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Feasibility and results of a case study of yoga to improve physical functioning in people with chronic traumatic brain injury

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dISABILITY ANd REHABILITATION 2016年第9期38卷 914-920页

作者： Schmid, Arlene A. Miller, Kristine K. van Puymbroeck, Marieke Schalk, Nancy Colorado State Univ Coll Hlth & Human Sci Dept Occupat Therapy Ft Collins CO 80523 USA Indiana Univ Sch Hlth & Rehabil Sci Dept Phys Therapy Indianapolis IN 46204 USA Roudebush Vet Adm VA Med Ctr Ctr Implementing Evidence Based Practice HSR&D Indianapolis IN USA Clemson Univ Coll Hlth & Human Dev Dept Pk Recreat & Tourism Management Clemson SC USA Heartland Yoga Therapy Indianapolis IN USA

Purpose: The purpose of this mixed-methods case study was to investigate whether an 8-week 1:1 yoga program was feasible and beneficial to people with traumatic brain injury (TBI). Method: This was a mixed-methods case study of one-to-one yoga for people with TBI included three people. We completed assessments before and after the 8-week yoga intervention and included measures of balance, balance confidence, pain, range of motion, strength and mobility. Qualitative interviews were included at the post-assessment. We include a percent change calculation and salient quotes that represent the perceived impact of the yoga intervention. Results: All participants completed the yoga intervention and all demonstrated improvements in physical outcome measures. For the group, balance increased by 36%, balance confidence by 39%, lower extremity strength by 100% and endurance by 105%. Qualitative data support the use of yoga to improve multiple aspects of physical functioning, one participant stated: "I mean it's rocked my world. It's changed my life. I mean all the different aspects. I mean physically, emotionally, mentally, it's given me you know my life back horizontal ellipsis ". Conclusions: Yoga, delivered in a one-to-one setting, appears to be feasible and beneficial to people with chronic TBI. Implications for Rehabilitation Chronic traumatic brain injury (TBI) leads to many aspects of physical functioning impairment. Yoga delivered in a one-to-one setting may be feasible and beneficial for people with chronic TBI.

关键词： Balance yoga traumatic brain injury

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Burnout and Self-Reported Quality of Care in Community Mental Health

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AdMINISTRATION ANd POLICY IN MENTAL HEALTH ANd MENTAL HEALTH SERVICES RESEARCH 2015年第1期42卷 61-69页

作者： Salyers, Michelle P. Fukui, Sadaaki Rollins, Angela L. Firmin, Ruth Gearhart, Timothy Noll, James P. Williams, Stacy davis, C. J. IUPUI Dept Psychol Indianapolis IN 46202 USA ACT Ctr Indiana Indianapolis IN USA Univ Kansas Sch Social Welf Off Mental Hlth Res & Training Lawrence KS USA Roudebush VAMC VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA Four Cty Counseling Ctr Logansport IN USA

Staff burnout is widely believed to be problematic in mental healthcare, but few studies have linked burnout directly with quality of care. The purpose of this study was to examine the relationship between burnout and a newly developed scale for quality of care in a sample of community mental health workers (N = 113). The Self-Reported Quality of Care scale had three distinct factors (Client-centered Care, General Work Conscientiousness, and Low Errors), with good internal consistency. Burnout, particularly personal accomplishment, and to a lesser extent depersonalization, were predictive of overall self-rated Quality of Care, over and above background variables.

关键词： Burnout Quality of care Community mental health

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A Qualitative Study of Chronic Pain in Operation Enduring Freedom/Operation Iraqi Freedom Veterans: "A Burden on My Soul"

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MILITARY MEdICINE 2014年第1期179卷 26-30页

作者： Matthias, Marianne S. Miech, Edward J. Myers, Laura J. Sargent, Christy Bair, Matthew J. Roudebush VA Med Ctr VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN 46202 USA Regenstrief Inst Hlth Care Indianapolis IN 46202 USA Indiana Univ Purdue Univ Dept Commun Studies Indianapolis IN 46202 USA Indiana Univ Dept Emergency Med Indianapolis IN 46202 USA Indiana Univ Dept Med Indianapolis IN 46202 USA

