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Frances M Weaver - One of the best experts on this subject based on the ideXlab platform.

  • lower extremity fracture prevention and management in persons with Spinal Cord Injuries and disorders the patient perspective
    Journal of Spinal Cord Medicine, 2021
    Co-Authors: Bella Etingen, Frances M Weaver, Laura D Carbone, Marylou Guihan, Cara Ray, Hamad Aslam, Rachel Elam
    Abstract:

    To describe patient experiences with fracture prevention and management among persons with Spinal Cord Injuries/disorders (SCI/D).Qualitative data collected via semi-structured telephone interviews...

  • potential of personal health reCord portals in the care of individuals with Spinal Cord Injuries and disorders provider perspectives
    Journal of Spinal Cord Medicine, 2018
    Co-Authors: Jennifer N Hill, Bridget Smith, Frances M Weaver, Barry Goldstein, Timothy P Hogan, Kim M Nazi, Florian P Thomas
    Abstract:

    Context/Objective: Although personal health reCord (PHR) portals are designed for patients, healthcare providers are a key influence in how patients use their features and realize benefits from them. A few studies have examined provider attitudes toward PHR portals, but none have focused on those who care for individuals with Spinal Cord Injuries and disorders (SCI/D). We characterize SCI/D provider perspectives of PHR portals, including perceived advantages and disadvantages of PHR portal use in SCI/D care.Design: Cross-sectional; semi-structured interviews.Setting: Spinal Cord Injury (SCI) Centers in the Veterans Health Administration.Participants: Twenty-six SCI/D healthcare providers.Interventions: None.Outcome Measures: Perceived advantages and disadvantages of PHR portals.Results: The complex situations of individuals with SCI/D shaped provider perspectives of PHR portals and their potential role in practice. Perceived advantages of PHR portal use in SCI/D care included the ability to coordinate inf...

  • dysfunctional sleep in persons with Spinal Cord Injuries and disorders
    Spinal Cord, 2012
    Co-Authors: Sherri L Lavela, Bridget Smith, Stephen P Burns, Barry Goldstein, Scott Miskevics, Frances M Weaver
    Abstract:

    Cross-sectional survey of veterans with Spinal Cord Injuries and disorders (SCI/D). To describe sleep dysfunction (independent of sleep apnea) in persons with traumatic and non-traumatic SCI/D, and to examine characteristics and health outcomes independently associated with sleep dysfunction unrelated to sleep apnea. Seven Veterans Affairs SCI care facilities in the United States. Mailed cross-sectional survey with follow-up calls completed by end of 2008. Bivariate analyses to compare measures outcomes in persons with SCI/D who were dysfunctional sleepers vs those who were not. Multivariate logistic regression used to identify variables independently associated with dysfunctional sleep in veterans with SCI/D. Overall, 49% of the sample had sleep dysfunction unrelated to sleep apnea. In this subgroup, bivariate analyses showed that a greater proportion of dysfunctional sleepers than non-dysfunctional sleepers were current smokers, had problems with drinking alcohol, hypertension, asthma, chronic obstructive pulmonary disease (COPD) and problematic weight gain. Variables independently associated with higher odds of dysfunctional sleep included white race, being a current smoker, problems with drinking alcohol, asthma, COPD and problematic weight gain. Consistent with epidemiological evidence for the general population, we found significant associations of sleep dysfunction with weight gain, smoking, alcohol misuse and select chronic conditions (COPD, asthma). Sustained sleep dysfunction may contribute to health deterioration and mortality, highlighting the need to address the high prevalence of sleep dysfunction (independent of sleep apnea) in persons with SCI/D. In particular, efforts aimed at modifying problematic weight gain, alcohol misuse and smoking are warranted in this cohort to improve sleep.

