Background: Rural residents are at greater risk for obesity than their urban peers, as they tend ... more Background: Rural residents are at greater risk for obesity than their urban peers, as they tend to have fewer resources and less access to medical services and health education. To address these barriers, we conducted TAKE ACTION, a small-scale pilot intervention to evaluate the effectiveness of a multidisciplinary, healthy lifestyle program for overweight youth and parents living in a rural community. Methods: 14 youth and 12 parents participated in the program. Eligible youth were between 6 and 17 years old with a BMI at or above the 85th percentile and a co-participating parent. Participants (n=26) received 16 sessions of graduated-intensity aerobic activity with supplemental nutritional education and behavior modification training. The program utilized community facilities and was supported by local organizations and businesses. Anthropomorphic and cardiovascular fitness assessments occurred pre- and post-intervention. Results: BMI, waist circumference, and waist-to-hip ratio f...
The management of type 2 diabetes mellitus (T2DM) by primary care physicians (PCPs) has become in... more The management of type 2 diabetes mellitus (T2DM) by primary care physicians (PCPs) has become increasingly complex due to limitations on consultation time, an increasing array of drug treatment options, and issues of comorbidities and polypharmacy. Diabetes is a progressive condition and treatment with a single glucose-lowering agent can only address limited pathophysiologic targets and does not provide adequate glycemic control in many cases. Consequently, most patients with T2DM will eventually require treatment with multiple glucose-lowering medications. Oral combination therapy in T2DM may be given as multiple-pills, or as single-pill, fixed-dose combinations (FDCs), the latter of which offer convenience, ease of administration, and a reduction in the medication burden. Therefore, FDCs can potentially improve patients' treatment adherence and optimize achievement and maintenance of glycemic targets. However, cost factors also need to be considered. An understanding of the issues associated with the use of combination therapy in T2DM will help PCPs to guide patient-centered decision making and promote the effective management of T2DM.
The Journal of the American Osteopathic Association, 2015
First introduced conceptually decades before the passage of the Patient Protection and Affordable... more First introduced conceptually decades before the passage of the Patient Protection and Affordable Care Act, the patient-centered medical home (PCMH) has evolved as a foundational element within the larger health care system or medical neighborhood, highlighting a coordinated and comprehensive disease management approach centered on intensive primary care interventions. More recently, in the wake of health care reform, accountable care organizations (ACOs) have been established to help health plans, physicians, hospitals, home health care practitioners, and other health care providers better coordinate care through an incentive-based payment arrangement. Osteopathic medicine is poised to proactively capitalize on these emerging health care models, with the anticipated end result of improved quality of care and reduced health care costs. As such, osteopathic physicians involved in the prevention and care of patients with type 2 diabetes mellitus need to identify models, best practices, and solutions to advance the medical neighborhood.
The Journal of the American Osteopathic Association, 2015
First introduced conceptually decades before the passage of the Patient Protection and Affordable... more First introduced conceptually decades before the passage of the Patient Protection and Affordable Care Act, the patient-centered medical home (PCMH) has evolved as a foundational element within the larger health care system or medical neighborhood, highlighting a coordinated and comprehensive disease management approach centered on intensive primary care interventions. More recently, in the wake of health care reform, accountable care organizations (ACOs) have been established to help health plans, physicians, hospitals, home health care practitioners, and other health care providers better coordinate care through an incentive-based payment arrangement. Osteopathic medicine is poised to proactively capitalize on these emerging health care models, with the anticipated end result of improved quality of care and reduced health care costs. As such, osteopathic physicians involved in the prevention and care of patients with type 2 diabetes mellitus need to identify models, best practices...
This paper presents a case-based approach to decision support for diabetes management in patients... more This paper presents a case-based approach to decision support for diabetes management in patients with Type 1 diabetes on insulin pump therapy. To avoid serious disease complications, including heart attack, blindness and stroke, these patients must continuously monitor their blood glucose levels and keep them as close to normal as possible. Achieving and maintaining good blood glucose control is a difficult task for these patients and their health care providers. A prototypical case-based decision support system was built to assist with this task. A clinical research study, involving 20 patients, yielded 50 cases of actual problems in blood glucose control, with their associated therapeutic adjustments and clinical outcomes, for the prototype's case base. The prototype operates by: (1) detecting problems in blood glucose control in large quantities of patient blood glucose and life event data; (2) finding similar past problems in the case base; and (3) offering the associated therapeutic adjustments stored in the case base to the physician as decision support. Results from structured evaluation sessions and a patient feedback survey encourage continued research and work towards a practical tool for diabetes management.
