247 results on '"Cynthia J. Brown"'
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2. Copyright
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Cynthia J. Brown
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- 2019
3. Index
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Cynthia J. Brown
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4. Bibliography
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Cynthia J. Brown
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5. Chapter 05
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Cynthia J. Brown
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6. Afterword
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Cynthia J. Brown
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- 2019
7. TitlePage
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Cynthia J. Brown
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8. ListofIllustrations
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Cynthia J. Brown
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9. [Untitled]
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Cynthia J. Brown
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- 2019
10. Dedication
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Cynthia J. Brown
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- 2019
11. FrontOther 01
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Cynthia J. Brown
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- 2019
12. A systematic review and meta‐analysis: Assessment of hospital walking programs among older patients
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Christine Loyd, Yue Zhang, Tara Weisberg, James Boyett, Elizabeth R. Huckaby, Jeri Grundhoefer, Steve Otero, Lisa Roberts, Samantha Giordano‐Mooga, Carmen Capo‐Lugo, Catherine H. Smith, Richard E. Kennedy, Barbara J. King, and Cynthia J. Brown
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hospitalization ,meta‐analysis ,mobility ,nursing care ,older adults ,systematic review ,Nursing ,RT1-120 - Abstract
Abstract Aim The aim of this study is to assess effect of hospital walking programs on outcomes for older inpatients and to characterize hospital walking dose reported across studies. Design A systematic review and meta‐analysis examining impact of hospital walking and/or reported walking dose among medical‐surgical inpatients. For inclusion, studies were observational or experimental, published in English, enrolled inpatients aged ≥ 65 yrs hospitalized for medical or surgical reasons. Methods Searches of PubMed, CINAHL, Embase, Scopus, NICHSR, OneSearch, ClinicalTrials.gov, and PsycINFO were completed in December 2020. Two reviewers screened sources, extracted data, and performed quality bias appraisal. Results Hospital walking dose was reported in 6 studies and commonly as steps/24 hr. Length of stay (LOS) was a common outcome reported. Difference in combined mean LOS between walking and control groups was −5.89 days. Heterogeneity across studies was considerable (I2 = 96%) suggesting poor precision of estimates. Additional, high‐quality trials examining hospital walking and patient outcomes of older patients is needed.
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- 2023
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13. A Danish version of the life-space assessment (LSA-DK) – translation, content validity and cultural adaptation using cognitive interviewing in older mobility limited adults
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Mette Merete Pedersen, Pia Kjær-Sørensen, Julie Midtgaard, Cynthia J. Brown, and Ann Christine Bodilsen
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Life-space assessment ,Older adults ,Cognitive interviewing ,Mobility ,Geriatrics ,RC952-954.6 - Abstract
Abstract Background Identification and prevention of mobility limitations in older adults is important to reduce adverse health outcomes. The Life-Space Assessment (LSA) provides a single measure of mobility including environmental and social resources of the older adult. Availability of the LSA for non-English speaking countries is still sparse. Therefore, we translated the LSA into Danish and performed a content validity analysis of the translation in older adults with mobility limitations. Methods After translation into Danish, the Danish version (LSA-DK) was content validated using cognitive interviewing in older mobility limited adults (+ 65) from an outpatient rehabilitation center (n = 12), medical wards at a university hospital (n = 11), and an assisted living facility (n = 7). The interviews were transcribed and analyzed according to the four stages of the Information Processing Model. Based on the analyses, recommendations for changes to the LSA-DK and to the manual were made and presented to the developers of the LSA. Results Consensus was reached on the LSA-DK. Thirty cognitive interviews were carried out. A wide range of sources of error primarily related to the comprehension, memory and decision process were identified. The frequency and type of error sources were most prevalent among assisted living facility informants and included difficulties in defining the geographical extension of neighborhood, town and outside town. The results led to adaptations to the questionnaire and manual to support implementation of the LSA-DK in clinical practice. Conclusions The Life-Space Assessment was translated into Danish and content validated based on cognitive interviews. Adaptations were made to support that the Danish version can be implemented in clinical practice and used in the assessment of mobility in older Danish adults.
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- 2019
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14. Ficolin-2 inhibitors are present in sera after prolonged storage at −80 °C
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Kimball Aaron Geno, Richard E. Kennedy, Patricia Sawyer, Cynthia J. Brown, and Moon H. Nahm
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Ficolins ,Lectins ,Storage artifacts ,Lectin pathway ,Complement ,Medicine ,Biology (General) ,QH301-705.5 - Abstract
Ficolins can activate the lectin pathway of the complement system that provides innate immune protection against pathogens, marks host cellular debris for clearance, and promotes inflammation. Baseline inflammation increases with aging in a phenomenon known as “inflammaging.” Although IL-6 and C-reactive protein are known to increase with age, contributions of many complement factors, including ficolins, to inflammaging have been little studied. Ficolin-2 is abundant in human serum and can recognize many target structures; therefore, ficolin-2 has potential to contribute to inflammaging. We hypothesized that inflammaging would alter ficolin-2 levels among older adults and examined 360 archived sera collected from older individuals. We found that these sera had apparently reduced ficolin-2 levels and that 84.2% of archived sera exhibited ficolin-2 inhibitors, which suppressed apparent amounts of ficolin-2 detected by enzyme-linked immunosorbent assay. Fresh serum samples were obtained from donors whose archived sera showed inhibitors, but the fresh sera did not have ficolin-2 inhibitors. Ficolin-2 inhibitors were present in other long-stored sera from younger persons. Furthermore, noninhibiting samples and fresh sera from older adults had apparently normal amounts of ficolin-2. Thus, ficolin-2 inhibitors may arise as an artifact of long-term storage of serum at −80 °C.
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- 2016
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15. Un análisis empírico de las juntas de directores y los derechos de los accionistas minoritarios latinoamericanos
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Marisela Santiago and Cynthia J. Brown
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gobierno corporativo ,derechos de los accionistas minoritarios ,junta de directoresiones ,política de pago ,dividendos ,readquisición de acciones ,Business ,HF5001-6182 - Abstract
El artículo examina la relación entre las estructuras de gobierno corporativo y la posibilidad de expropiación de los derechos de los accionistas minoritarios. Se analizaron 97 empresas de Brasil, Chile y México entre el 2000 y 2002. Los resultados indican que el aumento en el tamaño de la junta de directores, al incluir directores externos independientes, baja la posibilidad de la expropiación de los derechos de los acciones minoritarios. Además, a mayor tiempo de servicio en la junta de los directores externos independientes, a menor por ciento de propiedad de los CEOs y a más directores entrecruzados menor es la posibilidad de expropiación de los derechos de los accionistas minoritarios.
