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21.
Kurt Kroenke Tasneem L. Talib Timothy E. Stump Jacob Kean David A. Haggstrom Paige DeChant Kittie R. Lake Madison Stout Patrick O. Monahan 《Journal of general internal medicine》2018,33(8):1245-1252
Background
Symptoms account for more than 400 million clinic visits annually in the USA. The SPADE symptoms (sleep, pain, anxiety, depression, and low energy/fatigue) are particularly prevalent and undertreated.Objective
To assess the effectiveness of providing PROMIS (Patient-Reported Outcome Measure Information System) symptom scores to clinicians on symptom outcomes.Design
Randomized clinical trial conducted from March 2015 through May 2016 in general internal medicine and family practice clinics in an academic healthcare system.Participants
Primary care patients who screened positive for at least one SPADE symptom.Interventions
After completing the PROMIS symptom measures electronically immediately prior to their visit, the 300 study participants were randomized to a feedback group in which their clinician received a visual display of symptom scores or a control group in which scores were not provided to clinicians.Main Measures
The primary outcome was the 3-month change in composite SPADE score. Secondary outcomes were individual symptom scores, symptom documentation in the clinic note, symptom-specific clinician actions, and patient satisfaction.Key Results
Most patients (84%) had multiple clinically significant (T-score?≥?55) SPADE symptoms. Both groups demonstrated moderate symptom improvement with a non-significant trend favoring the feedback compared to control group (between-group difference in composite T-score improvement, 1.1; P?=?0.17). Symptoms present at baseline resolved at 3-month follow-up only one third of the time, and patients frequently still desired treatment. Except for pain, clinically significant symptoms were documented less than half the time. Neither symptom documentation, symptom-specific clinician actions, nor patient satisfaction differed between treatment arms. Predictors of greater symptom improvement included female sex, black race, fewer medical conditions, and receiving care in a family medicine clinic.Conclusions
Simple feedback of symptom scores to primary care clinicians in the absence of additional systems support or incentives is not superior to usual care in improving symptom outcomes.Trial Registration
clinicaltrials.gov identifier: NCT02383862.22.
23.
24.
Jenifer Thomas John Moring Madison Nagel Mariah Lee Colter Linford Tessa Woods Sarah Clinkenbeard 《The Journal for Nurse Practitioners》2018,14(7):545-551
The purpose of this study was to explore individual experiences of participation in multiple activities recommended for type 2 diabetes risk reduction. Twelve individuals at risk for type 2 diabetes described their experiences regarding risk-reduction activities. A grounded theory method guided data collection and analysis. Data analysis revealed facilitators and inhibitors associated with participation in recommended multiple behavior change for type 2 diabetes risk reduction. Our findings emphasize social and personal factors that increase or decrease the likelihood of adherence to prevention recommendations. Findings suggest that health care providers provide structured yet individualized recommendations to support multiple behavior change efforts. 相似文献
25.
Joseph B. Miller Alexander Lee Julian P. Suszanski Madison Tustian Jessica Levely Corcoran Steven Moore Lauren Rodriguez Christopher A. Lewandowski 《The American journal of emergency medicine》2018,36(6):1018-1021
Introduction
Retrospective data indicates that dehydration in acute ischemic stroke patients may be common, even though these patients frequently have elevated blood pressure. We sought to evaluate clinical and laboratory measures of intravascular volume status compared to more objective measures using ultrasound measurements of the inferior vena cava (IVC).Methods
This was a prospective observation study of acute ischemic stroke patients in the emergency department. Patients with NIH stroke scale ≥4 within 12?h of symptom onset were included. A trained ultrasonographer performed bi-dimensional imaging of the IVC with passive respiration to determine the percent inspiratory collapse and maximum diameter. We defined low intravascular volume as >50% IVC collapse and a maximal diameter?<?2.1?cm. Analysis was limited to patients with confirmed ischemic stroke.Results
There were 42 patients, of whom 31 had confirmed acute ischemic stroke. The mean age was 65?±?15?years, 52% were female, and 71% were hypertensive. The median NIH stroke scale score was 7 (IQR 5–15). Based on IVC ultrasound, low intravascular volume was present in 63% (95% CI 44–80%) of patients. A higher proportion of hypertensive patients had low intrasvascular volume (72% vs. 33%). There was poor correlation between IVC assessment of intrasvascular volume and blinded clinician assessment or laboratory markers of dehydration.Conclusion
The majority of ED acute ischemic stroke patients in this sample were hypertensive and demonstrated low intravascular volume based on IVC ultrasound. 相似文献26.
