Patricia Coon - Academia.edu (original) (raw)
Papers by Patricia Coon
Biochemistry, Mar 25, 1975
Galactose oxidase is a metalioenzyme containing a single copper atom per molecule. The mechanism ... more Galactose oxidase is a metalioenzyme containing a single copper atom per molecule. The mechanism of action of galactose oxidase is studied in this paper by investigating substrate specificity and activation by peroxidase, and probing the copper site by electron spin resonance (ESR) spectroscopy. Line-shape simulation of ESR spectra are also reported and a comparison is made between ob
Journal of the American Geriatrics Society, Oct 1, 1989
To determine the short-term functional and medical outcomes and predictors of outcome following d... more To determine the short-term functional and medical outcomes and predictors of outcome following discharge from an acute hospital emergency department, 100 elderly (greater than or equal to 65 yr) and 100 nonelderly (less than 65 yr) patients were studied prospectively. Patients were interviewed at three days and again at three weeks following emergency department discharge. The number of new prescriptions given to both groups in the emergency department was similar (elderly 41%; nonelderly, 31%). The elderly were as likely as the nonelderly to know the correct name (elderly, 88%; nonelderly, 87%), dosage schedule (elderly, 90%; nonelderly, 90%) and purpose (elderly, 85%; nonelderly, 94%) of their new medications. There was no difference in patients' understanding of the diagnosis (elderly, 72%; nonelderly, 72%) or in medication compliance (elderly, 81%; nonelderly, 74%). Elderly patients were more likely to keep scheduled follow-up appointments (87% vs 65%; P less than .05). Despite these similarities the elderly had worse medical outcomes at three weeks; 67% of the elderly were better and 20% were worse, including seven patients who required interim hospitalization, four of whom died. In contrast, 82% of the nonelderly were better and only 4% were worse (P less than .01). None of the nonelderly required hospitalization or had died. Functional impairments were more common in the elderly both at baseline (elderly, 26%; nonelderly, 6%; P less than .01) and at three weeks (elderly, 27%; nonelderly, 5%; P less than .001). Independent predictors of poor medical outcome included age greater than or equal to 65 (P less than .009) and functional impairment at baseline (P less than .022).(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Gerontology, Mar 1, 1989
The pattern of body fat distribution has been shown to be related to a large number of variables ... more The pattern of body fat distribution has been shown to be related to a large number of variables of clinical importance. A variety of indices have been devised, many of them simple enough to be useful in large-scale clinical studies. Relationships among these several indices and systematic information on the effects of age, sex, and obesity have, however, not been systematically studied. Five anthropometric ratios that classify individuals into different body types have been computed for 1179 men and women aged 17-96 years. These are: waist hip ratio, arm thigh ratio, waist thigh ratio, waist arm ratio, and subscapular triceps skinfold ratio. In general, the age patterns show progressive trends toward increasing upper and central body fat deposition with age. In women there tends to be a postmenopausal acceleration of this trend. The ratios are distinctly higher in men than in women and are also independently influenced by the body mass index. Predictive equations that take age and BMI into account for each of the indices for men and women have been provided.
