Biomedical subjects

Drew A Helmer

Publications and source records attributed to Drew A Helmer.

5 recordsLinked to original sources

PubMed2006

Developing a bioterrorism preparedness campaign for veterans: Using focus groups to inform materials development.

In the context of a global war on terrorism experts have focused on the potential for a bioterrorist incident to cause widespread health and psychological consequences. Preparation is critical to improving the U.S. response to future bioterrorist incidents and educating the public is recognized as a vital part of this preparedness effort. Under a grant from the U.S. Veterans Health Administration (VHA), researchers from a network of VA health care and research facilities initiated a program to develop and evaluate educational materials for veterans--including those with mental illness. This article describes the results of a series of focus groups with three veteran subpopulations of interest to characterize their concerns and information needs and summarizes the insights gained that helped guide materials development.

Bioterrorism↗

PubMed2006

The war-related illness and injury study centers: a resource for deployment-related health concerns.

Combat veterans often return from deployment having experienced a wide range of exposures, symptoms, and medical conditions. The Department of Veterans Affairs established war-related illness and injury study centers to serve combat veterans with unexplained illnesses. We report the exposures, clinical status, and utilization of 53 combat veterans who participated in the National Referral Program (NRP) from January 2002 until March 2004. Participants were primarily male (81%) and served in the Persian Gulf War (79%). Common diagnoses were chronic fatigue syndrome (n = 23, 43%), neurotic depression (n = 21, 40%), and post-traumatic stress disorder (n = 20, 38%). Self-reported exposures related to weaponry, disease prophylaxis, environmental hazards, stress, and poor hygiene. A small increase in mean SF-36V mental component scores (2.8 points, p = 0.009) and use of rehabilitation therapies (1.6 additional visits, p = 0.018) followed the NRP referral. The small gain in mental function suggests that the NRP may benefit combat veterans with long and complex medical histories.

Adult↗

PubMed2003

Ambulatory internal medicine education: use of an urgent care center.

BACKGROUND: Internal medicine residency programs have increased the time devoted to ambulatory medicine and the range of nonmedical areas in which expertise is expected. Whether existing teaching locations can provide residents with appropriate training in educationally targeted specialty (ETS) conditions (otolaryngology, urology, dermatology, ophthalmology, and orthopedics), is unknown. METHODS: An urgent care center (UCC) was developed at a teaching hospital to provide residents with additional experience in ambulatory medicine. To assess the frequency and nature of conditions seen by residents, 500 charts in the UCC, 500 charts in the resident continuity clinic (RCC), and 500 charts in the emergency room (ER) were selected at random and reviewed during a 2-month study period. Complaints were classified into three categories: general medicine, ETS conditions, and miscellaneous (upper respiratory infection, gynecology, and psychiatry). RESULTS: Four hundred seventy-six (95.2%) patients in the UCC and 491 (98.2%) patients in the ER had acute problems as compared with 236 (47.2%) patients in the RCC (P < 0.001). The number of ETS conditions was 302 (UCC), 104 (RCC), and 89 (ER; P < 0.001). The number in each category was otolaryngology, 88 (UCC), 17 (RCC), 19 (ER); urology, 43 (UCC), 10 (RCC), 14 (ER); dermatology, 41 (UCC), 11 (RCC), 11 (ER); ophthalmology, 25 (UCC), 7 (RCC), 10 (ER); and orthopedics, 105 (UCC), 59 (RCC), 35 (ER). CONCLUSION: Patients with ETS conditions were seen more often by residents in the UCC than in the other locations. In our institution, a UCC provides a useful opportunity for the clinical and didactic education of internal medicine residents in areas of acute care that were underrepresented in other rotations. New educational programs may be needed to ensure the education of residents in ambulatory medicine.

Adult↗

PubMed2003

Applying diabetes-related Prevention Quality Indicators to a national cohort of veterans with diabetes.

OBJECTIVE: The Prevention Quality Indicators (PQIs) are measures of hospitalizations that reflect quality of ambulatory care. We applied the PQIs of metabolic decompensation to Veterans Health Administration (VHA) utilizers with diabetes. We identified patient-level characteristics associated with hospitalization for metabolic decompensation, developed a risk-adjustment model for the measures, and compared regional network performance using these PQIs. RESEARCH DESIGN AND METHODS: This was a retrospective cohort study of 406575 veterans with diabetes who used the VHA between 1997 and 1999. The outcomes were the PQIs of uncontrolled diabetes, short-term complications, or a combined measure. Patient-level variables were identified from administrative databases. Variation in performance of the networks was compared between full risk adjustment and age and sex adjustment only. RESULTS: In fiscal year 1999, there were 1719 VHA discharges (4.2 per 1000 cohort members) for uncontrolled and short-term complications of diabetes. A logistic regression model including age, sex, marital status, Charlson Comorbidity Index, mental health condition, insulin use, and oral antiglycemic medication use was developed for risk adjustment of the combined PQI. Full risk adjustment changed performance ranks of the networks using the combined PQI outcome relative to age and sex adjustment only. Ten networks remained in the same quartile of performance, five moved one quartile, and seven moved two or more quartiles. CONCLUSIONS: The PQIs of uncontrolled and short-term complications of diabetes are uncommon outcomes among veterans with diabetes and should be used only as a combined outcome. More complete risk adjustment should be used when comparing systems of care using the combined measure.

Aged↗

PubMed2002

Birth order and its association with the onset of chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is a medically unexplained illness that is diagnosed on the basis of a clinical case definition; so it probably is an illness with multiple causes producing the same clinical picture. One way of dealing with this heterogeneity is to stratify patients based on illness onset. We hypothesized that either the whole group of CFS patients or that group which developed CFS gradually would show a relation with birth order, while patients who developed CFS suddenly, probably due to a viral illness, would not show such a relation. We hypothesized the birth order effect in the gradual onset group because those patients have more psychological problems, and birth order effects have been shown for psychological characteristics. We compared birth order in our CFS patients to that in a comparison group derived from U.S. demographic data. We found a tendency that did not reach formal statistical significance for a birth order effect in the gradual onset group, but not in either the sudden onset or combined total group. However, the birth order effect we found was due to relatively increased rates of CFS in second-born children; prior birth order studies of personality characteristics have found such effects to be skewed toward first-born children. Thus, our data do support a birth order effect in a subset of patients with CFS. The results of this study should encourage a larger multicenter study to further explore and understand this relation.

Adult↗