http://hdl.handle.net/10027/1009 Wed, 19 Jun 2013 12:27:16 GMT 2013-06-19T12:27:16Z http://hdl.handle.net/10027/8536 Questionable Effectiveness of the QuantiFERON-TB Gold Test (Cellestis) as a Screening Tool in Healthcare Workers Gandra, Sumanth; Scott, William S.; Somaraju, Vijaya; Wang, Huaping; Wilton, Suzanne; Feigenbaum, Michelle objective. The Center for Disease Control and Prevention recommends the use of QuantiFERON TB Gold test (QFTG; Cellestis) in all situations where the tuberculin skin test (TST) is used. In November 2007, our institution replaced its screening-tool TST with the QFTG in-tube assay (QFT-GIT) for annual screening of latent tuberculosis infection among healthcare workers (HCWs). This study evaluated the effectiveness of QFT-GIT test as screening tool in HCWs at our institution. methods. This retrospective study reviewed medical records of all HCWs who underwent screening with QFT-GIT from January 2008 through December 2008. results. Among the 6,530 HCWs screened with QFT-GIT from January through December 2008, 287 had a positive test result. Of the 287, 123 had positive TST results in the past, meaning that 164 HCWs had newly diagnosed latent tuberculosis infection by QFT-GIT. Of the 164 HCWs, 135 were retested by QFT-GIT and were simultaneously tested with TST within 4 weeks after the initial QFT-GIT. Of these 135 HCWs, 66 reverted to negative results and results remained positive for 69 with QFT-GIT. Only 2 HCWs had a positive TST result. conclusions. The disagreement between QFT-GIT and TST results and the high reversion rate with QFT-GIT raise concerns about the effectiveness of QFT-GIT as a sole screening test in HCWs. © 2011 by Endocrine Society, Journal of Clinical Endocrinology and Metabolism DOI: 10.1086/657336 Wed, 01 Dec 2010 06:00:00 GMT http://hdl.handle.net/10027/8536 2010-12-01T06:00:00Z http://hdl.handle.net/10027/8479 Missed opportunities for advance care planning communication during outpatient clinic visits Ahluwalia, Sangeeta; Levin, Jennifer; Lorenz, Karl; Gordon, Howard Background: Early provider-patient communication about future care is critical for patients with heart failure (HF); however, advance care planning (ACP) discussions are often avoided or occur too late to usefully inform care over the course of the disease. Objective: To identify opportunities for physicians to engage in ACP discussions and to characterize physicians’ responses to these opportunities. Design: Qualitative study of audio-recorded outpatient clinic visits. Participants: 52 patients > 65 years recently hospitalized for HF with one or more post-discharge follow-up outpatient visits, and their physicians (n=44), at two Veterans Affairs Medical Centers. Approach: Using content analysis methods, transcripts of outpatient follow-up visits were analyzed and coded for 1) patient statements pertaining to their future health or their future physical, psychosocial and spiritual/existential care needs, and 2) subsequent physician responses to patient statements, using an iterative consensus-based coding process. Results: In 13 of 71 consultations, patients expressed concerns, questions, and thoughts regarding their future care that gave providers opportunities to engage in an ACP discussion. The majority of these opportunities (84%) were missed by physicians. Instead, physicians responded by terminating the conversation, hedging their responses, denying the patient’s expressed emotion, or inadequately acknowledging the sentiment underlying the patient’s statement. Conclusions: Physicians often missed the opportunity to engage in ACP despite openers patients provided that could have prompted such discussions. Communication training efforts should focus on helping physicians identify patient openers and providing a toolbox to encourage appropriate physician responses; in order to successfully leverage opportunities to engage in ACP discussions. © 2012 by Springer Verlag, Journal of General Internal Medicine. The original publication is available at www.springerlink.com DOI: 10.1007/s11606-011-1917-0 Sun, 01 Apr 2012 05:00:00 GMT http://hdl.handle.net/10027/8479 2012-04-01T05:00:00Z http://hdl.handle.net/10027/8436 Sleep Telemedicine: Patient Satisfaction and Treatment Adherence Parikh, Roshni; TouVelle, Megan Nicole; Wang, Huaping; Zallek, Sarah Nath Objective: Obstructive sleep apnea is common, but access to diagnosis remains limited. Telemedicine may allow greater access to care; however, its effect on patient satisfaction and treatment adherence is unknown. This