysis (CCA) and a convergent-discriminant analysis using previously developed statements based on internal medicine milestones related to the six competencies. Ten participants were included from each of five stakeholder groups: patients, nurses, residents, faculty members, and administrators from each training site (total: 400 participants). RESULTS Moderate to high agreement and coherence for all groups were observed (CCA eigenvalue ratios ranging from 2.16 to 3.20); however, high differences in ranking order were seen between groups in four of the CCA statements, which may suggest between-group tension in these areas. Analyses revealed excellent construct validity (Zcontrast score of 5.323, P < .0001) for the six-competency framework. Average Spearman correlation between same-node statements was 0.012, and between different-node statements it was -0.096. CONCLUSIONS The ACGME's six-competency framework has reasonable face and construct validity across multiple stakeholders and sites. Stakeholders appear to share a single mental model of competence in this learning environment. Data patterns suggest possible improvements to the competency-milestone framework.
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Affiliation(s)
- C Scott Smith
- Boise VA Center of Excellence in Primary Care Education, Boise, ID 83702, USA.
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Freudenthal JJ, Boyd LD, Tivis R. Assessing change in health professions volunteers' perceptions after participating in Special Olympics healthy athlete events. J Dent Educ 2010; 74:970-979. [PMID: 20837738] [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
This study assessed perceptions of health professions student and faculty volunteers who participated with athletes at the 2009 Special Olympics World Winter Games in Healthy Athlete venues. The volunteers' perceptions and expectations of the abilities of intellectually disabled athletes were measured by administering pre-event and post-event questionnaires consisting of demographic questions and the Prognostic Belief Scale (PBS). Invitations to participate in the study were sent to 165 students and faculty members; of those, eighty (48.5 percent response rate) responded to the pre-event questionnaire, and sixty-seven (40.6 percent response rate) responded to the post-event questionnaire. Of the eighty respondents to the pre-event questionnaire, fifty-five (68.7 percent) also completed the post-event questionnaire. The ANOVA comparing pre- and post-event PBS scores between groups found a trend towards higher scores among the volunteers, but analysis did not demonstrate a significant effect in either group (p=.68) or the interaction of group by time (p=.46). Despite the findings from the PBS, participants' statements suggest the experience had an impact on their perceptions and expectations. Although not statistically significant, this study found a positive trend pre- to post-event in the volunteers' perceptions of the abilities of athletes with intellectual disabilities. In addition to didactic and clinical education, volunteer experiences may enhance care providers' knowledge, skill, and confidence levels for treating clients with intellectual disabilities.
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Affiliation(s)
- Jacqueline J Freudenthal
- Department of Dental Hygiene, Idaho State University, 921 S. 8 Avenue, Stop 8048, Pocatello, ID 83209-8048, USA.
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Freudenthal JJ, Boyd LD, Tivis R. Assessing Change in Health Professions Volunteers’ Perceptions After Participating in Special Olympics Healthy Athlete Events. J Dent Educ 2010. [DOI: 10.1002/j.0022-0337.2010.74.9.tb04952.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | - Linda D. Boyd
- Forsyth School of Dental Hygiene; Massachusetts College of Pharmacy and Health Sciences
| | - Rick Tivis
- Institute of Rural Health; Idaho State University-Meridian HSC
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Phillipp A, Stokes CD, Tivis R, Gans D, Piland N. Are medical offices prepared for the next disaster? J Med Pract Manage 2009; 25:97-99. [PMID: 19911544] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Disasters have an enormous economic impact on the United States as well as short- and long-term healthcare implications. Federal and state governments are providing billions of dollars to communities across the nation for emergency preparedness activities. An online poll conducted in July 2008 indicated that most medical practices in the United States, even though they believe they will be impacted by a disaster within the next five years, re port themselves to be inadequately prepared. In light of increased funding since 9/11 and hurricane Katrina, the results of the poll show that the very practices that are the foundation of our healthcare system that see and treat patients on a daily basis are not being included in preparedness efforts.
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Affiliation(s)
- Annette Phillipp
- Idaho State University, Institute of Rural Health, 12301 W. Explorer Drive, Suite 102, Boise, Idaho 83713, USA.