Objectives: Over half of the veterans returning from the conflicts in Iraq and Afghanistan are burdened with chronic pain. Although these young veterans may have to live with pain for the rest of their lives, little is known about the struggles this new group of veterans faces, or their perceptions of support from family, friends, and others. The purpose of this study is to understand Operation Enduring Freedom/Operation Iraqi Freedom veterans' experiences with chronic pain and social support. Methods: In-depth qualitative interviews were conducted with veterans who participated in an intervention for chronic pain. Grounded theory guided data analysis. Results: Veterans described a range of emotions associated with chronic pain, including hopelessness, anger, and fear that their pain would worsen. For some, talking about their pain was helpful, but others avoided talking about their pain, often because people did not understand or overreacted. Conclusion: Although support from friends and family is often effective, veterans and others with chronic pain are uniquely positioned to offer support to others with pain. Clinically, an approach to pain management in which veteran peers are integrated into chronic pain treatment approaches, similar to the Veterans Affairs' mental health model of care, might offer additional benefits for veterans with chronic pain.

关键词： VETERANS dISEASES CHRONIC pain RESEARCH SOCIAL support -- Research EMOTIONS (Psychology) GROUNdEd theory UNITEd States

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Proceedings from the 9th annual conference on the science of dissemination and implementation: Washington, dC, USA. 14-15 december 2016

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Implement Sci 2017年第SUPPL 1期12卷 48-48页

作者： david Chambers Lisa Simpson Gila Neta Ulrica von Thiele Schwarz Antoinette Percy-Laurry Gregory A. Aarons Ross Brownson Amanda Vogel Shannon Wiltsey Stirman Kenneth Sherr Rachel Sturke Wynne E. Norton Allyson varley Cynthia Vinson Lisa Klesges Suzanne Heurtin-Roberts M. Rashad Massoud Leighann Kimble Arne Beck Claire Neely Jennifer Boggs Carmel Nichols Wen Wan Erin Staab Neda Laiteerapong Nathalie Moise Ravi Shah Susan Essock Margaret Handley Amy Jones Jay Carruthers Karina davidson Lauren Peccoralo Lloyd Sederer Todd Molfenter Ashley Scudder Sarah Taber-Thomas Kristen Schaffner Amy Herschell Eva Woodward Jeffery Pitcock Mona Ritchie JoAnn Kirchner Julia E. Moore Sobia Khan Shusmita Rashid Jamie Park Melissa Courvoisier Sharon Straus daniel Blonigen Allison Rodriguez Luisa Manfredi Andrea Nevedal Joel Rosenthal david Smelson Christine Timko Nicole Stadnick Jennifer Regan Miya Barnett Anna Lau Lauren Brookman-Frazee Erick Guerrero Karissa Fenwick Yinfei Kong Gregory Aarons Rebecca Lengnick-Hall Benjamin Henwood Nina Sayer Craig Rosen Robert Orazem Brandy Smith Lindsey Zimmerman david Lounsbury Rachel Kimerling Jodie A. Trafton Steven Lindley Rahul Bhargava Hal Roberts Laura Gibson Gabriel J. Escobar Vincent Liu Benjamin Turk Arona Ragins Patricia Kipnis Ashley Ketterer Gruszkowski Michael W. Kennedy Emily Rentschler drobek Lior Turgeman Aleksandra Sasha Milicevic Terrence L. Hubert Larissa Myaskovsky Youxu C. Tjader Robert J. Monte Kathryn G. Sapnas Edmond Ramly diane R Lauver Christie M Bartels Shereef Elnahal Andrea Ippolito Hillary Peabody Carolyn Clancy Randall Cebul Thomas Love douglas Einstadter Shari Bolen Brook Watts Vera Yakovchenko Angela Park William Lukesh donald R. Miller david Thornton Mari-Lynn drainoni Allen L. Gifford Shawna Smith Julia Kyle Mark S Bauer daniel Eisenberg Celeste Liebrecht Michelle Barbaresso Amy Kilbourne Elyse Park Giselle Perez Jamie Ostroff Sarah Greene Michael Parchman Brian Austin Eric Larson Stefanie Ferreri Chris Shea Megan Smith Kea Turner Jennifer Bacci Kyle Bigham Geoffr Division of Cancer Control and Population Sciences National Cancer Institute Rockville MD 20850 USA AcademyHealth Washington DC 20009 USA Department of Learning Informatics Management and Ethics Karolinska Institutet Stockholm 17177 Sweden Department of Psychiatry University of California San Diego San Diego CA 92093 USA George Warren Brown School of Social Work Washington University in St. Louis St. Louis MO 63130 USA Center for Global Health National Cancer Institute Rockville MD 20850 USA Dissemination and Training Division VA National Center for PTSD Palo Alto CA 94305 USA Department of Global Health University of Washington Seattle WA 98105 USA Center for Global Health Studies Fogarty International Center National Institutes of Health Bethesda MD 20912 USA School of Public Health University of Alabama at Birmingham Birmingham AL 35243 USA School of Public Health University of Memphis Memphis TN 38152 USA USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project Bethesda Maryland 20814 USA Institute for Health Research Kaiser Permanente Denver CO 80231 USA ICSI Institute for Clinical Systems Improvement Bloomington MN 55425 USA Medicine University of Chicago Chicago IL 60637 USA Medicine Columbia University Medical Center New York NY 10032 USA Psychiatry Columbia University New York NY 10032 USA General Internal Medicine Epidemiology and Biostatistics University of California San Francisco San Francisco CA 94110 USA New York State Office of Mental Health New York NY 10001 USA Medicine Icahn School of Medicine at Mount Sinai New York NY 10029 USA Center for Health Enhancement System Studies University of Wisconsin Madison WI 53706 USA Department of Psychiatry University of Pittsburgh Pittsburgh PA 15213 USA Psychology University at Buffalo Buffalo NY 14260 USA Department of Psychology West Virginia University Morgantown WV 26506 USA MIRECC VA North Little Rock AR 72114 USA QUERI for Team-Based Behavioral Health Centr