  • smoking behavior and delivery of evidence based care for veterans with Spinal Cord Injuries and disorders
    Journal of Spinal Cord Medicine, 2011
    Co-Authors: Frances M Weaver, Bridget Smith, Charlesnika T Evans, Sherri L Lavela, Barry Goldstein, Scott Miskevics, Philip M Ullrich, Jonathan Strayer, Stephen P Burns
    Abstract:

    AbstractObjective: Little is known about those veterans with Spinal Cord Injuries and disorders (SCI/D) who smoke cigarettes. This study identified the factors associated with smoking in this population, motivations for smoking, and the readiness for smoking cessation. Current practices for the delivery of evidence-based tobacco cessation were also examined.Design: Methods included surveys of veterans with SCI/D, medical reCord reviews of current smokers, and telephone interviews with SCI/D providers.Setting: Six Veterans Health Administration facilities with SCI centers and one SCI clinic.Participants: Survey data were analyzed for 1210 veterans, 256 medical reCords were reviewed, and 15 providers served as key informants.Interventions: Observational study.Outcome measures: Veterans self-reported smoking status, quit attempts, methods and care received, motivation for smoking, and health care conditions. Medical reCord review and informant interviews examined the tobacco cessation care provided.Results: ...

  • association between obesity and diabetes mellitus in veterans with Spinal Cord Injuries and disorders
    American Journal of Physical Medicine & Rehabilitation, 2010
    Co-Authors: Suparna Rajan, Marguerite J Mcneely, Margaret C Hammond, Barry Goldstein, Frances M Weaver
    Abstract:

    Objectives: To examine the association between body mass index (BMI) and clinically diagnosed diabetes in veterans with Spinal Cord Injuries and disorders. We also sought to determine whether there is evidence to support a 10% reduction in BMI cut points, which would lower the upper limit of normal BMI from 24.99 to 22.49 kg/m 2 , for persons with Spinal Cord Injuries and disorders. Design: Cross-sectional analysis using clinical data on 1938 male veterans. Prevalence ratios (95% confidence intervals) were calculated using a generalized linear model and adjusted for age, race, tobacco use, and paraplegia/tetraplegia status. Results: Compared with the National Heart Lung Blood Institute normal BMI category (18.5―24.99 kg/m 2 ), the prevalence of diabetes was 50% higher (adjusted prevalence ratio: 1.50, 95% CI: 1.11―2.01) in the overweight category (25--29.99 kg/m 2 ) and ∼3-fold higher (for obese classes 1—3, adjusted prevalence ratio: 2.74—3.03) in the obese category (BMI ≥ 30 kg/m 2 ). Compared with the World Health Organization low-normal category (BMI, 18.5―22.99 kg/m 2 ), there was no significant difference in the prevalence of diabetes for those in the high normal weight (BMI, 23―24.99 kg/m 2 ) or low overweight (BMI, 25― 27.49 kg/m 2 ) categories. However, the prevalence of diabetes was 2-fold higher among those in the high overweight category (BMI, 27.5— 29.99 kg/m 2 ; adjusted prevalence ratio: 2.00, 95% CI: 1.33―2.99). Conclusions: BMI ≥25 kg/m 2 was associated with significantly higher diabetes prevalence in male veterans with Spinal Cord Injuries and disorders, and this risk was especially pronounced at BMI ≥27.5 kg/m 2 . These findings do not support the need to create Spinal Cord Injuries and disorder―specific BMI definitions of overweight for purposes of determining diabetes risk.

Stephen P Burns - One of the best experts on this subject based on the ideXlab platform.

  • multidrug resistant acinetobacter risk factors and outcomes in veterans with Spinal Cord Injuries and disorders
    American Journal of Infection Control, 2017
    Co-Authors: Swetha Ramanathan, Stephen P Burns, Sherri L Lavela, Katie J Suda, Margaret A Fitzpatrick, Linda Poggensee
    Abstract:

    Background Multidrug-resistant (MDR) Acinetobacter is a growing concern and has been identified as a serious threat by the Centers for Disease Control and Prevention. However, there is little information on MDR Acinetobacter in individuals with Spinal Cord Injuries and disorders (SCI/Ds). Therefore, the objective of this study was to identify risk factors for, and assess outcomes of, MDR Acinetobacter in veterans with SCI/Ds. Methods This was a retrospective cohort study from January 1, 2012-December 31, 2013, using national Veterans Affairs medical encounter and microbiology data. Results A total of 773 Acinetobacter cultures were identified in 571 patients, of which 58.9% were MDR. Inpatient culture, sputum and other specimen type, receipt of antibiotics within 90 days before culture date, and pressure ulcers were identified as independent predictors of MDR Acinetobacter. Highest odds of MDR Acinetobacter were seen with previous antibiotic use (odds ratio, 7.27; 95% confidence interval, 2.59-20.54). Thirty-day mortality was 5.3% in this study. Multidrug resistance, previous mechanical ventilation 90 days before the culture, and cancer were all independent risk factors for 30-day mortality. Conclusions There should be increased efforts to highlight the importance of antimicrobial stewardship to improve infection control to help limit spread of Acinetobacter in health care settings.

