Medicaid expansion and accessibility to healthcare: The Illinois experience.

Objective: The study examined the impact that the Medicaid expansion in Illinois had upon insurance rates, access to medical care, dental care, pharmaceuticals, and mental-health counseling between rural and urban counties.

Design And Sample: A serial cross-sectional design was used to assess the health perceptions of adults living in Illinois.

Measures: Survey data were collected in 2012 (n = 6,149) before the Medicaid expansion in Illinois and in 2015 (n = 3,532) after the expansion from rural (n = 4) and urban counties (n = 4).

Experience of nurse practitioners performing colonoscopy after endoscopic training in more than 1,000 patients.

 The demand for screening colonoscopy has continued to rise over the past two decades. As a result, the current workforce of gastroenterologists is unable to meet the needs for colorectal cancer (CRC) screening. Therefore, solutions are needed to improve this disparity, with non-physician endoscopists being a potential option.

Development of an advanced practice preceptor evaluation tool.

Background: Preceptors are essential in advanced practice registered nurse (APRN) and physician assistant (PA) fellowships; however, no tools exist for fellows to evaluate their preceptor.

Purpose: The study's purpose was to examine the use of a modified preceptor evaluation tool (PET) in a new population APRNs and PAs who participated in a formalized postgraduate fellowship program.

Methodological Orientation: A qualitative study involving cognitive interviewing methods was used to evaluate original and modified items of the PET as a means to determine face validity.

Coordination Pattern of the Thigh, Pelvic, and Lumbar Movements during the Gait of Patients with Hip Osteoarthritis.

There are limited reports on segment movement and their coordination pattern during gait in patients with hip osteoarthritis. To avoid the excessive stress toward the hip and relevant joints, it is important to investigate the coordination pattern between these segment movements, focusing on the time series data. This study aimed to quantify the coordination pattern of lumbar, pelvic, and thigh movements during gait in patients with hip osteoarthritis and in a control group.

Measurement of nonbillable service value activities by nurse practitioners, physician assistants, and clinical nurse specialists in ambulatory specialty care.

Background: Revenue-generating health care activities, generally accepted as a measure of productivity, do not account for the full range of health care activities that enhance patient care.

Purpose: We analyzed the quantity, duration, and type of "service value activities" performed by nurse practitioners (NPs), physician assistants (PAs), and clinical nurse specialists (CNSs), which are nonbillable service activities that contribute to billable service provision, quality of care, and value of care.

Methods: Data were obtained from ambulatory specialties at one health care institution over a 13-month period.

Predischarge Provider Visits as a Method of Improving Transitional Care Clinic Visit Rates.

Background: Transitional care interventions have been associated with reduced 30-day patient readmission, better quality of health care, and lower emergency department visits and health care costs.

Local Problem: Transition Services at a major quaternary care center was underutilized by patients who were referred to the program.

Methods: A pre-/postimplementation evaluation design was used to evaluate a quality improvement intervention.

Drug Prescribing and Outcomes After Pharmacogenomic Testing in a Developmental and Behavioral Health Pediatric Clinic.

Objective: To describe drug prescribing and outcomes after pharmacogenomic (PGx) testing in children with developmental and/or behavioral disorders.

Methods: This is a single-clinic retrospective analysis of patients aged 5 to 17 years with documented behavioral and/or development disorder(s) and having received PGx testing between May 2015 and May 2017. The primary endpoint was frequency of PGx-guided medication changes after testing.

Fronto-temporal dementia: a case study and strategies and support for caregivers.

Fronto-temporal dementia, also known as fronto-temporal lobular degeneration, is the second most common form of early-onset dementia with a prevalence equal to Alzheimer's dementia. Behavioural variant fronto-temporal dementia primarily involves the frontal and temporal lobes of the brain. Myelination of nerve fibres in these areas allow for highly synchronized action potential timing.

Impact of nurse practitioner navigation on access to care for patients with refractory gastroesophageal reflux disease.

Background: Gastroesophageal reflux disease (GERD) is a common digestive complaint that can negatively affect patients' quality of life and have serious complications if inadequately treated.

Local Problem: Facilitating prompt and efficient access to digestive care is imperative especially given the current burden of gastrointestinal diseases such as GERD.

Methods: A clinical team conducted a quality improvement study in which a nurse practitioner (NP) navigator performed a preconsultation chart review for patients with refractory GERD referred to an Esophagus Center between August and December 2018.

Coordination Among Shank, Rearfoot, Midfoot and Forefoot Kinematic Movement During Gait in Individuals With Hallux Valgus.

An important step in the management of hallux valgus is the objective analysis of foot mechanics in dynamic conditions. However, the manner which hallux valgus affects the foot motion is poorly understood. Moreover, hallux valgus deformity may affect foot intersegmental coordination patterns.

Relationships Between Trunk Movement Patterns During Lifting Tasks Compared With Unloaded Extension From a Flexed Posture.

Objectives: The purpose of this study was to investigate between movement patterns of trunk extension from full unloaded flexion and lifting techniques, which could provide valuable information to physical therapists, doctors of chiropractic, and other manual therapists.

Methods: A within-participant study design was used. Whole-body kinematic and kinetic data during lifting and full trunk flexion were collected from 16 healthy male participants using a 3-dimensional motion analysis system (Vicon Motion Systems).