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Abstract
BACKGROUND Historically, the concomitant use of nicotine among alcoholics has not been methodologically accounted for. Given the observed cognitive enhancing effects of acute nicotine on attentional processes, it is important that the potentially positive effects of nicotine be disentangled from the negative effects of chronic alcohol dependence. The current study was conducted to address this question and to test the hypothesis that alcoholics who are regular smokers are more sensitive to the effects of nicotine on cognition as compared to regular smoking community controls. METHODS A 2 [drug group; alcoholics (n = 28), community controls (n = 27)] X 2 nicotine dose level [low (7 mg dose) vs. high (14 or 21 mg dose)] double-blind design was used to assess the differential effects of nicotine dose on a battery of neurocognitive tests focusing on attentional efficiency. RESULTS As expected, the alcoholic group performed more poorly than did the control group. However, of greater interest to the current study was the finding that alcoholic participants differentially benefited from nicotine administration, as demonstrated in the differential dose effect. CONCLUSION The concomitant use of nicotine may serve to "mask" or "overcome" some of the negative effects of chronic alcohol dependence in newly recovering alcoholics. This potential effect has significant implications for treatment development and further understanding of the process of recovery of function in chronic alcoholics.
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Affiliation(s)
- Sara Jo Nixon
- Department of Psychiatry, McKnight Brain Institute, Newell, Gainesville, Florida 32611, USA.
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Abstract
Essential to clarifying the nature of health disparities and ultimately to developing appropriate responses is the access and availability of accurate, relevant data. This need is particularly obvious at the level of public health policy and practice. Unfortunately, current data sources are frequently restricted by a variety of factors, including jurisdictory limitations that restrict exchange of information between health delivery systems. This study was conducted to review conclusions drawn from disparate, yet functionally interdependent, data sources regarding alcohol-related medical outcomes among American Indians; specifically, non-reservation-residing Indian people. Data were collected from 1998 to 1999. The comparison revealed critical inconsistencies between data sources, reinforcing the call for enhanced data exchange and caution in interpreting data from singular sources.
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Affiliation(s)
- Sara Jo Nixon
- Department of Psychology, Neurocognitive Laboratory, University of Florida, Gainesville, Florida 32610, USA.
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Ceballos NA, Tivis R, Lawton-Craddock A, Nixond SJ. Nicotine and cognitive efficiency in alcoholics and illicit stimulant abusers: implications of smoking cessation for substance users in treatment. Subst Use Misuse 2006; 41:265-81. [PMID: 16467005 DOI: 10.1080/10826080500409076] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cigarette smoking is prevalent among alcoholics and illicit substance abusers. However, the potentially confounding effect of nicotine on studies of cognition in detoxified substance users has rarely been addressed. In the current study of 87 participants, behavioral and electrophysiological indices of cognitive efficiency were measured in tobacco smokers from four groups: alcoholics, illicit stimulant abusers, concurrent abusers, and control subjects. Data were collected from 2001 to 2003. We hypothesized that acute nicotine administration would modify cognitive deficits in alcoholics and illicit stimulant abusing groups. An adaptation of the Rapid Visual Information Processing task was administered after stabilization of nicotine levels via a high- or low-dose transdermal nicotine patch. Across groups, increased nicotine dose was associated with decreased reaction time (p = .03). A group x nicotine dose interaction trend was noted in which increased nicotine was associated with increased correct responding within the alcoholic group (p = .02). No significant differences in electrophysiology were observed. These results suggest that nicotine may modify cognitive efficiency in alcoholics and illicit stimulant abusers, a concept with relevance to both the design of experimental work and the treatment of alcohol and illicit stimulant dependence. Further work is needed to determine whether this effect predominantly reflects facilitation of cognition function or alleviation of nicotine withdrawal.
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Affiliation(s)
- Natalie A Ceballos
- Department of Behavioral Sciences, University of Minnesota School of Medicine, Duluth, 55812-3031, USA.