Endocrinology and Metabolism Clinics of North America, Dec 1, 1987
Medicine and Science in Sports and Exercise, Apr 1, 1989
Value in Health, 2019
Objectives: To evaluate differences in receipt of diabetes care services: A1C test, foot examinat... more Objectives: To evaluate differences in receipt of diabetes care services: A1C test, foot examination, dilated eye examination, flu vaccination and serum cholesterol test between privately health-insured and publicly health-insured diabetic subjects. Methods: Using the household component Medical Expenditure Panel Data Survey (MEPS) 2015 consolidated data, a secondary data analysis was carried out. Logistic regression was used to separately model the effect of insurance type on the receipt of each of the diabetes-care quality indicators: dilated eye examination, serum cholesterol test, foot examination, flu vaccination and A1C test. For subjects aged 18-64 yrs., private insurance-only versus public insurance-only users were compared using 348 eligible subjects, while for subjects above 64 yrs., Medicare-only versus Medicare plus private insurance users were compared using sample size of 240. Effects of age, education level, gender, income and race were controlled. Results: For subjects 18-64 yrs., the receipt of eye examination (OR 0.85, 95% CI: 0.51-1.41); foot examination (OR 0.716, 95% CI: 0.42-1.22), A1C test (OR 0.73, 95% CI: 0.40-1.34); flu vaccination (OR 0.901, 95% CI: 0.55-1.48); and serum cholesterol test (OR 1.35, 95% CI: 0.64-2.87); were not significantly associated with type of insurance coverage. Comparing Medicare versus Medicare plus private coverage for subjects above 64 yrs., the receipt of eye examination (OR 1.76, 95% CI: 0.88-3.50); feet examination (OR 1.13, 95% CI: 0.57-2.26), A1C test (OR 0.89, 95% CI: 0.38-2.08); and flu vaccination (OR 1.26, 95% CI: 0.63-2.50) were not significantly associated with type of coverage while odds of blood cholesterol test is higher (OR 1.35, 95% CI: 0.64-2.87) with Medicare plus private coverage users. Conclusions: Receipt of most key preventive and monitoring services among people with diabetes is similar between private and public insurance users, however elderly diabetic Medicare users with any additional private coverage are a little more likely to receive blood cholesterol test than Medicare-only users.
Value in Health, 2019
peripheral neuropathy reports) were considered, after inclusion criteria were applied. Fluoroquin... more peripheral neuropathy reports) were considered, after inclusion criteria were applied. Fluoroquinolones had the greatest proportion of peripheral neuropathy reports of all antibiotics studied, representing 14% of all fluoroquinolone reports. Peripheral neuropathy RORs (95%CI) were statistically significant for (in descending order):
Journal of Gerontology, 1987
Ülkemizde yaşlı nüfusun artmasına paralel olarak acil servislerin yaşlı nüfus tarafından kullanım... more Ülkemizde yaşlı nüfusun artmasına paralel olarak acil servislerin yaşlı nüfus tarafından kullanımı da artmaktadır. Bu çalışmada acil polikliniğe başvuran 65 yaş ve üzeri olguların klinik ve demografik verileri değerlendirilerek acil departmandan daha etkin ve yeterli faydalanması için neler yapılabileceğinin ortaya koyulması amaçlanmıştır. Gereç ve Yöntem: 2011 yılında Isparta Devlet hastanesi Acil servisine başvuran 65 yaş ve üzeri hastaların kayıtları geriye dönük olarak incelendi. Tüm veriler SPSS 17.0 programına yüklenerek değerlendirilmiştir. Bulgular: Çalışma süresince Acil servisimize başvuran toplam 114522 hastanın 14645'i (%12,7) geriatrik hastaydı. Yaş ortalamaları 74,6 ± 6, en sık başvuru nedeni kardiyolojik problemler 3120 (%21,3), solunum sistemi problemleri 2040 (%13,9) gastrointestinal problemler 1875 (%12,8), nörolojik problemler 1512 (%10,3) ve kas-iskelet sistemi problemleri 1230 (%8,4) izliyordu. Hastaların %71'i ayaktan tedavi edilirken 1877 hasta (%12,8) yatırılarak tedavi edilmiş ve 9 hasta acil serviste kaybedilmişti. Tartışma: Geriatrik hastaların acil servislerde takiplerinde, hastaların ve hastanelerin kendine has bazı bölgesel farklılıkları görülebilir. Her hastanenin kendi hasta profilini göz önüne alarak özel ihtiyaçlarını tespit edip, acil servis hizmetlerini bu özelliklere göre düzenlemelerini önermekteyiz.
