VA Palo Alto Healthcare System

About: VA Palo Alto Healthcare System is a healthcare organization based out in Palo Alto, California, United States. It is known for research contribution in the topics: Population & Health care. The organization has 2548 authors who have published 4605 publications receiving 209938 citations.

Post-traumatic amnesia after closed head injury: a review of the literature and some suggestions for further research

Abstract: Post-traumatic amnesia (PTA) is a transient sequela of closed head injury (CHI). The term PTA has been in clinical use for over half a century, and generally refers to the subacute phase of recovery immediately after unconsciousness following CHI. The duration of PTA predicts functional outcome after CHI, but its pathophysiological mechanism is not known. This paper compares current methods of determining the duration of PTA, summarizes reports on neuropsychological deficits in PTA, reviews available data that allow inferences about its mechanism, and suggests methods for further exploration of its pathophysiology.

A validated approach to evaluating psychometric properties of pain assessment tools for use in nonverbal critically ill adults.

Abstract: A valid pain assessment is the foundation of adequate pain management Pain assessment can be challenging, especially in adult intensive care unit (ICU) patients who are unable to self-report In such situations, relying on observational assessment tools is an alternative strategy This review describes and analyzes the development and psychometric properties of pain assessment tools developed for use with nonverbal critically ill adults A total of 32 relevant papers that described the psychometric properties of eight pain assessment tools were included The scale development process, psychometric properties (ie, reliability and validity), and feasibility of pain assessment tools were analyzed using a 0 to 20 scoring system Each pain assessment tool was scored independently by two reviewers Of the eight behavioral pain scales developed for use in adult ICU patients, the Behavioral Pain Scale (BPS) and the Critical-Care Pain Observation Tool (CPOT) are considered to be the most valid and reliable for this purpose, according to the available evidence Behavioral pain scales may be viable alternatives to assessing pain in ICU patients who are unable to self-report, but only valid, reliable, and feasible scales should be used for this purpose

A Practical Approach to Assessing and Mitigating Loneliness and Isolation in Older Adults

Abstract: Loneliness and social isolation are strongly associated with several adverse health outcomes in older persons including death and functional impairments. The strength of these associations has been compared with smoking. Accordingly, loneliness and isolation have significant public health implications. Despite the adverse impacts of loneliness and social isolation on quality of life, and their strong association with health outcomes, the evaluation of loneliness and isolation have not been integrated into medical care. The risks for loneliness may be of particular concern to persons with serious illness as patients and caregivers cope with the experience of loss, loss of independence, and increasing care needs. To date, there has been no uniform way of evaluating and documenting loneliness and social isolation as a part of a review of a patient's social determinants of health. This article provides a framework for healthcare systems, providers, and community members working with older adults to (1) understand loneliness, isolation, and its counterpart social connection; (2) describe the different ways loneliness affects health; and (3) create a framework for asking about and documenting these experiences. Finally, because the lack of studies assessing whether targeting loneliness can improve health outcomes is a major gap, we provide guidance on the future of interventions. J Am Geriatr Soc 67:657-662, 2019.