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Barriers to Prompt Presentation to Emergency Departments in Colorado after Onset of Stroke Symptoms
Adit A. Ginde,Edward P. Havranek,Erica A. Morse,Jason S. Haukoos,Stacy A. Trent
- , 2019, DOI: 10.5811/westjem.2018.10.38731
Abstract: Despite significant morbidity and mortality from stroke, patient delays to emergency department (ED) presentation following the onset of stroke symptoms are one of the main contraindications to treatment for acute ischemic stroke (AIS). Our objective was to identify patient and environmental factors associated with delayed presentations to the ED after onset of stroke symptoms
Intimate Partner Violence
Angela Keniston, MSPH,Barbara S. Cleary, MD,Edward P. Havranek, MD,Richard K. Albert, MD
- , 2008, DOI: 10.1002/jhm.340
Abstract: AbstractBACKGROUND:Although intimate partner violence is common, the prevalence in patients hospitalized on internal medicine services and whether it is associated with numerous positive responses to the review of systems are not known.OBJECTIVE:The objective of this study was to assess the prevalence of intimate partner violence in women hospitalized on an internal medicine service and to determine whether it is associated with the number or types of positive responses to the review of systems.DESIGN:This was a prospective, cross‐sectional survey.SETTING:The setting was a university‐affiliated public hospital.PATIENTS:The patients were women, 18 to 60 years old, hospitalized on an internal medicine service.MEASUREMENTS:The measurements were responses to screens for intimate partner violence and a review‐of‐systems questionnaire.RESULTS:Of the 78 women asked to participate, 72 agreed (92%). The prevalences of experiencing intimate partner violence at any time in the patient's life or within the year prior to presentation were 61% and 22%, respectively. Women with a history of intimate partner violence and women without a history of intimate partner violence had 11 ± 4 (mean ± standard deviation) and 8 ± 5 positive responses to the review of systems, respectively (P < 0.01). Women with 10 or more positive responses were more likely to have a history of intimate partner violence than those with 9 or fewer (odds ratio = 4.82, confidence interval = 1.63–14.23).CONCLUSIONS:Intimate partner violence is common in women hospitalized in an internal medicine service of a university‐affiliated public hospital. Although numerous somatic complaints are associated with a history of intimate partner violence, the high prevalence of this problem warrants screening of all women admitted to internal medical services. Journal of Hospital Medicine 2008;3:299–307. ？ 2008 Society of Hospital Medicine
Effect of the National Diabetes Prevention Program on Weight Loss for English
Edward P. Havranek,Kim K. McFann,Liesel Christoe-Frazier,Natalie D. Ritchie,Rocio I. Pereira
- , 2018, DOI: 10.1177/0890117117698623
Abstract: To study the effect of the National Diabetes Prevention Program (NDPP) on weight loss in Latinos. No-control, cohort study comparing Latino and non-Hispanic white (NHW) participants. A health-care system. Five hundred sixty-seven Latino and 175 NHW patients who enrolled in the NDPP. A total of 45.2% of Latinos selected the Spanish-language NDPP. The NDPP is a nationwide translation of a clinical trial and seeks to prevent diabetes through weight loss in a yearlong group program. Independent variables included ethnicity, class language, and number of sessions attended. Main outcomes were initial attendance, number of sessions attended, and weight loss. Multivariate logistic regression and analysis of covariance were used to determine differences in NDPP outcomes by ethnicity, language, and number of sessions attended. Mean attendance was 8.60 of 22 sessions. Each session was associated with 0.30% (±0.02; P < .001) body weight loss. Latinos were half as likely to attend as NHWs, odds ratio 0.52 (P < .001). Latino attendees came to 2.67 ± 0.63 (P < .001) fewer sessions than NHWs. There were no weight loss differences by ethnicity after controlling for attendance. Outcomes did not differ among Latinos in the English- and Spanish-language NDPP. Latinos appeared to benefit less from the NDPP compared to NHWs, likely due to lower attendance rates. Further efforts are needed to support their participation
Effect of Audit and Feedback on Physician Adherence to Clinical Practice Guidelines for Pneumonia and Sepsis
Adit A. Ginde,Edward P. Havranek,Jason S. Haukoos,Stacy A. Trent
- , 2019, DOI: 10.1177/1062860618796947