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Ceballos NA, Tivis R, Lawton-Craddock A, Nixon SJ. Visual-spatial attention in alcoholics and illicit stimulant abusers: effects of nicotine replacement. Prog Neuropsychopharmacol Biol Psychiatry 2005; 29:97-107. [PMID: 15610951 DOI: 10.1016/j.pnpbp.2004.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2004] [Indexed: 11/16/2022]
Abstract
Reports of alcohol or illicit drug-related cognitive impairments have frequently disregarded the potentially confounding effects of smoking status and nicotine withdrawal on these measures. This study addressed this issue by measuring visual-spatial attention via an adaptation of the Posner paradigm in three groups of tobacco smokers: controls without a history of alcoholism or illicit drug use (n=27; 20 male), chronic alcoholics (n=22; 18 male), and illicit stimulant abusers (n=36; 21 male). Throughout testing, nicotine levels were stabilized by the double-blind administration of a high (14 or 21 mg) or low (7 mg) dose transdermal nicotine patch. A significant effect of group was observed for number of correct responses to restriction trials (F=5.48, 2/79 df; p=.006). Performance was normalized in the illicit stimulant group, and alcoholic participants exhibited superior performance relative to both illicit stimulant abusers (p=.002) and controls (p=.01). These findings support the hypothesis that nicotine may have a compensatory or normalizing effect on attentional functions in substance abusers. Whether these results reflect the central nervous system-activating effects of nicotine or merely alleviation of nicotine withdrawal is a topic of ongoing research.
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Affiliation(s)
- Natalie A Ceballos
- Alcohol Research Center, Department of Psychiatry, University of Connecticut School of Medicine, 263 Farmington Avenue, MC-2103, Farmington, CT 06030-2103, USA.
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Affiliation(s)
- Deborah Jones-Saumty
- Department of Psychiatry & Behabioral Sciences, University of Oklahoma Health Sciences Center, OklahomaCity, Oklahoma 74571, USA.
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Abstract
BACKGROUND Although previous studies have found stimulant (i.e., cocaine, methamphetamine) abusers and alcoholics to have neuropsychological deficits, research examining which cognitive abilities are most affected by concurrent exposure to these substances is lacking. To address this issue, detoxified men and women who met criteria for dependence of (a) alcohol only (ALC) (n = 15); (b) stimulants only (STIM) (n = 15); and (c) both alcohol and stimulants (A/STIM) (n = 15) were compared with age- and education-matched community controls (n = 15). METHODS Tasks that measured visual spatial skills, problem-solving and abstraction, short-term memory, cognitive flexibility, and gross motor speed were administered to participants. For each test, both speed and accuracy were assessed and an efficiency ratio (accuracy/time) was derived. Based on an average of these efficiency ratios, an overall performance index of cognitive efficiency was obtained. RESULTS Overall, controls performed more efficiently than all other groups. However, they were statistically significantly better only in relation to the A/STIM and STIM groups (p < 0.01). Individual comparisons revealed that the ALC group performed significantly better than the STIM group, although the ALC group did not differ from either the control or A/STIM groups (p </= 0.05). This pattern of results was relatively consistent across the individual subtests of problem-solving/abstraction, short-term memory, and cognitive flexibility. CONCLUSIONS As expected, substance abuse was associated with cognitive inefficiency. More importantly, these findings suggest that the cognitive effects of chronic stimulant abuse are not additive with those of alcohol abuse. That is, singly addicted stimulant abusers demonstrated similar or greater neurocognitive impairments than individuals who abuse alcohol and stimulants concurrently. The reason for this pattern is speculative but may be attributed to alcohol's opposing actions on cerebrovascular effects brought on by stimulant abuse.
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Affiliation(s)
- Andrea Lawton-Craddock
- Center for Alcohol and Drug-Related Studies, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
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Abstract
OBJECTIVE Chronic alcoholics with a comorbid diagnosis of antisocial personality (ASP) symptomatology often exhibit early onset, severe course, and poor treatment outcomes. In addition, antisocial characteristics have been associated with a variety of cognitive deficits, including abnormalities of semantic processing, a deficit also found in alcoholics. Using the N400 task, this study investigated whether comorbid ASP symptomatology in alcoholics and community controls contributes to deficits in cognitive efficiency. METHOD The N400 component of the event-related potential was elicited in detoxified alcoholics (n = 71; 56 male) and community controls (n = 36; 22 female) by sentences with congruent, related/incongruent or unrelated/incongruent terminal words. Difference waveforms were derived, and both amplitude and latency measures were obtained. Antisocial personality symptomatology was assessed using the ASP section of the Diagnostic Interview Schedule IV. RESULTS Data were analyzed via linear regression using alcoholism, ASP positive (ASP+) status and their interaction term as predictors of N400 amplitude and latency. Significant latency findings were noted in the related/incongruent sentence condition. Increased N400 latency was predicted by ASP+ status at electrode site Pz (p = .01). The interaction of alcoholism and ASP+ status predicted increased N400 latency at electrode site P4 (p = .009), with ASP+ alcoholics demonstrating the greatest latency. CONCLUSIONS The presence of N400 latency differences in response to related/incongruent semantic information in the current study differs from previous findings in studies of chronic alcoholism that do not account for ASP. These data suggest that antisocial personality disorder and alcoholism may affect cognitive function via different underlying mechanisms.