study compares patient satisfaction and continuous positive airway pressure (CPAP) adherence of patients seen by videoconference with those seen in person. Materials and Methods: New patients seen via video or in person at a sleep center completed a survey, with three questions pertaining to satisfaction with the provider. Questions were scored 1–5; the sum was the patient satisfaction score. CPAP adherence was retrospectively analyzed in patients who met the physician via video or in person. Percentage of nights CPAP was used for ‡ 4 h and average minutes of CPAP use per night over 2 consecutive weeks were compared. Results: A Mann–Whitney test compared patient satisfaction of the 90 subjects (of whom, 56 met physician in person and 34 via video). Mean scores (in person, 14.82; video, 14.91; p = 0.851) did not differ between groups. Mann–Whitney tests compared CPAP adherence in the 172 subjects (of whom, 111 met physician in person and 61 via video). Mean percentage of nights CPAP was used ‡ 4 h (in person, 71%; video, 65%; p = 0.198) and the average minutes per night of CPAP use (in person, 340.55; video, 305.31; p = 0.153) did not differ between groups. Conclusions: The findings indicate that patients were equally satisfied with their provider and adherent to CPAP treatment whether they were seen in person or via video. Videoconferencing may improve access to patient care without reducing patient satisfaction or treatment adherence. This is a copy of an article published in the Telemedicine and e-Health © 2011 Copyright Mary Ann Liebert, Inc.; Telemedicine and e-Health is available online at: http://www.liebertonline.com. DOI: 10.1089/tmj.2011.0025 Sat, 01 Oct 2011 05:00:00 GMT http://hdl.handle.net/10027/8436 2011-10-01T05:00:00Z http://hdl.handle.net/10027/1153 Human Resting Muscle Tone (HRMT): Narrative Introduction and Modern Concepts Masi, Alfonse T.; Hannon, John Charles Human resting muscle (myofascial) tone (HRMT) is the passive tonus or tension of skeletal muscle that derives from its intrinsic (EMG-silent) molecular viscoelastic properties. The word tone has been used to convey varying clinical and physiological features that have led to confusion and controversy. HRMT is the vital low-level, passive tension, and resistance to stretch that contributes importantly to maintaining postural stability in balanced equilibrium positions. In contrast, co-contraction of muscle is an active neuromotor control that provides greater levels of tonus for increased stabilization. Functionally, HRMT is integrated with other passive fascial and ligamentous tensional networks of the body to form a biotensegrity system. This review aims to achieve better understandings of HRMT and its functional roles. Nature is frugal and Man’s adaptations to gravitational forces and erect postures seemingly evolved mechanisms in skeletal muscle tissues to economically enhance stability. Normal passive muscle tone helps maintain relaxed standing body posture with minimally increased energy costs (circa 7% over supine), and often for prolonged durations without fatigue. Available data infer polymorphic variations in normal myofascial tone. However, few quantitative studies have been performed to establish normal frequency distributions of degrees of myofascial tone. Clinical experience indicates that persons with certain symptomatic musculoskeletal conditions may have palpably increased resting muscle firmness or hardness (EMG-silent), such as that of the upper trapezius in tension-type headache, and the lumbodorsal extensors (hartspann) in degenerative lumbar disc disease and ankylosing spondylitis. In summary, resting skeletal muscle tone is an intrinsic viscoelastic tension exhibited within the body’s kinematic chains. It functions inseparably from fascial (i.e. myofascial) tissues and ligamentous structures. Thus, HRMT is a passive myofascial property which operates within networks of tensional tissues, i.e., biotensegrity. This passive tension is the CNS-independent component resulting from intrinsic molecular interactions of the actomyosin filaments in sarcomeric units of skeletal muscle and myofibroblast cells. The overarching CNS-activated muscle contractions generate far greater tensions transmitted by fascial elements. Interdisciplinary research on HRMT and its biodynamics promises greater effectiveness of clinical practitioners and productivity of investigators, which warrants priority attention. Tue, 01 Jan 2008 06:00:00 GMT http://hdl.handle.net/10027/1153 2008-01-01T06:00:00Z