Muscle co-contraction in elderly people change due to postural stability during single-leg standing.

Background: Muscle co-contraction is the simultaneous contraction of agonist and antagonist muscles crossing a joint, and it increases with age. This study primarily aimed to clarify the difference in the effect of a light fingertip contact to stationary surface on postural sway and muscle co-contraction during single-leg standing (SLS) between young and elderly groups; the secondary aim was to reveal the quantitative difference in the muscle co-contraction of the ankle joint among the three different support structure conditions in the elderly group.

Methods: This study included eight young adults (age 23.

Trunk lean gait decreases multi-segmental coordination in the vertical direction.

[Purpose] The strategy of trunk lean gait to reduce external knee adduction moment (KAM) may affect multi-segmental synergy control of center of mass (COM) displacement. Uncontrolled manifold (UCM) analysis is an evaluation index to understand motor variability. The purpose of this study was to investigate how motor variability is affected by using UCM analysis on adjustment of the trunk lean angle.

Biomechanical mechanism of lateral trunk lean gait for knee osteoarthritis patients.

The biomechanical mechanism of lateral trunk lean gait employed to reduce external knee adduction moment (KAM) for knee osteoarthritis (OA) patients is not well known. This mechanism may relate to the center of mass (COM) motion. Moreover, lateral trunk lean gait may affect motor control of the COM displacement.

Correction to: Differences of muscle co-contraction of the ankle joint between young and elderly adults during dynamic postural control at different speeds.

After the publication of this work [1] an error was noticed in Table 3. In the column 'Elderly', in the last row it states 98 ± 11.87** however the correct value should be: 34.

Clinical Factors and Outcomes of Dialysis-Dependent End-Stage Renal Disease Patients with Emergency Department Septic Shock.

Background: Infection is the second leading cause of death in end-stage renal disease (ESRD) patients. Prior investigations of acute septic shock in this specific population are limited.

Objective: We aimed to evaluate the clinical presentation and factors associated with outcome among ESRD patients with acute septic shock.

Differences of muscle co-contraction of the ankle joint between young and elderly adults during dynamic postural control at different speeds.

Background: Agonist and antagonist muscle co-contractions during motor tasks are greater in the elderly than in young adults. During normal walking, muscle co-contraction increases with gait speed in young adults, but not in elderly adults. However, no study has compared the effects of speed on muscle co-contraction of the ankle joint during dynamic postural control in young and elderly adults.

Lower limb kinematics during the swing phase in patients with knee osteoarthritis measured using an inertial sensor.

Background: During gait, the swing limb requires flexible control to adapt to ever changing environmental circumstances. However, few studies have focused on the mechanics of swing limb control in patients with knee osteoarthritis (OA). Investigating the variability of swing limb kinematics, which can be represented by variables such as the peak shank angular velocity during the swing phase obtained from an inertial sensor, provides insights into the adaptability of swing limb control.

Rear foot kinematics when wearing lateral wedge insoles and foot alignment influence the effect of knee adduction moment for medial knee osteoarthritis.

Lateral wedge insoles (LWIs) are prescribed for patients with medial knee osteoarthritis to reduce the external knee adduction moment (KAM). However, the biomechanical effects of LWIs are limited in some patients. The purpose of this study was to investigate whether the biomechanical effects of LWIs depend on individual foot alignment and to examine the relationship between change in KAM and changes in foot and ankle biomechanics when wearing LWIs.

Eastern Association for the Surgery of Trauma and Society of Trauma Nurses advanced practitioner position paper: Optimizing the integration of advanced practitioners in trauma and critical care.

Nurse practitioners and physician assistants, collectively known as advanced practitioners (APs), enhance the provision of care for the acutely injured patient. Despite their prevalence, institutions employ, train, and utilize these providers with significant variability. The Eastern Association for the Surgery of Trauma, the Society of Trauma Nurses, and the American Association of Surgical Physician Assistants acknowledge the value of APs and support their utilization in the management of injured and critically ill patients.

A Strategic Approach for Developing an Advanced Practice Workforce: From Postgraduate Transition-to-Practice Fellowship Programs and Beyond.

The healthcare provider landscape is rapidly changing. Given the imminent retirement of baby boomer physicians, implementation of the Affordable Care Act, and the increased utilization of health care services by an ever-aging population, the supply of providers cannot keep pace with the demand for services. This has led to an increased utilization of advanced clinical practitioners (ACPs).

Foot alignments influence the effect of knee adduction moment with lateral wedge insoles during gait.

Lateral wedge insoles (LWIs) reduce the peak external knee adduction moment (KAM). However, the efficacy of LWIs is limited in certain individuals for whom they fail to decrease KAM. Possible explanations for a lack of desired LWI response are variations in foot alignments.

Influences of trunk flexion on mechanical energy flow in the lower extremities during gait.

[Purpose] The time-series waveforms of mechanical energy generation, absorption, and transfer through the joints indicate how movements are produced and controlled. Previous studies have used these waveforms to evaluate and describe the efficiency of human movements. The purpose of this study was to examine the influence of trunk flexion on mechanical energy flow in the lower extremities during gait.