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Affiliation(s)
- Natalie A Ceballos
- Cognitive Studies Laboratory, Center for Alcohol and Drug-Related Studies, 800 NE 15th Street, Suite 410, Oklahoma City, Oklahoma 73104, USA.
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Abstract
The current study examined electrophysiological measures of cognitive efficiency in alcoholics and controls using a negative priming paradigm derived from DeSchepper and Treisman (J. Exp. Psychol. Learn. Mem. Cog. 22 (1996) 27). In this task, sets of novel shapes were presented: Two overlapping green and red shapes on the left and a single white shape on the right. Participants were instructed to ignore the red shape, but to determine whether the green shape was the same as or different from the white shape. On primed trials, previously red (to be ignored; i.e., irrelevant) shapes became green (relevant) shapes in a second component of the task. Participants who were capable of ignoring irrelevant stimuli were expected to experience more difficulty in the primed condition. Therefore, we predicted that, if alcohol-related impairment in cognitive efficiency is due to inability to respond "appropriately" (i.e., ignore irrelevant stimuli), alcoholics would experience less negative priming than normal controls. Both amplitude and latency of the P300 component of the event-related potential were measured in response to each trial condition. Using a 2 x 2 (group x condition) ANOVA with repeated conditions, a significant pattern of group x condition interactions was observed at right frontal, F4 (p=.05) and central parietal, Pz (p=.03) electrode sites on measures of P300 amplitude. A significant group x condition latency interaction was observed at the central parietal electrode, Pz (p=.006). Overall, controls exhibited increased P300 amplitude and latency in response to negatively primed trials. As predicted, alcoholics did not demonstrate this pattern, a finding consistent with alcohol-related cognitive inefficiency.
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Affiliation(s)
- Natalie A Ceballos
- Cognitive Studies Laboratory, Center for Alcohol and Drug-Related Studies, University of Oklahoma Health Sciences Center, 800 NE 15th Street, Suite 410, Oklahoma City, OK 73104, USA.
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Abstract
Chronic alcoholics often exhibit impairment in behavioral indicators of cognitive efficiency. However, potential neurophysiological correlates of this deficit are understudied. To examine this function, semantic expectancy was measured by recording the N400 component of the event-related potential (ERP), which is elicited by incongruent semantic information. Abstinent alcoholics, 21-45 days sober (n = 26; 12 males, 14 females), as well as age and education equated community controls (n = 26; 12 males, 14 females), were instructed to read silently 218 sentences ending with either congruent, related/incongruent, or unrelated/incongruent terminal words. Difference waveforms to the terminal word were derived, and amplitude and latency measures of the most negative peak between 300 and 600 ms were obtained. Electrode sites included the midline sites, Fz, Cz, and Pz; the temporal sites T3 and T4; and parietal sites P3 and P4. Significant group effects in amplitude were observed for the difference waveform under the unrelated/incongruent condition at T3, T4, and P4 (P < or = .05). Measures at P3, Pz, Fz, and Cz approached significance (P < or = .15). Although the overall pattern did not change when regression techniques were used to control for age, only the T4 site retained significance (P < or = .05). Across all electrode sites, alcoholics produced reduced N400 amplitudes relative to community controls. Latency was unaffected. There were no group effects for amplitude or latency measures in the related/incongruent condition. These data are consistent with the hypothesis that alcoholics suffer from a subtle deficiency in neurophysiologically based cognitive efficiency which renders them less likely to respond appropriately to irrelevant information.
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Affiliation(s)
- Sara Jo Nixon
- Cognitive Studies Laboratory, Oklahoma Center for Alcohol and Drug-Related Studies, University of Oklahoma Health Sciences Center, Suite 410, 800 Northeast 15th Street, Oklahoma City, OK 73104, USA.