Journal of Molecular Biology, Mar 1, 1977
The previously unidentified products of the remainder of those genes (Y-genes) known to be essent... more The previously unidentified products of the remainder of those genes (Y-genes) known to be essential for bacteriophage T4 capsid formation (genes 21, 31 and 40) have been identified by sodium dodecyl sulfate/urea/aerylamide gradient gel electrophoresis. Characteristics of this gel system, which differs from the standard gel system and has superior resolution of low molecular weight proteins, are described. Protein identifications have been confirmed by two-dimeusional isoelectrie focusing sodium dodeeyl sulfate/urea/acrylamide gradient gel electrophoresis. P31 (Mr approx. 16,000) and P40 (Mr approx. 14,000) are early proteins which are apparently not cleaved during head assembly, nor incorporated into either the mature phage head or prohead (T-particles); P31 appears to be greatly overproduced by cgrtain T4 mutants. P21 (/~/r approx. 26,000) is a late protein incorporated in large amounts into r-particles, but is cleaved during head maturation. Properties of these three proteins which appear to have morphogenetic rather than structural roles in capsid formation, are correlated with known properties of their structural genes. It appears that essential T4 head formation gene products in the capsid are limited to P20, P23", and P24".
cholesterol subspecies and elevated postheparin hepatic lipase activity in
Purpose: To determine whether a health information technology-based intervention to improve provi... more Purpose: To determine whether a health information technology-based intervention to improve provider-to-provider communication and standardize the discharge process will improve medication reconciliation and readmissions rates; patient follow-up, education, adherence, and care satisfaction; and provider satisfaction. Scope: Medically complex adults (managing at least two chronic conditions) discharged home from an urban hospital to a rural community were eligible to participate. A total of 1,197 patients were randomly selected from 4,300 eligible patients from 185 rural health centers. Methods: The primary intervention standardized the hospital discharge process by: (1) modifying the current electronic health record system to institute an electronic discharge " check list; " and (2) communicating key patient discharge information to rural primary care providers. A second intervention modified the EHR-based medication reconciliation process. Primary outcomes measures includ...
Journal of Leukocyte Biology, 1986
BMJ open diabetes research & care, 2018
Determine the effectiveness of a 16-week modified diabetes prevention program (DPP) administered ... more Determine the effectiveness of a 16-week modified diabetes prevention program (DPP) administered simultaneously to multiple rural communities from a single urban site, as compared with a similar face-to-face intervention. A 12-week intervention was evaluated to consider minimization of staff costs in communities where resources are limited. A prospective cohort study compared DPP interventions implemented in rural (via telehealth technology) and urban (face-to-face) communities using an intent-to-treat analysis. Primary outcome measures included 5% and 7% body weight loss. Logistic regression analyses were used to determine predictors of intervention success and included a variable for treatment effect. Between 2010 and 2015, up to 667 participants were enrolled in the study representing one urban and 15 rural communities across Montana. The 16-week urban and rural interventions were comparable; 33.5% and 34.6% of participants lost 7% body weight, respectively; 50% and 47% lost 5% (...
Medicine and Science in Sports and Exercise, 1980
Ostomy/wound management, 2005
Measures of effective diabetes management usually include laboratory results and the provider'... more Measures of effective diabetes management usually include laboratory results and the provider's point of view, omitting the patient perspective. To address this oversight, a descriptive study was conducted to examine congruence between rural patient self-reported and provider-documented information on American Diabetes Association recommended guidelines. Provider medical record information and patient questionnaires were matched for 149 patients with a diagnosis of type 2 diabetes being treated at rural healthcare facilities. Chi-squared testing showed a significant difference (P < 0.05) between patient and provider information in answers to questions on blood pressure and cholesterol testing, eye examination, influenza and pneumovax rates, and diabetic and nutrition education. Patients' perception of diabetes and blood pressure control did not always match documented values. To achieve diabetes control, providers must implement clinical practice guidelines and patients m...
Ostomy/wound management, 2004
Urban and rural elderly face a multitude of barriers to healthy aging and maintaining adequate nu... more Urban and rural elderly face a multitude of barriers to healthy aging and maintaining adequate nutrition. Looking at commonalties and differences between urban and rural elderly that are associated with nutritional risk is an important first step in identifying and correcting nutritional insufficiencies. To examine health behaviors and nutritional information associated with nutritional risk in urban and rural areas and to develop a profile of nutritional risk for rural and urban elderly, data from one retrospective and two prospective studies were analyzed. One hundred, eighty-three (183) urban-living and 167 rural-living older adults (average age 77 years old) participated in the studies. More than 60% of participants were women. Overall health ratings were significantly higher for urban than for rural elderly. Rural dwellers had significantly fewer dental visits (41% versus 76%) but higher albumin values than their urban counterparts. Results from the synthesis of these four stud...