Zuo Yu Zuo Melanie Yalavarthi Srilakshmi Gockman Kelsey Madison Jacqueline A. Shi Hui Woodard Wrenn Lezak Sean P. Lugogo Njira L. Knight Jason S. Kanthi Yogendra 《Journal of thrombosis and thrombolysis》2021,51(2):446-453
Journal of Thrombosis and Thrombolysis - Studies of patients with COVID-19 have demonstrated markedly dysregulated coagulation and a high risk of morbid arterial and venous thrombotic events.... 相似文献
27.
Michael R. Mooney John S. Douglas Jodi Fishman Mooney James D. Madison Robert O. Brandenburg Rex Fernald Robert A. Van Tassel 《Catheterization and cardiovascular interventions》1990,20(2):114-119
The MonorailTM Piccolino coronary angioplasty balloon catheter (MBC) was evaluated on 118 patients at two centers. Technical success was achieved in 110 patients (93%). Time for catheter exchange and total fluoroscopy time were significantly lower for the Monorail catheter than with standard equipment (exchange time 97 vs. 170 seconds P <.05 and fluoroscopy time 17 vs. 88 seconds P < 0.001). The advantages of rapid exchange and the ability of utilize 2 Monorail balloon catheters through one 9F guiding catheter for simultaneous inflations allowed for maximal flexibility in treating patients with bifurcation lesions. The double wire approach utilizing one Monorail balloon catheter with a 7F guiding catheter was also technically successful. The MonorailTM Piccolino balloon catheter has unique features that allow for greater ease of operator use, rapid catheter exchange, and optimal angiographic visualization. It is felt that this catheter design provides distinct advantages over standard angioplasty equipment. 相似文献
28.
Darren M. Winograd Cara L. Fresquez Madison Egli Emily K. Peterson Alyssa R. Lombardi Allison Megale Yajaira A. Cabrera Tineo Michael G. Verile Alison L. Phillips Jessica Y. Breland Susan Santos Lisa M. McAndrew 《Patient education and counseling》2021,104(8):1834-1859
ObjectiveIn response to COVID-19, we conducted a rapid review of risk communication interventions to mitigate risk from viruses to determine if such interventions are efficacious.MethodsWe searched for risk communication interventions in four databases: Medline, PsycInfo, the ProQuest Coronavirus Research Database, and CENTRAL. The search produced 1572 articles. Thirty-one articles were included in the final review.ResultsResults showed risk communication interventions can produce cognitive and behavior changes around viruses. Results were more consistently positive for interventions focused on HIV/AIDS as compared to influenza. There was no consistent best intervention approach when comparing peer health, audio/visual, and intensive multi-media interventions. Tailoring risk communication toward a target population, in comparison to not tailoring, was related to better outcomes.ConclusionThe results suggest that risk communication interventions can be efficacious at reducing risk from viruses. They also highlight the complexity of risk communication interventions. Additional research is needed to understand the mechanisms that lead risk communication to reduce risk from viruses.Practical valueResults support risk communication interventions to reduce risk from viruses. 相似文献
29.
Identical structural changes in inherited albumin variants from different populations. 总被引:2,自引:6,他引:2
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K Arai N Ishioka K Huss J Madison F W Putnam 《Proceedings of the National Academy of Sciences of the United States of America》1989,86(2):434-438
Alloalbuminemia is rare and has a cumulative frequency of only approximately 1 in 3,000 in Europeans and Japanese. The worldwide ethnic and geographic distribution of certain albumin genetic variants appears to be nonrandom. Moreover, we have found that structurally identical variants may occur at different frequencies in ethnically distinct populations, presumably owing to independent mutations. In this study, albumin B and two types of proalbumins, which as a group are the most common European albumin variants, have also been found in Asians. We have identified the amino acid substitution characteristic of albumin B (glutamic acid----lysine at position 570) in alloalbumins from six unrelated individuals of five different European descents and also in two Japanese and one Cambodian. The two types of proalbumins most common in Europe (Lille type, arginine----histidine at position -2; Christchurch type, arginine----glutamic acid at position -1) also occur in Japan. These results provide evidence for independent mutations at single sites in the albumin genome. The clustering of these and of several other amino acid exchanges in certain regions of the albumin molecule suggests two possibilities: that certain sites are hypermutable or that mutants involving certain sites are more subject to selection than mutants involving others. 相似文献