Hospitalized Adult Patient Characteristics Associated With Participation in a Volunteer-Assisted Mobility Program: A Feasibility Study.

BACKGROUND: Physical inactivity during hospitalization commonly results in functional decline. Structured multidisciplinary programs/approaches may be useful to promote mobility in hospitalized adults. PURPOSE: The purpose was to determine whether a volunteer-assisted mobility program was feasible to improve the ambulation of hospitalized patients, and examine the characteristics of patients associated with willingness to participate in the program. METHODS: A prospective descriptive correlation study was conducted in 2 acute care units. A volunteer-staffed program was implemented with the aim of improving the ambulation of hospitalized patients. RESULTS: Hospitalized patients (N = 490) were approached, with 39.2% (n = 192) agreeing to ambulate an average of 109.7 m (interquartile range = 51.45-172.2 m). Patients with a low clinical frailty score, high body mass index, or physical therapy order were more likely to participate in the volunteer-assisted mobility program. CONCLUSIONS: The findings suggest that a volunteer-assisted interdisciplinary program is a feasible way to promote the ambulation of some patients.

The meaning and role of ideology in system justification and resistance for high- and low-status people.

In this article we explore how beliefs about system ideals and the achievement of those ideals differentially predict system justification among low- and high-status groups. Our goal was to reconcile how people can promote system ideals such as equal opportunities for all and at the same time recognize that group-based disparities are, in part, due to these unfulfilled ideals. Three studies examined whether people perceived a discrepancy between a system's ideal goals and its achievement of those goals. Everyone endorsed these goal ideals more than they believed that the goals were being achieved; however, this discrepancy was larger for low-status people. The larger the perceived discrepancy, the more dissatisfied people were with the system and the more likely they were to support hierarchy-attenuating policies. Studies 2 and 3 also examined people's motivation for endorsing goal ideals. People of all statuses endorsed system ideals to promote an ideal system more than to legitimize the actual system (Study 2); however, high-status people were slightly more likely to endorse system ideals to legitimize the actual system than low-status people (Study 3). In summary, low-status people were more likely than high-status people to recognize discrepancies between system goals and system outcomes, show dissatisfaction with the American system, and prefer policies that would attenuate extant hierarchies.

Prevalence of Anguillicoloides crassus and growth variation in migrant yellow-phase American eels of the upper Potomac River drainage.

Prevalence of the non-native swim bladder nematode Anguillicoloides crassus has recently increased in American eels from estuaries of the North American Atlantic coast, but little is known about parasite prevalence or conditions of previous infection in upstream migrant eels within upper watersheds. This study is the first to confirm presence of A. crassus in the upper Potomac River watershed. We estimated A. crassus prevalence during 3 time periods: September to October 2006 (5/143 eels, 3.5%), August to October 2007 (0/49 eels), and June 2008 (0/50 eels). All eels were sampled from the Millville Dam eel ladder on the lower Shenandoah River, a Potomac River tributary located approximately 285 km upstream of Chesapeake Bay, USA. Of the 5 infected eels, parasite intensity was 1 for each eel, and mean intensity was also 1.0. A swim bladder degenerative index (SDI) was calculated for the 50 eels from the final sampling period, and 38% of those eels (19 of 50) showed signs of previous infection by A. crassus. We also aged 42 of the 50 eels (mean ± SE = 6.7 ± 0.29 yr, range 4 to 11 yr) from the final sampling period. Based on the range of possible SDI scores (0 to 6), severity of previously infected swim bladders was moderate (SDI = 1 or 2). Previously infected eels, however, had a lower length-at-age than that of uninfected eels. Female yellow-phase eels in upper watersheds develop into large highly fecund silver-phase adults; hence, a parasite-induced effect on growth of yellow-phase eels could ultimately reduce reproductive potential.

Built environment instruments for walkability, bikeability, and recreation: disability and universal design relevant?

BACKGROUND: Despite a plethora of instruments that measure the built environment with respect to its effect on potential physical activity, little is known about how relevant these instruments are for people with disabilities (PWDs). OBJECTIVE: This review comprises an in-depth review of instruments related to the built environment and physical activity, as well as an examination of such instruments to determine their applicability for PWDs. METHODS: In this paper, the term "built environment" refers to human-made structures (e.g., urban and rural design characteristics, recreational structures) that may facilitate or impede an individual's ability to be physically active. A content analysis was conducted on 95 instruments measuring walkability, bikeability, and recreation with respect to disability and universal design (UD) relevance. Instruments were also cataloged according to other dimensions, including psychometric properties, data collection modalities, and impact or use. RESULTS: Roughly one third of all instruments include some disability-specific items, and only a few UD principles are consistently demonstrated across all instruments. Psychometric information is available for approximately one half of the instruments. Most instruments use objective/audit methods of data collection, with less using subjective/perceived and Geographic Information System (GIS) methods. With respect to instrument impact/use, just over one half of the instruments have articles cited in the peer-reviewed literature. CONCLUSIONS: Recommendations for new and revised built environment instruments include more focus on specific disability populations, incorporation of all UD principles, as well as attention to psychometric quality and measurement specificity.

Geropsychology Mentoring: A Survey of Current Practices and Perceived Needs.

The need for clinical geropsychologists currently exceeds the availability, and this imbalance is expected to worsen along with the impending growth in the older adult population. Effective geropsychology mentoring may be helpful in meeting this challenge. However, little is known about mentoring within clinical geropsychology. The present paper reports on a survey of mentoring practices and needs. Findings indicate that a large majority of clinical geropsychology trainees and professionals at all levels have a mentor and that the contributions mentors make are highly valued. Among the needs identified by survey respondents was guidance for effective mentoring. Results of the survey suggest that efforts to enhance mentoring within clinical geropsychology may contribute to the goal of expanding the workforce to meet future needs.

