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1.
J Assoc Inf Sci Technol ; 70(9): 968-980, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31799335

RESUMEN

Information behavior may enhance hypertension self-management in African-Americans. The goal of this substudy was to examine relationships between measures of self-reported health information behavior and neural measures of health information processing in a sample of 19 prehypertensive African-Americans (mean age=52.5, 52.6% women). We measured 1) health information seeking, sharing, and use (surveys) and 2) neural activity using functional magnetic resonance imaging (fMRI) to assess response to health information videos. We hypothesized that differential activation (comparison of analytic vs. empathic brain activity when watching a specific type of video) would indicate better function in three, distinct cognitive domains: 1) Analytic Network, 2) Default Mode Network (DMN), and 3) ventromedial prefrontal cortex (vmPFC). Scores on the information sharing measure (but not seeking or use) were positively associated with differential activation in the vmPFC (rs=.53, p=.02) and the DMN (rs=.43, p=.06). Our findings correspond with previous work indicating that activation of the DMN and vmPFC is associated with sharing information to persuade others, and with behavior change. Although health information is commonly conveyed as detached and analytic in nature, our findings suggest that neural processing of socially and emotionally salient health information is more closely associated with health information sharing.

2.
J Vet Intern Med ; 33(4): 1585-1592, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31222803

RESUMEN

BACKGROUND: Typical atrioventricular accessory pathways (APs) are composed of myocardial cells. They provide electrical connections between atria and ventricles separate from the normal conduction system. Accessory pathways can participate in a macroreentrant circuit resulting in orthodromic atrioventricular reciprocating tachycardia (OAVRT). HYPOTHESIS: Because of ultrastructural similarities of typical AP cells to ventricular myocardial cells, we hypothesized lidocaine would be effective in blocking AP conduction, thus terminating OAVRT. ANIMALS: Thirty-two consecutive client-owned dogs presenting with narrow complex tachyarrhythmias were confirmed to have OAVRT by electrophysiologic study (EPS). METHODS: Prospective, nonrandomized, single-arm study with lidocaine administered IV to dogs during OAVRT in 2 mg/kg boluses to a cumulative dose of 8 mg/kg or development of adverse effects. Electrocardiograms were monitored continuously. Subsequent EPS was performed to confirm OAVRT and the absence of other tachycardia mechanisms. RESULTS: Twenty-seven dogs experienced OAVRT cardioversion with lidocaine, before or at the time of adverse effects. Orthodromic atrioventricular reciprocating tachycardia in 5 dogs did not cardiovert before adverse effects, precluding additional dosing. Median total lidocaine dose for cardioversion was 2 mg/kg (interquartile range, 2-5.5 mg/kg). Dogs with right free wall APs had a significantly higher rate of cardioversion than did dogs with right posteroseptal APs. CONCLUSIONS AND CLINICAL IMPORTANCE: Lidocaine successfully cardioverted OAVRT in 84.4% of dogs in our study before adverse effects precluded additional dosing. In 5 dogs with dose limited by adverse effects, it is unknown whether cardioversion would have occurred at a higher cumulative dose.


Asunto(s)
Antiarrítmicos/farmacología , Enfermedades de los Perros/tratamiento farmacológico , Lidocaína/farmacología , Taquicardia Reciprocante/veterinaria , Animales , Antiarrítmicos/administración & dosificación , Antiarrítmicos/efectos adversos , Cardiomiopatías/tratamiento farmacológico , Cardiomiopatías/veterinaria , Perros , Femenino , Lidocaína/administración & dosificación , Lidocaína/efectos adversos , Masculino , Estudios Prospectivos , Taquicardia Reciprocante/tratamiento farmacológico
3.
West J Nurs Res ; 41(5): 667-684, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-29954259

RESUMEN

African Americans are disproportionately impacted by hypertension, suffering earlier onset and greater severity of the disease, and premature cardiovascular mortality, than the general population. Managing hypertension is an unending concern for African American older adults. A better understanding of the self-management preferences of this vulnerable population will lead to the enhanced design of culturally acceptable interventions. This descriptive study examined focus group participants' perspectives on engaging in hypertension self-management activities with the goal of developing a co-created intervention. This study was part of a mixed methods study for which audio- and graphically-recorded focus groups were conducted with community-dwelling African American older adults ( N = 31) diagnosed with hypertension. The majority of the participants were women (87%); the mean age was 72 years ( SD = 7.53). Themes derived from data analyses centered on primary stressors of communication, healthy eating, and sleep related to blood pressure self-management. Based on these, the researchers co-created educational interventions.