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Patterns in Patient Safety with Computerized Consult Management and Clinical documentation

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Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care 2014年第1期3卷 134 - 141页

作者： Jason J. Saleem Richard M. Frankel Bradley N. doebbeling Emily S. Patterson Human Factors Engineering Office of Informatics and Analytics Veterans Health Administration Louisville KY USAVA HSR&D Center on Implementing Evidence-Based Practice Roudebush VA Medical Center Indianapolis IN USA VA HSR&D Center on Implementing Evidence-Based Practice Roudebush VA Medical Center Indianapolis IN USADepartment of Medicine Indiana University (IU) School of Medicine Indianapolis IN USA Department of BioHealth Informatics Indiana University (IU) School of Informatics and Computing Indianapolis IN USA Division of Health Information Management and Systems School of Health and Rehabilitation Sciences College of Medicine The Ohio State University Columbus OH USA

Patient safety issues continue to be prevalent in delivering care with the electronic health record (EHR) and other health information technology (HIT) tools. defining the unit of analysis for the study of clinical information systems is important based on the focus of the research. This study applies a conceptual framework with three levels of units of analysis for human-computer interaction (HCI) to identify and guide investigations at each level. Ethnographic observations and semi-structured, key-informant interviews were conducted with 40 healthcare workers across five primary care clinics, nine specialty clinics, and one inpatient ward at a tertiary-care Veterans Affairs Medical center (vaMC). Two researchers recorded the interactions and interview responses of 40 healthcare workers related to their work with computerized consultations, clinical documentation, and the EHR in general. Patient safety issues from these data were categorized using three different units of analysis: EHR interface-, team coordination / workflow-, and organizational-levels. A total of 30 patient safety issues were identified; 17 emerged from the observation and interview data on computerized consults, 10 from the data on clinical documentation, and 3 were related to the EHR in general. Patient safety issues were organized by level of unit of analysis and mapped to specific methods that could be used for further investigation. Relevant concepts are discussed to help guide investigations at each level.

