Jenenne Geske

From professional silos to interprofessional education: campuswide focus on quality of care.

Objectives The Institute of Medicine called for the integration of interprofessional education (IPE) into health professions curricula, in order to improve health care quality. In response, we developed, implemented, and evaluated a campus wide IPE program, shifting from traditional educational silos to greater collaboration. Methods Students (155) and faculty (30) from 6 academic programs (nursing, medicine, public health, allied health, dentistry, and pharmacy) engaged with a university hospital partner to deliver this program. The content addressed principles of IPE, teamwork development and 2 common quality care problems: hospital-acquired infections and communication errors. Pre-/post-surveys, the Readiness for Interprofessional Learning Scale, and the Interprofessional Education Perception Scale, were used for descriptive assessment of student learning. Results Students demonstrated increased understanding of health care quality and interprofessional teamwork principles and reported positive attitudes toward shared learning. While responses to the Readiness for Interprofessional Learning Scale grew more positive after the program, scores on the Interprofessional Education Perception Scale were more homogeneous. Both students and faculty highly evaluated the experience. Conclusion This program was a first step in preparing individuals for collaborative learning, fostering awareness and enthusiasm for IPE among students and faculty, and demonstrating the feasibility of overcoming common barriers to IPE such as schedule coordination and faculty buy-in.

Wii-Fit for Improving Gait and Balance in an Assisted Living Facility: A Pilot Study

Objectives. To determine the effects on balance and gait of a Wii-Fit program compared to a walking program in subjects with mild Alzheimers dementia (AD). Methods. A prospective randomized (1 : 1) pilot study with two intervention arms was conducted in an assisted living facility with twenty-two mild AD subjects. In both groups the intervention occurred under supervision for 30 minutes daily, five times a week for eight weeks. Repeated measures ANOVA and paired t-tests were used to analyze changes. Results. Both groups showed improvement in Berg Balance Scale (BBS), Tinetti Test (TT) and Timed Up and Go (TUG) over 8 weeks. However, there was no statistically significant difference between the groups over time. Intragroup analysis in the Wii-Fit group showed significant improvement on BBS (P = 0.003), and TT (P = 0.013). The walking group showed a trend towards improvement on BBS (P = 0.06) and TUG (P = 0.07) and significant improvement in TT (P = 0.06). Conclusion. This pilot study demonstrates the safety and efficacy of Wii-Fit in an assisted living facility in subjects with mild AD. Use of Wii-Fit resulted in significant improvements in balance and gait comparable to those in the robust monitored walking program. These results need to be confirmed in a larger, methodologically sound study.

The effect of HMG-CoA reductase inhibitors on cognition in patients with Alzheimer's dementia: a prospective withdrawal and rechallenge pilot study.

BACKGROUND Statins are well-known for their cardiovascular benefits. However, the cognitive effects of statins are not well understood. We hypothesized that individuals with preexisting dementia would be more vulnerable to statin-related cognitive effects. OBJECTIVE The aim of this study was to evaluate the impact on cognition of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitor (statin) discontinuation and rechallenge in individuals with Alzheimers dementia (AD) on statins at baseline. METHODS A 12-week prospective, open-label study was conducted in a geriatric clinic setting. Eighteen older subjects underwent a 6-week withdrawal phase of statins followed by a 6-week rechallenge. The primary outcome measure was cognition, measured by the Mini-Mental State Examination (MMSE); secondary outcome measures were the Consortium to Establish a Registry for Alzheimers Disease (CERAD) neuropsychological battery, Activities of Daily Living (ADL) scale, Instrumental ADL (IADL) scale, and fasting cholesterol. The change in outcome measures was assessed using repeated-measures ANOVA and paired t tests. RESULTS At the end of the intervention, there was a significant difference across time for MMSE score (P = 0.018), and total cholesterol (P = 0.0002) and a trend toward change across time for ADL (P = 0.07) and IADL (P = 0.06) scale scores. Further analyses using paired t tests indicated improvement in MMSE scores (Δ1.9 [3.0], P = 0.014) with discontinuation of statins and a decrease in MMSE scores (Δ1.9 [2.7], P = 0.007) after rechallenge. Total cholesterol increased with statin discontinuation (P = 0.0003) and decreased with rechallenge (P = 0.0007). The CERAD score did not show a change across time (P = 0.31). There was a trend toward improvement in ADL (P = 0.07) and IADL (P = 0.06) scale scores with discontinuation of statins, but no change with rechallenge. CONCLUSIONS This pilot study found an improvement in cognition with discontinuation of statins and worsening with rechallenge. Statins may adversely affect cognition in patients with dementia.

Experience with routine vaginal pH testing in a family practice setting

BACKGROUND: Despite recommendations by Centers for Disease Control and the American College of Obstetricians and Gynecologists, pH testing is infrequently performed during the evaluation of vaginitis. Consequently, little information exists on its use in a primary care setting. OBJECTIVE: The aim of this study was to describe our experience with routine pH testing, particularly the relationship between symptoms, pH and wet-mount microscopy. METHOD: A retrospective chart review was performed on 203 consecutive cases evaluated for vaginitis by wet-mount microscopy. RESULTS: Of the 203 cases, 21 had normal pH and no symptoms and 182 had symptoms, elevated pH or both; 85% of cases had abnormal wet-mount findings, including 75% with clue cells, 14% with Trichomonas vaginalis, 13% with yeast and 14% with mixed infections. Asymptomatic infection was present in 42% of cases with clue cells alone, 44% of cases with Trichomonas vaginalis alone, 38% of all trichomoniasis cases and 33% of cases with mixed infections. Elevated pH was associated with clue cells (p < 0.001), trichomoniasis (p = 0.01) and mixed infections (p = 0.003). Normal pH was associated with negative wet mount (p < 0.001) and to a lesser degree with uncomplicated vulvovaginal candidiasis (p = 0.06). CONCLUSION: Routine pH testing increased detection of trichomoniasis and bacterial vaginosis by prompting microscopy in a significant proportion of asymptomatic cases.

