Impact of interprofessional geriatric teamwork on students' perceptions of older persons and collaborative practice.

Health professions programs lack sufficient exposure to geriatric education in curricula. The Seniors Assisting in Geriatric Education (SAGE) Program exposes interprofessional (IP) teams of health professions students to older adults. To determine the impact of an interprofessional geriatric educational experience on student perceptions of team collaboration and older adults. IP teams of three or four students (n = 662) representing eight disciplines from two institutions were paired with an older adult to promote person-centered care over three semesters. Students completed two online questionnaires (pre- and post-SAGE Program, ~10 min). 136 students completed both questionnaires. Three IP collaborative practice sub-competencies under the Roles & Responsibilities and Interprofessional Communication Core Competencies increased significantly from pre- to post-SAGE Program (p ≤ 0.002). Comparison of the means for attitudes toward geriatric patients revealed statistically significant improvement in one item, Compassion (p < .002). The SAGE Program had a positive impact on IP collaborative practice and attitudes toward older people in some, but not all, areas.

Ethics in stuttering treatment in the schools: issues and intersections.

When the challenges of providing speech-language pathology services in school settings intersect with the complexities of meeting the unique needs of students who stutter, clinicians may encounter a variety of ethical issues. This article explores some of the ethical challenges of treating stuttering in school settings by discussing three clinical scenarios. Seedhouse's Ethics Grid is provided as a scaffold to support the critical analysis of school-based stuttering treatment issues. Factors examined include creating and respecting autonomy, serving student needs, doing good and minimizing risks, and telling the truth and keeping promises. In addition, clinical outcomes are considered in terms of their impact on students and family members, clinicians, students with communication disorders other than stuttering, and school personnel. Finally, some of the practical concerns when treating stuttering in school settings are discussed, including the law, codes of practice, wishes of others, as well as the effectiveness and efficiency of actions.

Cost of illness of chronic angina.

BACKGROUND: Angina pectoris is one of the principal manifestations of coronary artery disease (CAD). Chronic angina is a debilitating condition that affects millions of people in the United States. OBJECTIVE: The objective of the study is to estimate, from a societal perspective, the direct costs of chronic angina in the year 2000. METHODS: Data on medical utilization related to chronic angina were extracted from National Center for Health Statistics public-use databases and from IMS databases on medications (nitrates, beta-blockers, and calcium channel blockers). National average Medicare reimbursement rates were used to estimate costs. We identified medical utilization related to chronic angina based on International Classification of Diseases, Ninth Revision (ICD-9) codes. When ICD-9 codes that do not explicitly identify angina are used in medical databases, people with chronic angina may be coded as having CAD only. To address this, we developed upper- and lower-boundary estimates of the costs of chronic angina. The lower-boundary estimate is based on diagnoses that narrowly define the presence of chronic angina, and is termed "narrowly defined chronic angina." The upper-boundary estimate is based on diagnoses of CAD. RESULTS: The lower boundary on the cost of chronic angina is the estimated direct medical cost of narrowly defined chronic angina ($1.9 billion when it is the first-listed diagnosis and $8.9 billion when it is listed in any position). The upper boundary on the cost of chronic angina is the estimated total direct medical cost of CAD, which is $33 billion when it is the first-listed diagnosis and $75 billion when it is listed in any position. CONCLUSION: These analyses capture the range of direct costs that might be attributed to the care of chronic angina in the United States for the year 2000. Some components of care were not available, and estimated costs will be significantly higher if private payer reimbursement rates are used.

A systematic review of the economic burden of chronic angina.

BACKGROUND: Chronic angina carries an economic burden because of symptom management, the risk of major cardiovascular events, and lost productivity. The level of these costs has not been systematically quantified. OBJECTIVE: This study sought to assemble best evidence on the economic burden of chronic angina, including both the direct costs of healthcare and the indirect costs of lost productivity. METHODS: Studies published in English from January 1990 to June 2003 were located via electronic and manual searches and systematically reviewed. Eligible studies included those with information on cost of illness, cost of treatment, employment status, and/or work productivity and/or limitations for a population of patients with chronic angina. RESULTS: Seventeen studies assessed the healthcare cost of managing chronic angina. Cost estimates varied widely because of differing patient populations, healthcare settings, countries of origin, and year(s) of data collection. The most critical determinant of healthcare costs appeared to be the use of revascularization procedures. Twenty studies reported work limitations, 5 of which quantified productivity loss in monetary terms. Interventions for chronic angina resulted in some improvement in employment and work limitations over the short term. However, the positive effect of revascularization procedures tended to erode over the long term (3 years and beyond) in a substantial number of patients. CONCLUSIONS: Chronic angina carries substantial healthcare costs caused by frequent medical visits, medications, and expensive revascularization procedures. Workplace productivity loss because of angina is also substantial, but lasting long-term improvement in work status has been difficult to achieve.

Disfluencies of 3- and 5-year old Spanish-speaking children.

UNLABELLED: This study examined the disfluent speech of 32 normally fluent monolingual, Spanish-speaking children from Puerto Rico. The total frequencies and types of speech disfluencies were examined in 15 children (8 girls and 7 boys) aged 3;5-4;0 years (M=3.76) and 17 children (8 girls and 9 boys) aged 5;0-5;5 years (M=5.18). When examining the total frequencies of speech disfluencies, results revealed no main effects for age or gender as well as no interactions. Moreover, no differences were observed between the age groups in most of the disfluency types, including the rank orders of the types. Revisions, interjections, and single-syllable word repetitions were the most frequently observed speech disfluencies for both age groups. Broken words, blocks, and repetitions of more than one syllable were the least frequent. Overall, results revealed both similarities and differences when compared with the reported speech behaviors of English-speaking children. EDUCATIONAL OBJECTIVES: The reader will learn about and be able to describe: (1). the influence of age and gender on the total frequencies of speech disfluencies in 3- and 5-year old Spanish-speaking children from Puerto Rico; (2). the amount and type of difluencies in these young children; and (3). how the speech disfluencies of these Spanish-speaking children are similar to and different from those reported in the speech of English-speaking children.

Effects of length, complexity, and grammatical correctness on stuttering in Spanish-speaking preschool children.

PURPOSE: To explore the effects of utterance length, syntactic complexity, and grammatical correctness on stuttering in the spontaneous speech of young, monolingual Spanish-speaking children. METHOD: Spontaneous speech samples of 11 monolingual Spanish-speaking children who stuttered, ages 35 to 70 months, were examined. Mean number of syllables, total number of clauses, utterance complexity (i.e., containing no clauses, simple clauses, or subordinate and/or conjoined clauses), and grammatical correctness (i.e., the presence or absence of morphological and syntactical errors) in stuttered and fluent utterances were compared. RESULTS: Findings revealed that stuttered utterances in Spanish tended to be longer and more often grammatically incorrect, and contain more clauses, including more subordinate and/or conjoined clauses. However, when controlling for the interrelatedness of syllable number and clause number and complexity, only utterance length and grammatical incorrectness were significant predictors of stuttering in the spontaneous speech of these Spanish-speaking children. Use of complex utterances did not appear to contribute to the prediction of stuttering when controlling for utterance length. CONCLUSIONS: Results from the present study were consistent with many earlier reports of English-speaking children. Both length and grammatical factors appear to affect stuttering in Spanish-speaking children. Grammatical errors, however, served as the greatest predictor of stuttering.