Prospective Receptivity and Acceptability of Brief Alcohol Interventions Among Women and Racial/Ethnic Minority Veterans in Primary Care

Brief alcohol interventions (BAIs) are an evidence-based practice for addressing hazardous drinking among primary care patients, yet implementation of BAIs in practice has been difficult and disparities have been identified regarding implementing BAIs with women and racial/ethnic minority patients. Further, patient engagement is a commonly identified barrier to BAI implementation. This mixed methods study aimed to assess acceptability of BAIs among women and racial/ethnic minority primary care patients and to identify factors that may impact their receptivity to engaging in a BAI. Qualitative interviews were conducted with 17 patients who had screened positive for hazardous alcohol use. Patients reported neutral to positive acceptability ratings regarding BAIs, and qualitative responses yielded 4 main themes for factors that may impact receptivity to BAIs including: (1) delivery of the BAI, (2) patient-centeredness, (3) personal relevance, and (4) relationship with the provider. Results have potential implications for implementation of BAIs in primary care settings

Anterior Vocal Fold Scar.

No abstract availabl

Digitized ASIC (Adaptation, Standardization, Integration, and Compliance) Framework: An Innovation for Optimizing Technologies and Innovations for Medical and Higher Education.

This article serves several specific purposes: Presenting transferable information on transforming innovative ideas into educational products with practical applications; showcasing a digitized version of a leading innovation aimed at optimizing technologies and innovations in medical education, health professions education, and higher education; advancing an evidence-based approach to integrating innovations into educational ecosystems and promoting education through innovations and technologies. A 10-step approach to developing the ASIC framework (ASIC stands for Adaptation, Standardization, Integration, and Compliance) is presented, with explanations and illustrations of the processes and activities involved. Empirical evidence and sound principles are provided in support of activities to assure the validity and reliability of methods or procedures. The product of this innovative process is presented and described for the benefit of educators, academic leaders, and industry stakeholders on evidence-based practical approaches to deploying technologies for educational purposes to benefit learners or teachers, and the general society. The ASIC framework\u27s four tenets, which include Adaptation, Standardization, Integration, and Compliance, are clearly defined. Evidence is presented to support ASIC tenets\u27 roles in deploying educational technologies and innovations, as well as in transformation agendas involving leading changes with innovation. Possible applications of this successful approach to educational change agenda and roles are also presented. Adequate reference is made to a need to premise interventions on relevant theories and principles including the adult learning theory, cognitive load theory, Bloom\u27s taxonomy, and connectivism. The IDEO model for leading change with innovation is also highlighted. This article could help educators, innovators, and other stakeholders by providing evidence on methodical approaches to developing and deploying useful innovations

The Management of Upper-Extremity Xylazine-Associated Wounds.

PURPOSE: Xylazine has been associated with necrotic soft tissue wounds that have placed a challenging burden on patients who inject drugs in the Philadelphia region\u27s health care system over the last few years. An analysis of our initial experience is being presented to guide future treatment and directions for future research. METHODS: A retrospective review of 55 patients with patient-reported xylazine use and associated upper-extremity wounds at a single institution was performed. Patient demographics, treatments, and outcomes are presented. RESULTS: A large percentage of patients with xylazine-associated wounds were homeless (40%), had concomitant psychiatric diagnoses (26%), and had a history of tobacco use (84%). Comorbidities included 5% who were human immunodeficiency virus-positive and 67% who were hepatitis C virus-positive. The median number of hospital admissions per patient for xylazine-associated wounds was 3, with an average of 5.9 (range: 1-44 admissions). The median length of stay per hospital admission was 3 days, with an average of 5.3 days (range: 1-75). Among all included patients, 33 of 55 patients (60%) were treated nonoperatively with local wound care. Of the 22 patients who underwent surgery, there was a surgical complication rate of 59%, primarily related to continued wound issues, infections, and graft failures. The overall rate of patients who left the hospital against medical advice (AMA) was 49%. However, the mortality rate was 0%. Most surgical patients left AMA during their postoperative period hospital stay (64%) and demonstrated continued drug use per review of their hospital records (68%). CONCLUSIONS: Patients presenting with xylazine-associated wounds have a high incidence of homelessness, psychiatric diagnoses, tobacco smoking, hepatitis C virus, and a predilection both toward leaving the hospital AMA and repeated drug use. These variables create inherent challenges to reconstructive surgery, yielding a subsequently high complication rate identified in most surgically managed patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic study IV