Asunto(s)
Afroamericanos/psicología , Hipertensión/terapia , Automanejo/psicología , Anciano , Anciano de 80 o más Años , Femenino , Grupos Focales/métodos , Humanos , Hipertensión/fisiopatología , Hipertensión/psicología , Masculino , Persona de Mediana Edad , Investigación Cualitativa
4.
Nurs Res ; 68(2): 127-134, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30540702

RESUMEN

BACKGROUND: Although many of the proposed mediating processes of self-management interventions are operationally defined as cognitive processes (e.g., acquiring and using information, self-efficacy, motivation, and decision-making), little is known about their underlying brain mechanisms. Brain biomarkers of how people process health information may be an important characteristic on which to individualize health information to optimize self-management of chronic conditions. OBJECTIVES: We describe a program of research addressing the identification of brain biomarkers that differentially predict responses to two types of health information (analytic focused and emotion focused) designed to support optimal self-management of chronic conditions. METHODS: We pooled data from two pilot studies (N = 52) that included functional magnetic resonance imaging during a specially designed, ecologically valid protocol to examine brain activation (task differentiation) associated with two large-scale neural networks-the Analytic Network and the Empathy Network-and the ventral medial prefrontal cortex while individuals responded to different types of health information (analytic and emotional). RESULTS: Findings indicate that analytic information and emotional information are processed differently in the brain, and the magnitude of this differentiation in response to type of information varies from person to person. Activation in the a priori regions identified in response to both analytic and emotion information was confirmed. The feasibility of obtaining brain imaging data from persons with chronic conditions also is demonstrated. DISCUSSION: An understanding of brain signatures related to information processing has potential to assist in the design of more individualized, effective self-management interventions.


Asunto(s)
Cognición/fisiología , Emociones/fisiología , Automanejo/psicología , Función Ejecutiva , Humanos , Imagen por Resonancia Magnética , Vías Nerviosas/fisiología
5.
Res Gerontol Nurs ; 11(5): 249-256, 2018 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-30230518

RESUMEN

With the unprecedented growth of technology for disease prevention and management, little is known about the experience and adoption of such technology in African American older adults with hypertension. A 90-minute focus group session was used to explore African American older adults' (N = 21) experiences with using technology (mobile devices and applications) for hypertension self-management. Twenty participants reported owning smartphones and used this technology to communicate; seek, acquire, and share information; engage in entertainment; and organize and manage time. Participants expressed concerns about not being informed or trained sufficiently to integrate technology for hypertension self-management. There is a need to develop novel hypertension self-management interventions that integrate technology and training programs for this marginalized population that may help improve blood pressure control and address important clinical and public health priorities of uncontrolled hypertension. [Res Gerontol Nurs. 2018; 11(5):249-256.].


Asunto(s)
Afroamericanos/psicología , Hipertensión/terapia , Internet , Aplicaciones Móviles , Percepción , Automanejo , Teléfono Inteligente , Anciano , Actitud , Presión Sanguínea , Monitoreo Ambulatorio de la Presión Arterial , Comunicación , Femenino , Grupos Focales , Humanos , Hipertensión/fisiopatología , Hipertensión/psicología , Masculino , Educación del Paciente como Asunto/métodos , Integración de Sistemas
6.
J Vet Intern Med ; 32(5): 1517-1529, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30216552

RESUMEN

BACKGROUND: Atrioventricular accessory pathways (APs) in dogs have been reported rarely. Data regarding clinical presentation and long-term outcome after radiofrequency catheter ablation (RFCA) are limited. HYPOTHESIS/OBJECTIVES: To study clinical features, electrophysiologic characteristics, and outcome of RFCA in dogs with APs. ANIMALS: Eighty-nine dogs presented consecutively for RFCA of APs. METHODS: Case series. RESULTS: Labrador retrievers (47.2% of dogs) and male dogs (67.4% of dogs) were most commonly affected. Labrador retrievers were more likely to be male than non-Labrador breeds (P = .043). Clinical signs were nonspecific and most commonly included lethargy and gastrointestinal signs. Concealed APs were more prevalent in Labrador retrievers than other breeds (P = .001). Right-sided APs (91.7%) predominated over left-sided (8.3%). Tachycardia-induced cardiomyopathy (TICM) occurred in 46.1% of dogs, with complete resolution or substantial improvement noted on one-month postablation echocardiograms. Radiofrequency catheter ablation successfully eliminated AP conduction long term in 98.8% of dogs in which it was performed. Complications occurred in 5/89 dogs. Recurrence in 3 dogs was eliminated long term with a second procedure. CLINICAL IMPORTANCE/CONCLUSIONS: Accessory pathways are challenging to recognize in dogs because of nonspecific clinical signs, frequency of concealed APs that show no evidence of their presence during sinus rhythm, and intermittent occurrence of tachyarrhythmias resulting from APs. Tachycardia-induced cardiomyopathy commonly occurs with AP-mediated tachycardias and should be considered in any dog presenting with a dilated cardiomyopathic phenotype because of its good long-term prognosis with rhythm control. Radiofrequency catheter ablation is a highly effective method for eliminating AP conduction and providing long-term resolution.