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- 2009
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16. Poets, Patrons, and Printers: Crisis of Authority in Late Medieval France
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Cynthia J. Brown
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- 2019
17. Chapter six. The Rhétoriqueurs and the Transition from Manuscript to Print
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Cynthia J. Brown
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- 2023
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18. <scp>Hospital‐associated</scp> disability due to avoidable hospitalizations among older adults
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Rachel M. Skains, Yue Zhang, John D. Osborne, Tobias O'Leary, Mackenzie E. Fowler, Alayne Markland, Thomas W. Buford, Cynthia J. Brown, and Richard E. Kennedy
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Geriatrics and Gerontology - Published
- 2023
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19. A systematic review and meta‐analysis: Assessment of hospital walking programs among older patients
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Christine Loyd, Yue Zhang, Tara Weisberg, James Boyett, Elizabeth R. Huckaby, Jeri Grundhoefer, Steve Otero, Lisa Roberts, Samantha Giordano‐Mooga, Carmen Capo‐Lugo, Catherine H. Smith, Richard E. Kennedy, Barbara J. King, and Cynthia J. Brown
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General Nursing - Abstract
The aim of this study is to assess effect of hospital walking programs on outcomes for older inpatients and to characterize hospital walking dose reported across studies.A systematic review and meta-analysis examining impact of hospital walking and/or reported walking dose among medical-surgical inpatients. For inclusion, studies were observational or experimental, published in English, enrolled inpatients aged ≥ 65 yrs hospitalized for medical or surgical reasons.Searches of PubMed, CINAHL, Embase, Scopus, NICHSR, OneSearch, ClinicalTrials.gov, and PsycINFO were completed in December 2020. Two reviewers screened sources, extracted data, and performed quality bias appraisal.Hospital walking dose was reported in 6 studies and commonly as steps/24 hr. Length of stay (LOS) was a common outcome reported. Difference in combined mean LOS between walking and control groups was -5.89 days. Heterogeneity across studies was considerable (I
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- 2022
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20. Novel genetic loci associated with osteoarthritis in multi-ancestry analyses in the Million Veteran Program and UK Biobank
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Merry-Lynn N. McDonald, Preeti Lakshman Kumar, Vinodh Srinivasasainagendra, Ashwathy Nair, Alison P. Rocco, Ava C. Wilson, Joe W. Chiles, Joshua S. Richman, Sarah A. Pinson, Richard A. Dennis, Vivek Jagadale, Cynthia J. Brown, Saiju Pyarajan, Hemant K. Tiwari, Marcas M. Bamman, and Jasvinder A. Singh
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Genetics - Published
- 2022
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21. Providing Accessible Fall Prevention Education for Older Adults With Low Vision
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Sarah E. Blaylock, Mary Warren, Donald H. Lein, and Cynthia J. Brown
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Rehabilitation ,Physical Therapy, Sports Therapy and Rehabilitation ,Geriatrics and Gerontology - Published
- 2022
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22. Survive and thrive: Personal stories of persistence and resilience in aging research
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Melisa L. Wong, Cynthia J. Brown, Dalane W. Kitzman, Sandra Zeng, and Supriya G. Mohile
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Aging ,Geriatrics ,Financing, Organized ,Humans ,Geriatrics and Gerontology ,Geroscience ,Research Personnel ,United States ,Aged - Abstract
An academic career in aging research is filled with the incredible highs of important discoveries that improve the lives of older adults and repeated lows when papers and grants are rejected or studies are negative. To normalize the experience of setbacks and failures in aging research, we invited three senior investigators to share their journeys of persistence and resilience as they have navigated their research careers. This career development symposium was presented at the 2021 Annual Scientific Meeting of the American Geriatrics Society, which was held virtually. We aimed to connect researchers in aging, especially trainees and junior investigators, through personal stories of persistence and shared strategies to build resilience and respond to setbacks with a growth mindset.
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- 2022
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23. National Norms for the Elixhauser and Charlson Comorbidity Indexes Among Hospitalized Adults
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Garner Boogaerts, Christine Loyd, Yue Zhang, Richard E Kennedy, and Cynthia J Brown
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Abstracts ,Session 9000 (Poster) ,Aging ,Health (social science) ,Acute Care and Hospitalization ,Geriatrics and Gerontology ,Life-span and Life-course Studies ,AcademicSubjects/SOC02600 ,Health Professions (miscellaneous) - Abstract
Background Comorbidity burden is commonly measured among hospitalized adults, yet the U.S. national norms for 2 commonly used comorbidity indexes have not yet been reported. Thus, this study reports U.S. national norms for both Charlson Comorbidity Index (CCI) and the Elixhauser Comorbidity Index (ECI) among hospitalized adults based on age, biological sex, and race. Methods A retrospective observational cohort study using data from the Agency of Healthcare Research and Quality U.S. National Inpatient Sample database for 2017. Patient data were extracted from 7 159 694 inpatient adults, and analyses were focused on individuals older than 45 years, yielding 4 370 225 patients. International Classification of Diseases, 10th Edition, diagnostic codes were used to calculate CCI and ECI scores. These scores were then weighted for the U.S. national population. Results The weighted mean CCI was 1.22 (95% confidence interval [CI]: 1.22, 1.22), and the weighted mean ECI was 2.76 (95% CI: 2.76, 2.76). Both indexes had increasing average scores with increasing age, independent of sex and race (all p values < .001). Conclusion For the first time, U.S. national norms for the CCI and ECI are reported for adult inpatients. The norms can serve as a reference tool for determining if clinical and research populations have greater or lesser comorbidity burden than typical hospitalized adults in the United States for their age, sex, and race.
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- 2022
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24. The Project EPIC (Early Palliative Care In COPD) Hybrid Effectiveness-Implementation Pilot Randomized Controlled Trial of Telephonic Early Palliative Care (Sch467)
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Jun Yeong Byun, Rachel D. Wells, Avery C. Bechthold, Jazmine Coffee-Dunning, Margaret Armstrong, Cynthia J. Brown, Marie Bakitas, and Anand Iyer
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Anesthesiology and Pain Medicine ,Neurology (clinical) ,General Nursing - Published
- 2023
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25. Increased Attentional Focus on Walking by Older Adults Limits Maximum Speed and Is Related to Dynamic Stability
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Jutaluk Kongsuk, Cynthia J. Brown, Noah J. Rosenblatt, and Christopher P. Hurt
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Aging ,Exercise Test ,Humans ,Walking ,Geriatrics and Gerontology ,Gait ,human activities ,Aged ,Biomechanical Phenomena ,Walking Speed - Abstract
Background and Purpose: Older adults with lower balance confidence demonstrate a reduced willingness to experience instability as the task of walking becomes more challenging (i.e., walking with a faster speed). However, the specific reason why is not known. The purpose of this study was to investigate the extent to which capacity of increasing walking speeds relates to the attentional requirements (i.e., automaticity) of walking. Methods: Sixteen young (31 ± 5.85 years) and 15 older participants (69 ± 3.04 years) began walking on a treadmill at 0.4 m/s, and speed was increased by 0.2 m/s until the participant either chose to stop or reached a speed of 2.0 m/s. Sixty steps were collected at steady-state speed for each walking trial. Kinematic data were collected, and the margin of stability in the anterior direction (MOSAP) at heelstrike was quantified for each step. The timed up and go (TUG) and TUG dual (TUGdual) task were performed, from which an automaticity index (TUG/TUGdual × 100) was calculated. Older individuals were grouped based on whether they did or did not complete all walking speeds (i.e., completers [n = 9] or noncompleters [n = 6]). The fastest walking speed attempted (FSA), automaticity index, and MOSAP were compared, and correlations were assessed between the FSA/MOSAP and the automaticity index. Results: A significant difference was identified in an average MOSAP at heelstrike between older completer and noncompleter groups (p < 0.001). Further, older adults with lower automaticity index choose to stop walking at lower speeds (p = 0.001). The FSA was positively correlated with the automaticity index (ρ = 0.81, p < 0.001). Finally, the average MOSAP at FSA and the automaticity index were also negatively correlated (r = −0.85, p < 0.001). Conclusion: Older adults with lower automaticity of walking choose to stop walking at speeds before they completed all walking speeds, which may relate with increased attentional demands required to maintain dynamic stability at higher walking speeds. Given that these were otherwise healthy adults, the combination of FSA and an automaticity of walking may help to identify individuals who should be considered for an assessment to identify walking problems.
