Peter Toyinbo | University of South Florida (original) (raw)

Papers by Peter Toyinbo

Problem: Evidence based chronic disease self-management programs (CDSMPs) have reported success i... more Problem: Evidence based chronic disease self-management programs (CDSMPs) have reported success in improving health outcomes. Yet few attempt to address the complex issues associated with the co-occurrence of minor depression and chronic illness. With co-occurrence rates of depression and chronic illnesses (e.g. CVD, diabetes) reported as high as 30%, translation of health behavior research into practice is vital to improved health outcomes. This multiphase, community-based participatory research study was designed to better understand the needs and preferences of Latinos living with chronic illness and minor depression (ICDs), their families, and key stakeholders (i.e. service providers). Methods: This study employed a mixed methods design including: a) focus groups with ICDs (n=5) and family members (n=4) and b) semi-structured interviews followed by a survey with key stakeholders (n=31) to obtain views on living with chronic illness, barriers and facilitators to self-management, ...

Nursing Outlook, 2021

BACKGROUND Responding to National Academy of Medicine and National Council of State Boards of Nur... more BACKGROUND Responding to National Academy of Medicine and National Council of State Boards of Nursing recommendations, the Department of Veterans Health Affairs (VHA) implemented full practice authority (FPA) for Advanced Practice Registered Nurses in VHA medical centers (VAMCs) in 2017. PURPOSE To evaluate FPA policy implementation's impact on quality indicators including access to care as measured by new patient appointments in primary, specialty and mental health services. METHODS Linear growth models compared early (n = 85) vs. late (n = 55) FPA implementing VAMCs on the trajectories of each of the three quality indicators. FINDINGS Early FPA implementing VAMCs showed greater rates of improvement over time in new patient appointments completed within 30 days of preferred date for primary care (p = .003), specialty care (p = 0.05), and mental health (p = 0.001). DISCUSSION VAMCs that started implementation of FPA policy early showed greater improvement in access to care for Veterans over time than VAMCs that did not.

Optometry and Vision Science, 2021

We know the prevalence of traumatic brain injury (TBI) related vision impairment and ocular injur... more We know the prevalence of traumatic brain injury (TBI) related vision impairment and ocular injury symptoms. Lacking is an understanding of healthcare utilization to treat these symptoms. Utilization knowledge is important to structuring access to treatment, identifying clinical training needs, and providing evidence of the effectiveness of treatment. This manuscript reports rehabilitation, glasses/contacts, and imaging/photography/ video recommendations made by optometrists and ophthalmologists as part of the VA mandated Performance of Traumatic Brain Injury Specific Ocular Health and Visual Functioning Examination administered to Veterans with TBI at VA polytrauma specialty facilities. Using a retrospective design, natural language processing, descriptive and regression statistics, data were analysed for 2,458 Operation Enduring Freedom/Operation Iraqi Freedom veterans who were administered the mandated exam between 2008 and 2017. Of the 2,458 veterans, vision rehabilitation was recommended for 24%, glasses/contacts were recommended for 57% and further imaging/photography/video testing were recommended for 58%. Using key words in the referral, we determined that 37% of veterans were referred to Blind Rehabilitation, 16% to Occupational Therapy, and 3% to Low Vision Clinics. More than 50% of the referrals could have been treated by Blind Rehabilitation, Occupational Therapy, or Low Vision clinics. Rehabilitation referrals were significantly associated with younger age, floaters, photosensitivity, double vision, visual field and balance deficits, dizziness, and difficulty reading. In comparison, prescriptions for glasses and contacts were associated with older age, photosensitivity, blurred vision, decreased visual field and night vision, difficulty reading, and dry eye. Imaging/photography/video testing were associated with floaters, photosensitivity and headache. Findings delineate service delivery models available to veterans with TBI-related vision impairment. The challenge these data address is the lack of clear paths from diagnosis of TBI to identification of vision dysfunction deficits to specialized vision rehabilitation, and finally to community reintegration and community based-vision rehabilitation.