Abstract: The objective was to estimate the effect of feedback with blinded peer comparison on emergency physician adherence to guidelines for appropriate antibiotic administration for inpatient pneumonia and completion of the 3-hour Surviving Sepsis Bundle for severe sepsis. The authors performed a quasi-experiment using a stepped wedge design at a single urban safety net hospital. Attending emergency physicians were randomized into 6 clusters. Once a cluster crossed into the intervention group, physicians in that cluster began receiving detailed feedback with blinded peer comparison on their adherence to guidelines for pneumonia and sepsis. Feedback with blinded peer comparison significantly improved guideline adherence from 52% without feedback to 65% with feedback (difference = 13%, 95% confidence interval = 4% to 22%). In adjusted analyses, the odds of providing guideline adherent care were 1.8 (95% confidence interval = 1.01-3.2) after the introduction of feedback with blinded peer comparison. Feedback with blinded peer comparison significantly improved emergency physician guideline adherence
Patient Perspectives on a Text Messaging Program to Support Asthma Management: A Qualitative Study
Catia Chávez,Edward P. Havranek,Karen Albright,Laura P. Hurley,Mark Anderson,Melanie Stowell,Reina Doyle,Suzanne Dircksen
- , 2019, DOI: 10.1177/1524839918770209
Abstract: Introduction. This study investigated participants’ acceptance of a short messaging service (SMS) intervention designed to support asthma management, including suggestions regarding program delivery and message content. Methods. Individual and group interviews were conducted with patients from a safety-net health care system in Denver, Colorado. Eligible participants were English or Spanish speakers between the ages of 13 and 40 years, with diagnosed persistent asthma. All individual and group interviews were digitally recorded, transcribed, translated from Spanish to English (where applicable), and analyzed for thematic content by experienced analysts using established qualitative content techniques. The qualitative software package ATLAS.ti was used for data analysis and management. Results. This study included a total of 43 participants. In general, participants were receptive toward the SMS program and supported the use of tailored and interactive messages. Adolescents supported the idea of enhancing care by sending messages to a support person, such as a parent or guardian. However, adults were less receptive toward this idea. Participants also preferred directive educational messages and cues to action, while general messages reminding them of their asthma diagnosis were viewed less favorably. Implications. The results from this study will inform a randomized control trial evaluating the efficacy of the SMS intervention
Longitudinal Changes in Vascular Risk Markers and Mortality Rates among a Latino Population with Hypertension
Angela Keniston,Brenda Beaty,Carlin S. Long,Edward P. Havranek,Matthew C. Pflederer,Mori J. Krantz,Philip S. Mehler
- , 2016, DOI: 10.14503/THIJ-15-5053
Abstract: Vascular markers such as pulse-wave velocity and carotid intima-media thickness (CIMT) might improve the prediction of incident cardiovascular disease beyond traditional risk factors. These vascular markers have not been well characterized in minority populations and might be more useful than inflammatory biomarkers. We conducted a prospective, longitudinal cohort study among hypertensive patients in an urban safety-net hospital. We evaluated inflammatory biomarkers, arterial pulse-wave velocity, and carotid intima-media thickness at baseline, 1 year, and 2 years. The primary outcome variable was CIMT. Generalized linear mixed-effects models were used to evaluate associations between CIMT and predictive variables accounting for the correlation of multiple measurements within subjects over time. For our secondary outcome, we used administrative and National Death Index data to determine all-cause death, and univariate relationships were evaluated
Pulse wave velocity and carotid atherosclerosis in White and Latino patients with hypertension
Mori J Krantz, Carlin S Long, Patrick Hosokawa, Elhum Karimkhani, Miriam Dickinson, Raymond O Estacio, Frederick A Masoudi, Edward P Havranek
BMC Cardiovascular Disorders , 2011, DOI: 10.1186/1471-2261-11-15
Abstract: We performed a cross sectional study of Latino and White hypertension patients in a safety-net healthcare system. Framingham risk factors, markers of inflammation (hsCRP, LPpLA2), arterial stiffness (Pulse wave velocity, augmentation index, and central aortic pressure), and endothelial function (brachial artery flow-mediated dilatation) were measured. Univariate and multivariable associations between these parameters and an index of extracoronary atherosclerosis (carotid intima media thickness) was performed.Among 177 subjects, mean age was 62 years, 67% were female, and 67% were Latino. In univariate analysis, markers associated with carotid intima media thickness (IMT) at p < 0.25 included pulse wave velocity (PWV), augmentation index (AIx), central aortic pressure (cAP), and LpPLA2 activity rank. However, AIx, cAP, and LpPLA2 activity were not