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Integrating depression Care: The Time Has Come

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JOURNAL OF GENERAL INTERNAL MEdICINE 2013年第3期28卷 333-335页

作者： Kroenke, Kurt Roudebush VA Med Ctr VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA Indiana Univ Dept Med Indianapolis IN USA Regenstrief Inst Inc Indianapolis IN USA

The Veterans Health Administration (VHA) has been an excellent health care system in which to implement and evaluate new models of integrating depression care. A single payer providing comprehensive medical and mental health services for eligible beneficiaries, a commitment to the parity of mental with medical disorders, an investment in mental health resources, and a nationwide electronic medical record all reduce some of the barriers that commonly exist in other practice settings. Also, primary care has received extra attention, including routine depression screening (97 % of eligible patients received depression screening in 2010) and the funding of additional mental health resources embedded in primary care. This issue of JGIM includes two reports on the VHA track record of integrating depression care.

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"Attention on the flight deck": What ambulatory care providers can learn from pilots about complex coordinated actions

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PATIENT EdUCATION ANd COUNSELING 2013年第3期93卷 367-372页

作者： Frankel, Richard M. Saleem, Jason J. Roudebush VA Med Ctr Ctr Implementing Evidence Based Practice VA Hlth Serv Res & Dev HSR&D Indianapolis IN USA Indiana Univ Ctr Hlth Serv & Outcomes Res Indianapolis IN 46204 USA Regenstrief Inst Inc Indianapolis IN USA IU Sch Med Dept Med Indianapolis IN USA Vet Hlth Adm Off Informat & Analyt Indianapolis IN USA

Objective: Technical and interpersonal challenges of using electronic health records (EHRs) in ambulatory care persist. We use cockpit communication as an example of highly coordinated complex activity during flight and compare it with providers' communication when computers are used in the exam room. Methods: Maximum variation sampling was used to identify two videotapes from a parent study of primary care physicians' exam room computer demonstrating the greatest variation. We then produced and analyzed visualizations of the time providers spent looking at the computer and looking at the patient. Results: Unlike the cockpit which is engineered to optimize joint attention on complex coordinated activities, we found polar extremes in the use of joint focus of attention to manage the medical encounter. Conclusion: We conclude that there is a great deal of room for improving the balance of interpersonal and technical attention that occurs in routine ambulatory visits in which computers are present in the exam room. practice implications: Using well-known aviation practices can help primary care providers become more aware of the opportunities and challenges for enhancing the physician patient relationship in an era of exam room computing. Published by Elsevier Ireland Ltd.

关键词： Person/machine interaction Electronic health records Social interaction Situation awareness

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Paper- and computer-based workarounds to electronic health record use at three benchmark institutions

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JOURNAL OF THE AMERICAN MEdICAL INFORMATICS ASSOCIATION 2013年第E1期20卷 E59-E66页

作者： Flanagan, Mindy E. Saleem, Jason J. Millitello, Laura G. Russ, Alissa L. doebbeling, Bradley N. Indiana Univ Ctr Hlth Serv & Outcomes Res Indianapolis IN 46202 USA Roudebush VA Med Ctr VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN USA Regenstrief Inst Inc Indianapolis IN USA Appl Decis Sci Cincinnati OH USA Purdue Univ Dept Pharm Practice W Lafayette IN 47907 USA IU Sch Med Dept Med Indianapolis IN USA IU Sch Informat Indianapolis IN USA

Background Healthcare professionals develop workarounds rather than using electronic health record (EHR) systems. Understanding the reasons for workarounds is important to facilitate user-centered design and alignment between work context and available health information technology tools. Objective To examine both paper-and computer-based workarounds to the use of EHR systems in three benchmark institutions. Methods Qualitative data were collected in 11 primary care outpatient clinics across three healthcare institutions. data collection methods included direct observation and opportunistic questions. In total, 120 clinic staff and providers and 118 patients were observed. All data were analyzed using previously developed workaround categories and examined for potential new categories. Additionally, workarounds were coded as either paper-or computer-based. Results Findings corresponded to 10 of 11 workaround categories identified in previous research. All 10 of these categories applied to paper-based workarounds;five categories also applied to computer-based workarounds. One new category, no correct path (eg, a desired option did not exist in the computer interface, precipitating a workaround), was identified for computer-based workarounds. The most consistent reasons for workarounds across the three institutions were efficiency, memory, and awareness. Conclusions Consistent workarounds across institutions suggest common challenges in outpatient clinical settings and failures to accommodate these challenges in EHR design. An examination of workarounds provides insight into how providers adapt to limiting EHR systems. Part of the design process for computer interfaces should include user-centered methods particular to providers and healthcare settings to ensure uptake and usability.

