Showing papers by "Gayle E. Reiber published in 2013"

Primary care provider and imaging technician satisfaction with a teledermatology project in rural Veterans Health Administration clinics.

Abstract: Objective: Assessment of a multisite rural teledermatology project between 2009 and 2012 in four Pacific Northwest states that trained primary care providers and imaging technicians in state-of-the-art techniques of telemedicine. Materials and Methods: In 2012, we assessed provider and imaging technician acceptability and satisfaction with a 32-item survey instrument based on the Patient Satisfaction Questionnaire developed by Ware et al. (Eval Program Plann 1983;6:247–63) and modified for telemedicine by Kraai et al. (J Card Fail 2011;17:684–690). Survey questions covered eight satisfaction domains: interpersonal manner, technical quality, accessibility, finances, efficacy, continuity, physical environment, and availability. Results: Overall, 71% of the primary care providers and 94% of the imaging technicians reported being satisfied or extremely satisfied with the teledermatology project. Most (95%) providers found the continuing education classes on dermatology diagnosis and treatment topics ...

VA Location and Structural Factors Associated with On-Site Availability of Reproductive Health Services

Abstract: INTRODUCTION With the increasing number of women Veterans enrolling in the Veterans Health Administration (VA), there is growing demand for reproductive health services. Little is known regarding the on-site availability of reproductive health services at VA and how this varies by site location and type.

Peripheral Neuropathy Defined by Monofilament Insensitivity and Diabetes Status : NHANES 1999–2004

Abstract: OBJECTIVE To determine whether diabetes status, including prediabetes, is associated with increased risk of peripheral neuropathy as defined by monofilament insensitivity. RESEARCH DESIGN AND METHODS This study used data from the 1999–2004 National Health and Nutrition Examination Survey ( n = 7,818). Peripheral neuropathy was defined as one or more insensate sites detected by a Semmes-Weinstein 10-g monofilament. Generalized linear models were used to directly estimate relative risks (RRs) for the association of diabetes status and peripheral neuropathy. RESULTS After adjustment compared with no diabetes, prediabetes [RR 1.11 (95% CI 0.92–1.34)] and undiagnosed diabetes [1.08 (0.73–1.61)] were associated with modest increases in risk of peripheral neuropathy, and diabetes was associated with a 74% higher risk of peripheral neuropathy [1.74 (1.50–2.01)]. CONCLUSIONS Diabetes is associated with increased risk of peripheral neuropathy defined by monofilament insensitivity, but prediabetes and undiagnosed diabetes may be associated with only a modest increase in risk.

Major traumatic limb loss among women veterans and servicemembers.

Abstract: The number of women veterans is rapidly growing, and little is known regarding the health and healthcare needs of women veterans with traumatic limb loss. The objective of this study was to summarize physical and mental health conditions and rates of prosthetic prescriptions among women service members and veterans with major traumatic limb loss. Researchers and clinicians who administered the Survey for Prosthetic Use contacted and enrolled 283 servicemembers and veterans of Operation Iraqi Freedom/Operation Enduring Freedom with major traumatic limb loss. Participants provided information on health status; comorbidities; other combat injuries; and prosthetic device use, rejection, and replacement. Of the 283 veterans, 9 (3%) were women. Compared with men, women reported more than a threefold higher prevalence of migraine (67% vs 20%, p = 0.001). Compared with men, women received 0.42 more prostheses per year, rejected 0.11 more prostheses per year, but replaced 0.18 fewer prostheses per year. With the exception of migraine headaches, men and women servicemembers and veterans with major traumatic limb loss report similarly high prevalence of physical and mental health conditions. Women report higher rates of prosthesis receipt and rejection and lower rates of prosthesis replacement than men. These findings highlight some potential issues specific to women veterans that may require additional clinical attention.

