Comparing Treatment Effectiveness and Patient-Reported Outcome Measures of Four Treatment Options for Obstructive Sleep Apnea.

Background: Continuous positive airway pressure (CPAP), mandibular advancement device (MAD), upper airway stimulation (UAS), and maxillomandibular advancement (MMA) are techniques to reduce apnea hypopnea index (AHI) in obstructive sleep apnea (OSA) patients. Current literature does not include a direct comparison of the 4 methods.

Purpose: The purpose of this study is to measure and compare the efficacy of 4 common OSA treatments: CPAP, MAD, UAS, MMA.

Patient Markers of Successful Diabetes Management.

Purpose: For individuals with diabetes, diabetes health status may not align with A1C targets. Patients may use nonclinical targets when assessing their diabetes management success. Identifying these targets is important in developing patient-centered management plans.

Association of Prediabetes Status Awareness With Behaviors and Perception of Health.

Introduction: Lifestyle modification can significantly reduce the risk of developing diabetes. However, the effect of prediabetes status awareness on perceptions of health and health behaviors are mixed. We used the 2015 to 2016 National Health and Nutrition Examination Survey (NHANES) data to evaluate the association of prediabetes status awareness with self-reported perception of health and health behaviors.

Contrasting cumulative risk and multiple individual risk models of the relationship between Adverse Childhood Experiences (ACEs) and adult health outcomes.

Background: A very large body of research documents relationships between self-reported Adverse Childhood Experiences (srACEs) and adult health outcomes. Despite multiple assessment tools that use the same or similar questions, there is a great deal of inconsistency in the operationalization of self-reported childhood adversity for use as a predictor variable. Alternative conceptual models are rarely used and very limited evidence directly contrasts conceptual models to each other.

What Do Adults Think About Their Adverse Childhood Experiences (ACEs), and Does It Matter?

We examined the self-reported adulthood impact of adverse childhood experiences (ACE's), including both the amount (magnitude) and type (valence positive or negative) of impact reported, in order to characterize variability in impact ratings, as well as to quantify their predictive ability with respect to health outcomes. We descriptively characterized impact by type of event and analyzed associations between impact ratings and demographic characteristics of respondents to explore resilience. We also analyzed the relationships between impact ratings and health outcomes.

Identifying Older Patients at High Risk for Emergency Department Visits and Hospitalization.

Hospitalizations are costly, potentially hazardous for older patients, and sometimes preventable. With Medicare's implementation of hospital penalties for 30-day readmissions on certain index conditions, health care organizations have prioritized addressing those issues that lead to avoidable hospitalizations. Little is known about the utility and feasibility of using standardized tools to identify adults at risk for hospitalizations in primary care.

Patient Uncertainty as a Predictor of 30-day Return Emergency Department Visits: An Observational Study.

Objective: The objective was to examine the relationship between patient uncertainty at the time of emergency department (ED) discharge as measured by the "Uncertainty Scale" (U-Scale) and 30-day return ED visits. We hypothesized that a higher score on the U-Scale predicts a higher likelihood of a 30-day return ED visit.

Methods: This was a cross-sectional single-site pilot study performed with adult patients discharged from an urban academic ED to assess the relationship of U-Scale total and subscale scores with 30-day return ED visits.

The effect of diabetes self-management education on HbA1c and quality of life in African-Americans: a systematic review and meta-analysis.

Background: Type 2 diabetes presents a major morbidity and mortality burden in the United States. Diabetes self-management education (DSME) is an intervention associated with improved hemoglobin A1c(HbA1c) and quality of life(QOL), and is recommended for all individuals with type 2 diabetes. African-Americans have disproportionate type 2 diabetes morbidity and mortality, yet no prior meta-analyses have examined DSME outcomes exclusively in this population.

Exploring patient-centeredness: The relationship between self-reported empathy and patient-centered communication in medical trainees.

Objective: To explore the relationships between self-reported Empathy and the patient-centered communication patterns of physician trainees.

Methods: "Eighty-four 3rd year medical students completed the Jefferson Scale of Empathy (JSE - student version) and had recordings of a single OSCE analyzed using the Roter Interactional Analysis System (RIAS). Correlation and regression were employed to explore the relationships among JSE total score, 3 JSE subscales, 10 composite codes of provider communication, and a summary 'patient centered communication' ratio, reflecting the balance of psychosocial and emotional to biomedical communication of the simulated patient and student.

Development and preliminary validation of a scale to measure patient uncertainty: The "Uncertainty Scale".

Research suggests that patient uncertainty related to experiencing symptoms may drive decisions to seek care. The only validated measure of patient uncertainty assesses uncertainty related to defined illness. In prior work, we engaged patients to describe uncertainty related to symptoms and used findings to develop the 'U-Scale' scale.

Practicing safety: a quality improvement intervention to test tools to enhance pediatric psychosocial care for children 0-3 years.

Background: Child maltreatment is a significant public health issue in the United States. Yet, fewer than half of pediatricians discuss behavioral, developmental, or parenting issues with parents.

Objective: This paper describes the testing of bundles of tools and processes, part of a larger intervention, Practicing Safety, targeted at changing physician and staff behavior to identify families at risk for child maltreatment, provide anticipatory guidance, refer to community resources, and follow-up and track at-risk families.

A primary care-public health partnership addressing homelessness, serious mental illness, and health disparities.

Background: People with histories of homelessness and serious mental illness experience profound health disparities. Housing First is an evidenced-based practice that is working to end homelessness for these individuals through a combination of permanent housing and community-based supports.

Methods: The Jefferson Department of Family and Community Medicine and a Housing First agency, Pathways to Housing-PA, has formed a partnership to address multiple levels of health care needs for this group.

INVOLVING PARENTS IN A COMMUNITY-BASED, CULTURALLY-GROUNDED MENTAL HEALTH INTERVENTION FOR AMERICAN INDIAN YOUTH: PARENT PERSPECTIVES, CHALLENGES, AND RESULTS.

An important predictor of youth well-being and resilience is the presence of nurturing adults in a youth's life. Parents are ideally situated to fulfill this role but often face challenges and stressors that impede their ability to provide adequate support and guidance. American Indian parents may also be affected by intergenerational transmission of trauma and loss of traditional parenting practices, as a result of forced boarding school and/or relocation.

Visual processing of facial affect.

To evaluate the role of the fusiform gyrus in identifying and processing facial emotional expression in humans, MEG data were collected while six healthy subjects judged whether photographs of faces displayed emotion (happiness or disgust) compared to neutral faces and equiluminant scrambled faces. For all six subjects, a magnetic source localizing to right fusiform gyrus was evident approximately 150 ms following presentation of face stimuli, but not following non-face stimuli. MEG source strength for this component was greatest for happy, intermediate for disgust, and lowest for neutral facial expressions, suggesting that activity in fusiform gyrus is sensitive to both face-specific stimuli and to the affective content of the face.