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Article ; Online: Cardiovascular Disease Incidence and Cardiovascular Health Among Diverse Women With Breast and Gynecologic Cancers.

Nolan, Timiya S / Sinnott, Jennifer A / Krok-Schoen, Jessica L / Arthur, Elizabeth K / Ridgway-Limle, Emily / Gray Ii, Darrell M / Addison, Daniel / Smith, Sakima / Williams, Karen Patricia / Hood, Darryl B / Joseph, Joshua J / Felix, Ashley

Oncology nursing forum

2024 Volume 51, Issue 2, Page(s) 113–125

Abstract: Objectives: To examine if racial differences in cardiovascular health (CVH) are associated with cardiovascular disease (CVD) disparities among women with breast and gynecologic cancers.: Sample & setting: The sample consisted of 252 Black women and ... ...

Abstract	Objectives: To examine if racial differences in cardiovascular health (CVH) are associated with cardiovascular disease (CVD) disparities among women with breast and gynecologic cancers. Sample & setting: The sample consisted of 252 Black women and 93 White women without a self-reported history of cancer or CVD who developed a breast or gynecologic malignancy. Women who developed CVD before their cancer diagnosis were excluded. Methods & variables: CVH was classified using metrics of the American Heart Association's Life's Simple 7 framework. Metrics were summed to create a total CVH score (0-7). Associations among race, ideal CVH (score of 5-7), and CVD incidence following cancer diagnosis were estimated with Cox proportional hazards models. Results: Ideal CVH was similar between Black women (33%) and White women (37%). Race and CVH were not associated with CVD incidence. Implications for nursing: In a small sample of women diagnosed with breast and gynecologic cancers, racial disparities in CVH and CVD incidence were not observed. Additional investigation of potential confounders relating to social determinants of health tied to the construct of race is warranted.
MeSH term(s)	United States/epidemiology ; Female ; Humans ; Incidence ; Cardiovascular Diseases/epidemiology ; Genital Neoplasms, Female/epidemiology ; Self Report
Language	English
Publishing date	2024-03-05
Publishing country	United States
Document type	Journal Article
ZDB-ID	604886-9
ISSN	1538-0688 ; 0190-535X ; 1538-0688
ISSN (online)	1538-0688 ; 0190-535X
ISSN	1538-0688
DOI	10.1188/24.ONF.113-125
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Article ; Online: Trends in diagnosis of painful neck and back conditions, 2002 to 2011.

Sinnott, Patricia L / Dally, Sharon K / Trafton, Jodie / Goulet, Joseph L / Wagner, Todd H

Medicine

2017 Volume 96, Issue 20, Page(s) e6691

Abstract: Neck and back pain are pervasive problems. Some have suggested that rising incidence may be associated with the evidence of rising prevalence.To describe the trends in diagnosis of painful neck and back conditions in a large national healthcare system.A ... ...

Abstract	Neck and back pain are pervasive problems. Some have suggested that rising incidence may be associated with the evidence of rising prevalence.To describe the trends in diagnosis of painful neck and back conditions in a large national healthcare system.A retrospective observational cohort study to describe the incidence and prevalence of diagnosis of neck and back pain in a national cohort.Patients were identified by International Classification of Diseases, 9 Revision (ICD-9) codes in Department of Veterans Affairs (VA) national utilization datasets in calendar years 2002 to 2011.Descriptive statistics were used to analyze the data. Prevalent cases were compared with all veterans who sought health care in each year. Incident cases were identified following a 2 years clean period in which the patient was enrolled and received care, but not services for any back or neck pain conditions.From 2004 to 2011, 3% to 4% of the population was diagnosed with incident back pain problems, the rate increasing on average, 1.75% per year. During the same period, 12.3% to 16.2% of the population was diagnosed with a prevalent back pain problem, the rate increasing on average 4.09% per year.In a national population, the prevalence rate for diagnosis of neck and back pain grew 1.8 to 2.3 times faster than the incidence rate. This suggests that the average duration of episodes of care is increasing. Additional research is needed to understand the influences on the differential rate of change and to develop efficient and effective care systems.
MeSH term(s)	Back Pain/diagnosis ; Back Pain/epidemiology ; Comorbidity ; Female ; Humans ; Incidence ; International Classification of Diseases ; Male ; Middle Aged ; Neck Pain/diagnosis ; Neck Pain/epidemiology ; Prevalence ; Retrospective Studies ; United States ; United States Department of Veterans Affairs/trends ; Veterans
Language	English
Publishing date	2017-06-27
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	80184-7
ISSN	1536-5964 ; 0025-7974
ISSN (online)	1536-5964
ISSN	0025-7974
DOI	10.1097/MD.0000000000006691
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Article ; Online: Cost-effectiveness of supported employment for veterans with spinal cord injuries.