Journal of Vocational Rehabilitation, 2019

BACKGROUND: There is a paucity of research regarding employment services for adults with autism. ... more BACKGROUND: There is a paucity of research regarding employment services for adults with autism. Interventions typically focus on adapting behaviors of the person rather than customized approaches and environmental adaptations that may improve employment matching and ongoing, competitive employment rates. OBJECTIVE: The ACCESS intervention protocolizes the customized employment (CE) process and has the potential to optimize employment outcomes in adults with autism. Lessons learned during the implementation of the Phase I open trial are presented. METHODS: The study utilizes a randomized pre-test post-test experimental control group design. Phase I-open trial (N = 10) of the study tested feasibility and acceptability of the ACCESS intervention. Phase II-randomized controlled trial (N = 30) will test preliminary efficacy of an amended intervention protocol. RESULTS: Findings from the open trial suggest the need for a revised recruitment strategy and an extended timeframe for the intervention. Thorough screening of practitioners and assessing participants' work motivation may reduce attrition. CONCLUSION: An evidence-based, user-friendly process that employs well-trained practitioners is critical to successful implementation of CE services with fidelity and consistency. A collaborative approach to training, implementation, documentation, evaluation, and pre and post-employment supports is essential to promote an effective and sustainable intervention.

Psychiatry Research, 2019

The purpose of this trial was to test whether right prefrontal cortex 1 Hz versus 10 Hz rTMS prov... more The purpose of this trial was to test whether right prefrontal cortex 1 Hz versus 10 Hz rTMS provides a significantly greater improvement in PTSD symptoms and/or function. Veterans 18 to 50 years of age suffering from PTSD were randomized to right prefrontal 1 Hz rTMS [2400 pulses/session] versus right prefrontal 10 Hz rTMS [2400 pulses/session]. The treatments were performed 5 days a week for 6 weeks with a 3-week taper using the NeuroStar system. There were one month and three months post treatment follow-up evaluations. Forty-four participants were enrolled with 17 being randomized to 1 Hz rTMS and 18 to 10 Hz rTMS. Both groups had significant improvement in PTSD and depression scores from baseline to the end of acute treatment. The 10 Hz group but not the 1 Hz group demonstrated significant improvement in function. Although both groups demonstrated significant improvement in PTSD and depression symptoms, a significant advantage for either the 1 Hz or 10 Hz frequency group on any of the scales acquired was not demonstrated. Further work is required with larger samples sizes to test whether low or high frequency is superior or if individual differences would indicate the more effective frequency.

The Clinical Neuropsychologist, 2021

Objective: Investigate the effectiveness of Concussion Coach, an interactive smartphone applicati... more Objective: Investigate the effectiveness of Concussion Coach, an interactive smartphone application, as a treatment for residual neurobehavioral symptoms and distress in Veterans with a history of mild traumatic brain injury (mild TBI). Methods: Veterans with mild TBI were randomized to Concussion Coach (n = 238) or Treatment-as-Usual (TAU) (n = 241) in a 3-month randomized controlled trial. Primary outcome measures included postconcussive symptom (PCS) severity as measured by the Neurobehavioral Symptom Inventory (NSI), and psychological distress as measured by the Brief Symptom Inventory-18 (BSI-18). Measures of self-efficacy, social support, and comfort with technology were administered as potential moderators and mediators. An intention-to-treat (ITT) analysis was performed (N = 461: Concussion Coach = 231 and TAU = 230) using Bayesian Network (BN)modeling. Results: The probability of decreased PCS severity was significantly greater for those assigned to Concussion Coach, .35 [.32,.37], than for TAU, .29 (.27, .32), with an odds ratio (OR) of 1.29. Also, Concussion Coach showed a significantly greater probability of increased self-efficacy (.36 [.32, .39]) than did TAU (.28 [.25, .30], OR = 1.42). In turn, self-efficacy (increased vs. decreased) showed a significantly greater probability of decreased PCS severity (.51 [.47, .54] vs. .27 [.24, .30], OR = 2.71) and decreased psychological distress (.53 [.49, .56] vs. .32 [.29, .35], OR = 2.35), suggesting that self-efficacy may have mediated Concussion Coach effects. Conclusions: Concussion Coach is effective at reducing PCS severity and psychological distress. Increased self-efficacy/perception of self-management of symptoms may be key to successful treatment of residual symptoms in those with history of concussion.