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Abstract
OBJECTIVE The current study was conducted as a preliminary examination of substance use and some of its correlates in nonreservation-residing American Indians. METHOD A group of 522 American-Indian (AI) subjects (473 men) were compared with two sets of geographic controls: (1) an equal number of African Americans (AA) and (2) an equal number of European Americans (EA). All received treatment in the same facilities over the same time period. RESULTS Contrary to expectations, the ethnic/racial groups were remarkably similar on a number of alcohol use variables, including the amount consumed in the 6 months prior to treatment and the number of previous treatments. Among those self-reporting as problem drinkers, there were group differences in the age of first drink (AA mean = 13.54, AI mean = 12.24 and EA mean = 11.71) and first drunk (AA mean = 15.80, AI mean = 14.23 and EA mean = 14.08) and the number of alcohol-related problems (AA mean = 7.52, AI mean = 8.49 and EA mean = 8.46). On these measures, AI and EA subjects did not differ whereas AA subjects reported a later age of onset and fewer negative consequences. EA and AI male subjects reported marijuana as their most frequently used "other" drug, whereas AA male subjects listed stimulants as their primary drugs. Regardless of ethnic/racial group, women did not differ on their drug(s) of choice, reporting stimulants as the most frequently abused drug (after accounting for alcohol use). CONCLUSIONS This preliminary study is remarkable for the observed similarities among groups. Future studies using more rigorous sampling are needed to provide clarification of this preliminary study.
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Affiliation(s)
- S J Nixon
- Oklahoma Center for Alcohol and Drug-Related Studies, University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA
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Beatty WW, Tivis R, Stott HD, Nixon SJ, Parsons OA. Neuropsychological deficits in sober alcoholics: influences of chronicity and recent alcohol consumption. Alcohol Clin Exp Res 2000; 24:149-54. [PMID: 10698365] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND The relationships between severity of neuropsychological (NP) deficits and quantity and duration of alcoholic drinking remain controversial. Eckardt et al. (1998) proposed that NP deficits can be observed only if chronicity of alcohol abuse equals or exceeds 10 years. In this study we tested the hypothesis of Eckardt et al. and reexamined the relationship of NP performance and alcohol consumption. METHODS One hundred sixty-two alcoholics and 165 controls completed a NP test battery at least 3 weeks after the alcoholics attained sobriety. Chronicity varied from 4 to 9 years for 55 alcoholics and from 10 to 33 years for the remaining 107. RESULTS Compared to controls, both groups of alcoholics were impaired on the Shipley Vocabulary and Abstraction tests and on two versions of the Digit Symbol test, but there was no difference between the two alcoholic groups on any measure. Regression analyses that controlled for age and education showed that chronicity predicted less than 0.5% of the variance on NP measures. By contrast, a measure of recent alcohol consumption, the Quantity-Frequency Index, contributed significantly (approximately 5% of the variance) to the prediction of alcoholics' NP performance. CONCLUSIONS These data provide weak support for a dose effect relationship between degree of NP impairment and level of alcoholic drinking in the past 6 months but no evidence for an influence of chronicity.
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Affiliation(s)
- W W Beatty
- Center for Alcohol and Drug-Related Studies, Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City 26901, USA.
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Beatty WW, Tivis R, Stott HD, Nixon SJ, Parsons OA. Neuropsychological Deficits in Sober Alcoholics: Influences of Chronicity and Recent Alcohol Consumption. Alcohol Clin Exp Res 2000. [DOI: 10.1111/j.1530-0277.2000.tb04584.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tivis LJ, Tivis R, Nixon SJ. Cognitive efficiency in alcoholics and polysubstance abusers: Family history revisited. Psychology of Addictive Behaviors 1999. [DOI: 10.1037/0893-164x.13.4.284] [Citation(s) in RCA: 2] [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: 11/08/2022]
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Beatty WW, Wilbanks SL, Blanco CR, Hames KA, Tivis R, Paul RH. Memory disturbance in multiple sclerosis: reconsideration of patterns of performance on the selective reminding test. J Clin Exp Neuropsychol 1996; 18:56-62. [PMID: 8926297 DOI: 10.1080/01688639608408262] [Citation(s) in RCA: 47] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Comparison of the average performance by 99 patients with multiple sclerosis (MS) and 32 healthy controls on the Selective Reminding Test (SRT) suggested that the patients' memory deficits arose primarily from difficulties in retrieving information from long-term storage. However, six different cluster analysis methods indicated three distinct patterns of SRT performance by patients, emphasizing the heterogeneity of memory function in MS. Approximately 25% of the patients performed normally while about 22% exhibited a severe amnesia-like disturbance. The remaining patients (53%) showed mild to moderate memory impairments, but only two patients met strict operational criteria for "pure retrieval failure".