The Journal of the American Osteopathic Association
Medical students are major stakeholders in the changing world of healthcare. Initiatives to chang... more Medical students are major stakeholders in the changing world of healthcare. Initiatives to change the specialty makeup and geographic distribution of the physician workforce, changes in the organization of healthcare delivery systems, and financing systems for healthcare will profoundly alter their practice environment while they are in school and just beginning to make career decisions. The decisions of osteopathic medical students, who currently make up 30% of the profession, will shape the profession's response to the new initiatives and determine its place in emerging healthcare systems. The authors surveyed first- and second-year osteopathic medical students to ascertain their perceived knowledge, opinions, and intentions as they relate to healthcare reform. They discovered that increasing numbers of students intend to practice in primary care fields. The student respondents support some of the major changes proposed by reformers in greater numbers than physicians as a whole, and have different priorities that they would like to see addressed in reform. This study reveals links between respondents' intentions to practice primary care and support for specific reform items, but the results show no link between anticipated indebtedness and respondents' intentions to enter primary care or specialty fields. The authors conclude that healthcare reform, although still in debate, has already exerted an influence on the decision-making processes of medical students.
The Journal of the American Osteopathic Association
One house staff member accounted for the majority of house staff patient admissions that did not ... more One house staff member accounted for the majority of house staff patient admissions that did not have an osteopathic examination in the postintervention data. If these admissions were excluded from analysis, the percentage of patients receiving an osteopathic examination would be 96.5 (82 of 85 patients). † Statistical significance cannot be determined because 0% cannot be used as a baseline measurement.
This paper presents preliminary work in using case-based reasoning (CBR) for diabetes management.... more This paper presents preliminary work in using case-based reasoning (CBR) for diabetes management. The long range goal of the project is to provide intelligent decision support to people with Type 1 diabetes on insulin pump therapy. Case-based reasoning (CBR) was se-lected for this application because: (a) existing guidelines for managing diabetes are general and must be tailored to individual patient needs; (b) physical and lifestyle factors combine to influence blood glucose levels; and (c) CBR has been successfully applied to the management of other long-term medical conditions. Progress to date includes: (a) construction of software tools for data collection and visualization; (b) compilation of a case library; and (c) implementation of code for automated problem detection to identify new problem cases in raw patient data. Work contin-ues on a CBR therapy advisor that will propose individualized solutions for detected problems in blood glucose control.
The most common types of supraventricular tachycardia are caused by a reentry phenomenon producin... more The most common types of supraventricular tachycardia are caused by a reentry phenomenon producing accelerated heart rates. Symptoms may include palpitations (pulsation in the neck), chest pain, lightheadedness or dizziness, and dyspnea. It is unusual for supraventricular tachycardia to be caused by structurally abnormal hearts. Diagnosis is often delayed because of the misdiagnosis of anxiety or panic disorder. Patient history is important in uncovering the diagnosis, whereas the physical examination may or may not be helpful, and usually necessitates use of a Holter monitor or an event recorder to capture the arrhythmia and confirm a diagnosis. Treatment consists of short-term or as needed pharmacotherapy using calcium channel or beta blockers when vagal maneuvers fail to halt or slow the rhythm. In those who require long-term pharmacotherapy, atrioventricular nodal blocking agents or class IC or III antiarrhythmics can be used; however, these agents should generally be managed by...
Was this a case of Addison's disease, hemochromatosis, or melanoma? Or did one of the patient... more Was this a case of Addison's disease, hemochromatosis, or melanoma? Or did one of the patient's medications have something to do with it?
The rash was asymptomatic and had developed over the past few years. The patient wasn't takin... more The rash was asymptomatic and had developed over the past few years. The patient wasn't taking any prescriptions and hadn't changed detergents.
The Journal of the American Osteopathic Association
The American Osteopathic Association developed its Clinical Assessment Program (AOA-CAP) for Resi... more The American Osteopathic Association developed its Clinical Assessment Program (AOA-CAP) for Residencies to provide a mechanism for osteopathic residency programs to measure and improve their quality of patient care. To compare program performance in processes of care and intermediate outcomes for patients with diabetes mellitus in residency programs that contributed data to the AOA-CAP for the first time vs residency programs that contributed data repeatedly. Osteopathic family medicine residency programs that entered data into the AOA-CAP diabetes registry between July 1, 2005, and December 31, 2007, were included in the present study. Residency programs were separated into those that entered data into the registry for the first time during the 2005-2007 cycle (ie, first-time programs) and those that also entered data into the registry during the previous cycle (2003-2005) (ie, repeat programs). Measures of processes of care were annual foot examination, annual referral for ophtha...