Telemedicine and e-Health, 2009
The objective of this study was to determine the reliability of the Mini-Mental State Examination... more The objective of this study was to determine the reliability of the Mini-Mental State Examination (MMSE) administration via telehealth with a focus on the auditory and visual test components. Reliability was assessed through use of an in-person collaborator and by assessment of faxed test copies. The MMSE was administered via telehealth with the assistance of a face-to-face collaborator. Patient responses were recorded by both the remote and in-person nurse and compared item by item; total scores for each subject were also compared. Visual items were assessed through a blinded separate scoring of a faxed copy. Percent agreement per item and total score were calculated and correlations between scores were determined by Pearson correlation coefficients. Mean score differences and associated 95% confidence intervals were calculated. Eighty percent of individual items demonstrated remote to in-person agreement of >95% and all items were >85.5% in agreement. Pearson correlation coefficients demonstrated high correlations (>0.86) between 80% of the items examined. Mean differences in scored test items were not significantly different from zero. This study demonstrates the utility of using telehealth for cognitive assessment by MMSE. It supports the use of telehealth to improve healthcare access among patients for whom distance, cost, and mobility are potential barriers to attending face-to-face clinical visits. Continued validation and reliability testing is warranted to ensure that all healthcare provided via telehealth maintains an equal quality level to that of in-person care.
Telemedicine and e-Health, 2011
Objective: The objectives of this study were to demonstrate the feasibility of telehealth technol... more Objective: The objectives of this study were to demonstrate the feasibility of telehealth technology to provide a team approach to diabetes care for rural patients and determine its effect on patient outcomes when compared with face-to-face diabetes visits. Materials and Methods: An evaluation of a patient-centered interdisciplinary team approach to diabetes management compared telehealth with face-to-face visits on receipt of recommended preventive guidelines, vascular risk factor control, patient satisfaction, and diabetes self-management at baseline and 1, 2, and 3 years postintervention. Results: One-year postintervention the receipt of recommended dilated eye exams increased 31% and 43% among telehealth and face-to-face patients, respectively (p = 0.28). Control of two or more risk factors increased 37% and 69% (p = 0.21). Patient diabetes care satisfaction rates increased 191% and 131% among telehealth and face-to-face patients, respectively (p = 0.51). A comparison of telehealth with face-to-face patients resulted in increased self-reported blood glucose monitoring as instructed (97% vs. 89%; p = 0.63) and increased dietary adherence (244% vs. 159%; p = 0.86), respectively. Receipt of a monofilament foot test showed a significantly greater improvement among face-to-face patients (17% vs. 35%; p = 0.01) at 1 year postintervention, but this difference disappeared in years 2 and 3. Conclusions: Telehealth proved to be an effective mode for the provision of diabetes care to rural patients. Few differences were detected in the delivery of a team approach to diabetes management via telehealth compared with face-to-face visits on receipt of preventive care services, vascular risk factor control, patient satisfaction, and patient self-management. A team approach using telehealth may be a viable strategy for addressing the unique challenges faced by patients living in rural communities.
Journal of Diabetes Science and Technology, 2010
In this issue of Journal of Diabetes Science and Technology, Rao and colleagues present a compari... more In this issue of Journal of Diabetes Science and Technology, Rao and colleagues present a comparison of three iPhone diabetes data management applications: the Diamedic Diabetes Logbook, Blood Sugar Diabetes Control, and WaveSense Diabetes Manager. These applications provide patients the ability to enter blood glucose readings manually, view graphs and simple statistics, and email data to health care providers. While these applications show promise, they are limited in their current forms. All require manual data entry and none convert insulin-to-carbohydrate ratios to insulin dose. Future development of these types of technology should consider integration with blood glucose meters and expanded calculation capabilities, as well as monitoring of other risk factors, e.g., blood pressure and lipids, and tracking of preventive examinations, e.g., eye, foot, and renal.