Sinnott, Patricia L / Joyce, Vilija / Su, Pon / Ottomanelli, Lisa / Goetz, Lance L / Wagner, Todd H

Archives of physical medicine and rehabilitation

2014 Volume 95, Issue 7, Page(s) 1254–1261

Abstract: Objective: To estimate the cost-effectiveness of a supported employment (SE) intervention that had been previously found effective in veterans with spinal cord injuries (SCIs).: Design: Cost-effectiveness analysis, using cost and quality-of-life data ...

Abstract	Objective: To estimate the cost-effectiveness of a supported employment (SE) intervention that had been previously found effective in veterans with spinal cord injuries (SCIs). Design: Cost-effectiveness analysis, using cost and quality-of-life data gathered in a trial of SE for veterans with SCI. Setting: SCI centers in the Veterans Health Administration. Participants: Subjects (N=157) who completed a study of SE in 6 SCI centers. Subjects were randomly assigned to the intervention of SE (n=81) or treatment as usual (n=76). Intervention: A vocational rehabilitation program of SE for veterans with SCI. Main outcome measures: Costs and quality-adjusted life years, which were estimated from the Veterans Rand 36-Item Health Survey, extrapolated to Veterans Rand 6 Dimension utilities. Results: Average cost for the SE intervention was $1821. In 1 year of follow-up, estimated total costs, including health care utilization and travel expenses, and average quality-adjusted life years were not significantly different between groups, suggesting the Spinal Cord Injury Vocational Integration Program intervention was not cost-effective compared with usual care. Conclusions: An intensive program of SE for veterans with SCI, which is more effective in achieving competitive employment, is not cost-effective after 1 year of follow-up. Longer follow-up and a larger study sample will be necessary to determine whether SE yields benefits and is cost-effective in the long run for a population with SCI.
MeSH term(s)	Adult ; Aged ; Cost-Benefit Analysis ; Employment, Supported/economics ; Employment, Supported/methods ; Health Services/economics ; Health Services/utilization ; Hospitals, Special ; Humans ; Middle Aged ; Quality of Life ; Quality-Adjusted Life Years ; Rehabilitation, Vocational/economics ; Rehabilitation, Vocational/methods ; Spinal Cord Injuries/rehabilitation ; Travel/economics ; United States ; United States Department of Veterans Affairs ; Veterans
Language	English
Publishing date	2014-07
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	80057-0
ISSN	1532-821X ; 0003-9993
ISSN (online)	1532-821X
ISSN	0003-9993
DOI	10.1016/j.apmr.2014.01.010
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Article: Using lean management to reduce blood culture contamination.

Sinnott, Patricia L / Breckenridge, Julia S / Helgerson, Paul / Asch, Steven

Joint Commission journal on quality and patient safety

2011 Volume 41, Issue 1, Page(s) 26–22

Abstract: Background: Blood culture contamination (BCC) is a common and avoidable complication of patient care and incurs considerable cost. A quality improvement (QI) initiative was undertaken at a large Department of Veterans Affairs (VA) medical center to ... ...

Abstract	Background: Blood culture contamination (BCC) is a common and avoidable complication of patient care and incurs considerable cost. A quality improvement (QI) initiative was undertaken at a large Department of Veterans Affairs (VA) medical center to reduce the BCC rate. Methods: Lean management QI methods, including a rapid process improvement workshop (RPIW), were used to identify root causes of variation in blood culture procedures and countermeasures (potential improvement strategies) to address each problem were developed. BCC rates were collected for five and one quarter years, including the pre-RPIW (baseline) period, and changes in the contamination rates were calculated. The observed change in BCC rates was compared to a forecast of the pre-RPIW trend and estimated BCCs avoided. Results for the primary medical center were compared with those of a similarly complex VA medical center during the same time periods using difference-in-differences methodology. Results: Qualitative assessment of the processes of care identified four root cause problems, each of which was addressed with countermeasures. The BCC rate at the primary medical center decreased significantly from the baseline period in each year of follow-up, improving from 4.2% in the 19-month baseline period to 2.8% in the last 12 months of follow-up (April 2013-March 2014), while changes from baseline in the BCC rate at the comparison site were significant in only one year of follow-up. An estimated 261 BCCs were avoided at the primary medical center in the follow-up period. Conclusion: The QI initiative was successful in reducing BCC rates and in producing continued improvement for nearly four years of follow-up. Further study will determine if these results are generalizable to other settings.
Language	English
Publishing date	2011-05-24
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	1189890-2
ISSN	1938-131X ; 1549-425X ; 1553-7250 ; 1070-3241 ; 1549-3741
ISSN (online)	1938-131X ; 1549-425X
ISSN	1553-7250 ; 1070-3241 ; 1549-3741
DOI	10.1016/s1553-7250(15)41004-9
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Article: The multimorbidity collaborative medication review and decision making (MyComrade) study: a pilot cluster randomised trial in two healthcare systems.