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Affiliation(s)
- W W Beatty
- Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA
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Abstract
This study was conducted to examine the role of childhood behavioral disorders (CBDs) and residual attention deficit disorder (ADDRT) in alcohol-related cognitive dysfunction in male and female subjects. Alcoholic (n = 44 females, 56 males) and control (n = 40 females, 40 males) subjects completed assessments that included measures of CBDs, ADDRT, and cognitive and psychosocial functioning. Cognitive tests were specifically designed to assess efficiency in function. As expected, alcoholics were inferior to controls in their cognitive efficiency [F(1,171) = 10.43, p = 0.0015]. Alcoholics reported more CBDs [F(1,161) = 12.02, p = 0.0007], regardless of sex. They also reported more ADDRT [F(1,173) = 44.12, p = 0.0001] than did controls. There were also sex [F(1,173) = 13.31, p = 0.0004] and group by sex effects [F(1,173) = 3.93, p = 0.05]. Female alcoholics reported more ADDRT symptoms than any other group. Regression equations conducted to clarify the relation between group, sex, CBDs, ADDRT, and cognitive efficiency indicated that the best predictor of cognitive efficiency was group classification (alcoholic versus control). That is, although symptoms of behavioral disorders were reported significantly more frequently by both male and female alcoholic subjects, these symptoms could not account for the cognitive impairment observed in either sex.
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Affiliation(s)
- S J Nixon
- University of Oklahoma Health Sciences Center, Oklahoma City, USA
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Abstract
The mild generalized dysfunction hypothesis of alcohol abuse's deleterious effects on cognitive processes has gained support from a number of studies in which detoxified alcoholics have a lower mean performance level than peer controls on a variety of neuropsychological tests. This approach might obscure consistent but different patterns of preserved and impaired cognitive performance among subgroups of alcoholics, suggestive of alternative hypotheses. To test this possibility, neuropsychological test data from two large, independent samples of alcoholics (sample 1, n = 143; sample 2, n = 130) and controls (sample 1, n = 97; sample 2, n = 83) were subjected to separate centroid hierarchical cluster analyses. For both samples, the majority of alcoholics (94% and 94%) exhibited a pattern of impaired verbal and nonverbal performance and deficits in memory and perceptual motor skill, with normal motor skill. The alcoholics who did not fit this pattern showed more severe or wide-ranging impairments. These findings indicate that empirical support for the mild generalized dysfunction hypothesis of alcoholics' cognitive deficits is not an artifact of averaging.
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Affiliation(s)
- R Tivis
- Department of Psychiatry and Behavioral Sciences, Oklahoma Center for Alcohol and Drug-Related Studies, University of Oklahoma Health Sciences Center, Oklahoma City 73104, USA
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Abstract
This study compared the performance of alcoholics (18 male, 16 female) with community controls (15 male, 12 female) on the Adaptive Skills Battery (ASB), a test of interpersonal problem-solving. The ASB consists of 30 situations. Fifteen situations require subjects' typical responses and 15, their optimal responses. Male and female alcoholics were inferior to controls in their typical responses [F(1,57) = 45.22, p = 0.0001], but did not differ on the optimal responses (F less than 1). Further analyses indicated that decreased feelings of self-efficacy could not account for the alcoholic deficit. Females were superior to males in the optimal response condition [(F(1,56) = 9.90, p = 0.003]. No significant group x sex interactions were obtained. Performance on the ASB was not correlated with performance on traditional measures of problem-solving. Post-hoc correlational analyses revealed differential patterns between depression scores and performance for alcoholics and controls. These data suggest that (1) female and male alcoholics exhibit similar interpersonal problem-solving deficits, (2) alcoholic self-efficacy expectancies cannot account for the impairment, (3) the ASB appears to assess aspects of problem-solving not typically examined, and (4) the role of depression in alcoholic performance deserves continued empirical evaluation.
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Affiliation(s)
- S J Nixon
- Oklahoma Center for Alcohol and Drug Related Studies, Department of Psychiatry and Behavioral Sciences, University of Oklahoma, Oklahoma City 73104
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