Context.-The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 1994 prompte... more Context.-The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 1994 prompted many questions about changes in quality of care. Objective.-To evaluate the effect on perinatal outcomes of the transition to TennCare in 1994. Design.-Before and after retrospective cohort analysis. Setting and Population.-Births to women residing in Tennessee between 1990 and 1995 with complete demographic information on birth certificates, with a focus on women enrolled in Medicaid giving birth in 1993 (before TennCare) and 1995 (after TennCare). Outcome Measures.-Late prenatal care (after the fourth month of pregnancy) or inadequate prenatal visits, low and very low birth weight, and death in the first 60 days of life. Results.-Tennessee residents had 72 014 study births in 1993 and 72 278 in 1995, of which 37 543 (52.1%) and 35 707 (49.4%) were to women enrolled in Medicaid at delivery. For these Medicaid births, there were no changes after TennCare in the proportions with late prenatal care (16.2% in 1993 vs 15.8% in 1995), inadequate prenatal visits (5.9% vs 5.6%), low birth weight (9.4% vs 9.0%), very low birth weight (1.6% vs 1.5%), and death in the first 60 days (0.6% both years). These findings were unchanged in multivariate analysis, in analysis of high-risk subgroups, and in analysis of women with demographics characteristic of Medicaid women. Conclusion.-Study perinatal outcomes did not change among Medicaid births following the transition to TennCare.
Journal of Graduate Medical Education, Mar 1, 2010
Background The Accreditation Council for Graduate Medical Education promotes direct observation o... more Background The Accreditation Council for Graduate Medical Education promotes direct observation of residents as a key assessment tool for competency in patient care, professionalism, and communication skills. Although tools exist, validity and reliability have not been demonstrated for most, and many tools may have limited feasibility because of time constraints and other reasons. We conducted a study to measure feasibility of a simplified observation tool to evaluate these competencies and provide timely feedback.
Further dissemination of medical education work presented at national meetings is limited. The pu... more Further dissemination of medical education work presented at national meetings is limited. The purpose of this study was to explore dissemination outcomes of scholarly work in pediatric medical education. Council on Medical Student Education in Pediatrics (COMSEP) members who presented at COMSEP national meetings from 1998 to 2008 received a questionnaire about scholarly dissemination outcomes. Descriptive statistics and chi-square analysis explored variables related to dissemination. Qualitative analysis of free text comments explored barriers to dissemination. Outcomes were determined for 81% of presentations (138/171). The dissemination rate was 67% (92/138 presentations), with 47 publications (34%). Dissemination rates did not vary by presentation type (poster vs. oral) or project type. There was no relationship between presentation type, project type, and dissemination method. Barriers included perceived inadequate time, mentorship, and methodological skills for scholarly work. Most projects were further disseminated. Additional resources including mentoring and protected time for scholarly work are needed by educators to optimize dissemination.
This study examined the effects of diagnosis (functional versus organic), physician practice orie... more This study examined the effects of diagnosis (functional versus organic), physician practice orientation (biomedical versus biopsychosocial), and maternal trait anxiety (high versus low) on mothers' responses to a child's medical evaluation for chronic abdominal pain. Mothers selected for high (n = 80) and low (n = 80) trait anxiety imagined that they were the mother of a child with chronic abdominal pain described in a vignette. They completed questionnaires assessing their negative affect and pain catastrophizing. Next, mothers were randomly assigned to view one of four video vignettes of a physician actor reporting results of the child's medical evaluation. Vignettes varied by diagnosis (functional versus organic) and physician practice orientation (biomedical versus biopsychosocial). Following presentation of the vignettes, baseline questionnaires were re-administered and mothers rated their satisfaction with the physician. Results indicated that mothers in all conditions reported reduced distress pre-to post-vignette; however, the degree of the reduction differed as a function of diagnosis, presentation, and anxiety. Mothers reported more post-vignette negative affect, pain catastrophizing, and dissatisfaction with the physician when the physician presented a functional rather than an organic diagnosis. These effects were significantly greater for mothers with high trait anxiety who received a functional diagnosis presented by a physician with a biomedical orientation than for mothers in any other condition. Anxious mothers of children evaluated for chronic abdominal pain may be less distressed and more satisfied when a functional diagnosis is delivered by a physician with a biopsychosocial rather than a biomedical orientation.
Measles is extremely contagious and is one of the leading causes of vaccine-preventable illness a... more Measles is extremely contagious and is one of the leading causes of vaccine-preventable illness and death in developing countries, claiming more than 100,000 lives each year. Measles was declared eliminated in the US in 2000 due to decades of successful vaccination for the measles. As a result, an increasing number of US healthcare professionals and the public have never seen the disease. Unfortunately, the Measles resurged in the US in 2019 with 1,282 confirmed cases. To assist in diagnosing measles, we collected more than 1300 images of a variety of skin conditions, with which we employed residual deep convolutional neural network to distinguish measles rash from other skin conditions, in an aim to create a phone application in the future. On our image dataset, our model reaches a classification accuracy of 95.2%, sensitivity of 81.7%, and specificity of 97.1%, indicating the model is effective in facilitating an accurate detection of measles to help contain measles outbreaks.
