Providing Underserved Patients With Medical Homes: Assessing the Readiness of Safety-Net Health Centers

Surveys safety-net health centers' potential to become patient-centered medical homes based on eight change concepts to improve care delivery, efficiency, and health outcomes. Outlines challenges, areas for improvement, and strategies for transformation

Deep Disagreement and Patience as an Argumentative Virtue

A popular approach to analyzing the concept of evidence is to identify a unique set of normative criteria that delineate the concept. However, disagreements about evidence seem deep, and using this approach raises concerns about the imposition of dominant norms. Such an imposition excludes important sources of knowledge and leads to argumentative vices such as unwillingness to engage. Virtue argumentation, like its predecessors from ethics and epistemology, focuses on practical applicability through the cultivation of habits and character rather than the articulation of universal principles or consistent theories. While Andrew Aberdein and others have been working to develop taxonomies of argumentative virtues, an important argumentative virtue that has been overlooked is the virtue of patience. Patience is a virtue necessary to continue to engage in argument rather than lose hope in the face of seemingly intractable disputes such as the nature of evidence. However, the importance of patience to argumentation and the long life of many disagreements also raises questions about the limits of argumentation in cases where patience and cooperation might be inappropriate responses—for instance, in the face of entrenched injustice

Exploring Unintended Pregnancy in the United States Military: A Phenomenological Approach

Nearly half of the 6.7 million pregnancies in the United States each year are unintended. The U.S. unintended pregnancy rate is significantly higher than the rate in many other developed countries. By age 45, more than half of all American women will have experienced an unintended pregnancy, and three in ten will have had an abortion. Previous empirical research aimed to fix the rate of unintended pregnancy before it was adequately explored. The rationale for this study emanated from the belief that interventions intended to reduce the rate of unintended pregnancy will be more successful if the essence of unintended pregnancy is better understood. The purpose of this phenomenological study was to generate skepticism about accepted meanings and interpretations concerning unintended pregnancy and to critique ideologies that distort those meanings and interpretations. The rate of unintended pregnancy for women in the U.S. military, using the most conservative measure, is 50% higher than rates of unintended pregnancy among similarly aged women in the general, non military, public. Using a critical hermeneutic philosophical approach, this study used the lived experience, as described by servicewomen who faced an unintended pregnancy, as a tool for better understanding the social, cultural, political, and historical context in which that pregnancy occurred. Findings suggest that women at risk for unintended pregnancy may not have the practical knowledge to critically think about their own sexual practices, may have a poor appreciation of their sexual selves, and may fear moral judgment for acknowledging any sexual behaviors

Eating disorder examination-questionnaire (EDE-Q): Norms for a clinical sample of males

Normative data on the Eating Disorder Examination Questionnaire (EDE-Q) for a clinical sample of males in the United States are presented. Thirty-eight males completed the EDE-Q at time of admission to an inpatient unit for eating disorders. The majority of males were diagnosed with unspecified eating disorder (73.7%, n = 28). Mean age at time of admission was 24.4 years (SD = 12.6), mean body mass index at time of admission was 21.5 kg/m2 (SD = 9.5), and mean length of stay was 13.6 days (SD = 9.3). Mean scores, standard deviations, and percentile ranks for the global and subscale scores are provided. Although the prevalence of eating disorders remains lower among males compared to females, body dissatisfaction and eating disorder psychopathology are fairly common among males

Nurses’ Resilience Levels and the Effects of Workplace Violence on Patient Care

Nurses experience high rates of violence on the job, which is a significant stressor. Stress can alter nurses\u27 care of patients, but stress can be mitigated by resilience. The purpose of this study was to examine the relationship between nurses\u27 resilience levels and their reports of patient care following episodes of workplace violence. Six themes emerged from nurses\u27 (n = 57) responses to workplace violence: vigilance, cautious yet individualized with care, part of the job, growth, jaded, and no effect. Low resilience levels were found in nurses with themes of feeling jaded, cautious yet individualized with care, and vigilance. High resilience levels were found in nurses with themes of no effect, growth, cautious yet individualized with care, and vigilance. Nurses\u27 resilience scores were related to their patient care descriptions after episodes of workplace violence. Raising nurses\u27 resilience levels through training might help them to positively overcome the effects of workplace violence, limiting impacts to patient care