Kirwan, Collette / Hynes, Lisa / Hart, Nigel / Mulligan, Sarah / Leathem, Claire / McQuillan, Laura / Maxwell, Marina / Carr, Emma / Roche, Kevin / Walkin, Scott / McCarthy, Caroline / Bradley, Colin / Byrne, Molly / Smith, Susan M / Hughes, Carmel / Corry, Maura / Kearney, Patricia M / McCarthy, Geraldine / Cupples, Margaret /

Gillespie, Paddy / Hobbins, Anna / Newell, John / Glynn, Liam / Roshan, Davood / Sinnott, Carol / Murphy, Andrew W

Pilot and feasibility studies

2022 Volume 8, Issue 1, Page(s) 225

Abstract: Background: While international guidelines recommend medication reviews as part of the management of multimorbidity, evidence on how to implement reviews in practice in primary care is lacking. The MyComrade (MultimorbiditY Collaborative Medication ... ...

Abstract	Background: While international guidelines recommend medication reviews as part of the management of multimorbidity, evidence on how to implement reviews in practice in primary care is lacking. The MyComrade (MultimorbiditY Collaborative Medication Review And Decision Making) intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care. Aim: The pilot study aimed to assess the feasibility of a definitive trial of the MyComrade intervention across two healthcare systems (Republic of Ireland (ROI) and Northern Ireland (NI)). Design: A pilot cluster-randomised controlled trial was conducted (clustered at general practice level), using specific progression criteria and a process evaluation framework. Setting: General practices in the ROI and NI. Participants: Eligible practices were those in defined geographical areas who had GP's and Practice Based Pharmacists (PBP's) (in NI) willing to conduct medication reviews. Eligible patients were those aged 18 years and over, with multi morbidity and on ten or more medications. Intervention: The MyComrade intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care, using a planned collaborative approach guided by an agreed checklist, within a specified timeframe. Outcome measures: Feasibility outcomes, using pre-determined progression criteria, assessed practice and patient recruitment and retention and intervention acceptability and fidelity. Anonymised patient-related quantitative data, from practice medical records and patient questionnaires were collected at baseline, 4 and 8 months, to inform potential outcome measures for a definitive trial. These included (i) practice outcomes-completion of medication reviews; (ii) patient outcomes-treatment burden and quality of life; (iii) prescribing outcomes-number and changes of prescribed medications and incidents of potentially inappropriate prescribing; and (iv) economic cost analysis. The framework Decision-making after Pilot and feasibility Trials (ADePT) in conjunction with a priori progression criteria and process evaluation was used to guide the collection and analysis of quantitative and qualitative data. Results: The recruitment of practices (n = 15) and patients (n = 121, mean age 73 years and 51% female), representing 94% and 38% of a priori targets respectively, was more complex and took longer than anticipated; impacted by the global COVID-19 pandemic. Retention rates of 100% of practices and 85% of patients were achieved. Both practice staff and patients found the intervention acceptable and reported strong fidelity to the My Comrade intervention components. Some practice staff highlighted concerns such as poor communication of the reviews to patients, dissatisfaction regarding incentivisation and in ROI the sustainability of two GPs collaboratively conducting the medication reviews. Assessing outcomes from the collected data was found feasible and appropriate for a definitive trial. Two progression criteria met the 'Go' criterion (practice and patient retention), two met the 'Amend' criterion (practice recruitment and intervention implementation) and one indicated a 'Stop - unless changes possible' (patient recruitment). Conclusion: The MyComrade intervention was found to be feasible to conduct within two different healthcare systems. Recruitment of participants requires significant time and effort given the nature of this population and the pairing of GP and pharmacist may be more sustainable to implement in routine practice. Trial registration: Registry: ISRCTN, ISRCTN80017020 date of confirmation 4/11/2019; retrospectively registered.
Language	English
Publishing date	2022-10-04
Publishing country	England
Document type	Journal Article
ZDB-ID	2809935-7
ISSN	2055-5784
ISSN	2055-5784
DOI	10.1186/s40814-022-01107-y
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Article: The MultimorbiditY COllaborative Medication Review And DEcision Making (MyComrade) study: a protocol for a cross-border pilot cluster randomised controlled trial.