Biochemistry, Mar 25, 1975
Galactose oxidase is a metalioenzyme containing a single copper atom per molecule. The mechanism ... more Galactose oxidase is a metalioenzyme containing a single copper atom per molecule. The mechanism of action of galactose oxidase is studied in this paper by investigating substrate specificity and activation by peroxidase, and probing the copper site by electron spin resonance (ESR) spectroscopy. Line-shape simulation of ESR spectra are also reported and a comparison is made between ob
Journal of the American Geriatrics Society, Oct 1, 1989
To determine the short-term functional and medical outcomes and predictors of outcome following d... more To determine the short-term functional and medical outcomes and predictors of outcome following discharge from an acute hospital emergency department, 100 elderly (greater than or equal to 65 yr) and 100 nonelderly (less than 65 yr) patients were studied prospectively. Patients were interviewed at three days and again at three weeks following emergency department discharge. The number of new prescriptions given to both groups in the emergency department was similar (elderly 41%; nonelderly, 31%). The elderly were as likely as the nonelderly to know the correct name (elderly, 88%; nonelderly, 87%), dosage schedule (elderly, 90%; nonelderly, 90%) and purpose (elderly, 85%; nonelderly, 94%) of their new medications. There was no difference in patients&amp;#39; understanding of the diagnosis (elderly, 72%; nonelderly, 72%) or in medication compliance (elderly, 81%; nonelderly, 74%). Elderly patients were more likely to keep scheduled follow-up appointments (87% vs 65%; P less than .05). Despite these similarities the elderly had worse medical outcomes at three weeks; 67% of the elderly were better and 20% were worse, including seven patients who required interim hospitalization, four of whom died. In contrast, 82% of the nonelderly were better and only 4% were worse (P less than .01). None of the nonelderly required hospitalization or had died. Functional impairments were more common in the elderly both at baseline (elderly, 26%; nonelderly, 6%; P less than .01) and at three weeks (elderly, 27%; nonelderly, 5%; P less than .001). Independent predictors of poor medical outcome included age greater than or equal to 65 (P less than .009) and functional impairment at baseline (P less than .022).(ABSTRACT TRUNCATED AT 250 WORDS)
Journal of Gerontology, Mar 1, 1989
The pattern of body fat distribution has been shown to be related to a large number of variables ... more The pattern of body fat distribution has been shown to be related to a large number of variables of clinical importance. A variety of indices have been devised, many of them simple enough to be useful in large-scale clinical studies. Relationships among these several indices and systematic information on the effects of age, sex, and obesity have, however, not been systematically studied. Five anthropometric ratios that classify individuals into different body types have been computed for 1179 men and women aged 17-96 years. These are: waist hip ratio, arm thigh ratio, waist thigh ratio, waist arm ratio, and subscapular triceps skinfold ratio. In general, the age patterns show progressive trends toward increasing upper and central body fat deposition with age. In women there tends to be a postmenopausal acceleration of this trend. The ratios are distinctly higher in men than in women and are also independently influenced by the body mass index. Predictive equations that take age and BMI into account for each of the indices for men and women have been provided.