  • a retrospective review of safety using a nursing driven protocol for autonomic dysreflexia in patients with Spinal Cord Injuries
    Journal of Spinal Cord Medicine, 2016
    Co-Authors: Ryan Solinsky, Stephen P Burns, Jelena N Svircev, Jennifer James, Aaron E Bunnell
    Abstract:

    Objective/Background: Autonomic dysreflexia is a potentially life-threatening condition which afflicts a significant proportion of individuals with Spinal Cord Injuries (SCI). To date, the safety and efficacy of several commonly used interventions for this condition have not been studied.Design: A retrospective chart review of the safety of a previously implemented nursing driven inpatient autonomic dysreflexia protocol.Methods: Seventy-eight male patients with SCI who experienced autonomic dysreflexia while inpatient at our Veterans Affairs SCI unit over a 3–1/2-year period were included. The safety of a nursing driven protocol utilizing conservative measures, nitroglycerin paste, and oral hydralazine was evaluated.Outcome Measures: Occurrence of adverse events and relative hypotensive events during all episodes treated with the protocol, and efficacy of attaining target blood pressure for all episodes with protocol adherence and for initial episode experienced by each patient.Results: Four hundred forty...

  • dysfunctional sleep in persons with Spinal Cord Injuries and disorders
    Spinal Cord, 2012
    Co-Authors: Sherri L Lavela, Bridget Smith, Stephen P Burns, Barry Goldstein, Scott Miskevics, Frances M Weaver
    Abstract:

    Cross-sectional survey of veterans with Spinal Cord Injuries and disorders (SCI/D). To describe sleep dysfunction (independent of sleep apnea) in persons with traumatic and non-traumatic SCI/D, and to examine characteristics and health outcomes independently associated with sleep dysfunction unrelated to sleep apnea. Seven Veterans Affairs SCI care facilities in the United States. Mailed cross-sectional survey with follow-up calls completed by end of 2008. Bivariate analyses to compare measures outcomes in persons with SCI/D who were dysfunctional sleepers vs those who were not. Multivariate logistic regression used to identify variables independently associated with dysfunctional sleep in veterans with SCI/D. Overall, 49% of the sample had sleep dysfunction unrelated to sleep apnea. In this subgroup, bivariate analyses showed that a greater proportion of dysfunctional sleepers than non-dysfunctional sleepers were current smokers, had problems with drinking alcohol, hypertension, asthma, chronic obstructive pulmonary disease (COPD) and problematic weight gain. Variables independently associated with higher odds of dysfunctional sleep included white race, being a current smoker, problems with drinking alcohol, asthma, COPD and problematic weight gain. Consistent with epidemiological evidence for the general population, we found significant associations of sleep dysfunction with weight gain, smoking, alcohol misuse and select chronic conditions (COPD, asthma). Sustained sleep dysfunction may contribute to health deterioration and mortality, highlighting the need to address the high prevalence of sleep dysfunction (independent of sleep apnea) in persons with SCI/D. In particular, efforts aimed at modifying problematic weight gain, alcohol misuse and smoking are warranted in this cohort to improve sleep.

  • smoking behavior and delivery of evidence based care for veterans with Spinal Cord Injuries and disorders
    Journal of Spinal Cord Medicine, 2011
    Co-Authors: Frances M Weaver, Bridget Smith, Charlesnika T Evans, Sherri L Lavela, Barry Goldstein, Scott Miskevics, Philip M Ullrich, Jonathan Strayer, Stephen P Burns
    Abstract:

    AbstractObjective: Little is known about those veterans with Spinal Cord Injuries and disorders (SCI/D) who smoke cigarettes. This study identified the factors associated with smoking in this population, motivations for smoking, and the readiness for smoking cessation. Current practices for the delivery of evidence-based tobacco cessation were also examined.Design: Methods included surveys of veterans with SCI/D, medical reCord reviews of current smokers, and telephone interviews with SCI/D providers.Setting: Six Veterans Health Administration facilities with SCI centers and one SCI clinic.Participants: Survey data were analyzed for 1210 veterans, 256 medical reCords were reviewed, and 15 providers served as key informants.Interventions: Observational study.Outcome measures: Veterans self-reported smoking status, quit attempts, methods and care received, motivation for smoking, and health care conditions. Medical reCord review and informant interviews examined the tobacco cessation care provided.Results: ...