Pilot and feasibility studies

2022 Volume 8, Issue 1, Page(s) 73

Abstract: Background: While international guidelines recommend medication reviews as part of the management of multimorbidity, evidence on how to implement reviews in practice in primary care is lacking. The MultimorbiditY Collaborative Medication Review And ... ...

Abstract	Background: While international guidelines recommend medication reviews as part of the management of multimorbidity, evidence on how to implement reviews in practice in primary care is lacking. The MultimorbiditY Collaborative Medication Review And Decision Making (MyComrade) intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care. Our aim in this pilot study is to evaluate the feasibility of a trial of the intervention with unique modifications accounting for contextual variations in two neighbouring health systems (Republic of Ireland (ROI) and Northern Ireland (NI)). Methods: A pilot cluster randomised controlled trial will be conducted, using a mixed-methods process evaluation to investigate the feasibility of a trial of the MyComrade intervention based on pre-defined progression criteria. A total of 16 practices will be recruited (eight in ROI; eight in NI), and four practices in each jurisdiction will be randomly allocated to intervention or control. Twenty people living with multimorbidity and prescribed ≥ 10 repeat medications will be recruited from each practice prior to practice randomisation. In intervention practices, the MyComrade intervention will be delivered by pairs of general practitioners (GPs) in ROI, and a GP and practice-based pharmacist (PBP) in NI. The GPs/GP and PBP will schedule the time to review the medications together using a checklist. Usual care will proceed in practices in the control arm. Data will be collected via electronic health records and postal questionnaires at recruitment and 4 and 8 months after randomisation. Qualitative interviews to assess the feasibility and acceptability of the intervention and explore experiences related to multimorbidity management will be conducted with a purposive sample of GPs, PBPs, practice administration staff and patients in intervention and control practices. The feasibility of conducting a health economic evaluation as part of a future definitive trial will be assessed. Discussion: The findings of this pilot study will assess the feasibility of a trial of the MyComrade intervention in two different health systems. Evaluation of the progression criteria will guide the decision to progress to a definitive trial and inform trial design. The findings will also contribute to the growing evidence-base related to intervention development and feasibility studies. Trial registration: ISRCTN Registry, ISRCTN80017020 . Date of confirmation is 4/11/2019.
Language	English
Publishing date	2022-03-28
Publishing country	England
Document type	Journal Article
ZDB-ID	2809935-7
ISSN	2055-5784
ISSN	2055-5784
DOI	10.1186/s40814-022-01018-y
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Article ; Online: Identifying neck and back pain in administrative data: defining the right cohort.

Sinnott, Patricia L / Siroka, Andrew M / Shane, Andrea C / Trafton, Jodie A / Wagner, Todd H

Spine

2011 Volume 37, Issue 10, Page(s) 860–874

Abstract: Study design: We reviewed existing methods for identifying patients with neck and back pain in administrative data. We compared these methods using data from the Department of Veterans Affairs.: Objective: To answer the following questions: (1) what ... ...