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- 2021
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26. Use of local anesthesia for inguinal hernia repair has decreased over time in the VA system
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C. M. Cullum, S. C. Lee, Timothy P. Hogan, Miles Berger, Audrey R. Stevens, Celette Sugg Skinner, Jennie Meier, Courtney J. Balentine, Herbert J. Zeh, Cynthia J. Brown, and Joan S. Reisch
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Adult ,medicine.medical_specialty ,Time Factors ,medicine.medical_treatment ,Hernia, Inguinal ,Anesthesia, General ,law.invention ,Primary outcome ,Hernia surgery ,Randomized controlled trial ,law ,medicine ,Humans ,Unilateral inguinal hernia ,Local anesthesia ,Veterans Affairs ,Herniorrhaphy ,Aged ,business.industry ,Middle Aged ,Hernia repair ,medicine.disease ,Surgery ,Inguinal hernia ,business ,Anesthesia, Local - Abstract
In 2003, randomized trials demonstrated potentially improved outcomes when local instead of general anesthesia is used for inguinal hernia repair. Our study aimed to evaluate how the use of local anesthesia for this procedure changed over time following the publication of the trials' level 1 evidence.We used the 1998-2018 Veterans Affairs Surgical Quality Improvement Program database to identify adults who underwent open, unilateral inguinal hernia repair under local or general anesthesia. Our primary outcome was the percentage of cases performed under local anesthesia. We used a time-series design to examine the trend and rate of change of the use of local anesthesia.We included 97,437 veterans, of which 22,333 (22.9%) had hernia surgery under local anesthesia. The median age of veterans receiving local anesthesia remained stable at 64-67 years over time. The use of local anesthesia decreased steadily, from 38.2% at the beginning year to 15.1% in the final year (P 0.0001). The publication of results from randomized trials (in 2003) did not appear to increase the overall use or change the rate of decline in the use of local anesthesia. Overall, we found that the use of local anesthesia decreased by about 1.5% per year.The utilization of local anesthesia for inguinal hernia repair in the VA has steadily declined over the last 20 + years, despite data showing equivalence or superiority to general anesthesia. Future studies should explore barriers to the use of local anesthesia for hernia repair.
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- 2021
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27. Health Professionals Palliative Care Education for Older Adults: Overcoming Ageism, Racism, and Gender Bias
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Shena Gazaway, Deborah Ejem, Michael D. Barnett, Cynthia J. Brown, Marie Bakitas, Ella H. Bowman, and Erin R. Harrell
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Geriatrics ,medicine.medical_specialty ,Medical education ,Palliative care ,ComputingMilieux_THECOMPUTINGPROFESSION ,Health professionals ,business.industry ,Pain medicine ,media_common.quotation_subject ,education ,Racism ,humanities ,Health equity ,Health professional education ,Invited Commentary ,Health care ,medicine ,Health disparities ,Geriatrics and Gerontology ,business ,Curriculum ,media_common - Abstract
Purpose of review Most aging Americans lack access to specialist palliative care aimed at those experiencing serious illness and/or high symptom burden at end of life. The curricula used by training programs for all healthcare professions should focus on helping learners develop the primary palliative care skills and competencies necessary to provide compassionate bias-free care for adults with serious illness. We believe there is much opportunity to improve this landscape via the incorporation of palliative care competencies throughout generalist healthcare professional programs. Recent findings Several recent publications highlight multiple issues with recruitment and retention of diverse students and faculty into healthcare professional training programs. There are also concerns that the curricula are reinforcing age, race, and gender biases. Due to these biases, healthcare professionals graduate from their training programs with socialized stereotypes unquestioned when caring for older adult minority patients and caregivers. Summary Important lessons must be incorporated to assure that bias against age, race, and gender are discovered and openly addressed in healthcare professional’s education programs. This review highlights these three types of bias and their interrelationships with the aim of revealing hidden truths in the education of healthcare professionals. Ultimately, we offer targeted recommendations of focus for programs to address implicit bias within their curricula.
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- 2021
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28. Local Anesthesia is Associated with Fewer Complications in Umbilical Hernia Repair in Frail Veterans
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Simon J. Craddock Lee, Miles Berger, Herbert J. Zeh, Courtney J. Balentine, Cynthia J. Brown, Joan S. Reisch, C. Munro Cullum, Celette Sugg Skinner, Timothy P. Hogan, and Jennie Meier
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Databases, Factual ,Frail Elderly ,Operative Time ,Veterans Health ,Anesthesia, General ,Article ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Umbilical hernia repair ,Humans ,Complication rate ,Local anesthesia ,Veterans Affairs ,Herniorrhaphy ,Aged ,Aged, 80 and over ,Frailty ,business.industry ,Middle Aged ,medicine.disease ,Surgery ,Acs nsqip ,Umbilical hernia ,Logistic Models ,Treatment Outcome ,Elective Surgical Procedures ,030220 oncology & carcinogenesis ,Linear Models ,Operative time ,Female ,030211 gastroenterology & hepatology ,business ,Hernia, Umbilical ,Anesthesia, Local - Abstract
Background The optimal anesthesia modality for umbilical hernia repair is unclear. We hypothesized that using local rather than general anesthesia would be associated with improved outcomes, especially for frail patients. Methods We utilized the 1998-2018 Veterans Affairs Surgical Quality Improvement Program to identify patients who underwent elective, open umbilical hernia repair under general or local anesthesia. We used the Risk Analysis Index to measure frailty. Outcomes included complications and operative time. Results There were 4958 Veterans (13%) whose hernias were repaired under local anesthesia. Compared to general anesthesia, local was associated with a 12%-24% faster operative time for all patients, and an 86% lower (OR 0.14, 95%CI 0.03-0.72) complication rate for frail patients. Conclusions Local anesthesia may reduce the operative time for all patients and complications for frail patients having umbilical hernia repair.
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- 2021
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29. Comparison of Postoperative Outcomes of Laparoscopic vs Open Inguinal Hernia Repair
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Jennie Meier, Audrey Stevens, Miles Berger, Konstantinos I. Makris, Athanasios Bramos, Joan Reisch, C. Munro Cullum, Simon C. Lee, Celette Sugg Skinner, Herbert Zeh, Cynthia J. Brown, and Courtney J. Balentine
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Surgery - Abstract
ImportanceAdvocates of laparoscopic surgery argue that all inguinal hernias, including initial and unilateral ones, should be repaired laparoscopically. Prior work suggests outcomes of open repair are improved by using local rather than general anesthesia, but no prior studies have compared laparoscopic surgery with open repair under local anesthesia.ObjectiveTo evaluate postoperative outcomes of open inguinal hernia repair under general or local anesthesia compared with laparoscopic repair.Design, Setting, and ParticipantsThis retrospective cohort study identified 107 073 patients in the Veterans Affairs Surgical Quality Improvement Program database who underwent unilateral initial inguinal hernia repair from 1998 to 2019. Data were analyzed from October 2021 to March 2022.ExposuresPatients were divided into 3 groups for comparison: (1) open repair with local anesthesia (n = 22 333), (2) open repair with general anesthesia (n = 75 104), and (3) laparoscopic repair with general anesthesia (n = 9636).Main Outcomes and MeasuresOperative time and postoperative morbidity were compared using quantile regression and inverse probability propensity weighting. A 2-stage least-squares regression and probabilistic sensitivity analysis was used to quantify and address bias from unmeasured confounding in this observational study.ResultsOf 107 073 included patients, 106 529 (99.5%) were men, and the median (IQR) age was 63 (55-71) years. Compared with open repair with general anesthesia, laparoscopic repair was associated with a nonsignificant 0.15% (95% CI, −0.39 to 0.09; P = .22) reduction in postoperative complications. There was no significant difference in complications between laparoscopic surgery and open repair with local anesthesia (−0.05%; 95% CI, −0.34 to 0.28; P = .70). Operative time was similar for the laparoscopic and open general anesthesia groups (4.31 minutes; 95% CI, 0.45-8.57; P = .048), but operative times were significantly longer for laparoscopic compared with open repair under local anesthesia (10.42 minutes; 95% CI, 5.80-15.05; P Conclusions and RelevanceIn this study, laparoscopic and open repair with local anesthesia were reasonable options for patients with initial unilateral inguinal hernias, and the decision should be made considering both patient and surgeon factors.