Endocrinology and Metabolism Clinics of North America, Dec 1, 1987
Medicine and Science in Sports and Exercise, Apr 1, 1989
Value in Health, 2019
Objectives: To evaluate differences in receipt of diabetes care services: A1C test, foot examinat... more Objectives: To evaluate differences in receipt of diabetes care services: A1C test, foot examination, dilated eye examination, flu vaccination and serum cholesterol test between privately health-insured and publicly health-insured diabetic subjects. Methods: Using the household component Medical Expenditure Panel Data Survey (MEPS) 2015 consolidated data, a secondary data analysis was carried out. Logistic regression was used to separately model the effect of insurance type on the receipt of each of the diabetes-care quality indicators: dilated eye examination, serum cholesterol test, foot examination, flu vaccination and A1C test. For subjects aged 18-64 yrs., private insurance-only versus public insurance-only users were compared using 348 eligible subjects, while for subjects above 64 yrs., Medicare-only versus Medicare plus private insurance users were compared using sample size of 240. Effects of age, education level, gender, income and race were controlled. Results: For subjects 18-64 yrs., the receipt of eye examination (OR 0.85, 95% CI: 0.51-1.41); foot examination (OR 0.716, 95% CI: 0.42-1.22), A1C test (OR 0.73, 95% CI: 0.40-1.34); flu vaccination (OR 0.901, 95% CI: 0.55-1.48); and serum cholesterol test (OR 1.35, 95% CI: 0.64-2.87); were not significantly associated with type of insurance coverage. Comparing Medicare versus Medicare plus private coverage for subjects above 64 yrs., the receipt of eye examination (OR 1.76, 95% CI: 0.88-3.50); feet examination (OR 1.13, 95% CI: 0.57-2.26), A1C test (OR 0.89, 95% CI: 0.38-2.08); and flu vaccination (OR 1.26, 95% CI: 0.63-2.50) were not significantly associated with type of coverage while odds of blood cholesterol test is higher (OR 1.35, 95% CI: 0.64-2.87) with Medicare plus private coverage users. Conclusions: Receipt of most key preventive and monitoring services among people with diabetes is similar between private and public insurance users, however elderly diabetic Medicare users with any additional private coverage are a little more likely to receive blood cholesterol test than Medicare-only users.
Value in Health, 2019
peripheral neuropathy reports) were considered, after inclusion criteria were applied. Fluoroquin... more peripheral neuropathy reports) were considered, after inclusion criteria were applied. Fluoroquinolones had the greatest proportion of peripheral neuropathy reports of all antibiotics studied, representing 14% of all fluoroquinolone reports. Peripheral neuropathy RORs (95%CI) were statistically significant for (in descending order):
Journal of Gerontology, 1987
Ülkemizde yaşlı nüfusun artmasına paralel olarak acil servislerin yaşlı nüfus tarafından kullanım... more Ülkemizde yaşlı nüfusun artmasına paralel olarak acil servislerin yaşlı nüfus tarafından kullanımı da artmaktadır. Bu çalışmada acil polikliniğe başvuran 65 yaş ve üzeri olguların klinik ve demografik verileri değerlendirilerek acil departmandan daha etkin ve yeterli faydalanması için neler yapılabileceğinin ortaya koyulması amaçlanmıştır. Gereç ve Yöntem: 2011 yılında Isparta Devlet hastanesi Acil servisine başvuran 65 yaş ve üzeri hastaların kayıtları geriye dönük olarak incelendi. Tüm veriler SPSS 17.0 programına yüklenerek değerlendirilmiştir. Bulgular: Çalışma süresince Acil servisimize başvuran toplam 114522 hastanın 14645'i (%12,7) geriatrik hastaydı. Yaş ortalamaları 74,6 ± 6, en sık başvuru nedeni kardiyolojik problemler 3120 (%21,3), solunum sistemi problemleri 2040 (%13,9) gastrointestinal problemler 1875 (%12,8), nörolojik problemler 1512 (%10,3) ve kas-iskelet sistemi problemleri 1230 (%8,4) izliyordu. Hastaların %71'i ayaktan tedavi edilirken 1877 hasta (%12,8) yatırılarak tedavi edilmiş ve 9 hasta acil serviste kaybedilmişti. Tartışma: Geriatrik hastaların acil servislerde takiplerinde, hastaların ve hastanelerin kendine has bazı bölgesel farklılıkları görülebilir. Her hastanenin kendi hasta profilini göz önüne alarak özel ihtiyaçlarını tespit edip, acil servis hizmetlerini bu özelliklere göre düzenlemelerini önermekteyiz.