  • using va data for research in persons with Spinal Cord Injuries and disorders lessons from sci queri
    Journal of Rehabilitation Research and Development, 2010
    Co-Authors: Bridget Smith, Charlesnika T Evans, Frances M Weaver, Stephen P Burns, Sherri L Lavela, Suparna Rajan, Marylou Guihan, Scott Miskevics, Philip M Ullrich
    Abstract:

    The Department of Veterans Affairs (VA) provides integrated services to more than 25,000 veterans with Spinal Cord Injuries and disorders (SCI/D). VA data offer great potential for providing insights into healthcare utilization and morbidity, and these capabilities are central to efforts to improve healthcare for veterans with SCI/D. The objective of this article is to introduce researchers to the use of VA data to examine questions related to SCI/D using examples from Spinal Cord Injury (SCI) Quality Enhancement Research Initiative studies. Sources of VA data available to investigators interested in SCI/D-related research include national-level VA administrative and clinical databases and primary data (medical reCord review, patient surveys). Methods used to identify veterans with SCI/D include the Allocation Resource Center cohort, the Spinal Cord Dysfunction (SCD) Registry, and the VA inpatient SCI flag; only 33% of veterans were included in all three groups (n = 12,306). While neurological level of SCI was unknown for approximately a third of veterans (from SCD Registry data alone), the percent decreased to 13% when augmented with diagnostic codes. Primary data can be used to augment other missing SCI data and to provide more detailed information about complications commonly associated with SCI/D. Language: en

Sherri L Lavela - One of the best experts on this subject based on the ideXlab platform.

  • the relationship between pain interference and psychosocial well being among veterans with Spinal Cord Injuries disorders
    Journal of Neuroscience Nursing, 2017
    Co-Authors: Bella Etingen, Scott Miskevics, Sherri L Lavela
    Abstract:

    OBJECTIVES The study objectives were to compare psychosocial well-being in individuals with Spinal Cord Injuries/disorders (SCI/D) and above-mean ("high") versus below-mean ("low") pain interference, and to determine whether psychosocial well-being was negatively associated with pain interference. METHODS Data were collected via a cross-sectional survey mailed in late 2014 to early 2015 to a national sample of veterans with SCI/D who received prior-year Veterans Affairs healthcare and assessed demographics, injury-related factors, select health conditions, pain interference, and psychosocial well-being. Bivariate comparisons and multivariate linear regressions identified factors related to higher pain interference. RESULTS Approximately 79% of the sample (n = 813) reported high pain interference. Veterans with high (vs. low) pain interference reported worse perceptions of all included psychosocial well-being measures. Regression results indicated that higher pain interference was associated with higher grief/loss (β = 0.38, P < .0001) and negative psychosocial illness impact (β = 0.39, P < .0001), and lower positive affect (β = -0.39, P < .0001), resilience (β = -0.31, P < .0001), and life satisfaction (β = -0.39, P < .0001). CONCLUSIONS The pain experience is independently associated with poor psychosocial well-being among individuals with SCI/D. Efforts to decrease perceptions of pain interference and improve factors associated with psychosocial well-being may symbiotically improve outcomes in SCI/D cohorts. Such efforts may focus on effective pain management programs aligned with patients' treatment preferences.

  • multidrug resistant acinetobacter risk factors and outcomes in veterans with Spinal Cord Injuries and disorders
    American Journal of Infection Control, 2017
    Co-Authors: Swetha Ramanathan, Stephen P Burns, Sherri L Lavela, Katie J Suda, Margaret A Fitzpatrick, Linda Poggensee
    Abstract:

    Background Multidrug-resistant (MDR) Acinetobacter is a growing concern and has been identified as a serious threat by the Centers for Disease Control and Prevention. However, there is little information on MDR Acinetobacter in individuals with Spinal Cord Injuries and disorders (SCI/Ds). Therefore, the objective of this study was to identify risk factors for, and assess outcomes of, MDR Acinetobacter in veterans with SCI/Ds. Methods This was a retrospective cohort study from January 1, 2012-December 31, 2013, using national Veterans Affairs medical encounter and microbiology data. Results A total of 773 Acinetobacter cultures were identified in 571 patients, of which 58.9% were MDR. Inpatient culture, sputum and other specimen type, receipt of antibiotics within 90 days before culture date, and pressure ulcers were identified as independent predictors of MDR Acinetobacter. Highest odds of MDR Acinetobacter were seen with previous antibiotic use (odds ratio, 7.27; 95% confidence interval, 2.59-20.54). Thirty-day mortality was 5.3% in this study. Multidrug resistance, previous mechanical ventilation 90 days before the culture, and cancer were all independent risk factors for 30-day mortality. Conclusions There should be increased efforts to highlight the importance of antimicrobial stewardship to improve infection control to help limit spread of Acinetobacter in health care settings.

  • effect of the environment on participation in Spinal Cord Injuries disorders the mediating impact of resilience grief and self efficacy
    Rehabilitation Psychology, 2017
    Co-Authors: Sara M Locatelli, Scott Miskevics, Bella Etingen, Sherri L Lavela
    Abstract:

    OBJECTIVE The objective of the study was to test the hypothesis that the influence of environmental barriers on participation will be fully mediated by psychosocial factors (resilience, grief or loss, and self-efficacy) among individuals with Spinal Cord Injuries and disorders. METHOD This was a cross-sectional mailed survey with a national sample of veterans with Spinal Cord Injuries and disorders (n = 565), which included measures of demographics, perceived environmental barriers, participation, resilience, grief or loss, and self-efficacy. Data were analyzed using a latent variable path analysis; the model fit was assessed using χ2, normed χ2, root mean square error of approximation (RMSEA; <0.07), Comparative Fit Index (CFI; ≥0.95), and Tucker-Lewis Index (TLI; ≥0.95). RESULTS Participants were mostly male (93.9%), Caucasian or White (74.2%), and, on average, 62.4 years of age (SD = 10.48). Almost 62% had paraplegia, and 38.3% had a motor or sensory complete injury. The hypothesized model showed excellent fit, χ2(42) = 153.40, normed χ2 = 3.65, RMSEA = 0.07, CFI = 0.96, TLI = 0.95. To assess for full mediation, a direct path was added from environment to participation. This model showed nearly identical fit, χ2(41) = 153.39, normed χ2 = 3.74, RMSEA = 0.07, CFI = 0.96, TLI = 0.95; the path from environment to participation was not significant, unstandardized coefficient = -0.04, p = .92. Examination of indirect effects of the hypothesized model demonstrated that environment significantly influences participation through psychosocial factors, unstandardized coefficient = -4.85, p < .001. Together these results support full mediation. CONCLUSIONS In conclusion the present study expands upon past research by suggesting that perceived environmental barriers play a role in internal factors, such as resilience and self-efficacy, which in turn influence participation. Interventions to improve environmental barriers may be warranted, but attention must also be paid to resilience, grief or loss, and self-efficacy to increase participation. (PsycINFO Database ReCord

  • perceptions of shared decision making among patients with Spinal Cord Injuries disorders
    Topics in Spinal Cord Injury Rehabilitation, 2016
    Co-Authors: Sara M Locatelli, Bella Etingen, Allen W Heinemann, Holly Demark Neumann, Ana Miskovic, David Chen, Sherri L Lavela
    Abstract:

    Background: Individuals with Spinal Cord Injuries/disorders (SCI/D) are interested in, and benefit from, shared decision making (SDM). Objective: To explore SDM among individuals with SCI/D and how demographics and health and SCI/D characteristics are related to SDM. Method: Individuals with SCI/D who were at least 1 year post injury, resided in the Chicago metropolitan area, and received SCI care at a Veterans Affairs (VA; n = 124) or an SCI Model Systems facility (n = 326) completed a mailed survey measuring demographics, health and SCI/D characteristics, physical and mental health status, and perceptions of care, including SDM, using the Combined Outcome Measure for Risk Communication and Treatment Decision-Making Effectiveness (COMRADE) that assesses decision-making effectiveness (effectiveness) and risk communication (communication). Bivariate analyses and multiple linear regression were used to identify variables associated with SDM. Results: Participants were mostly male (83%) and White (70%) and w...