Background: Rural residents are at greater risk for obesity than their urban peers, as they tend ... more Background: Rural residents are at greater risk for obesity than their urban peers, as they tend to have fewer resources and less access to medical services and health education. To address these barriers, we conducted TAKE ACTION, a small-scale pilot intervention to evaluate the effectiveness of a multidisciplinary, healthy lifestyle program for overweight youth and parents living in a rural community. Methods: 14 youth and 12 parents participated in the program. Eligible youth were between 6 and 17 years old with a BMI at or above the 85th percentile and a co-participating parent. Participants (n=26) received 16 sessions of graduated-intensity aerobic activity with supplemental nutritional education and behavior modification training. The program utilized community facilities and was supported by local organizations and businesses. Anthropomorphic and cardiovascular fitness assessments occurred pre- and post-intervention. Results: BMI, waist circumference, and waist-to-hip ratio f...
The management of type 2 diabetes mellitus (T2DM) by primary care physicians (PCPs) has become in... more The management of type 2 diabetes mellitus (T2DM) by primary care physicians (PCPs) has become increasingly complex due to limitations on consultation time, an increasing array of drug treatment options, and issues of comorbidities and polypharmacy. Diabetes is a progressive condition and treatment with a single glucose-lowering agent can only address limited pathophysiologic targets and does not provide adequate glycemic control in many cases. Consequently, most patients with T2DM will eventually require treatment with multiple glucose-lowering medications. Oral combination therapy in T2DM may be given as multiple-pills, or as single-pill, fixed-dose combinations (FDCs), the latter of which offer convenience, ease of administration, and a reduction in the medication burden. Therefore, FDCs can potentially improve patients' treatment adherence and optimize achievement and maintenance of glycemic targets. However, cost factors also need to be considered. An understanding of the issues associated with the use of combination therapy in T2DM will help PCPs to guide patient-centered decision making and promote the effective management of T2DM.
The Journal of the American Osteopathic Association, 2015
First introduced conceptually decades before the passage of the Patient Protection and Affordable... more First introduced conceptually decades before the passage of the Patient Protection and Affordable Care Act, the patient-centered medical home (PCMH) has evolved as a foundational element within the larger health care system or medical neighborhood, highlighting a coordinated and comprehensive disease management approach centered on intensive primary care interventions. More recently, in the wake of health care reform, accountable care organizations (ACOs) have been established to help health plans, physicians, hospitals, home health care practitioners, and other health care providers better coordinate care through an incentive-based payment arrangement. Osteopathic medicine is poised to proactively capitalize on these emerging health care models, with the anticipated end result of improved quality of care and reduced health care costs. As such, osteopathic physicians involved in the prevention and care of patients with type 2 diabetes mellitus need to identify models, best practices, and solutions to advance the medical neighborhood.
The Journal of the American Osteopathic Association, 2015
First introduced conceptually decades before the passage of the Patient Protection and Affordable... more First introduced conceptually decades before the passage of the Patient Protection and Affordable Care Act, the patient-centered medical home (PCMH) has evolved as a foundational element within the larger health care system or medical neighborhood, highlighting a coordinated and comprehensive disease management approach centered on intensive primary care interventions. More recently, in the wake of health care reform, accountable care organizations (ACOs) have been established to help health plans, physicians, hospitals, home health care practitioners, and other health care providers better coordinate care through an incentive-based payment arrangement. Osteopathic medicine is poised to proactively capitalize on these emerging health care models, with the anticipated end result of improved quality of care and reduced health care costs. As such, osteopathic physicians involved in the prevention and care of patients with type 2 diabetes mellitus need to identify models, best practices...
This paper presents a case-based approach to decision support for diabetes management in patients... more This paper presents a case-based approach to decision support for diabetes management in patients with Type 1 diabetes on insulin pump therapy. To avoid serious disease complications, including heart attack, blindness and stroke, these patients must continuously monitor their blood glucose levels and keep them as close to normal as possible. Achieving and maintaining good blood glucose control is a difficult task for these patients and their health care providers. A prototypical case-based decision support system was built to assist with this task. A clinical research study, involving 20 patients, yielded 50 cases of actual problems in blood glucose control, with their associated therapeutic adjustments and clinical outcomes, for the prototype's case base. The prototype operates by: (1) detecting problems in blood glucose control in large quantities of patient blood glucose and life event data; (2) finding similar past problems in the case base; and (3) offering the associated therapeutic adjustments stored in the case base to the physician as decision support. Results from structured evaluation sessions and a patient feedback survey encourage continued research and work towards a practical tool for diabetes management.