Mentoring in Clinical Geropsychology: Across the Stages of Professional Development.

Projected growth in demand for clinical geropsychologists will require expanding the number of qualified geropsychology mentors at all stages of professional development. This special section provides information on mentoring from expert geropsychology mentors who offer their perspectives, and summarize relevant research, on mentoring graduate students, interns and postdoctoral fellows, junior faculty and members of special populations. The present paper provides an introduction to the special section by establishing the need for increased mentoring within clinical geropsychology, presenting results of a survey of mentoring practices and needs, and discussing ways in which the field is responding to the challenge.

A pilot safety study of lenalidomide and radiotherapy for patients with newly diagnosed glioblastoma multiforme.

PURPOSE: To define the maximum tolerated dose (MTD) of lenalidomide, an analogue of thalidomide with enhanced immunomodulatory and antiangiogenic properties and a more favorable toxicity profile, in patients with newly diagnosed glioblastoma multiforme (GBM) when given concurrently with radiotherapy. PATIENTS AND METHODS: Patients with newly diagnosed GBM received radiotherapy concurrently with lenalidomide given for 3 weeks followed by a 1-week rest period and continued lenalidomide until tumor progression or unacceptable toxicity. Dose escalation occurred in groups of 6. Determination of the MTD was based on toxicities during the first 12 weeks of therapy. The primary endpoint was toxicity. RESULTS: Twenty-three patients were enrolled, of whom 20 were treated and evaluable for both toxicity and tumor response and 2 were evaluable for toxicity only. Common toxicities included venous thromboembolic disease, fatigue, and nausea. Dose-limiting toxicities were eosinophilic pneumonitis and transaminase elevations. The MTD for lenalidomide was determined to be 15 mg/m(2)/d. CONCLUSION: The recommended dose for lenalidomide with radiotherapy is 15 mg/m(2)/d for 3 weeks followed by a 1-week rest period. Venous thromboembolic complications occurred in 4 patients, and prophylactic anticoagulation should be considered.

Vascular risk and depression in the Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE).

OBJECTIVE: Although vascular depression has received considerable research attention, relatively little research in this area has focused on minority samples. This study investigated the association between baseline vascular risk factors (VRFs) and risk for elevated depressive symptoms at 2-year follow-up in a sample of 964 individuals without significant depressive symptomotology (CES-D < 12) or cognitive impairment (MMSE>or= 24) at baseline from the Hispanic Established Population for the Epidemiologic Study of the Elderly. METHODS: We examined the associations between self-reported baseline vascular risk factors (chest pain, heart attack, stroke, hypertension, diabetes, and smoking) and a composite of these risk factors with elevated depressive symptoms (CES-D >or= 16) at 2-year follow-up. RESULTS: Seventy-four (7.7%) of the 964 participants without evidence of depression at baseline demonstrated elevated depressive symptoms (CESD >or= 16) 2 years later. There was an overall pattern of higher rates of elevated depressive symptoms at 2-year follow-up with increasing number of vascular risk factors (0 VRFs = 6.4%, 1 VRF = 5.5%, 2 VRFs = 7.7%, and 3 or more VRFs = 14.7%). After controlling for demographic variables, physical functioning, and other medical conditions, the cumulative vascular risk index was significantly associated with elevated depressive symptoms at 2-year follow-up (p < 0.05). CONCLUSIONS: Our results suggest vascular conditions may contribute to risk for depression over time among Mexican American elders, and this is relatively independent of other medical conditions. These findings suggest that depression is an additional long-term complication of these common cardiovascular disorders.

Evaluating Parkinson's disease patients at home: utility of self-videotaping for objective motor, dyskinesia, and ON-OFF assessments.

The objective is to test feasibility and utility of home-based videos for assessing Parkinson's disease (PD) patients. As part of a clinical trial, patients opted between coming to the study sites or learning to videotape assessments at home. Those opting for at-home filming completed training on videotape techniques. Ten-minute films were taken at 30-minute intervals over 8.5 hours, 2 and 4 weeks after study entry using a protocol covering most items of the UDPRS motor examination and all Rush Dyskinesia Rating Scale items. After each filming, patients marked their ON/OFF status, based on prior training. We determined the number of patients who elected self-taping and the quality of video segments obtained. To assess ON/OFF patient accuracy, we compared the rater's and patient's assessment of ON/OFF at each time point. Of 12 participants, 10 elected self-videotaping and only 1 time point was missed (99.5% taping compliance). All self-recorded video segments were clear with all protocol elements included. With the exception of one missed ON/OFF rating, patient-based self-ratings occurred on time. Rating ON/OFF, UPDRS, and RDRS assessments for 8.5 hours required 170 minutes by the blinded rater. In spite of patient training, mean ON/OFF concordance between rater and patients was only 64%. At home video-based self-recordings are feasible and allow accurate rater-based ON/OFF assessments. In this group of patients with no or mild fluctuations, in spite of pretrial training, patients were inaccurate in separating ON vs. OFF status.

Collaborative models of patient care:new opportunities for hospital social workers.

Hospitals are increasingly recognizing the importance of moving away from the traditional medical model of care to more collaborative models that integrate patients and families into the planning and delivery of healthcare. A few existing studies suggest that collaborative models of care result in higher levels of consumer satisfaction, treatment compliance, effective team performance, and increased care coordination (Gance-Cleveland, 2005; DiMatteo et al., 2002; Reid Ponte et al., 2004; Institute for Family-Centered Care, 2004). Key values underpinning social work practice make medical social workers well-positioned to play leadership roles as hospitals make the shift to more patient-centered care. Specific strategies are presented for medical social workers to use in advocating for change in the way health services are planned and delivered within hospital settings.