Asunto(s)
Fascículo Atrioventricular Accesorio/veterinaria , Ablación por Catéter/veterinaria , Enfermedades de los Perros/terapia , Fascículo Atrioventricular Accesorio/terapia , Animales , Perros , Femenino , Masculino , Taquicardia/terapia , Taquicardia/veterinaria , Resultado del Tratamiento
7.
Int J Hypertens ; 2018: 7591289, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29971159

RESUMEN

Hypertension is a lifelong disease that requires self-management. Additionally, there are disparities in hypertension self-management that disproportionately affect African Americans. Interventions designed in collaboration with older adults have the potential to improve hypertension self-management. The purpose of this design paper is to describe the process in which African American older adults and nurse researchers cocreated an intervention to address stress in the self-management of hypertension. A semistructured interview guide was used to elicit feedback on self-management behaviors to cocreate an intervention with the participants. Participants provided constant iterative feedback on the design used for the intervention. Participants prioritized the content and mode of delivery. African American older adults with hypertension (N = 31; 87% women) participated in two focus group sessions. The primary stressors identified by the group that influenced their blood pressure self-management were as follows: (a) measuring blood pressure and using home blood pressure monitors; (b) difficulty communicating with family and friends; (c) sleep management and pain at night; and (d) healthy eating. Based on the participants' feedback, we created four biweekly (2-hour) group sessions that incorporated their suggestions and addressed their concerns. Health care providers can use this technique to engage African American older adults in participant-centered hypertension self-management.

8.
J Vis Exp ; (136)2018 06 10.
Artículo en Inglés | MEDLINE | ID: mdl-29939172

RESUMEN

The hormone cortisol is typically assessed in saliva, serum, or urine samples. More recently, cortisol has been successfully extracted from hair, including humans. The advantage of hair cortisol concentration is that it reflects a retrospective representation of hypothalamic-pituitary-adrenal (HPA) axis function over time, much like hemoglobin A1C represents glycemic control. However, obtaining hair samples can be challenging, due to the cultural beliefs and hair care practices of minority participants. For example, African Americans may be reluctant to provide samples. Additionally, few researchers are trained to collect hair samples from African Americans. The purpose of this paper is to present a culturally informed protocol to help researchers obtain hair samples from African Americans. To illustrate the representative results of this protocol implementation, de-identified data from African Americans that participated in a community-based study on chronic stress are provided. Hair practice preferences are assessed. The participants are made comfortable by showing pictures of hair samples prior to cutting their hair. The single strain twist and gently pull method is used to collect approximately 30 - 50 strands of hair from the posterior vertex region of the scalp. This protocol will significantly improve collection of hair samples from African Americans.


Asunto(s)
Cabello/química , Hidrocortisona/metabolismo , Sistema Hipotálamo-Hipofisario/fisiopatología , Sistema Hipófiso-Suprarrenal/fisiopatología , Afroamericanos , Anciano , Femenino , Humanos , Hidrocortisona/análisis , Masculino , Estudios Retrospectivos
9.
J Cardiovasc Nurs ; 33(3): E1-E9, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29634648