Religious Coping and Mental Health Outcomes: An Exploratory Study of Socioeconomically Disadvantaged Patients

OBJECTIVE This study was designed to investigate the association between religious coping and mental health in a socioeconomically disadvantaged population. METHODS Participants were selected as they presented for mental healthcare at a community health center for patients with little, if any, financial resources or insurance. A total of 123 patients participated in this study. Multiple regression analysis was used to identify religious coping predictors for mental health outcomes. RESULTS Positive religious coping (PRC) was significantly associated with and predictive of better mental health (P < .01). Conversely, negative religious coping (NRC) was found to be significantly associated with poorer mental health scores (P = .031) with gender, income, and ethnicity controlled for in the model. The relationship between NRC and inferior mental health outcomes was more robust than the relationship between PRC and improved mental health scores. CONCLUSIONS This study illustrates the important association between PRC and NRC and mental health outcomes among economically disadvantaged patients. Interpretation of these findings and clinical implications are offered.

Predictors of Health-Related Quality of Life After Bariatric Surgery

BackgroundBariatric surgery is typically associated with improvement in health-related quality of life (HRQoL). However, recent reports are conflicting, and the aim of this study was to determine factors that would be predictive for long-term outcomes after bariatric procedures.MethodsOne thousand five hundred and seventy-three patients at one Midwestern academic medical center who underwent any type of bariatric surgery were sent the SF-36 survey. Three hundred and fifty completed surveys collected over a 3-month period were returned. Multivariate analysis was conducted.ResultsThe physical and mental component scores were significantly lower than the norm population mean. Age at time of surgery, pre-surgical body mass index (BMI) and duration since surgery were negatively related to HRQoL.ConclusionsImprovements in HRQoL following bariatric surgery do not appear to be sustained over the long term. Older patients and those with high pre-surgical obesity do not appear to have the same benefits in HRQoL over time.

Mental health problems due to community violence exposure in a small urban setting

Objective Studies conducted in large metropolitan inner-city communities with high violent crime rates have demonstrated an association between exposure to violence and mental health problems; therefore the purpose of this study was to determine if similar trends exist in smaller inner-city communities with substantially lower violent crime rates. Methods One hundred twenty-six children and young adults living in inner-city Omaha, Nebraska, were screened for posttraumatic stress disorder (PTSD), depression, and anxiety symptoms and assessed for community violence exposure (CVE). Pearson’s correlation and analysis of variance were used to determine the relationship between PTSD, depression, and anxiety symptoms and CVE. Results A statistically significant relationship was found between CVE and PTSD and anxiety symptoms among participants despite their having lower rates of exposure to violent events in comparison with other studies. No association was found between violence and depression symptoms. Additionally, the presence of anxiety and depression, as well as increased age of participants, was associated with higher rates of PTSD symptoms. Conclusion We recommend that health care providers in smaller cities, where the effects of violent crime may be underestimated or overlooked, be informed of the existence of this public health problem within their community and that they screen at-risk patients for mental health problems.

Partnering With Community-Dwelling Individuals With Diabetes for Health Behavior Change Using Action Plans: An Innovation in Health Professionals Education and Practice.

Health care practitioners support or hinder an individual’s attempts to self-manage health behavior. Practitioners must understand an individual’s health needs and goals to effectively partner for behavior change. Self-management support (SMS) promote efforts toward positive health behavior change. Practitioners need training to provide effective SMS, beginning with their formal education. The purpose of this educational practice project was to integrate an evidence-based intervention (SMS using action plans) into a nursing curriculum. Three sequential steps included (1) providing foundational SMS education, (2) SMS application with students’ personal action plans, and (3) implementing SMS with community-dwelling individuals with diabetes. Students (n = 130) partnered with participants (n = 85), developing short- (n = 240) and long-term (n = 99) action plans during home visits. The average baseline Diabetes Empowerment Scale score measuring participant’s perceived psychosocial diabetes management self-efficacy was 4.3 (1-5 scale, SD = 0.51, n = 83). Most common short-term actions related to physical activity (n = 100, 42%) and healthy eating (n = 61, 25%). Average participant confidence level was 7.7 (SD = 1.9, 0-10 scale). Short-term goal evaluation (n = 209) revealed 66% (n = 137) were met more than 50% of the time. Both participants (99%) and students (99%) expressed satisfaction with home visit and action plan experiences. This teaching–learning experience is replicable and applicable to any professional health care student.

Mind-Body Therapy: Attitudes, Beliefs and Practices of Graduate Faculty and Students from Accredited Marriage and Family Therapy Programs in the U.S. and Canada

CONTEXT Interest in CAM and mind-body therapies (MBT) among mental health professionals has increased over the last decade. Individuals seeking treatment for mental health concerns often use MBTs and expect clinicians to be aware of such treatments. Yet, current data reveal a critical gap in training, practice, and the needs of those seeking treatment. OBJECTIVE To determine the attitudes, beliefs, and practices of marriage and family therapists regarding MBTs. DESIGN Electronic survey method using Likert-type scale questions. PARTICIPANTS Clinical faculty members and graduate students (N = 140) from accredited Marriage and Family Therapy programs in the United States and Canada. RESULTS Findings revealed that a majority of respondents believed that graduate programs should introduce MBT topics during course of training and that MBTs are valuable in the treatment of various clinical problems. Respondents were familiar with at least one form of MBT and reported using such in personal and professional settings.