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- 2022
30. Project EPIC (Early Palliative Care In COPD): A Multiphase Evaluation of the EPIC Telehealth Intervention
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Anand S, Iyer, Rachel D, Wells, J Nicholas, Dionne-Odom, Avery C, Bechthold, Margaret, Armstrong, Jun Yeong, Byun, Lanier, O'Hare, Richard, Taylor, Stephanie, Ford, Jazmine, Coffee-Dunning, Mark T, Dransfield, Cynthia J, Brown, and Marie A, Bakitas
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Early, concurrent palliative care interventions in chronic obstructive pulmonary disease (COPD) are limited. Project EPIC (Early Palliative Care In COPD) is a multiphase mixed methods study working to fill this gap.To conduct a formative and summative evaluation of EPIC, a telephonic nurse coach-led early palliative care intervention for COPD adapted from the ENABLE intervention in cancer.Phase I Formative Evaluation: Patients with moderate-to-very-severe COPD, family caregivers, and pulmonary and palliative care clinicians rated the acceptability and feasibility of EPIC (≥4 out of 5 on a Likert-scale survey). Phase II Summative Evaluation: Patients and family caregivers in Phase I participated in a pilot of the 3-month EPIC prototype to evaluate intervention and data collection feasibility (≥70% completion) and to seek qualitative feedback.Phase I Formative Evaluation: Patients (n=10), family caregivers (n=10), pulmonary clinicians (n=6), and palliative care clinicians (n=6) found EPIC acceptable and feasible to support adaptation, while priority early palliative care needs in COPD from our prior research mapped well to the EPIC prototype. Phase II Summative Evaluation: Patients (n=5; ages 49-72, 40% moderate COPD, 40% Black) and their family caregivers (n=5; ages 51-73, 40% Black) completed 100% of EPIC prototype components, including weekly telephone sessions, a 1-month follow-up call, Advance Directive, palliative care clinic attendance, and 95% of monthly phone data collection sessions. Feedback from participants about EPIC was all positive.EPIC was acceptable and feasible in patients with COPD and their family caregivers. Larger feasibility and effectiveness trials are warranted.
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- 2022
31. Using local rather than general anesthesia for inguinal hernia repair is associated with shorter operative time and enhanced postoperative recovery
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Jennie Meier, Celette Sugg Skinner, Timothy P. Hogan, Munro Cullum, Cynthia J. Brown, Miles Berger, Herbert J. Zeh, Courtney J. Balentine, Joan S. Reisch, and Simon J. Craddock Lee
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Male ,Hospitals, Veterans ,Operative Time ,Hernia, Inguinal ,Postoperative recovery ,Anesthesia, General ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Humans ,Local anesthesia ,030212 general & internal medicine ,Veterans Affairs ,Aged ,Retrospective Studies ,Veterans ,business.industry ,Age Factors ,Mean age ,General Medicine ,Middle Aged ,Inguinal hernia surgery ,medicine.disease ,Texas ,Inguinal hernia ,Treatment Outcome ,030220 oncology & carcinogenesis ,Anesthesia ,Anesthesia Recovery Period ,Cohort ,Operative time ,Female ,Surgery ,business ,Anesthesia, Local - Abstract
Background Inguinal hernia repair is the most common general surgery procedure and can be performed under local or general anesthesia. We hypothesized that using local rather than general anesthesia would improve outcomes, especially for older adults. Methods This is a retrospective review of 97,437 patients in the Veterans Affairs Surgical Quality Improvement Program who had open inguinal hernia surgery under local or general anesthesia. Outcomes included 30-day postoperative complications, operative time, and recovery time. Results Our cohort included 22,333 (23%) Veterans who received local and 75,104 (77%) who received general anesthesia. Mean age was 62 years. Local anesthesia was associated with a 37% decrease in the odds of postoperative complications (95% CI 0.54–0.73), a 13% decrease in operative time (95% CI 17.5–7.5), and a 27% shorter recovery room stay (95% CI 27.5–25.5), regardless of age. Conclusions Using local rather than general anesthesia is associated with a profound decrease in complications (equivalent to “de-aging” patients by 30 years) and could significantly reduce costs for this common procedure.
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- 2021
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32. Delirium Mediates Incidence of Hospital-Associated Disability Among Older Adults
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Hyun Freeman, Roy C. Martin, Caroline Whittington, Yue Zhang, John D. Osborne, Tobias O'Leary, Jasmine K. Vickers, Kellie L. Flood, Rachel M. Skains, Alayne D. Markland, Thomas W. Buford, Cynthia J. Brown, and Richard E. Kennedy
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Health Policy ,General Medicine ,Geriatrics and Gerontology ,General Nursing - Published
- 2023
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33. Project EPIC (Early Palliative Care In COPD): A Formative and Summative Evaluation of the EPIC Telehealth Intervention
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Anand S. Iyer, Rachel D. Wells, J. Nicholas Dionne-Odom, Avery C. Bechthold, Margaret Armstrong, Jun Yeong Byun, Lanier O'Hare, Richard Taylor, Stephanie Ford, Jazmine Coffee-Dunning, Mark T. Dransfield, Cynthia J. Brown, and Marie A. Bakitas
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Anesthesiology and Pain Medicine ,Neurology (clinical) ,General Nursing - Published
- 2023
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34. Using Local Anesthesia for Inguinal Hernia Repair Reduces Complications in Older Patients
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Munro Cullum, Cynthia J. Brown, Celette Sugg Skinner, Miles Berger, Courtney J. Balentine, Simon J. Craddock Lee, Joan S. Reisch, and Jennie Meier
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Male ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Hernia, Inguinal ,Anesthesia, General ,Patient Readmission ,Article ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Older patients ,medicine ,Humans ,In patient ,Local anesthesia ,Herniorrhaphy ,Aged ,Retrospective Studies ,business.industry ,Middle Aged ,medicine.disease ,Hernia repair ,United States ,Surgery ,Cost savings ,Inguinal hernia ,030220 oncology & carcinogenesis ,Propensity score matching ,Operative time ,Female ,030211 gastroenterology & hepatology ,business ,Anesthesia, Local - Abstract
BACKGROUND: Inguinal hernia repair is the most common general surgery operation in the United States. Nearly 80% of inguinal hernia operations are performed under general anesthesia versus 15%–20% using local anesthesia, despite the absence of evidence for superiority of the former. Although patients aged 65 years and older are expected to benefit from avoiding general anesthesia, this presumed benefit has not been adequately studied. We hypothesized that the benefits of local over general anesthesia for inguinal hernia repair would increase with age. MATERIALS AND METHODS: We analyzed 87,794 patients in the American College of Surgeons National Surgical Quality Improvement Project who had elective inguinal hernia repair under local or general anesthesia from 2014–2018, and we used propensity scores to adjust for known confounding. We compared postoperative complications, 30-day readmissions, and operative time for patients aged
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- 2021
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35. Racial Disparities Exist in Outcomes After Major Fragility Fractures