JMIR research protocols, Jan 19, 2017

Pressure ulcers (PrUs) are a frequent, serious, and costly complication for veterans with spinal ... more Pressure ulcers (PrUs) are a frequent, serious, and costly complication for veterans with spinal cord injury (SCI). The health care team should periodically identify PrU risk, although there is no tool in the literature that has been found to be reliable, valid, and sensitive enough to assess risk in this vulnerable population. The immediate goal is to develop a risk assessment model that validly estimates the probability of developing a PrU. The long-term goal is to assist veterans with SCI and their providers in preventing PrUs through an automated system of risk assessment integrated into the veteran's electronic health record (EHR). This 5-year longitudinal, retrospective, cohort study targets 12,344 veterans with SCI who were cared for in the Veterans Health Administration (VHA) in fiscal year (FY) 2009 and had no record of a PrU in the prior 12 months. Potential risk factors identified in the literature were reviewed by an expert panel that prioritized factors and determin...

BMC Health Services Research, Nov 5, 2022

Objectives: The Veterans Administration (VA) Mobility Screening and Solutions Tool (VA MSST) was ... more Objectives: The Veterans Administration (VA) Mobility Screening and Solutions Tool (VA MSST) was developed to screen a patient's safe mobility level 'in the moment' and provide clinical decision support related to the use of safe patient handling and mobility (SPHM) equipment. This evidence-based flowchart tool is a common language tool that enables any healthcare worker at any time to accurately measure and communicate patient mobility and transfer equipment needs across disciplines and settings. Methods: The VA MSST has four levels and differentiates between the need for powered and non-powered equipment depending on the patient's independence. Subject matter experts wrote scenarios for interrater reliability and validity testing. The initial VA MSST draft iteration was reviewed by 163 VA staff (mostly physical therapists and occupational therapists) amongst simulation scenarios and provided content validity, and additional insight and suggestions. Revisions were made to create the final VA MSST which was evaluated by over 200 healthcare workers from varied disciplines (including medical doctors, advanced practice registered nurses, registered nurses, licensed practical nurses, certified nursing assistants, occupational therapists, physical therapists, speech therapists, radiology and ultrasound technicians, etc.). An instruction video and eighteen scenario videos were embedded in an online survey. The survey intended to demonstrate the interrater reliability and validity (concurrent and construct) of the VA MSST. Over 500 VA staff (raters) received a survey invitation via email. Results: Raters (N = 230) from multiple disciplines and healthcare settings independently screened patient mobility status for each of 18 scenarios using the VA MSST. The raters were diverse in their age and years of experience. The estimated interrater reliability (IRR) for VA MSST was excellent and statistically significant with an estimated Krippendorff's alpha (ICC (C, k)) of 0.998 [95% CI: 0.996-0.999]. Eighty-two percent of raters reported that overall VA MSST instructions were clear or very clear and understandable. VA MSST ratings made by technicians and nursing assistants group correlated strongly (r = 0.99, p < 0.001) with the 'gold standard' (experienced physical therapists), suggesting a high concurrent validity of the tool. The VA MSST significantly discriminated between the different levels of patient mobility required for safe mobilization as intended (each difference, p < 0.0001); this suggests a good construct validity.

Accurate pressure ulcer measurement is critical in assessing the effectiveness of treatment. Howe... more Accurate pressure ulcer measurement is critical in assessing the effectiveness of treatment. However, the traditional measuring process is subjective. Each health care provider may measure the same wound differently, especially related to the depth of the wound. Even the same health care provider may obtain inconsistent measurements when measuring the same wound at multiple times. Also, the measuring process requires frequent contact with the wound, which increases risk of contamination or infection and can be uncomfortable for the patient. This manuscript describes a new automatic pressure ulcer monitoring system (PrUMS), which uses a tablet connected to a 3D scanner, to provide an objective, consistent, noncontact measurement method. We combine color segmentation on 2D images and 3D surface gradients to automatically segment the wound region for advanced wound measurements. To demonstrate the system, two pressure ulcers on a mannequin are measured with PrUMS; ground-truth is provi...