  • documentation of weight management practices for individuals with Spinal Cord Injuries and disorders
    Spinal Cord, 2016
    Co-Authors: Sara M Locatelli, Sherri L Lavela
    Abstract:

    This cross-sectional chart review study included 100 US Veterans with Spinal Cord Injuries/disorders (SCI/D) who received care at a Veterans Affairs (VA) SCI facility during a 12-month period. Progress notes were examined to extract need for weight management (WM), patient–provider discussions about risk due to overweight/obesity, recommended lifestyle changes and/or follow-up and WM education. To understand what WM services are offered to Veterans with SCI/D within the VA SCI System of Care during comprehensive preventive health evaluations (annual evaluations), inpatient stays and outpatient visits. VA SCI System of Care, Department of Veterans Affairs, United States. Overall, 73% demonstrated a need for WM. Weight was most frequently addressed during the nutrition assessment of annual evaluations, but this assessment was most likely to be skipped. Nutrition histories were missing many key components. Over half received WM education; individuals who were described as overweight/obese by their provider were more likely to receive education. Most of the Veterans who were seen in an inpatient setting were weighed; weight was only discussed with 12%. Less than half of the Veterans with outpatient visits were weighed, and 23% received WM recommendations. Weight was frequently discussed during nutrition assessments, but infrequently addressed during outpatient or inpatient encounters. Few Veterans received specific recommendations on caloric/nutrient requirements and nutrition histories were missing recommended elements. Additional work is needed to help providers to incorporate WM information into care.

Dingjun Hao - One of the best experts on this subject based on the ideXlab platform.

  • 15 surgical treatment of lower cervical fracture dislocation with Spinal Cord Injuries using the anterior approach a 10 year case review with minimum five year follow up
    The Spine Journal, 2019
    Co-Authors: Biao Wang, Dingjun Hao
    Abstract:

    BACKGROUND CONTEXT Lower cervical fracture-dislocations are often caused by flexion-stretch Injuries and frequently combine with Spinal Cord Injuries which can cause serious damage. To date, there is no clear consensus on the best treatment option for lower cervical fracture-dislocation. In recent years, anterior approach surgery with direct decompression and reduction has been widely accepted. However, a long-term follow-up study with a large sample size to assess the clinical efficacy of the anterior approach is rarely seen in the literature. PURPOSE Through this retrospective cohort study, we assessed the clinical outcomes of anterior approach surgery. STUDY DESIGN/SETTING A retrospective cohort study. PATIENT SAMPLE A total of 218 cases. OUTCOME MEASURES Odom's criteria, the Cobb angle of kyphosis, the Neck Disability Index (NDI) and the Japanese Orthopedic Association (JOA) scoring system. METHODS From January 2001 to January 2011, 312 patients with lower cervical spine fracture-dislocation with Spinal Cord Injuries who were treated by the anterior approach were retrospectively analyzed. A total of 218 cases (70%) were deemed to have integrity of data and were obtained for follow-up. The average age of the 218 patients was 42.6 years (range: 21-72), and the cases included 121 males and 97 females. All patients underwent decompression, reduction, bone grafting and arthrodesis by anterior means. The clinical efficacy was evaluated using Odom's criteria and statistical analysis based on the Cobb angle of kyphosis, the Neck Disability Index (NDI) and the Japanese Orthopedic Association (JOA) scoring system. The neurofunctional recovery of each patient was assessed by the American Spinal Injury Association (ASIA) system. RESULTS Follow-up for patients was for 8.9±2.9 years on average, with a range from 5 to 15 years. No loss of cervical reduction and lordosis curvature, and no plate- or screw-associated complications were observed during the follow-up. The kyphosis angle and NDI and JOA scores were significantly changed from preoperative values of 10.6±8.9°, 39.7±4.3 and 7.6±2.4 to last follow-up values of -5.2±8.6°, 10.8±4.6 and 15.6±1.2, respectively (p CONCLUSIONS For lower cervical fracture-dislocation with Spinal Cord Injuries, satisfactory clinical outcomes can be obtained by choosing the anterior surgical approach. By restoring the normal structure of the cervical spine and promoting functional recovery, the anterior approach achieved a good long-term curative effect. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

  • surgical treatment of lower cervical fracture dislocation with Spinal Cord Injuries by anterior approach 5 to 15 year follow up
    World Neurosurgery, 2018
    Co-Authors: Wenjie Gao, Biao Wang, Dingjun Hao, Ziqi Zhu, Hua Guo, Lingbo Kong
    Abstract:

    Background Lower cervical fracture-dislocations frequently occur with Spinal Cord Injuries. There is no clear consensus on best treatment option. Anterior approach surgery with direct decompression and reduction has become widely accepted. We assessed clinical outcomes of anterior approach surgery in a retrospective cohort study. Methods From January 2001 to January 2011, 312 patients with lower cervical spine fracture-dislocation with Spinal Cord Injuries who were treated by the anterior approach were retrospectively analyzed. Of 312 patients, 218 (70%; 121 men and 97 women) met inclusion criteria. Clinical efficacy was evaluated using Odom's criteria and statistical analysis based on Cobb angle of kyphosis and Neck Disability Index and Japanese Orthopedic Association scores. Neurofunctional recovery of patients was assessed by the American Spinal Injury Association system. Results Average follow-up was 8.9 ± 2.9 years (range, 5–15 years). Kyphosis angle and Neck Disability Index and Japanese Orthopaedic Association scores were significantly changed from preoperative values of 10.6° ± 8.9° and 39.7 ± 4.3 and 7.6 ± 2.4 to last follow-up values of −5.2° ± 8.6° and 10.8 ± 4.6 and 15.6 ± 1.2 (P Conclusions For lower cervical fracture-dislocation with Spinal Cord Injuries, satisfactory clinical outcomes can be obtained with an anterior approach. The anterior approach restored normal cervical spine structure and promoted functional recovery to achieve a good long-term curative effect.

Bridget Smith - One of the best experts on this subject based on the ideXlab platform.

  • characterization of telehealth use in veterans with Spinal Cord Injuries and disorders
    Pm&r, 2021
    Co-Authors: Bella Etingen, Rachael N Martinez, Timothy P Hogan, Maya N Hatch, Bridget A Cotner, Itala Manosha Wickremasinghe, Jennifer L Sippel, Bridget Smith
    Abstract:

    BACKGROUND Individuals with Spinal Cord Injuries and disorders (SCI/D) require frequent interdisciplinary health care to address impairments in mobility, autonomic function, and secondary complications. Telehealth has the capacity to substantially transform health care delivery and improve care by increasing access and communication. However, relatively little is known about telehealth use in this specific population. Here we attempt to fill part of this gap. OBJECTIVE To investigate the frequency and characteristics associated with telehealth use in Veterans with SCI/D. DESIGN Cross-sectional, descriptive project. SETTING Veterans Health Administration (VHA) facilities. PARTICIPANTS A total of 15 028 Veterans living with SCI/D who received services from the VHA SCI/D System of Care. INTERVENTION Not applicable. OUTCOME MEASURES Frequency and characteristics associated with VHA telehealth utilization. RESULTS Of the 15 028 Veterans with SCI/D included in the evaluation, 17% used some form of telehealth in VHA Fiscal Year (FY)2017. Veterans older than 65 years of age had lower odds (odds ratio [OR] = 0.88, P < .05, confidence interval [CI] 0.80-0.98) of using telehealth. Being Caucasian (OR = 1.29, P < .01, CI 1.09-1.52), living in rural areas (OR = 1.16, P < .01, CI 1.05-1.28), living greater distances away from the VHA (P < .01 for all distances), and being in priority group 8, meaning that Veterans have higher copayment requirements (OR = 1.46, P < .001, CI 1.19-1.81), were all significantly associated with greater odds of telehealth use. The most frequent types of telehealth used were real-time clinical video and store-and-forward between a provider and patient within the same hub network. CONCLUSION There are opportunities to increase telehealth adoption in the SCI/D arena. The findings from this project highlight which Veterans are currently using telehealth services, as well as gaps regarding telehealth adoption in this population.

  • effect of the affordable care act on healthcare utilization for veterans with Spinal Cord Injuries and disorders
    Journal of Spinal Cord Medicine, 2020
    Co-Authors: Rachael N Martinez, Bridget Smith, Dustin D French, Timothy P Hogan, Beverly Gonzalez, Chad Osteen, Maya N Hatch
    Abstract:

    Context/Objective: Provisions of the Affordable Care Act (ACA) potentially increase insurance options for Veterans with disabilities. We examined Veterans with Spinal Cord Injuries and disorders (S...