Guiding Transformation: How Medical Practices Can Become Patient-Centered Medical Homes

Describes in detail eight change concepts as a guide to transforming a practice into a patient-centered medical home, including engaged leadership, quality improvement strategy, continuous and team-based healing relationships, and enhanced access

Vocational rehabilitation following traumatic brain injury: what is the evidence for clinical practice?

Traumatic brain injury (TBI) typically affects young adults with potentially many years of working life ahead of them. For people who were in work prior to their injury, return to work (RTW) is a common goal. However, a systematic review of RTW rates for people with TBI who were in work prior to their injury found that approximately 41% were in work at one and two years post TBI [1]. Since TBI is a leading cause of morbidity worldwide in young adults [2], this discrepancy between what people with TBI want and what they achieve is important. The question is does the research evidence inform clinicians how to help a person with TBI return to work

Comparison of an Endangered Species’ Seed Bank Before and After Ungulate Removal

The purpose of this study was to assess the impact of the removal of ungulates on the soil seed bank of the endemic Santa Rosa Island manzanita (Arctostaphylos confertiflora). A. confertiflora was trampled and browsed by non-native ungulates between the years 1850 and 2011 which reduced its ability to produce seeds.This species is an obligate seeder, meaning that sprouting from seeds in the soil is its only method of reproduction. Due in part to the lack of its soil seed bank, this species was federally listed as endangered by the US Fish and Wildlife Service in 1997. In order to assess the trend in its seed bank density, researchers compared its density in 2004 to its density in 2018. There are three stands of of A. confertiflora on the island, and this study collected data on the seed banks in each location. The overall methodology for surveying the seed bank was by selecting sixteen random plants in each stand and collecting 12 soil samples under the canopy of each one, which were sieved to count the number of seeds. The number of seeds was extrapolated to determine the number of seeds per square meter (seeds/m2) of soil surface sampled. The data set examined for this poster focuses on only one of the three stands; data on the other two stands have yet to be examined. This pilot data set found a 213% increase in number of seeds/m2 in the stand from 2004 to 2018, although results were not statistically significant at the 95% confidence level (Mann-Whitney U=. A Mann-Whitney U test found that the 2018 seed bank at Telephone Road did not have a significantly higher number of seeds than the 2004 seed bank (U=88.5, p=0.13). These data can be used by agency scientists to evaluate status and plan further management for A. confertiflora conservation and recovery

Practices and Attitudes of Nursing Students Toward Patients With Disordered Eating Behaviors

Disordered eating (DE) behaviors are associated with obesity and eating disorders. This study describes practices and attitudes of nursing students toward patients exhibiting DE and how personal DE behaviors affect practices and attitudes. Most respondents had a mental health rotation (74.7 percent) and DE education (68 percent); however, only 34.7 percent felt prepared to screen for DE, and only 44 percent were taught to screen. Those scoring high for DE behaviors (n = 7) indicated greater rates of feeling prepared to screen. This knowledge can help nurse educators design curricula to increase the preparation of nurses to address DE behaviors

Precision Medicine: From Science To Value.

Precision medicine is making an impact on patients, health care delivery systems, and research participants in ways that were only imagined fifteen years ago when the human genome was first sequenced. Discovery of disease-causing and drug-response genetic variants has accelerated, while adoption into clinical medicine has lagged. We define precision medicine and the stakeholder community required to enable its integration into research and health care. We explore the intersection of data science, analytics, and precision medicine in the formation of health systems that carry out research in the context of clinical care and that optimize the tools and information used to deliver improved patient outcomes. We provide examples of real-world impact and conclude with a policy and economic agenda necessary for the adoption of this new paradigm of health care both in the United States and globally