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Ligong Chen, Jeffrey R. Curtis, James M. Shikany, Kenneth G. Saag, Nicole C. Wright, and Cynthia J. Brown
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medicine.medical_specialty ,Osteoporosis ,030209 endocrinology & metabolism ,Medicare ,Article ,White People ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Prevalence ,medicine ,Risk of mortality ,Humans ,Humerus ,Debility ,Femur ,030212 general & internal medicine ,Osteoporosis, Postmenopausal ,Aged ,Aged, 80 and over ,Bone Density Conservation Agents ,business.industry ,Incidence ,Ulna ,Health Status Disparities ,medicine.disease ,United States ,Black or African American ,medicine.anatomical_structure ,Female ,Geriatrics and Gerontology ,business ,Ulna Fractures ,Osteoporotic Fractures ,Cohort study - Abstract
BACKGROUND Fractures associated with postmenopausal osteoporosis (PMO) are associated with pain, disability, and increased mortality. A recent, nationwide evaluation of racial difference in outcomes after fracture has not been performed. OBJECTIVE To determine if 1-year death, debility, and destitution rates differ by race. DESIGN Observational cohort study. SETTING US Medicare data from 2010 to 2016. PARTICIPANTS Non-Hispanic black and white women with PMO who have sustained a fragility fracture of interest: hip, pelvis, femur, radius, ulna, humerus, and clinical vertebral. MEASUREMENTS Outcomes included 1-year: (1) mortality, identified by date of death in Medicare vital status information, (2) debility, identified as new placement in long-term nursing facilities, and (3) destitution, identified as becoming newly eligible for Medicaid. RESULTS Among black and white women with PMO (n = 4,523,112), we identified 399,000 (8.8%) women who sustained a major fragility fracture. Black women had a higher prevalence of femur (9.0% vs 3.9%; P
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- 2020
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36. A Qualitative Study of Pulmonary and Palliative Care Clinician Perspectives on Early Palliative Care in Chronic Obstructive Pulmonary Disease
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Cynthia J. Brown, Dina Khateeb, Lanier O'Hare, James Dionne-Odom, Mark T. Dransfield, Anand S Iyer, Rodney Tucker, and Marie Bakitas
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Male ,medicine.medical_specialty ,Palliative care ,Pulmonary disease ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,0302 clinical medicine ,030502 gerontology ,medicine ,Humans ,Intensive care medicine ,Qualitative Research ,General Nursing ,Terminal Care ,COPD ,business.industry ,Palliative Care ,Advanced stage ,Original Articles ,General Medicine ,medicine.disease ,Anesthesiology and Pain Medicine ,030220 oncology & carcinogenesis ,Hospice and Palliative Care Nursing ,0305 other medical science ,business ,Qualitative research - Abstract
Background: Guidelines recommend that pulmonary clinicians involve palliative care in chronic obstructive pulmonary disease (COPD); however, integration before advanced stage, that is, early palliative care, is rare. Objective: To explore and compare pulmonary and palliative care clinician perspectives on barriers, facilitators, and potential referral criteria for early palliative care in COPD. Design: Qualitative descriptive formative evaluation study. Setting/Subjects: Pulmonary and palliative care clinicians at a tertiary academic medical center. Measurements: Transcribed interviews were thematically analyzed by specialty to identify within- and across-specialty perspectives on barriers, facilitators, and referral criteria. Results: Twelve clinicians (n = 6 pulmonary, n = 6 palliative care) participated. Clinicians from both specialties agreed that early palliative care could add value to disease-focused COPD care. Perspectives on many barriers and facilitators were shared between specialties along broad educational, clinical, and operational categories. Pulmonary and palliative care clinicians shared concerns about the misconception that palliative care was synonymous to end-of-life care. Pulmonologists were particularly concerned about the potential risks of opioids and benzodiazepines in COPD. Both specialties stressed the need for clearly defined roles, consensus referral criteria, and novel delivery models. Although no single referral criterion was discussed by all, frequent hospitalizations and emotional symptoms were raised by most across disciplines. Multimorbidity and poor prognosis were discussed only by palliative care clinicians, whereas medication adherence was discussed only by pulmonary clinicians. Conclusions: Pulmonary and palliative care clinicians supported early palliative care in COPD. Continued needs include addressing pulmonologists' misconceptions of palliative care, establishing consensus referral criteria, and implementing novel early palliative care models.
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- 2020
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37. The Relation Between Pet Ownership, Anxiety, and Depressive Symptoms in Late Life: Propensity Score Matched Analyses
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Richard E. Kennedy, Courtney J. Bolstad, Cynthia J. Brown, Ben Porter, and Michael R. Nadorff
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Activities of daily living ,Sociology and Political Science ,business.industry ,Veterinary (miscellaneous) ,Article ,Education ,Pet ownership ,Rurality ,Anthropology ,Propensity score matching ,Medicine ,Marital status ,Antidepressant ,Anxiety ,Animal Science and Zoology ,medicine.symptom ,business ,Depression (differential diagnoses) ,health care economics and organizations ,Clinical psychology - Abstract
The purpose of this study was to explore the differences in anxiety and depressive symptoms between older adult pet owners and non-pet owners after accounting for various correlates. Research findings on the anxiety-relieving and antidepressant effects of late-life pet ownership are mixed and limited. This may be due in part to various characteristics that impact the likelihood of owning a pet. Propensity score matching was used to pair 169 pet owners with 169 non-pet owners aged 70 to 91 years who participated in the University of Alabama at Birmingham Study of Aging. One set of propensity scores was created using age, sex, race, rurality, marital status, and income, as well as self-reported health, difficulty with activities of daily living, and difficulty with instrumental activities of daily living. A second set of scores was created using age, sex, race, rurality, marital status, and income. Multiple linear regression analyses were then used to explore the relation between pet ownership status and anxiety or depressive symptoms, controlling for the other symptoms. Pet ownership was significantly associated with lower self-reported anxiety symptoms (β = -0.14) but not depressive symptoms (β = -0.03) in the data matched without health variables. When propensity score matching included health variables, pet ownership was related to neither symptoms of anxiety (β = -0.08) nor depression (β = 0.05). These results suggest that owning a pet in later life is related to fewer anxiety symptoms, over and above the impact of depressive symptoms, even after accounting for various demographic and economic covariates. However, general and functional health appear to be critical to this relation, but the direction of this relation could not be determined from our analyses (i.e., it is not clear whether the relation between pet ownership and anxiety symptoms is confounded by, mediates, or is mediated by health). This study is the first large-scale analysis to find a significant relation between pet ownership and fewer anxiety symptoms in older adults.
