Background: Uncertainty is a pervasive challenge in clinical practice. Whereas the importance of humility in navigating uncertainty has been discussed, empirical research on how humility is practiced or expressed (i.e.
View Article and Find Full Text PDFDespite the effectiveness of treating substance use disorders in primary care, access to such services remains limited. In this project, quality improvement methods were used to create and evaluate a rapid-access pathway for substance use treatment services in community health clinics. A "secret shopper" test gathered information about wait times and requirements.
View Article and Find Full Text PDFIntroduction: Acute valvular emergencies, a time-sensitive diagnosis, are nearly impossible to diagnose without ultrasound, and missing the diagnosis can significantly impact patient outcomes. Many emergency physicians lack access to echo technicians and may be uncomfortable performing the ultrasound themselves. Approaching the paucity of review articles, none of which are focused for the emergency physician, can be quite daunting, even for those with extensive ultrasound training.
View Article and Find Full Text PDFHealth literacy-responsive health professionals will be increasingly important in addressing healthcare access and equity issues. This international scoping review aims to understand the extent and ways in which health professionals respond to healthcare users' health literacy, identifying tools used to measure health literacy responsiveness and training to support the development of these attributes. Four online databases were searched.
View Article and Find Full Text PDFDamage to the primary visual cortex (V1) or its afferent white matter tracts results in loss of vision in the contralateral visual field that can present as homonymous visual field deficits. Recent evidence suggests that visual training in the blind field can partially reverse blindness at trained locations. However, the efficacy of visual training to improve vision is highly variable across subjects, and the reasons for this are poorly understood.
View Article and Find Full Text PDFBackground: Several studies indicate that people who stutter show greater variability in speech movements than people who do not stutter, even when the speech produced is perceptibly fluent. Speaking to the beat of a metronome reliably increases fluency in people who stutter, regardless of the severity of stuttering.
Objectives: Here, we aimed to test whether metronome-timed speech reduces articulatory variability.
A long-standing neurobiological explanation of stuttering is the incomplete cerebral dominance theory, which refers to competition between two hemispheres for 'dominance' over handedness and speech, causing altered language lateralization. Renewed interest in these ideas came from brain imaging findings in people who stutter of increased activity in the right hemisphere during speech production or of shifts in activity from right to left when fluency increased. Here, we revisited this theory using functional MRI data from children and adults who stutter, and typically fluent speakers (119 participants in total) during four different speech and language tasks: overt sentence reading, overt picture description, covert sentence reading and covert auditory naming.
View Article and Find Full Text PDFProg Community Health Partnersh
September 2024
Background: Individuals with opioid use disorder and cooccurring mental health concerns experience heightened consequences and lower rates of treatment access. Engaging patients as research partners alongside health systems is critical for tailoring care for this population. Collaborative care is promising for the treatment of co-occurring disordersObjectives: We used a community-participatory partnered research1 approach to partner with patients, providers, and clinic administrators to adapt and implement a collaborative care intervention for co-occurring disorders in primary care.
View Article and Find Full Text PDFUnlabelled: Interpersonal violence is a common type of trauma experienced by people with opioid use disorder (OUD), especially for people with co-occurring OUD and mental illness (COD). However, little is known about demographic and clinical characteristics of individuals with COD who have experienced an interpersonal violence traumatic event compared to those who have experienced a non-violent trauma, and how experiences of interpersonal violence are associated with treatment utilization. Data presented are from a randomized clinical trial testing collaborative care for COD in primary care.
View Article and Find Full Text PDFChildren with developmental language disorder (DLD) struggle to learn their native language for no apparent reason. While research on the neurobiological underpinnings of the disorder has focused on the role of corticostriatal systems, little is known about the role of the cerebellum in DLD. Corticocerebellar circuits might be involved in the disorder as they contribute to complex sensorimotor skill learning, including the acquisition of spoken language.
View Article and Find Full Text PDFIn this exploratory study we compare and contrast two methods for deriving a laterality index (LI) from functional magnetic resonance imaging (fMRI) data: the weighted bootstrapped mean from the LI Toolbox (toolbox method), and a novel method that uses subtraction of activations from homologous regions in left and right hemispheres to give an array of difference scores (mirror method). Data came from 31 individuals who had been selected to include a high proportion of people with atypical laterality when tested with functional transcranial Doppler ultrasound (fTCD). On two tasks, word generation and semantic matching, the mirror method generally gave better agreement with fTCD laterality than the toolbox method, both for individual regions of interest, and for a large region corresponding to the middle cerebral artery.
View Article and Find Full Text PDFBackground: Implementing evidence-based practices (EBPs) within service systems is critical to population-level health improvements - but also challenging, especially for complex behavioral health interventions in low-resource settings. "Mis-implementation" refers to poor outcomes from an EBP implementation effort; mis-implementation outcomes are an important, but largely untapped, source of information about how to improve knowledge exchange.
Aims And Objectives: We present mis-implementation cases from three pragmatic trials of behavioral health EBPs in U.
Approximately 7% of children have developmental language disorder (DLD), a neurodevelopmental condition associated with persistent language learning difficulties without a known cause. Our understanding of the neurobiological basis of DLD is limited. Here, we used FreeSurfer to investigate cortical surface area and thickness in a large cohort of 156 children and adolescents aged 10-16 years with a range of language abilities, including 54 with DLD, 28 with a history of speech-language difficulties who did not meet criteria for DLD, and 74 age-matched controls with typical language development (TD).
View Article and Find Full Text PDFBackground: Misuse of prescription opioids is a well-established contributor to the US opioid epidemic. The primary objective of this study was to identify which level of care delivery (ie patient, prescriber, or hospital) produced the most unwarranted variation in opioid prescribing after common surgical procedures.
Study Design: Electronic health record data from a large multihospital healthcare system were used in conjunction with random-effect models to examine variation in opioid prescribing practices after similar inpatient and outpatient surgical procedures between October 2019 and September 2021.
The colour of seafood flesh is often not homogenous, hence measurement of colour requires repeat measurements to obtain a representative average. The aim of this study was to determine the optimal number of repeat colour measurements required for three different devices [machine vision (digital image using camera, and computer processing); Nix Pro; Minolta CR400 colorimeter] when measuring three species of seafood (Atlantic salmon, , = 8; rockling, , = 8; banana prawns, , = 105) for raw and cooked samples. Two methods of analysis for number of repeat measurements required were compared.
View Article and Find Full Text PDFThe COVID-19 pandemic disrupted typical travel behavior worldwide. In the United States (U.S.
View Article and Find Full Text PDFBackground: Excess opioid prescribing after surgery can lead to prolonged opioid use and diversion. We interviewed surgeons who were part of a three-group cluster-randomised controlled trial aimed at reducing prescribed opioid quantities after surgery via two versions of a monthly emailed behavioural 'nudge' (messages encouraging but not mandating compliance with social norms and clinical guidelines around prescribing) at the end of the implementation year in order to understand surgeons' reasoning for changing or continuing their prescribing behaviour as a result of the intervention and the context for their rationale.
Methods: The study took place at a large healthcare system in northern California with surgeons from three surgical specialties-orthopaedics, obstetrics/gynaecology and general surgery.