Abstract	Study design: We reviewed existing methods for identifying patients with neck and back pain in administrative data. We compared these methods using data from the Department of Veterans Affairs. Objective: To answer the following questions: (1) what diagnosis codes should be used to identify patients with neck pain and back pain in administrative data; (2) because the majority of complaints are characterized as nonspecific or mechanical, what diagnosis codes should be used to identify patients with nonspecific or mechanical problems in administrative data; and (3) what procedure and surgical codes should be used to identify patients who have undergone a surgical procedure on the neck or back. Summary of background data: Musculoskeletal neck and back pain are pervasive problems, associated with chronic pain, disability, and high rates of health care utilization. Administrative data have been widely used in formative research, which has largely relied on the original work of Volinn, Cherkin, Deyo, and Einstadter and the Back Pain Patient Outcomes Assessment Team first published in 1992. Significant variation in reports of incidence, prevalence, and morbidity associated with these problems may be due to nonstandard or conflicting methods to define study cohorts. Methods: A literature review produced 7 methods for identifying neck and back pain in administrative data. These code lists were used to search Veterans Health Administration data for patients with back and neck problems, and to further categorize each case by spinal segment involved, as nonspecific/mechanical and as surgical or not. Results: There is considerable overlap in most algorithms. However, gaps persist. Conclusion: Gaps are evident in existing methods and a new framework to identify patients with neck pain and back pain in administrative data is proposed.
MeSH term(s)	Back Pain/diagnosis ; Back Pain/epidemiology ; Clinical Coding/methods ; Clinical Coding/standards ; Cohort Studies ; Databases, Factual/standards ; Humans ; Neck Pain/diagnosis ; Neck Pain/epidemiology ; Pain Measurement/methods ; Pain Measurement/standards ; Statistics as Topic/methods ; Statistics as Topic/standards ; United States/epidemiology ; United States Department of Veterans Affairs/standards
Language	English
Publishing date	2011-11-01
Publishing country	United States
Document type	Journal Article ; Research Support, U.S. Gov't, Non-P.H.S. ; Review
ZDB-ID	752024-4
ISSN	1528-1159 ; 0362-2436
ISSN (online)	1528-1159
ISSN	0362-2436
DOI	10.1097/BRS.0b013e3182376508
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Article ; Online: Workforce Projections 2010-2020: Annual Supply and Demand Forecasting Models for Physical Therapists Across the United States.

Landry, Michel D / Hack, Laurita M / Coulson, Elizabeth / Freburger, Janet / Johnson, Michael P / Katz, Richard / Kerwin, Joanne / Smith, Megan H / Wessman, Henry C Bud / Venskus, Diana G / Sinnott, Patricia L / Goldstein, Marc

Physical therapy

2016 Volume 96, Issue 1, Page(s) 71–80

Abstract: Background: Health human resources continue to emerge as a critical health policy issue across the United States.: Objective: The purpose of this study was to develop a strategy for modeling future workforce projections to serve as a basis for ... ...

Abstract	Background: Health human resources continue to emerge as a critical health policy issue across the United States. Objective: The purpose of this study was to develop a strategy for modeling future workforce projections to serve as a basis for analyzing annual supply of and demand for physical therapists across the United States into 2020. Design: A traditional stock-and-flow methodology or model was developed and populated with publicly available data to produce estimates of supply and demand for physical therapists by 2020. Methods: Supply was determined by adding the estimated number of physical therapists and the approximation of new graduates to the number of physical therapists who immigrated, minus US graduates who never passed the licensure examination, and an estimated attrition rate in any given year. Demand was determined by using projected US population with health care insurance multiplied by a demand ratio in any given year. The difference between projected supply and demand represented a shortage or surplus of physical therapists. Results: Three separate projection models were developed based on best available data in the years 2011, 2012, and 2013, respectively. Based on these projections, demand for physical therapists in the United States outstrips supply under most assumptions. Limitations: Workforce projection methodology research is based on assumptions using imperfect data; therefore, the results must be interpreted in terms of overall trends rather than as precise actuarial data-generated absolute numbers from specified forecasting. Conclusions: Outcomes of this projection study provide a foundation for discussion and debate regarding the most effective and efficient ways to influence supply-side variables so as to position physical therapists to meet current and future population demand. Attrition rates or permanent exits out of the profession can have important supply-side effects and appear to have an effect on predicting future shortage or surplus of physical therapists.
MeSH term(s)	Forecasting ; Health Services Needs and Demand ; Humans ; Models, Theoretical ; Physical Therapists/supply & distribution ; United States
Language	English
Publishing date	2016-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	415886-6
ISSN	1538-6724 ; 0031-9023
ISSN (online)	1538-6724
ISSN	0031-9023
DOI	10.2522/ptj.20150010
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Article ; Online: Racial differences in veterans' satisfaction with examination of disability from posttraumatic stress disorder.

Rosen, Marc I / Afshartous, David R / Nwosu, Samuel / Scott, Melanie C / Jackson, James C / Marx, Brian P / Murdoch, Maureen / Sinnott, Patricia L / Speroff, Theodore

Psychiatric services (Washington, D.C.)

2013 Volume 64, Issue 4, Page(s) 354–359

Abstract: Objective: The examination that determines if a veteran has service-connected posttraumatic stress disorder (PTSD) affects veterans' lives for years. This study examined factors potentially associated with veterans' perception of their examination's ... ...