Journal of Molecular Biology, Mar 1, 1977
The previously unidentified products of the remainder of those genes (Y-genes) known to be essent... more The previously unidentified products of the remainder of those genes (Y-genes) known to be essential for bacteriophage T4 capsid formation (genes 21, 31 and 40) have been identified by sodium dodecyl sulfate/urea/aerylamide gradient gel electrophoresis. Characteristics of this gel system, which differs from the standard gel system and has superior resolution of low molecular weight proteins, are described. Protein identifications have been confirmed by two-dimeusional isoelectrie focusing sodium dodeeyl sulfate/urea/acrylamide gradient gel electrophoresis. P31 (Mr approx. 16,000) and P40 (Mr approx. 14,000) are early proteins which are apparently not cleaved during head assembly, nor incorporated into either the mature phage head or prohead (T-particles); P31 appears to be greatly overproduced by cgrtain T4 mutants. P21 (/~/r approx. 26,000) is a late protein incorporated in large amounts into r-particles, but is cleaved during head maturation. Properties of these three proteins which appear to have morphogenetic rather than structural roles in capsid formation, are correlated with known properties of their structural genes. It appears that essential T4 head formation gene products in the capsid are limited to P20, P23", and P24".
cholesterol subspecies and elevated postheparin hepatic lipase activity in
Purpose: To determine whether a health information technology-based intervention to improve provi... more Purpose: To determine whether a health information technology-based intervention to improve provider-to-provider communication and standardize the discharge process will improve medication reconciliation and readmissions rates; patient follow-up, education, adherence, and care satisfaction; and provider satisfaction. Scope: Medically complex adults (managing at least two chronic conditions) discharged home from an urban hospital to a rural community were eligible to participate. A total of 1,197 patients were randomly selected from 4,300 eligible patients from 185 rural health centers. Methods: The primary intervention standardized the hospital discharge process by: (1) modifying the current electronic health record system to institute an electronic discharge " check list; " and (2) communicating key patient discharge information to rural primary care providers. A second intervention modified the EHR-based medication reconciliation process. Primary outcomes measures includ...
Journal of Leukocyte Biology, 1986
BMJ open diabetes research & care, 2018
Determine the effectiveness of a 16-week modified diabetes prevention program (DPP) administered ... more Determine the effectiveness of a 16-week modified diabetes prevention program (DPP) administered simultaneously to multiple rural communities from a single urban site, as compared with a similar face-to-face intervention. A 12-week intervention was evaluated to consider minimization of staff costs in communities where resources are limited. A prospective cohort study compared DPP interventions implemented in rural (via telehealth technology) and urban (face-to-face) communities using an intent-to-treat analysis. Primary outcome measures included 5% and 7% body weight loss. Logistic regression analyses were used to determine predictors of intervention success and included a variable for treatment effect. Between 2010 and 2015, up to 667 participants were enrolled in the study representing one urban and 15 rural communities across Montana. The 16-week urban and rural interventions were comparable; 33.5% and 34.6% of participants lost 7% body weight, respectively; 50% and 47% lost 5% (...
Medicine and Science in Sports and Exercise, 1980
Ostomy/wound management, 2005
Measures of effective diabetes management usually include laboratory results and the provider'... more Measures of effective diabetes management usually include laboratory results and the provider's point of view, omitting the patient perspective. To address this oversight, a descriptive study was conducted to examine congruence between rural patient self-reported and provider-documented information on American Diabetes Association recommended guidelines. Provider medical record information and patient questionnaires were matched for 149 patients with a diagnosis of type 2 diabetes being treated at rural healthcare facilities. Chi-squared testing showed a significant difference (P < 0.05) between patient and provider information in answers to questions on blood pressure and cholesterol testing, eye examination, influenza and pneumovax rates, and diabetic and nutrition education. Patients' perception of diabetes and blood pressure control did not always match documented values. To achieve diabetes control, providers must implement clinical practice guidelines and patients m...
Ostomy/wound management, 2004
Urban and rural elderly face a multitude of barriers to healthy aging and maintaining adequate nu... more Urban and rural elderly face a multitude of barriers to healthy aging and maintaining adequate nutrition. Looking at commonalties and differences between urban and rural elderly that are associated with nutritional risk is an important first step in identifying and correcting nutritional insufficiencies. To examine health behaviors and nutritional information associated with nutritional risk in urban and rural areas and to develop a profile of nutritional risk for rural and urban elderly, data from one retrospective and two prospective studies were analyzed. One hundred, eighty-three (183) urban-living and 167 rural-living older adults (average age 77 years old) participated in the studies. More than 60% of participants were women. Overall health ratings were significantly higher for urban than for rural elderly. Rural dwellers had significantly fewer dental visits (41% versus 76%) but higher albumin values than their urban counterparts. Results from the synthesis of these four stud...