Sex Differences in Associations of Depressive Symptoms with Cardiovascular Risk Factors and Metabolic Syndrome among African Americans

Abstract: Young to middle-aged women usually have notably lower rates of cardiovascular disease (CVD) than their male counterparts, but African American women lack this advantage. Their elevated CVD may be influenced by sex differences in associations between depressed mood and CVD risk factors. This cross-sectional study examined whether relations between scores on the Center for Epidemiologic Studies-Depression (CES-D) scale and a spectrum of CVD risk factors varied by sex among African Americans (n = 1076; ages 30–64) from the Healthy Aging in Neighborhoods of Diversity across the Life Span (HANDLS) study. Sex-stratified multiple regressions and logistic regressions were conducted. Among women, CES-D scores correlated positively with systolic blood pressure and waist-to-hip ratio (P's < .05), but inversely with high-density lipoprotein cholesterol (HDL-C) (P < .01). Women had twice the odds for metabolic syndrome if CES-D scores ≥16 and had a ≥14% increase in odds of hypertension, abdominal obesity, and low HDL-C with each 5-unit increase in CES-D scores. Among men, CES-D scores correlated positively with high-sensitivity C-reactive protein (P < .05), and odds of hypertension increased by 21% with each 5-unit increase in CES-D scores. Depressive symptoms may promote premature CVD risk in African Americans, at least in part, via CVD risk factors and prevalent metabolic syndrome, particularly in African American women.

Does incorporation of a clinical support template in the electronic medical record improve capture of wound care data in a cohort of veterans with diabetic foot ulcers

Abstract: PURPOSE The purpose of this cohort study was to evaluate the effect of a 1-year intervention of an electronic medical record wound care template on the completeness of wound care documentation and medical coding compared to a similar time interval for the fiscal year preceding the intervention. METHODS From October 1, 2006, to September 30, 2007, a "good wound care" intervention was implemented at a rural Veterans Affairs facility to prevent amputations in veterans with diabetes and foot ulcers. The study protocol included a template with foot ulcer variables embedded in the electronic medical record to facilitate data collection, support clinical decision making, and improve ordering and medical coding. RESULTS The intervention group showed significant differences in complete documentation of good wound care compared to the historic control group (χ = 15.99, P < .001), complete documentation of coding for diagnoses and procedures (χ = 30.23, P < .001), and complete documentation of both good wound care and coding for diagnoses and procedures (χ = 14.96, P < .001). CONCLUSIONS An electronic wound care template improved documentation of evidence-based interventions and facilitated coding for wound complexity and procedures.

Weight Loss After Diagnosis with Gestational Diabetes and Birth Weight Among Overweight and Obese Women

Abstract: To determine if, among overweight or obese women with gestational diabetes (GDM), weight loss after GDM diagnosis is associated with lower infant birth weight within levels of overweight or obesity class. Overweight and obese women with singleton pregnancies managed for GDM at a large diabetes and pregnancy program located in Charlotte, NC between November 2000 and April 2010, were eligible for this retrospective cohort study. All were managed using a rigorous standardized clinical protocol. Clinical information including maternal pre-pregnancy body mass index, gestational weight gain, treatment, and medical and obstetric history was abstracted from medical records. The association of weight loss after GDM diagnosis and birth weight was analyzed using linear regression stratified by maternal pre-pregnancy overweight or obesity class (I, II/III). Of the 322 women in this study 19 % lost weight between diagnosis of GDM and delivery. After adjustment for maternal age, parity, race/ethnicity, gestational week at first hemoglobin A1c (A1C), A1C at diagnosis, weight gain prior to GDM, treatment with insulin or oral hypoglycemic agents, gestational age at delivery, and infant sex, weight loss was associated with 238.3 g lower mean infant birth weight among overweight women (95 % CI -393.72, -82.95 g), but was not associated with lower mean infant birth weight among obese class II/III women (95 % CI -275.61, 315.38 g). Weight loss, after diagnosis of GDM, is associated with lower infant birth weight among overweight women, but not among obese class II/III women.