  • potential of personal health reCord portals in the care of individuals with Spinal Cord Injuries and disorders provider perspectives
    Journal of Spinal Cord Medicine, 2018
    Co-Authors: Jennifer N Hill, Bridget Smith, Frances M Weaver, Barry Goldstein, Timothy P Hogan, Kim M Nazi, Florian P Thomas
    Abstract:

    Context/Objective: Although personal health reCord (PHR) portals are designed for patients, healthcare providers are a key influence in how patients use their features and realize benefits from them. A few studies have examined provider attitudes toward PHR portals, but none have focused on those who care for individuals with Spinal Cord Injuries and disorders (SCI/D). We characterize SCI/D provider perspectives of PHR portals, including perceived advantages and disadvantages of PHR portal use in SCI/D care.Design: Cross-sectional; semi-structured interviews.Setting: Spinal Cord Injury (SCI) Centers in the Veterans Health Administration.Participants: Twenty-six SCI/D healthcare providers.Interventions: None.Outcome Measures: Perceived advantages and disadvantages of PHR portals.Results: The complex situations of individuals with SCI/D shaped provider perspectives of PHR portals and their potential role in practice. Perceived advantages of PHR portal use in SCI/D care included the ability to coordinate inf...

  • sociotechnical perspective on implementing clinical video telehealth for veterans with Spinal Cord Injuries and disorders
    Telemedicine Journal and E-health, 2017
    Co-Authors: Rachael N Martinez, Barry Goldstein, Timothy P Hogan, Salva Balbale, Keshonna Lones, Christine Woo, Bridget Smith
    Abstract:

    Abstract Background: Real-time videoconferencing technology such as clinical video telehealth (CVT) offers a means to reach patient populations who face limited access to healthcare. The Veterans Health Administration has invested in CVT to improve care access for U.S. military veterans with Spinal Cord Injuries and disorders (SCI/D); however, no studies have assessed the factors that influence implementation of this technology in clinical practice for individuals with SCI/D. Introduction: Guided by a sociotechnical perspective, the purpose of this study was to identify factors that influence implementation of CVT for veterans with SCI/D. Materials and Methods: We conducted semistructured telephone interviews with 40 healthcare providers who use CVT to deliver services to veterans with SCI/D. Results: Factors related to workflow and communication were widely reported as implementation barriers. Coordinating logistics for CVT appointments was challenging, and effective communication between CVT team member...

  • dysfunctional sleep in persons with Spinal Cord Injuries and disorders
    Spinal Cord, 2012
    Co-Authors: Sherri L Lavela, Bridget Smith, Stephen P Burns, Barry Goldstein, Scott Miskevics, Frances M Weaver
    Abstract:

    Cross-sectional survey of veterans with Spinal Cord Injuries and disorders (SCI/D). To describe sleep dysfunction (independent of sleep apnea) in persons with traumatic and non-traumatic SCI/D, and to examine characteristics and health outcomes independently associated with sleep dysfunction unrelated to sleep apnea. Seven Veterans Affairs SCI care facilities in the United States. Mailed cross-sectional survey with follow-up calls completed by end of 2008. Bivariate analyses to compare measures outcomes in persons with SCI/D who were dysfunctional sleepers vs those who were not. Multivariate logistic regression used to identify variables independently associated with dysfunctional sleep in veterans with SCI/D. Overall, 49% of the sample had sleep dysfunction unrelated to sleep apnea. In this subgroup, bivariate analyses showed that a greater proportion of dysfunctional sleepers than non-dysfunctional sleepers were current smokers, had problems with drinking alcohol, hypertension, asthma, chronic obstructive pulmonary disease (COPD) and problematic weight gain. Variables independently associated with higher odds of dysfunctional sleep included white race, being a current smoker, problems with drinking alcohol, asthma, COPD and problematic weight gain. Consistent with epidemiological evidence for the general population, we found significant associations of sleep dysfunction with weight gain, smoking, alcohol misuse and select chronic conditions (COPD, asthma). Sustained sleep dysfunction may contribute to health deterioration and mortality, highlighting the need to address the high prevalence of sleep dysfunction (independent of sleep apnea) in persons with SCI/D. In particular, efforts aimed at modifying problematic weight gain, alcohol misuse and smoking are warranted in this cohort to improve sleep.