RESUMEN

BACKGROUND: Exercise is a common recommendation to reduce the risk factors of metabolic syndrome, yet there are limited data on the influence of lifestyle exercise after cardiac events on metabolic syndrome factors. OBJECTIVE: The purpose of this study was to determine whether lifestyle exercise improves metabolic syndrome profile in older adults after a cardiac event. METHODS: Participants were from a post-cardiac-event lifestyle exercise study. Five metabolic syndrome factors were assessed: waist circumference, triglycerides, high-density lipids, glucose, and systolic and diastolic blood pressure. Objective measures of exercise were obtained from heart rate monitors over a year. Logistic regression was used to determine whether participants who engaged in the minimum recommendation of 130 hours of exercise or greater during the 12-month period improved their metabolic syndrome profile by improving at least 1 metabolic syndrome factor. RESULTS: In the sample of 116 participants (74% men; average age, 67.5 years), 43% exercised at the recommended amount (≥130 h/y) and 28% (n = 33) improved their metabolic syndrome profile. After controlling for confounding factors of age, gender, race, diabetes, functional ability, and employment, subjects who exercised at least 130 hours a year were 3.6 times more likely to improve at least 1 metabolic syndrome factor (95% confidence interval, 1.24-10.49). Of the 28% who improved their metabolic syndrome profile, 72% increased their high-density lipoprotein and 60.6% reduced their waist circumference and glucose. CONCLUSIONS: After a cardiac event, older patients who engage in lifestyle exercise at the recommended amount have improvement in their metabolic syndrome profile.


Asunto(s)
Ejercicio , Estilo de Vida , Síndrome Metabólico/terapia , Anciano , Anciano de 80 o más Años , Angioplastia Coronaria con Balón , Glucemia/análisis , Puente de Arteria Coronaria , Femenino , Humanos , Lipoproteínas HDL/sangre , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Circunferencia de la Cintura
11.
J Assoc Inf Sci Technol ; 69(1): 168-171, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29546230

RESUMEN

Nearly half of African-American women have hypertension, which increases their risk for cardiovascular disease and stroke. A plethora of consumer health information products and services exist to inform people with hypertension and to promote self-management among them. Promotion of information sharing by African-American women represents a promising, culturally-applicable strategy for consumer health information services focused on hypertension self-management. Yet, how African-American women share hypertension information with others is unclear. The purpose of this qualitative, descriptive study was to examine practices of information sharing in African-American women with hypertension. Thirteen women (mean age = 73, SD = 9.87) participated in one of two focus groups held at an urban community health center. Thematic analysis revealed that the women shared information about how they self-managed their blood pressure 1) with female family members and friends, 2) about ways in which they adapted self-management strategies to work for them, 3) mostly in group settings, and 4) because they wanted to prevent others from suffering and reinforce their own knowledge about hypertension self-management. New findings emerged regarding assessing "readiness" for information. Study findings will be used to inform the design of an information sharing intervention to support self-management of hypertension in African-American women.

12.
Res Gerontol Nurs ; 11(1): 39-47, 2018 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-29370445

RESUMEN

The prevalence of hypertension is highest among African American women, who often occupy caregiving roles. The purpose of the current study is to describe intergenerational caregiving and communication themes that emerged during focus groups with African American older adult women (mean age = 73 years) on information sharing and self-management of hypertension. Thematic analysis revealed two overarching themes: Caregiving Responsibilities and Improving the Health of Younger Generations. Women wanted to help younger generations better manage their blood pressures. These findings suggest that intergenerational relationships may have an important role in managing health conditions, such as hypertension. Further examination of intergenerational relationships as targets for blood pressure self-management intervention is warranted to: (a) address the need for women to share their wisdom, and (b) help improve blood pressure management among African American individuals across the lifespan. [Res Gerontol Nurs. 2018; 11(1):39-47.].


Asunto(s)
Afroamericanos/psicología , Comunicación , Promoción de la Salud/métodos , Hipertensión/terapia , Difusión de la Información/métodos , Relaciones Intergeneracionales , Autocuidado/métodos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Grupos Focales , Humanos , Persona de Mediana Edad , Medio Oeste de Estados Unidos
13.
Clin Nurse Spec ; 31(6): 311-318, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28991014

RESUMEN

PURPOSE: Despite increased awareness and the advent of methods to manage the disease, hypertension is poorly controlled among African American women. This study explored hypertension knowledge and blood pressure in a sample of African American women. DESIGN: A descriptive, cross-sectional design was used to collect survey data on hypertension knowledge. METHODS: African American women attending a church conference were invited to complete a questionnaire, which included the Check Your High Blood Pressure Prevention IQ survey, and had their blood pressures measured. RESULTS: Of the 151 women who participated, 62% were diagnosed with hypertension. Many of the women, even those not diagnosed with hypertension, had elevated blood pressures. Although the average scores showed that the women scored well on the survey, there were 4 items on the survey that a percentage of the women had difficulty with: questions about (1) stress as a cause of hypertension, (2) symptoms associated with high blood pressure, (3) whether hypertension could be cured, and (4) the amount of exercise needed to help reduce blood pressure. CONCLUSION: Despite efforts to increase awareness and control of hypertension, considerable misconceptions about the disease were found in this sample of African American women. To improve self-management of hypertension among this group, advanced practice nurses need to directly address these misconceptions.