Telemedicine and e-Health, 2009
The objective of this study was to determine the reliability of the Mini-Mental State Examination... more The objective of this study was to determine the reliability of the Mini-Mental State Examination (MMSE) administration via telehealth with a focus on the auditory and visual test components. Reliability was assessed through use of an in-person collaborator and by assessment of faxed test copies. The MMSE was administered via telehealth with the assistance of a face-to-face collaborator. Patient responses were recorded by both the remote and in-person nurse and compared item by item; total scores for each subject were also compared. Visual items were assessed through a blinded separate scoring of a faxed copy. Percent agreement per item and total score were calculated and correlations between scores were determined by Pearson correlation coefficients. Mean score differences and associated 95% confidence intervals were calculated. Eighty percent of individual items demonstrated remote to in-person agreement of >95% and all items were >85.5% in agreement. Pearson correlation coefficients demonstrated high correlations (>0.86) between 80% of the items examined. Mean differences in scored test items were not significantly different from zero. This study demonstrates the utility of using telehealth for cognitive assessment by MMSE. It supports the use of telehealth to improve healthcare access among patients for whom distance, cost, and mobility are potential barriers to attending face-to-face clinical visits. Continued validation and reliability testing is warranted to ensure that all healthcare provided via telehealth maintains an equal quality level to that of in-person care.
Telemedicine and e-Health, 2011
Objective: The objectives of this study were to demonstrate the feasibility of telehealth technol... more Objective: The objectives of this study were to demonstrate the feasibility of telehealth technology to provide a team approach to diabetes care for rural patients and determine its effect on patient outcomes when compared with face-to-face diabetes visits. Materials and Methods: An evaluation of a patient-centered interdisciplinary team approach to diabetes management compared telehealth with face-to-face visits on receipt of recommended preventive guidelines, vascular risk factor control, patient satisfaction, and diabetes self-management at baseline and 1, 2, and 3 years postintervention. Results: One-year postintervention the receipt of recommended dilated eye exams increased 31% and 43% among telehealth and face-to-face patients, respectively (p = 0.28). Control of two or more risk factors increased 37% and 69% (p = 0.21). Patient diabetes care satisfaction rates increased 191% and 131% among telehealth and face-to-face patients, respectively (p = 0.51). A comparison of telehealth with face-to-face patients resulted in increased self-reported blood glucose monitoring as instructed (97% vs. 89%; p = 0.63) and increased dietary adherence (244% vs. 159%; p = 0.86), respectively. Receipt of a monofilament foot test showed a significantly greater improvement among face-to-face patients (17% vs. 35%; p = 0.01) at 1 year postintervention, but this difference disappeared in years 2 and 3. Conclusions: Telehealth proved to be an effective mode for the provision of diabetes care to rural patients. Few differences were detected in the delivery of a team approach to diabetes management via telehealth compared with face-to-face visits on receipt of preventive care services, vascular risk factor control, patient satisfaction, and patient self-management. A team approach using telehealth may be a viable strategy for addressing the unique challenges faced by patients living in rural communities.
Journal of Diabetes Science and Technology, 2010
In this issue of Journal of Diabetes Science and Technology, Rao and colleagues present a compari... more In this issue of Journal of Diabetes Science and Technology, Rao and colleagues present a comparison of three iPhone diabetes data management applications: the Diamedic Diabetes Logbook, Blood Sugar Diabetes Control, and WaveSense Diabetes Manager. These applications provide patients the ability to enter blood glucose readings manually, view graphs and simple statistics, and email data to health care providers. While these applications show promise, they are limited in their current forms. All require manual data entry and none convert insulin-to-carbohydrate ratios to insulin dose. Future development of these types of technology should consider integration with blood glucose meters and expanded calculation capabilities, as well as monitoring of other risk factors, e.g., blood pressure and lipids, and tracking of preventive examinations, e.g., eye, foot, and renal.