关键词： electronic health record workarounds

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"I'm Not Abusing or Anything": Patient-physician communication about opioid treatment in chronic pain

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PATIENT EdUCATION ANd COUNSELING 2013年第2期93卷 197-202页

作者： Matthias, Marianne S. Krebs, Erin E. Collins, Linda A. Bergman, Alicia A. Coffing, Jessica Bair, Matthew J. Roudebush VA Med Ctr VA HSR&D Ctr Implementing Evidence Based Practice Indianapolis IN 46202 USA Regenstrief Inst Inc Indianapolis IN USA Indiana Univ Purdue Univ Dept Commun Studies Indianapolis IN 46202 USA Minneapolis VA Hlth Care Syst Minneapolis MN USA Univ Minnesota Sch Med Dept Med Minneapolis MN 55455 USA Indiana Univ Sch Med Dept Med Indianapolis IN 46202 USA

Objective: To characterize clinical communication about opioids through direct analysis of clinic visits and in-depth interviews with patients. Methods: This was a pilot study of 30 patients with chronic pain, who were audio-recorded in their primary care visits and interviewed after the visit about their pain care and relationship with their physicians. Emergent thematic analysis guided data interpretation. Results: Uncertainties about opioid treatment for chronic pain, particularly addiction and misuse, play an important role in communicating about pain treatment. Three patterns of responding to uncertainty emerged in conversations between patients and physicians: reassurance, avoiding opioids, and gathering additional information. Results are interpreted within the framework of Problematic Integration theory. Conclusion: Although it is well-established that opioid treatment for chronic pain poses numerous uncertainties, little is known about how patients and their physicians navigate these uncertainties. This study illuminates ways in which patients and physicians face uncertainty communicatively and collaboratively. practice implications: Acknowledging and confronting the uncertainties inherent in chronic opioid treatment are critical communication skills for patients taking opioids and their physicians. Many of the communication behaviors documented in this study may serve as a model for training patients and physicians to communicate effectively about opioids. Published by Elsevier Ireland Ltd.

关键词： Chronic pain Opioids Patient-provider communication Qualitative research

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do persons with schizophrenia who have better metacognitive capacity also have a stronger subjective experience of recovery?

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PSYCHIATRY RESEARCH 2013年第3期209卷 381-385页

作者： Kukla, Marina Lysaker, Paul H. Salyers, Michelle P. Richard L Roudebush VA Med Ctr HSR&D Ctr Excellence Implementing Evidence Based Indianapolis IN 46202 USA Indiana Univ Purdue Univ Dept Psychol Indianapolis IN 46202 USA Richard L Roudebush VA Med Ctr Day Hosp Indianapolis IN 46202 USA Indiana Univ Sch Med Bloomington IN 47405 USA ACT Ctr Indiana Indianapolis IN 46202 USA

Research suggests that persons with schizophrenia experience deficits in the ability to synthesize complex and integrated representations of themselves and others. While impairments in these metacognitive capacities are hypothetically related to the ability to make sense of the challenges of schizophrenia, little is known about their relationship with the subjective experience of recovery from mental illness. To examine this question, this study investigated whether persons with stronger self-reported recovery had better metacognitive capacity, after controlling for severity of psychiatric symptoms. Forty-six outpatients with schizophrenia spectrum disorders who were taking part in a study of the Illness Management and Recovery program were concurrently administered the Recovery Assessment Scale, the Positive and Negative Syndrome Scale, and the Indiana Psychiatric Illness Interview which was scored using the Abbreviated Metacognitive Assessment Scale. Analysis of covariance revealed that metacognitive capabilities reflecting self-reflectivity and decentration were differentially related to several components of recovery beyond the effects of psychiatric symptoms. The metacognitive abilities to think about oneself in a sophisticated way and form integrated ideas about oneself and others within the larger world, understanding that none are the metaphorical center are present in individuals holding strong perceptions of recovery. Published by Elsevier Ireland Ltd.

关键词： Recovery Metacognition Schizophrenia Symptoms

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