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- 2021
38. The Queen's Library: Image-Making at the Court of Anne of Brittany, 1477-1514
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Cynthia J. Brown
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- 2011
39. Development of Dynamic Measures to Assess Balance Confidence and State Anxiety While Walking at Increasing Speeds in Young and Older Adults
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Jutaluk Kongsuk, Suzanne E. Perumean-Chaney, David C. Knight, Cynthia J. Brown, Amy W. Amara, and Christopher P. Hurt
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Rehabilitation ,Exercise Test ,Humans ,Reproducibility of Results ,Physical Therapy, Sports Therapy and Rehabilitation ,Walking ,Geriatrics and Gerontology ,Anxiety ,Gerontology ,Aged ,Walking Speed - Abstract
The purpose of this study was to determine the test–retest reliability and construct validity of tools to assess how balance confidence (BC) and state anxiety (SA) change with progressively increasing walking speeds. Sixteen young adults and 15 older adults attended two sessions. Individuals began walking on a treadmill at 0.4 m/s Participants chose to continue increasing the treadmill speed (up to 2.0 m/s) or to discontinue the protocol while rating their BC and SA after completing each speed. BC at participants’ fastest speed attempted demonstrated high and moderate test–retest reliability among young (intraclass correlation coefficient [ICC] = .908) and older adults (ICC = .704). SA for young adults and older adults was good (ICC = .833) and fair (ICC = .490), respectively. Our measures also correlated with measures of dynamic stability while walking for young (r = −.67, p = .008) and older adults (r = .54, p = .046). Our dynamic measures of BC and SA are valid and reliable in young and older adults.
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- 2021
40. A Danish version of the life-space assessment (LSA-DK) – translation, content validity and cultural adaptation using cognitive interviewing in older mobility limited adults
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Pia Kjær-Sørensen, Julie Midtgaard, Cynthia J. Brown, Mette Merete Pedersen, and Ann Christine Bodilsen
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Male ,Gerontology ,Denmark ,medicine.medical_treatment ,lcsh:Geriatrics ,Danish ,03 medical and health sciences ,Cognition ,0302 clinical medicine ,Information processing theory ,Cognitive interviewing ,Surveys and Questionnaires ,medicine ,Content validity ,Humans ,Translations ,030212 general & internal medicine ,Mobility Limitation ,Cognitive interview ,Adaptation (computer science) ,Aged ,Aged, 80 and over ,Mobility ,Rehabilitation ,business.industry ,Reproducibility of Results ,Middle Aged ,Translating ,language.human_language ,Comprehension ,lcsh:RC952-954.6 ,Life-space assessment ,Older adults ,language ,Environment Design ,Female ,Geriatrics and Gerontology ,business ,030217 neurology & neurosurgery ,Research Article - Abstract
Background Identification and prevention of mobility limitations in older adults is important to reduce adverse health outcomes. The Life-Space Assessment (LSA) provides a single measure of mobility including environmental and social resources of the older adult. Availability of the LSA for non-English speaking countries is still sparse. Therefore, we translated the LSA into Danish and performed a content validity analysis of the translation in older adults with mobility limitations. Methods After translation into Danish, the Danish version (LSA-DK) was content validated using cognitive interviewing in older mobility limited adults (+ 65) from an outpatient rehabilitation center (n = 12), medical wards at a university hospital (n = 11), and an assisted living facility (n = 7). The interviews were transcribed and analyzed according to the four stages of the Information Processing Model. Based on the analyses, recommendations for changes to the LSA-DK and to the manual were made and presented to the developers of the LSA. Results Consensus was reached on the LSA-DK. Thirty cognitive interviews were carried out. A wide range of sources of error primarily related to the comprehension, memory and decision process were identified. The frequency and type of error sources were most prevalent among assisted living facility informants and included difficulties in defining the geographical extension of neighborhood, town and outside town. The results led to adaptations to the questionnaire and manual to support implementation of the LSA-DK in clinical practice. Conclusions The Life-Space Assessment was translated into Danish and content validated based on cognitive interviews. Adaptations were made to support that the Danish version can be implemented in clinical practice and used in the assessment of mobility in older Danish adults.
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- 2019
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41. A Formative Evaluation of Patient and Family Caregiver Perspectives on Early Palliative Care in Chronic Obstructive Pulmonary Disease across Disease Severity
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Rodney Tucker, Anand S Iyer, Stephanie M Ford, Elizabeth Sockwell, J. Nicholas Dionne-Odom, Mark T. Dransfield, Marie Bakitas, Nataliya V. Ivankova, Sheri Tims, and Cynthia J. Brown
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Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Palliative care ,Pulmonary disease ,Anxiety ,Severity of Illness Index ,Interviews as Topic ,Formative assessment ,Pulmonary Disease, Chronic Obstructive ,03 medical and health sciences ,0302 clinical medicine ,Disease severity ,Adaptation, Psychological ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Qualitative Research ,Aged ,Original Research ,COPD ,Depression ,business.industry ,Palliative Care ,Middle Aged ,medicine.disease ,humanities ,respiratory tract diseases ,Respiratory Function Tests ,Caregivers ,Social Isolation ,030228 respiratory system ,Quality of Life ,Female ,business ,Qualitative research - Abstract
Rationale: Little direction exists on how to integrate early palliative care in chronic obstructive pulmonary disease (COPD). Objectives: We sought to identify patient and family caregiver early palliative care needs across stages of COPD severity. Methods: As part of the Medical Research Council Framework developmental phase for intervention development, we conducted a formative evaluation of patients with moderate to very severe COPD (forced expiratory volume in 1 s [FEV(1)]/FVC < 70% and FEV(1) < 80%-predicted) and their family caregivers. Validated surveys on quality of life, anxiety and depressive symptoms, and social isolation quantified symptom severity. Semi-structured interviews were analyzed for major themes on early palliative care and needs in patients and family caregivers and across COPD severity stages. Results: Patients (n = 10) were a mean (±SD) age of 60.4 (±7.5) years, 50% African American, and 70% male, with 30% having moderate COPD, 30% severe COPD, and 40% very severe COPD. Family caregivers (n = 10) were a mean age of 58.3 (±8.7) years, 40% African American, and 10% male. Overall, 30% (n = 6) of participants had poor quality of life, 45% (n = 9) had moderate–severe anxiety symptoms, 25% (n = 5) had moderate–severe depressive symptoms, and 40% (n = 8) reported social isolation. Only 30% had heard of palliative care, and most participants had misconceptions that palliative care was end-of-life care. All participants responded positively to a standardized description of early palliative care and were receptive to its integration as early as moderate stage. Five broad themes of early palliative care needs emerged: 1) coping with COPD; 2) emotional symptoms; 3) respiratory symptoms; 4) illness understanding; and 5) prognostic awareness. Coping with COPD and emotional symptoms were commonly shared early palliative care needs. Patients with very severe COPD and their family caregivers prioritized illness understanding and prognostic awareness compared with those with moderate–severe COPD. Conclusions: Patients with moderate to very severe COPD and their family caregivers found early palliative care acceptable and felt it should be integrated before end-stage. Of the five broad themes of early palliative care needs, coping with COPD and emotional symptoms were the highest priority, followed by respiratory symptoms, illness understanding, and prognostic awareness.