Asunto(s)
Enfermería de Práctica Avanzada , Afroamericanos/psicología , Conocimientos, Actitudes y Práctica en Salud/etnología , Hipertensión/etnología , Relaciones Enfermero-Paciente , Educación del Paciente como Asunto/métodos , Automanejo/psicología , Adulto , Afroamericanos/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Estudios Transversales , Femenino , Humanos , Hipertensión/prevención & control , Persona de Mediana Edad , Adulto Joven
14.
Res Gerontol Nurs ; 10(4): 155-161, 2017 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-28742924

RESUMEN

Managing missing data in a secondary analysis is daunting, particularly if the data of interest were not included in the parent study design. The current study describes the use of geocoding to replace missing data from a parent study for a secondary analysis of socioeconomic and neighborhood characteristics in community-dwelling older adults who are dually eligible for Medicare and Medicaid. Geocoding was used to link participants' addresses to data from the American Community Survey to replace missing income and neighborhood data. After geocoding, data completeness was 100% for neighborhood poverty and education composition, and 99.9% for income. Using geocoding provides the gerontological nurse researcher with a sample that is more reflective of the population. The current findings can be used to tailor neighborhood-centered interventions to promote health in low-income older adults. [Res Gerontol Nurs. 2017; 10(4):155-161.].


Asunto(s)
Actividades Cotidianas , Recolección de Datos/métodos , Evaluación Geriátrica/estadística & datos numéricos , Vida Independiente/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Características de la Residencia/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Sesgo , Femenino , Humanos , Masculino , Clase Social , Apoyo Social , Estados Unidos
15.
Gerontologist ; 55 Suppl 1: S140-5, 2015 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-26055775

RESUMEN

Prolonged stress is a potentially harmful and often undetected risk factor for chronic illness in older adults. Cortisol, one indicator of the body's hormonal responses to stress, is regulated by the hypothalamic-pituitary-adrenal (HPA) axis and is commonly measured in saliva, urine, or blood samples. Cortisol possesses a diurnal pattern and thus collection timing is critical. Hair cortisol is a proxy measure to the total retrospective activity of the HPA axis over the preceding months, much like hemoglobin A1c is a proxy measure of glucose control over the past 3 months. The aim of this review is to examine a novel biomarker, hair cortisol, as a practical measure of long-term retrospective cortisol activity associated with chronic stress in older adults. Hair cortisol analysis advances the science of aging by better characterizing chronic stress as a risk factor for chronic illness progression and as a biomarker of the effectiveness of stress reduction interventions.


Asunto(s)
Biomarcadores/metabolismo , Cabello/metabolismo , Hidrocortisona/metabolismo , Sistema Hipotálamo-Hipofisario/metabolismo , Sistema Hipófiso-Suprarrenal/metabolismo , Anciano , Humanos , Estudios Retrospectivos
16.
Geriatr Nurs ; 36(2 Suppl): S16-20, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-25784082

RESUMEN

Dually enrolled Medicare-Medicaid older adults are a vulnerable population. We tested House's Conceptual Framework for Understanding Social Inequalities in Health and Aging in Medicare-Medicaid enrollees by examining the extent to which disparities indicators, which included race, age, gender, neighborhood poverty, education, income, exercise (e.g., walking), and physical activity (e.g., housework) influence physical function and emotional well-being. This secondary analysis included 337 Black (31%) and White (69%) older Medicare-Medicaid enrollees. Using path analysis, we determined that race, neighborhood poverty, education, and income did not influence physical function or emotional well-being. However, physical activity (e.g., housework) was associated with an increased self-report of physical function and emotional well-being of ß = .23, p < .001; ß = .17, p < .01, respectively. Future studies of factors that influence physical function and emotional well-being in this population should take into account health status indicators such as allostatic load, comorbidity, and perceived racism/discrimination.