The Journal of the American Osteopathic Association
Medical students are major stakeholders in the changing world of healthcare. Initiatives to chang... more Medical students are major stakeholders in the changing world of healthcare. Initiatives to change the specialty makeup and geographic distribution of the physician workforce, changes in the organization of healthcare delivery systems, and financing systems for healthcare will profoundly alter their practice environment while they are in school and just beginning to make career decisions. The decisions of osteopathic medical students, who currently make up 30% of the profession, will shape the profession's response to the new initiatives and determine its place in emerging healthcare systems. The authors surveyed first- and second-year osteopathic medical students to ascertain their perceived knowledge, opinions, and intentions as they relate to healthcare reform. They discovered that increasing numbers of students intend to practice in primary care fields. The student respondents support some of the major changes proposed by reformers in greater numbers than physicians as a whole, and have different priorities that they would like to see addressed in reform. This study reveals links between respondents' intentions to practice primary care and support for specific reform items, but the results show no link between anticipated indebtedness and respondents' intentions to enter primary care or specialty fields. The authors conclude that healthcare reform, although still in debate, has already exerted an influence on the decision-making processes of medical students.
The Journal of the American Osteopathic Association
One house staff member accounted for the majority of house staff patient admissions that did not ... more One house staff member accounted for the majority of house staff patient admissions that did not have an osteopathic examination in the postintervention data. If these admissions were excluded from analysis, the percentage of patients receiving an osteopathic examination would be 96.5 (82 of 85 patients). † Statistical significance cannot be determined because 0% cannot be used as a baseline measurement.
This paper presents preliminary work in using case-based reasoning (CBR) for diabetes management.... more This paper presents preliminary work in using case-based reasoning (CBR) for diabetes management. The long range goal of the project is to provide intelligent decision support to people with Type 1 diabetes on insulin pump therapy. Case-based reasoning (CBR) was se-lected for this application because: (a) existing guidelines for managing diabetes are general and must be tailored to individual patient needs; (b) physical and lifestyle factors combine to influence blood glucose levels; and (c) CBR has been successfully applied to the management of other long-term medical conditions. Progress to date includes: (a) construction of software tools for data collection and visualization; (b) compilation of a case library; and (c) implementation of code for automated problem detection to identify new problem cases in raw patient data. Work contin-ues on a CBR therapy advisor that will propose individualized solutions for detected problems in blood glucose control.
The most common types of supraventricular tachycardia are caused by a reentry phenomenon producin... more The most common types of supraventricular tachycardia are caused by a reentry phenomenon producing accelerated heart rates. Symptoms may include palpitations (pulsation in the neck), chest pain, lightheadedness or dizziness, and dyspnea. It is unusual for supraventricular tachycardia to be caused by structurally abnormal hearts. Diagnosis is often delayed because of the misdiagnosis of anxiety or panic disorder. Patient history is important in uncovering the diagnosis, whereas the physical examination may or may not be helpful, and usually necessitates use of a Holter monitor or an event recorder to capture the arrhythmia and confirm a diagnosis. Treatment consists of short-term or as needed pharmacotherapy using calcium channel or beta blockers when vagal maneuvers fail to halt or slow the rhythm. In those who require long-term pharmacotherapy, atrioventricular nodal blocking agents or class IC or III antiarrhythmics can be used; however, these agents should generally be managed by...
Was this a case of Addison's disease, hemochromatosis, or melanoma? Or did one of the patient... more Was this a case of Addison's disease, hemochromatosis, or melanoma? Or did one of the patient's medications have something to do with it?
The rash was asymptomatic and had developed over the past few years. The patient wasn't takin... more The rash was asymptomatic and had developed over the past few years. The patient wasn't taking any prescriptions and hadn't changed detergents.
The Journal of the American Osteopathic Association
The American Osteopathic Association developed its Clinical Assessment Program (AOA-CAP) for Resi... more The American Osteopathic Association developed its Clinical Assessment Program (AOA-CAP) for Residencies to provide a mechanism for osteopathic residency programs to measure and improve their quality of patient care. To compare program performance in processes of care and intermediate outcomes for patients with diabetes mellitus in residency programs that contributed data to the AOA-CAP for the first time vs residency programs that contributed data repeatedly. Osteopathic family medicine residency programs that entered data into the AOA-CAP diabetes registry between July 1, 2005, and December 31, 2007, were included in the present study. Residency programs were separated into those that entered data into the registry for the first time during the 2005-2007 cycle (ie, first-time programs) and those that also entered data into the registry during the previous cycle (2003-2005) (ie, repeat programs). Measures of processes of care were annual foot examination, annual referral for ophtha...
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Papers by jay shubrook