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- 2019
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42. Association Between Executive Dysfunction and Instrumental Activities of Daily Living: Racial and Ethnic Differences Among Community-Dwelling Older Adults in the Southeastern US
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Richard E. Kennedy, Courtney P. Williams, Stephanie L. Garrett, Richard M. Allman, Patricia Sawyer, and Cynthia J. Brown
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Male ,Gerontology ,Activities of daily living ,Ethnic group ,Neuropsychological Tests ,White People ,Article ,Executive Function ,Sex Factors ,Cultural diversity ,Activities of Daily Living ,Prevalence ,Humans ,Medicine ,Dementia ,Cognitive Dysfunction ,Association (psychology) ,Aged ,Aged, 80 and over ,business.industry ,Cognition ,Health Status Disparities ,General Medicine ,medicine.disease ,Southeastern United States ,Health equity ,Black or African American ,Cross-Sectional Studies ,Female ,Independent Living ,business ,human activities ,Executive dysfunction - Abstract
OBJECTIVE: Examining cultural differences in assessment of cognitive/ functional disability among older Americans is needed. This analysis examined associations between day-to-day function, measured by activities of daily living (ADL), and cognition, measured by CLOX scores, among older African American (AA) and non-Hispanic White (nHW) community-dwelling women and men. METHODS: Design- Cross-sectional Setting- Homes of community-dwelling older adults. Participants- 893 Medicare beneficiaries > 65 living in west-central Alabama, without diagnoses of dementia, who were participants in the University of Alabama at Birmingham (UAB) Study of Aging, and who had complete data. Measurements- Physical function was assessed by self-reported ADL difficulty; cognitive function by CLOX, a clock drawing-task. Multivariable, linear regression models were used to examine associations within race/sex specific groups. RESULTS: After controlling for socio-demographic factors and comorbidities, CLOX1 scores were inversely and significantly correlated with ADL for AA men (β=−0.205, P= 0.003). CLOX2 scores were similarly associated with ADL and IADL for the total group (β=−0.118, P= 0.001, and β=−0.180, P
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- 2019
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43. Ambulation Patterns Post-Discharge in Older Adults Identified as Fall Risk: A Descriptive Pilot Study
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Haocen Wang, Barbara J. King, Roger L. Brown, Cynthia J. Brown, Fang lin Kuo, and Linsey M. Steege
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Aged, 80 and over ,medicine.medical_specialty ,Activities of daily living ,business.industry ,Health Policy ,Human factors and ergonomics ,Poison control ,Walking ,Severity of Illness Index ,Suicide prevention ,Patient Discharge ,Occupational safety and health ,Severity of illness ,Injury prevention ,Physical therapy ,medicine ,Humans ,Accidental Falls ,Functional ability ,Geriatrics and Gerontology ,business ,Geriatric Assessment ,Gerontology ,General Nursing ,Aged - Abstract
Older adults identified as fall risk during a hospital stay may be at high risk for decreased ambulation during hospitalization and after discharge. Little is known about ambulation frequency in older adults identified as fall risk during a hospital stay or their trajectory of ambulation patterns after an acute hospitalization. Individual ambulation frequency, patterns, functional performance, and fear of falls for 14 older adults were studied. Accelerometers were worn by patients during their hospital stay and for 4 weeks post-discharge. Novel analytics using piecewise regression were used to analyze data. Patterns of ambulation were heterogeneous, and 64% of patients demonstrated no change in the first 2 weeks post-discharge. Increase in ambulation frequency was positively correlated with higher Katz Activities of Daily Living Index scores, gait speed, and lower fear of falls score. Ambulation patterns in older adults identified as fall risk show promise in capturing ambulation recovery and functional ability post-discharge. [Res Gerontol Nurs. 2019; 12(3):113–119.]
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- 2019
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44. Development and evolution of a two-day intensive resident experience in geriatric medicine
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Channing R. Ford, Richard M. Allman, Theodore M. Johnson, Angela G. Rothrock, Cynthia J. Brown, and Christine Loyd
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Models, Educational ,medicine.medical_specialty ,education ,Adult population ,Education ,medicine ,Humans ,Program Development ,Aged ,Geriatrics ,geography ,Medical education ,Summit ,geography.geographical_feature_category ,Education, Medical ,Role modeling ,Resident training ,Internship and Residency ,Resident education ,Quality Improvement ,Active learning ,Curriculum ,Geriatrics and Gerontology ,Family Practice ,Psychology ,Needs Assessment - Abstract
As the older adult population increases, the need to enhance medical education and training in Geriatric Medicine (GM) is essential. To enhance resident training, faculty at two southeastern universities developed a Resident Award Summit, a two-day active learning experience, designed to expose family and internal medicine residents to GM principles and the various career options available in GM. Over 10 years, 353 residents from 108 residency programs participated. Resident feedback indicated that attending the event had a positive impact on future practice (M = 4.65, SD = .58) and showed that the amount of GM training received was limited, with 83.5% and 70.2% ranking adequacy of medical student and resident training as limited, respectively. To impact practice, long-term change must occur. Experiences such as the Resident Award Summit allow GM faculty to educate and prepare residents though positive teaching experiences, providing residents with the skills needed to care for older adults in their communities.
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- 2019
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45. A Surgeon’s Guide to Treating Older Patients With Colorectal Cancer
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Celette Sugg Skinner, Sooyeon Kim, Cynthia J. Brown, Courtney J. Balentine, and Simon J. Craddock Lee
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medicine.medical_specialty ,Hepatology ,Inpatient stay ,Colorectal cancer ,business.industry ,Gastroenterology ,Postoperative recovery ,medicine.disease ,Article ,Colorectal surgery ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,Older patients ,030220 oncology & carcinogenesis ,Survivorship curve ,medicine ,030211 gastroenterology & hepatology ,Intensive care medicine ,business - Abstract
PURPOSE OF REVIEW: Review strategies to improve outcomes of colorectal cancer treatment in older patients. RECENT FINDINGS: Older colorectal patients face many barriers to recovery during their initial inpatient stay following surgery and after leaving the hospital. In addition to the risk of inpatient morbidity and mortality, older patients are more likely to require post-acute care services, to face nutritional deficits, and to experience complications of chemoradiation. SUMMARY: In order to improve outcomes for older patients with colorectal cancer, it is important for surgeons to recognize their unique needs and to develop plans to address them. The involvement of a multidisciplinary team with geriatric experience can guide planning for surgery, the immediate postoperative recovery, and long-term survivorship.
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- 2019
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46. The Importance and Opportunity for Healthy Aging Through Lifestyle, Behavior Medicine Among Older Adults With Multiple Sclerosis: the Case Based on Physical Activity
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John R. Rinker, Cynthia J. Brown, Robert W. Motl, Gary Cutter, and Marcas M. Bamman
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Gerontology ,education.field_of_study ,medicine.medical_specialty ,Neurology ,business.industry ,Multiple sclerosis ,Population ,Cognition ,Context (language use) ,Disease ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Health promotion ,030220 oncology & carcinogenesis ,Medicine ,Neurology (clinical) ,Healthy aging ,business ,education ,030217 neurology & neurosurgery - Abstract
There is a “graying” of the population of persons living with multiple sclerosis (MS), and the effects of normal aging occur on top of those associated with MS itself (i.e., aging with a long-term disabling disease). We develop the perspective that “Lifestyle Behavior Medicine for Healthy Aging with MS” may be an effective strategy for promoting healthy longevity in this immune-mediated, neurodegenerative disease of the central nervous system. The perspective is based on recent evidence regarding (a) outcomes of aging with MS for declines in physical and cognitive functions; (b) lifestyle behaviors as putative influences of those outcomes for yielding healthy aging in MS; and (c) health promotion, largely focused on physical activity, in the context of the patient-provider interaction in comprehensive MS care. The lack of effective pharmacological treatment options combined with evidence for age-related declines in function over-and-beyond MS itself supports implementing Lifestyle, Behavior Medicine for Healthy Aging with MS in the context of comprehensive MS care for older adults with MS.