A. T. Still\u27s “The Rule of Fluid, Nerve, Fascia, Muscle, and Bone”–An Investigation Beyond “The Rule of the Artery”

No abstract available

Improving Patient Engagement through Whole Health: Veteran Perspectives on a Values Assessment Tool

Amidst rising rates of costly chronic diseases, a growing emphasis for integrated primary care settings is offering proactive, person-centered, and whole-person care. Through its Whole Health approach, the Veterans Health Administration (VA) is a leading force in this movement. VA’s Whole Health focuses on delivering patient-centered care that engages and empowers Veterans to improve health outcomes. The Personal Health Inventory (PHI) is a brief, whole-person focused, values assessment of what matters most that can lead to personalized health planning. Using a concurrent triangulation (convergent) mixed methods design, we examined the perspectives of 25 post-9/11 Veterans using semi-structured telephone interviews. Qualitative and quantitative questions covered independent PHI completion including acceptability, preferred methods to enhance feasibility (including feedback on a brief introductory overview), and potential impact on healthcare experience. Matrix analysis informed by rapid qualitative analysis was used to analyze responses, and quantitative data were integrated using a joint display. We found that average ratings of acceptability were high across domains for the PHI and independent PHI completion was feasible. The PHI was helpful for prompting reflection and possible action, and highly relevant to what Veterans value in healthcare. Strategies that were identified to improve feasibility and acceptability of independent PHI completion included using the introductory overview piloted with this sample and discussing a completed PHI with the healthcare team. The PHI could help support patient/provider communication and understanding, increase self-awareness and motivation, and help tailor/plan treatment options. Overall, Veterans perceive completion of the PHI as acceptable, feasible, and beneficial. Future directions for research include implementation of the PHI, evaluations of applied use for discussions of what matters most to patients as supported by various members of the integrated primary care team, and expansion to non-VA integrated primary care settings

Bundling Procedures in Critically Ill Trauma Patients: Should It Be Done?

BACKGROUND: The precautions brought on by the COVID-19 pandemic led to the growing practice of bundling lines in patients requiring intubation. Our study aims to examine the effect of immediate bundled lines (IBL) on traumatic injuries. We hypothesized that severely injured patients may benefit from IBL. METHODS: A retrospective review of all intubated trauma patients (1/2015-12/2020) at a Level I Trauma Center was conducted. Patients ≤18 years and those who died or were transferred prior to intensive care unit (ICU) admission were excluded. IBL was defined as placement of central venous catheter (CVC) and arterial line (AL) ≤4 hours after intubation. Delayed lines were any lines placed \u3e4 hours after intubation. Primary outcome was time from intubation to CVC and AL. RESULTS: 728 patients were included. The majority received CVC and/or AL with 17.7% in a delayed fashion. Severe head injury (AIS ≥3) most often had immediate AL or delayed bundled lines ( DISCUSSION: Intubated trauma patients who presented with certain mechanisms (GSW, pedestrian struck), received blood transfusions, or exhibited severe/profound ISS may be more likely to receive IBL. IBL is not superior to either immediate AL or to no lines in terms of mortality. No lines had a significant effect on ICU LOS or hospital LOS, except in the setting of severe head injury

Impact of a clinician-directed educational program on communicating with patients regarding gun violence at two community urban healthcare centers.