Abstract	Objective: The examination that determines if a veteran has service-connected posttraumatic stress disorder (PTSD) affects veterans' lives for years. This study examined factors potentially associated with veterans' perception of their examination's quality. Methods: Veterans (N=384) being evaluated for an initial PTSD service-connection claim were randomly assigned to receive either a semistructured interview or the examiner's usual interview. Immediately after the interview, veterans completed confidential ratings of the examinations' quality and of their examiners' interpersonal qualities and competence. Extensive data characterizing the veterans, the 33 participating examiners, and the examinations themselves were collected. Results: Forty-seven percent of Caucasian veterans and 34% of African-American veterans rated their examination quality as excellent. African Americans were less likely than Caucasians to assign a higher quality rating (odds ratio=.61, 95% confidence interval=.38-.99, p=.047). Compared with Caucasians, African Americans rated their examiners as having significantly worse interpersonal qualities but not lower competence. Ratings were not significantly related to the veterans' age, gender, marital status, eventual diagnosis of PTSD, Global Assessment of Functioning score, the examiner's perception of the prevalence of malingering, or the presence of a third party during the examination. Conclusions: Ratings of disability examinations were generally high, although ratings were less favorable among African-American veterans than among Caucasian veterans.
MeSH term(s)	Adult ; African Americans ; Disability Evaluation ; European Continental Ancestry Group ; Female ; Humans ; Interview, Psychological ; Male ; Middle Aged ; Patient Satisfaction/ethnology ; Stress Disorders, Post-Traumatic/diagnosis ; United States ; United States Department of Veterans Affairs ; Veterans/psychology ; Veterans Disability Claims ; Young Adult
Language	English
Publishing date	2013-01-15
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	1220173-x
ISSN	1557-9700 ; 1075-2730
ISSN (online)	1557-9700
ISSN	1075-2730
DOI	10.1176/appi.ps.201100526
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Article ; Online: Effectiveness of supported employment for veterans with spinal cord injuries: results from a randomized multisite study.

Ottomanelli, Lisa / Goetz, Lance L / Suris, Alina / McGeough, Charles / Sinnott, Patricia L / Toscano, Rich / Barnett, Scott D / Cipher, Daisha J / Lind, Lisa M / Dixon, Thomas M / Holmes, Sally Ann / Kerrigan, Anthony J / Thomas, Florian P

Archives of physical medicine and rehabilitation

2012 Volume 93, Issue 5, Page(s) 740–747

Abstract: Objective: To examine whether supported employment (SE) is more effective than treatment as usual (TAU) in returning veterans to competitive employment after spinal cord injury (SCI).: Design: Prospective, randomized, controlled, multisite trial of ... ...

Abstract	Objective: To examine whether supported employment (SE) is more effective than treatment as usual (TAU) in returning veterans to competitive employment after spinal cord injury (SCI). Design: Prospective, randomized, controlled, multisite trial of SE versus TAU for vocational issues with 12 months of follow-up data. Setting: SCI centers in the Veterans Health Administration. Participants: Subjects (N=201) were enrolled and completed baseline interviews. In interventional sites, subjects were randomly assigned to the SE condition (n=81) or the TAU condition (treatment as usual-interventional site [TAU-IS], n=76). In observational sites where the SE program was not available, 44 subjects were enrolled in a nonrandomized TAU condition (treatment as usual-observational site [TAU-OS]). Interventions: The intervention consisted of an SE vocational rehabilitation program called the Spinal Cord Injury Vocational Integration Program, which adhered as closely as possible to principles of SE as developed and described in the individual placement and support model of SE for persons with mental illness. Main outcome measures: The primary study outcome measurement was competitive employment in the community. Results: Subjects in the SE group were 2.5 times more likely than the TAU-IS group and 11.4 times more likely than the TAU-OS group to obtain competitive employment. Conclusions: To the best of our knowledge, this is the first and only controlled study of a specific vocational rehabilitation program to report improved employment outcomes for persons with SCI. SE, a well-prescribed method of integrated vocational care, was superior to usual practices in improving employment outcomes for veterans with SCI.
MeSH term(s)	Adult ; Employment/economics ; Employment/statistics & numerical data ; Employment, Supported ; Female ; Humans ; Male ; Middle Aged ; Salaries and Fringe Benefits/statistics & numerical data ; Spinal Cord Injuries/rehabilitation ; Time Factors ; United States ; United States Department of Veterans Affairs ; Veterans/statistics & numerical data
Language	English
Publishing date	2012-05
Publishing country	United States
Document type	Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	80057-0
ISSN	1532-821X ; 0003-9993
ISSN (online)	1532-821X
ISSN	0003-9993
DOI	10.1016/j.apmr.2012.01.002
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