In its latest neurotoxicity guidelines released by the US EPA Office of Prevention, Pesticides an... more In its latest neurotoxicity guidelines released by the US EPA Office of Prevention, Pesticides and Toxic Substances (OPPTS) in 1998, it is recommended that in a neurobehavioral testing, at a minimum, for acute studies, observations and activity testing should be made before the initiation of exposure, at the estimated TOPE (time of peak effects) within 8 hrs of dosing, and at 7 and 14 days after dosing. It is recommended that estimation of TOPE be made by dosing pairs of rats across a range of doses and making regular observations of gait and arousal. However it is well known that TOPE may vary with end points or exposure conditions. In order to derive quantitative safety measures such as the benchmark doses (BMD), dose-time-response modeling must be done first and a model-based estimate is then implied. In many cases, the overall BMD corresponds to a TOPE estimate. In such cases a substantial variation in the TOPE estimate in turn may result in substantial variation in BMD estimate...

The journal of behavioral health services & research, Jan 26, 2016

Caring for dependent relatives has become a normative challenge for families in the USA and throu... more Caring for dependent relatives has become a normative challenge for families in the USA and throughout the world. The study objective was to examine the relationship of family caregiving responsibilities and the mental health and well-being of individuals, ages 18-24 years, referred to as emerging young adults. It was hypothesized that young adult caregivers with past and present responsibilities would report significantly more symptoms of depression and anxiety, have lower self-esteem, and use less adaptive coping styles than non-caregiving peers. The sample consisted of 353 undergraduates (81 past caregivers, 76 current/past caregivers, and 196 non-caregivers). Caregivers were also evaluated in terms of care recipients, duration of caregiving, tasks, and hours of effort. Caregivers had significantly higher levels of symptoms of depression and anxiety than non-caregivers. Research to clarify how caregiving interacts with other stressors in emerging young adults and influences behav...

JMIR research protocols, Jan 18, 2013

Health care workers, such as nurses, nursing aides, orderlies, and attendants, who manually move ... more Health care workers, such as nurses, nursing aides, orderlies, and attendants, who manually move patients, are consistently listed in the top professions for musculoskeletal injuries (MSIs) by the Bureau of Labor Statistics. These MSIs are typically caused by high-risk patient caregiving activities. In 2008, a safe patient handling (SPH) program was implemented in all 153 Veterans Administration Medical Centers (VAMCs) throughout the United States to reduce patient handling injuries. The goal of the present study is to evaluate the effects associated with the national implementation of a comprehensive SPH program. The primary objectives of the research were to determine the effectiveness of the SPH program in improving direct care nursing outcomes and to provide a context for understanding variations in program results across sites over time. Secondary objectives of the present research were to evaluate the effectiveness of the program in reducing direct and indirect costs associate...

The Journal of nursing administration, 2014

The objective of the study was to identify which components of a system-wide safe patient handlin... more The objective of the study was to identify which components of a system-wide safe patient handling (SPH) program reduced musculoskeletal injury (MSI) due to patient handling among nurses. The 3-year longitudinal study from 2008 to 2011 used a pretest-posttest design. The study was conducted in the Veterans Health Administration, and all medical centers participated. The outcome was 2011 MSI incidence rates due to patient-related handling for nurses, expressed as injuries per 10 000 full-time employees. Three organizational risk factors, bed days of care, facility complexity level, and baseline MSI incidence rate, were significantly associated with MSI incidence rate and explained 21% of its variation. Five SPH components, including deployment of ceiling lifts and other new technologies, peer leader effectiveness, competency in SPH equipment use, facility coordinator link with safety committee, and peer leader training, uniquely accounted for an additional 23% of the total variation....

American journal of epidemiology, Jan 16, 2016

We sought to further define the epidemiology of the complex, multiple injuries collectively known... more We sought to further define the epidemiology of the complex, multiple injuries collectively known as polytrauma/blast-related injury (PT/BRI). Using a systems science approach, we performed Bayesian network modeling to find the most accurate representation of the complex system of PT/BRI and identify key variables for understanding the subsequent effects of blast exposure in a sample of Florida National Guard members (1,443 deployed to Operation Enduring Freedom/Operation Iraqi Freedom and 1,655 not deployed) who completed an online survey during the period from 2009 to 2010. We found that postdeployment symptoms reported as present at the time of the survey were largely independent of deployment per se. Blast exposure, not mild traumatic brain injury (TBI), acted as the primary military deployment-related driver of PT/BRI symptoms. Blast exposure was indirectly linked to mild TBI via other deployment-related traumas and was a significant risk for a high level of posttraumatic stres...

JMIR Research Protocols, Nov 22, 2019