CONTEXT: Gun violence negatively impacts not only victims but also their families and surrounding communities. Resources and counseling services may be available to support families affected by gun violence, but the families and their clinicians may not know about these resources or how to access them. OBJECTIVES: The objective of this study was to investigate the impact of a clinician-directed educational program on patient reports of their discussions with their physician regarding gun violence, prevention, and available resources for support and treatment. METHODS: This quasi-experimental, cross-sectional, survey-based, quality-improvement study included pre-, mid-, and posttraining surveys administered to patients and clinicians participating in an educational program at two urban healthcare centers in Philadelphia. The educational program included office enhancements (handouts and posters) and lunchtime presentations for clinicians regarding gun violence prevalence, prevention strategies, local support resources, and impacts on mental health for patients and their families. The anonymous patient survey was offered to all patients seen at two urban healthcare centers in Philadelphia during three nonconsecutive weeks over 3 months. RESULTS: Among 542 patients seen over the 3 weeks of survey collection, 428 completed the survey (response rate of 79 %). Sixty-four percent acknowledged being impacted by gun violence including the death of a loved one, witnessing a shooting, or being shot themselves. Over the course of the educational program, patients reported significant increases in (1) awareness of materials related to gun violence in the waiting areas, by 17.2 %, (2) discussions of gun violence with their clinician, by 12.1 %, and (3) discussions of methods to prevent gun injury, by 9.7 %. At the end of the study, 19.3 % of patients reported having discussions with their clinician about gun violence, and 14.3 % discussed strategies to prevent gun injury. Participating clinicians reported high levels of satisfaction and increased confidence when talking to patients about gun violence at the end of the program. CONCLUSIONS: Providing clinician-directed education and printed materials increased the frequency with which clinicians discussed gun violence, prevention, and available resources with their patients. Increases were modest, with opportunities for improvement. A holistic and multifaceted approach is required to support families affected by gun violence, including education for clinicians and dissemination of information for families

Prosthetic Options for Persons with High-Level and Bilateral Amputation

[No abstract available

Exploring the prevalence of gout among underrepresented low socioeconomic status type 2 diabetes populations.

BACKGROUND: Underserved and underrepresented populations often lack access to affordable, quality healthcare, educational resources, and nutritious foods, all of which contribute to increased risk of Type 2 Diabetes and gout. Type 2 Diabetes is a condition characterized by the denaturation of the insulin receptors, due to chronically high blood glucose levels, leading to impaired regulation of blood sugar. Gout is a chronic inflammatory disease affecting joints in the lower limbs, marked by elevated serum urate levels and the accumulation of uric acid crystals in synovial fluid, causing painful flare-ups that significantly impact quality of life. METHODS: This multisite cross-sectional study was conducted in three low-income senior residential communities across the mid-Atlantic United States, including Philadelphia and Harrisburg, Pennsylvania, and Clinton, Maryland. A total of 88 consenting participants were surveyed on their health history and tested for hemoglobin A1c (HbA1c), blood glucose, and uric acid levels using finger-stick blood tests and commercially available devices. Inclusion criteria included individuals of any gender, aged 35-92, residing in these communities. Exclusion criteria were a personal history of cancer, organ transplantation, or current pregnancy. Educational materials were provided after discussing each participant\u27s results. RESULTS: There is an identifiable prevalence of gout among this population of low-income senior adults living with Type 2 Diabetes. Among the participants, 30.7% had serum urate levels indicative of hyperuricemia, exceeding the national average of 20.1% as reported by the National Health and Nutrition Examination Survey. Participants with high HbA1c had significantly higher uric acid levels compared to those with lower HbA1c levels, with diabetic levels of HbA1c accounting for approximately 40% of the variance in uric acid levels. Additionally, study participants who smoked cigarettes were more likely to have hyperuricemia than non-smokers. CONCLUSION: Preventive educational efforts focused on diet and lifestyle are critical to reducing the incidence of gout and Type 2 Diabetes in low-income elderly populations. Diabetic individuals are at a higher risk of developing hyperuricemia and gout compared to non-diabetics. Community-based educational health programs are necessary to make a measurable impact on these populations, prevent disease progression, and reduce the burden on healthcare systems