significantly associated with carotid IMT after adjusting for Framingham risk factors (all p > .10). Only PWV retained a significant association with carotid IMT independent of the Framingham general risk profile parameters (p = .016). No statistically significant interactions between Framingham and other independent variables with ethnicity (all p > .05) were observed.In this safety net cohort, PWV is a potentially useful adjunctive atherosclerotic risk marker independent of traditional risk factors and irrespective of ethnicity.An emerging concept in cardiovascular disease (CVD) prevention is a shift in focus from predicting isolated coronary events to broader prediction of any CVD event. This has led to derivation of a new Framingham CVD risk profile [1] beyond the traditional score for predicting 10-year coronary disease events [2]. To illustrate this, data from the National Health and Nutrition Examination Surveys compared the two instruments among US men and women and found that just 3% of individuals were at a high (>20%) predicted coronary disease risk, whereas 18% were at high CVD risk when CVD death, myocardial in
Circulating adiponectin levels are lower in Latino versus non-Latino white patients at risk for cardiovascular disease, independent of adiposity measures
Rocio I Pereira, Cecilia CL Wang, Patrick Hosokawa, L Miriam Dickinson, Michel Chonchol, Mori J Krantz, John F Steiner, Daniel H Bessesen, Edward P Havranek, Carlin S Long
BMC Endocrine Disorders , 2011, DOI: 10.1186/1472-6823-11-13
Abstract: We utilized cross-sectional data from subjects in the Latinos Using Cardio Health Actions to reduce Risk study. Participants were Latino (n = 119) and non-Latino white (n = 60) men and women with hypertension and at least one other risk factor for CVD (age 61 ± 10 yrs, 49% with T2DM), seen at an integrated community health and hospital system in Denver, Colorado. Total and HMW adiponectin was measured by RIA and ELISA respectively. Fasting glucose and insulin were used to calculate the homeostasis model insulin resistance index (HOMA-IR). Variables independently associated with adiponectin levels were identified by linear regression analyses. Adiponectin's contribution to ethnic differences in insulin resistance was assessed in multivariate linear regression models of Latino ethnicity, with logHOMA-IR as a dependent variable, adjusting for possible confounders including age, gender, adiposity, and renal function.Mean adiponectin levels were lower in Latino than white patients (beta estimates: -4.5 (-6.4, -2.5), p < 0.001 and -1.6 (-2.7, -0.5), p < 0.005 for total and HMW adiponectin), independent of age, gender, BMI/waist circumference, thiazolidinedione use, diabetes status, and renal function. An expected negative association between adiponectin and waist circumference was seen among women and non-Latino white men, but no relationship between these two variables was observed among Latino men. Ethnic differences in logHOMA-IR were no longer observed after controlling for adiponectin levels.Among patients with CVD risk, total and HMW adiponectin is lower in Latinos, independent of adiposity and other known regulators of adiponectin. Ethnic differences in adiponectin regulation may exist and future research in this area is warranted. Adiponectin levels accounted for the observed variability in insulin resistance, suggesting a contribution of decreased adiponectin to insulin resistance in Latino populations.Latinos in the United States have a higher incidence and prev
A Cognitive Emotional Methodology for Critical Thinking  [PDF]
Edward P. Hanna
Advances in Applied Sociology (AASoci) , 2013, DOI: 10.4236/aasoci.2013.31003
Abstract: This essay provides a theoretical foundation for a cognitive emotional methodology for critical thinking that is currently being utilized by the author in undergraduate and graduate social work advanced seminar classes. Through a review of the literature, the paper suggests that most approaches to teaching critical thinking do not integrate cognitive emotional criteria in the teaching method, and this is problematic for social work education. Citing recent literature about teaching empathy and values, and merging that work with clinical theory and practice, a theoretical foundation is established for a methodology that is in its formative stages. The methodology and its constructs are described. Although the methodology is presented though the vehicle of social work education, it is asserted that the methodology has broader utility.


The Role of Viscoelasticity in Biomechanics
Antonin Havranek
Bulletin of Applied Mechanics , 2009,
Abstract: The necessity of using viscoelastic models instead of the only elastic ones is emphasized in rheological modeling of muscle function. The problem is visualized by an attractive beer-glass experiment.
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