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- 2021
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47. Racial and Ethnic Disparities in Access to Local Anesthesia for Inguinal Hernia Repair
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Herbert J. Zeh, Simon J. Craddock Lee, Miles Berger, C. Munro Cullum, Courtney J. Balentine, Audrey R. Stevens, Joan S. Reisch, Timothy P. Hogan, Cynthia J. Brown, Celette Sugg Skinner, and Jennie Meier
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Operative Time ,Ethnic group ,Hernia, Inguinal ,Logistic regression ,Article ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Ethnicity ,Medicine ,Humans ,Local anesthesia ,Healthcare Disparities ,Veterans Affairs ,Herniorrhaphy ,Aged ,Retrospective Studies ,Veterans ,African american ,business.industry ,General surgery ,Middle Aged ,medicine.disease ,Hernia repair ,United States ,Acs nsqip ,Inguinal hernia ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Female ,business ,Anesthesia, Local - Abstract
BACKGROUND: Many studies have identified racial disparities in healthcare, but few have described disparities in the use of anesthesia modalities. We examined racial disparities in the use of local versus general anesthesia for inguinal hernia repair. We hypothesized that African American and Hispanic patients would be less likely than Caucasians to receive local anesthesia for inguinal hernia repair. MATERIALS AND METHODS: We included 78,766 patients aged ≥18 years in the Veterans Affairs Surgical Quality Improvement Program database who underwent elective, unilateral, open inguinal hernia repair under general or local anesthesia from 1998–2018. We used multiple logistic regression to compare use of local versus general anesthesia and 30-day postoperative complications by race/ethnicity. RESULTS: In total, 17,892 (23%) patients received local anesthesia. Caucasian patients more frequently received local anesthesia (15,009; 24%), compared to African Americans (2353; 17%) and Hispanics (530; 19%), p < 0.05. After adjusting for covariates, we found that African Americans (OR 0.82, 95% CI 0.77–0.86) and Hispanics (OR 0.77, 95% CI 0.69–0.87) were significantly less likely to have hernia surgery under local anesthesia compared to Caucasians. Additionally, local anesthesia was associated with fewer postoperative complications for African American patients (OR 0.46, 95% CI 0.27–0.77). CONCLUSIONS: Although local anesthesia was associated with enhanced recovery for African American patients, they were less likely to have inguinal hernias repaired under local than Caucasians. Addressing this disparity requires a better understanding of how surgeons, anesthesiologists, and patient-related factors may affect the choice of anesthesia modality for hernia repair.
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- 2021
48. Novel genetic loci associated with osteoarthritis in multi-ancestry analyses in the Million Veteran Program and UK Biobank
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Merry-Lynn N, McDonald, Preeti, Lakshman Kumar, Vinodh, Srinivasasainagendra, Ashwathy, Nair, Alison P, Rocco, Ava C, Wilson, Joe W, Chiles, Joshua S, Richman, Sarah A, Pinson, Richard A, Dennis, Vivek, Jagadale, Cynthia J, Brown, Saiju, Pyarajan, Hemant K, Tiwari, Marcas M, Bamman, and Jasvinder A, Singh
- Subjects
Genetic Loci ,Humans ,United Kingdom ,Biological Specimen Banks - Abstract
Osteoarthritis is a common progressive joint disease. As no effective medical interventions are available, osteoarthritis often progresses to the end stage, in which only surgical options such as total joint replacement are available. A more thorough understanding of genetic influences of osteoarthritis is essential to develop targeted personalized approaches to treatment, ideally long before the end stage is reached. To date, there have been no large multiancestry genetic studies of osteoarthritis. Here, we leveraged the unique resources of 484,374 participants in the Million Veteran Program and UK Biobank to address this gap. Analyses included participants of European, African, Asian and Hispanic descent. We discovered osteoarthritis-associated genetic variation at 10 loci and replicated findings from previous osteoarthritis studies. We also present evidence that some osteoarthritis-associated regions are robust to population ancestry. Drug repurposing analyses revealed enrichment of targets of several medication classes and provide potential insight into the etiology of beneficial effects of antiepileptics on osteoarthritis pain.
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- 2021
49. Using Local Rather than General Anesthesia for Inguinal Hernia Repair May Significantly Reduce Complications for Frail Veterans
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Timothy P. Hogan, Simon J. Craddock Lee, C. Munro Cullum, Herbert J. Zeh, Miles Berger, Celette Sugg Skinner, Courtney J. Balentine, Joan S. Reisch, Jennie Meier, and Cynthia J. Brown
- Subjects
Male ,Databases, Factual ,medicine.medical_treatment ,Frail Elderly ,Psychological intervention ,Hernia, Inguinal ,Anesthesia, General ,Article ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Postoperative Complications ,Randomized controlled trial ,law ,medicine ,Humans ,Local anesthesia ,030212 general & internal medicine ,Veterans Affairs ,Herniorrhaphy ,Aged ,Veterans ,Aged, 80 and over ,Frailty ,business.industry ,Incidence (epidemiology) ,Incidence ,Postoperative complication ,General Medicine ,medicine.disease ,Hernia repair ,Inguinal hernia ,Elective Surgical Procedures ,030220 oncology & carcinogenesis ,Anesthesia ,Surgery ,Female ,business ,Anesthesia, Local - Abstract
Background Frailty predisposes patients to poor postoperative outcomes. We evaluated whether using local rather than general anesthesia for hernia repair could mitigate effects of frailty. Methods We used the Risk Analysis Index (RAI) to identify 8,038 frail patients in the 1998–2018 Veterans Affairs Surgical Quality Improvement Program database who underwent elective, open unilateral inguinal hernia repair under local or general anesthesia. Our outcome of interest was the incidence of postoperative complications. Results In total, 5,188 (65%) patients received general anesthesia and 2,850 (35%) received local. Local anesthesia was associated with a 48% reduction in complications (OR 0.52, 95%CI 0.38–0.72). Among the frailest patients (RAI≥70), predicted probability of a postoperative complication ranged from 22 to 33% with general anesthesia, compared to 13–21% with local. Conclusions Local anesthesia was associated with a ∼50% reduction in postoperative complications in frail Veterans. Given the paucity of interventions for frail patients, there is an urgent need for a randomized trial comparing effects of anesthesia modality on postoperative complications in this vulnerable population.
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- 2021
50. Succeeding in Aging Research During the Pandemic: Strategies for Fellows and Junior Faculty
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Andrew B. Cohen, Heather E. Whitson, Kenneth E. Covinsky, Susan J. Zieman, Anna L. Parks, Cynthia M. Boyd, Cynthia J. Brown, and Michael A. Steinman
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2019-20 coronavirus outbreak ,Faculty, Medical ,Coronavirus disease 2019 (COVID-19) ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,Faculty medical ,Medical and Health Sciences ,Special Article ,Hospital ,COVID‐19 ,Medical ,Pandemic ,Medical Staff, Hospital ,Medical Staff ,Medicine ,early‐career researchers ,Humans ,Fellowships and Scholarships ,early-career researchers ,Medical education ,business.industry ,SARS-CoV-2 ,COVID-19 ,aging research ,Faculty ,Research Personnel ,Career Mobility ,Geriatrics ,Research studies ,Special Articles ,junior faculty ,Geriatrics and Gerontology ,business - Abstract
Fellows and junior faculty conducting aging research have encountered substantial new challenges during the COVID-19 pandemic. They report that they have been uncertain how and whether to modify existing research studies, have faced difficulties with job searches, and have struggled to balance competing pressures including greater clinical obligations and increased responsibilities at home. Many have also wondered if they should shift gears and make COVID-19 the focus of their research. We asked a group of accomplished scientists and mentors to grapple with these concerns and to share their thoughts with readers of this journal.
- Published
- 2021
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