Browsing by Author "Karvonen-Gutierrez, Carrie A."

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    Effectiveness of the Tobacco Tactics program in the Department of Veterans Affairs
    (European Publishing, 2014-06-06) Duffy, Sonia A.; Ronis, David; Karvonen-Gutierrez, Carrie A.; Ewing, Lee A.; Dalack, Gregory W.; Smith, Patricia M.; Carmody, Timothy P.; Hicks, Thomas; Hermann, Christopher; Reeves, Pamela; Flanagan, Petra; Medicine, School of Medicine
    Background: Smoking cessation interventions during hospitalization have been shown to be efficacious, yet are rarely incorporated into practice. The purpose of this study was to determine the effectiveness of the Tobacco Tactics program in three Veterans Affairs (VA) hospitals. Materials and methods: In this quasi-experimental pre- post- comparison effectiveness trial, inpatient nurses were educated to provide the Tobacco Tactics intervention in the Ann Arbor, MI and Detroit, MI VA hospitals, while the Indianapolis, IN VA hospital was the control site (N=1,070). The Tobacco Tactics nurse toolkit included: 1) one contact hour for training; 2) a PowerPoint presentation on behavioral and pharmaceutical interventions; 3) a pocket card “Helping Smokers Quit: A Guide for Clinicians”; 4) pharmaceutical and behavioral protocols; and 5) a computerized template for nurse documentation. The patient toolkit included: 1) a brochure; 2) a videotape “Smoking: Getting Ready to Quit;” 3) a Tobacco Tactics manual; 4) pharmaceuticals; 5) a 1-800-QUIT-NOW help line card; and 6) post-discharge telephone calls. Smoking patients were surveyed in the hospital and again six-months post-discharge. Urinary cotinine tests were used to verify six-month smoking status. Results: The average age was 55.3 years, most were male (94%) and not married (76%). After adjustment for the propensity of being assigned to treatment condition, there were significant improvements in 6-month quit rates in the pre- to post-intervention time periods in Ann Arbor (p=0.004) and Detroit (p<0.001) compared to the Indianapolis control site. The intervention was particularly effective in Detroit where pre-intervention quit rates were 4% compared to 13% post-intervention. Conclusions: This study showed that training staff nurses to integrate smoking cessation services into their routine care may increase quit rates. The Tobacco Tactics program, which meets the newly released (2011) Joint Commission standards that apply to all inpatient smokers, has the potential to significantly decrease smoking among patients admitted to VA hospitals.
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    Sex and External Size Specific Limitations in Assessing Bone Health From Adult Hand Radiographs
    (Wiley, 2022-06-29) Bigelow, Erin M.R.; Goulet, Robert W.; Ciarelli, Antonio; Schlecht, Stephen H.; Kohn, David H.; Bredbenner, Todd L.; Harlow, Sioban D.; Karvonen-Gutierrez, Carrie A.; Jepsen, Karl J.; Orthopaedic Surgery, School of Medicine
    Morphological parameters measured for the second metacarpal from hand radiographs are used clinically for assessing bone health during growth and aging. Understanding how these morphological parameters relate to metacarpal strength and strength at other anatomical sites is critical for providing informed decision-making regarding treatment strategies and effectiveness. The goals of this study were to evaluate the extent to which 11 morphological parameters, nine of which were measured from hand radiographs, relate to experimentally measured whole-bone strength assessed at multiple anatomical sites and to test whether these associations differed between men and women. Bone morphology and strength were assessed for the second and third metacarpals, radial diaphysis, femoral diaphysis, and proximal femur for 28 white male donors (18-89 years old) and 35 white female donors (36-89+ years old). The only morphological parameter to show a significant correlation with strength without a sex-specific effect was cortical area. Dimensionless morphological parameters derived from hand radiographs correlated significantly with strength for females, but few did for males. Males and females showed a significant association between the circularity of the metacarpal cross-section and the outer width measured in the mediolateral direction. This cross-sectional shape variation contributed to systematic bias in estimating strength using cortical area and assuming a circular cross-section. This was confirmed by the observation that use of elliptical formulas reduced the systematic bias associated with using circular approximations for morphology. Thus, cortical area was the best predictor of strength without a sex-specific difference in the correlation but was not without limitations owing to out-of-plane shape variations. The dependence of cross-sectional shape on the outer bone width measured from a hand radiograph may provide a way to further improve bone health assessments and informed decision making for optimizing strength-building and fracture-prevention treatment strategies.