Asunto(s)
Ejercicio , Disparidades en el Estado de Salud , Medicaid , Medicare , Salud Mental , Anciano , Anciano de 80 o más Años , Emociones , Femenino , Humanos , Masculino , Factores Socioeconómicos , Estados Unidos
18.
ACS Synth Biol ; 4(3): 221-7, 2015 Mar 20.
Artículo en Inglés | MEDLINE | ID: mdl-24905764

RESUMEN

We have used design of experiments (DOE) and systematic variance to efficiently explore glutathione transferase substrate specificities caused by amino acid substitutions. Amino acid substitutions selected using phylogenetic analysis were synthetically combined using a DOE design to create an information-rich set of gene variants, termed infologs. We used machine learning to identify and quantify protein sequence-function relationships against 14 different substrates. The resulting models were quantitative and predictive, serving as a guide for engineering of glutathione transferase activity toward a diverse set of herbicides. Predictive quantitative models like those presented here have broad applicability for bioengineering.


Asunto(s)
Sustitución de Aminoácidos/genética , Glutatión Transferasa/química , Resistencia a los Herbicidas/genética , Proteínas de Plantas/química , Biología Sintética/métodos , Triticum/genética , Secuencia de Aminoácidos , Glutatión Transferasa/genética , Glutatión Transferasa/metabolismo , Aprendizaje Automático , Datos de Secuencia Molecular , Proteínas de Plantas/genética , Proteínas de Plantas/metabolismo , Proyectos de Investigación , Análisis de Secuencia de Proteína
19.
Popul Health Manag ; 14(3): 137-42, 2011 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-21323461

RESUMEN

Interdisciplinary care management is advocated for optimal care of patients with many types of chronic illnesses; however, few models exist that have been tested using randomized trials. The purpose of this report is to describe the theoretical basis for the After Discharge Management of Low Income Frail Elderly (AD-LIFE) trial, which is an ongoing 2-group randomized trial (total n = 530) to test a chronic illness management and transitional care intervention. The intervention is based on Wagner's chronic illness care model and involves comprehensive posthospitalization nurse-led interdisciplinary care management for low income frail elders with chronic illnesses, employs evidence-based protocols that were developed using the Assessing Care of Vulnerable Elders (ACOVE) guidelines, emphasizes patient activation, and integrates with community-based long-term care and other community agencies. The primary aim of the AD-LIFE trial is to test a chronic illness management intervention in vulnerable patients who are eligible for Medicare and Medicaid. This model, with its standardized, evidence-based medical and psychosocial intervention protocols, will be easily transportable to other sites interested in optimizing outcomes for chronically ill older adults. If the results of the AD-LIFE trial demonstrate the superiority of the intervention, then this data will be important for health care policy makers.


Asunto(s)
Continuidad de la Atención al Paciente , Anciano Frágil , Alta del Paciente , Proyectos de Investigación , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Técnicas de Apoyo para la Decisión , Medicina Basada en la Evidencia , Promoción de la Salud , Humanos , Masculino , Modelos Teóricos , Médicos de Atención Primaria , Pobreza/economía , Pobreza/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Autocuidado/métodos , Estados Unidos
20.
J Speech Lang Hear Res ; 53(3): 620-32, 2010 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-20029051

RESUMEN

PURPOSE: In the present study, the authors investigated the association between wet vocal quality (WVQ) and prandial material in the larynx during phonation. The presence of such material is indicative of oropharyngeal dysphagia and results from entry of material into the laryngeal vestibule during swallowing. The primary aim of the study was to determine whether clinicians reliably perceive WVQ during phonation when prandial material is in the larynx. METHOD: Seventy-eight subjects underwent videofluoroscopic swallow study, and simultaneous recording of time-linked videofluoroscopic and acoustic data was conducted during postswallow phonation. Experienced dysphagia clinicians then rated randomized audio samples for presence or absence of WVQ. RESULTS: WVQ is not reliably perceived by clinicians when material is present in the larynx in the region of the glottis during phonation, and there is a high degree of interrater variability for perceptual judgments of wetness. CONCLUSIONS: Material in the larynx during phonation may result in multiple voice quality percepts, and even experienced clinicians may not be adept at identifying the perceptual consequences of this. Observation of laryngeal physiology during voicing when material is in the larynx using vocal tract imaging can improve reliability in the identification of wet vocal quality.


Asunto(s)
Trastornos de Deglución/diagnóstico , Deglución , Fonación , Calidad de la Voz , Adulto , Anciano , Anciano de 80 o más Años , Deglución/fisiología , Trastornos de Deglución/fisiopatología , Fluoroscopía , Glotis/fisiopatología , Humanos , Laringoscopía , Laringe/fisiopatología , Masculino , Persona de Mediana Edad , Variaciones Dependientes del Observador , Fonación/fisiología , Reproducibilidad de los Resultados , Acústica del Lenguaje , Percepción del Habla , Grabación en Video , Calidad de la Voz/fisiología
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