After completing this article, readers should be able to: 1. List the etiologic agents that commo... more After completing this article, readers should be able to: 1. List the etiologic agents that commonly cause urticaria, angioedema, and anaphylaxis. 2. Recognize the signs and symptoms of anaphylaxis and be able to deliver rapid,effective treatment for anaphylaxis. 3. Distinguish between acute and chronic urticaria, and recognize the differences in their evaluation and treatment. 4. List the causes of papular urticaria. 5. Discuss the acute management of stinging insect anaphylaxis.
Abstract Context.—The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 199... more Abstract Context.—The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 1994 prompted many questions about changes in quality of care. Objective.—To evaluate the effect on perinatal outcomes of the transition to TennCare in 1994.
Journal of The Medical Library Association, Oct 2, 2017
Objectives: Multi-institutional research increases the generalizability of research findings. How... more Objectives: Multi-institutional research increases the generalizability of research findings. However, little is known about characteristics of collaborations across institutions in health sciences education research. Using a systematic review process, the authors describe characteristics of published, peer-reviewed multiinstitutional health sciences education research to inform educators who are considering such projects. Methods: Two medical librarians searched MEDLINE, the Education Resources Information Center (ERIC), EMBASE, and CINAHL databases for English-language studies published between 2004 and 2013 using keyword terms related to multi-institutional systems and health sciences education. Teams of two authors reviewed each study and resolved coding discrepancies through consensus. Collected data points included funding, research network involvement, author characteristics, learner characteristics, and research methods. Data were analyzed using descriptive statistics. Results: One hundred eighteen of 310 articles met inclusion criteria. Sixty-three (53%) studies received external and/or internal financial support (87% listed external funding, 37% listed internal funding). Forty-five funded studies involved graduate medical education programs. Twenty (17%) studies involved a research or education network. Eighty-five (89%) publications listed an author with a master's degree or doctoral degree. Ninety-two (78%) studies were descriptive, whereas 26 studies (22%) were experimental. The reported study outcomes were changes in student attitude (38%; n=44), knowledge (26%; n=31), or skill assessment (23%; n=27), as well as patient outcomes (9%; n=11). Conclusions: Multi-institutional descriptive studies reporting knowledge or attitude outcomes are highly published. Our findings indicate that funding resources are not essential to successfully undertake multiinstitutional projects. Funded studies were more likely to originate from graduate medical or nursing programs.
Objectives After completing this article, readers should be able to: 1. Describe the indications ... more Objectives After completing this article, readers should be able to: 1. Describe the indications for a tonsillectomy and adenoidectomy. 2. Know the complications of a tonsillectomy and adenoidectomy. 3. Recognize the serious outcomes that may be associated with tonsillar or adenoidal hypertrophy or both. 4. Discuss the importance of proper evaluation of velopharyngeal insufficiency in a child being considered for tonsillectomy, adenoidectomy, or both. Clinical Presentation Children who have abnormalities of the tonsils or adenoids usually have problems related to malignancy, obstruction, or infection. Malignancy Although most tonsillar asymmetry is benign, pharyngeal cancer, usually lymphoma, may present with asymmetric tonsillar hypertrophy. Children who have a malignancy often have other symptoms that distinguish their disease from benign tonsillar asymmetry, such as fevers, night sweats, weight loss, dysphagia, and adenopathy greater than 3 cm. Obstruction Children who have adenotonsillar hypertrophy often have airway obstruction that causes problems with sleep. Such problems range from primary snoring to OSAS. Accordingly,
Context.-The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 1994 prompte... more Context.-The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 1994 prompted many questions about changes in quality of care. Objective.-To evaluate the effect on perinatal outcomes of the transition to TennCare in 1994. Design.-Before and after retrospective cohort analysis. Setting and Population.-Births to women residing in Tennessee between 1990 and 1995 with complete demographic information on birth certificates, with a focus on women enrolled in Medicaid giving birth in 1993 (before TennCare) and 1995 (after TennCare). Outcome Measures.-Late prenatal care (after the fourth month of pregnancy) or inadequate prenatal visits, low and very low birth weight, and death in the first 60 days of life. Results.-Tennessee residents had 72 014 study births in 1993 and 72 278 in 1995, of which 37 543 (52.1%) and 35 707 (49.4%) were to women enrolled in Medicaid at delivery. For these Medicaid births, there were no changes after TennCare in the proportions with late prenatal care (16.2% in 1993 vs 15.8% in 1995), inadequate prenatal visits (5.9% vs 5.6%), low birth weight (9.4% vs 9.0%), very low birth weight (1.6% vs 1.5%), and death in the first 60 days (0.6% both years). These findings were unchanged in multivariate analysis, in analysis of high-risk subgroups, and in analysis of women with demographics characteristic of Medicaid women. Conclusion.-Study perinatal outcomes did not change among Medicaid births following the transition to TennCare.
Journal of Graduate Medical Education, Mar 1, 2010
Background The Accreditation Council for Graduate Medical Education promotes direct observation o... more Background The Accreditation Council for Graduate Medical Education promotes direct observation of residents as a key assessment tool for competency in patient care, professionalism, and communication skills. Although tools exist, validity and reliability have not been demonstrated for most, and many tools may have limited feasibility because of time constraints and other reasons. We conducted a study to measure feasibility of a simplified observation tool to evaluate these competencies and provide timely feedback.
Further dissemination of medical education work presented at national meetings is limited. The pu... more Further dissemination of medical education work presented at national meetings is limited. The purpose of this study was to explore dissemination outcomes of scholarly work in pediatric medical education. Council on Medical Student Education in Pediatrics (COMSEP) members who presented at COMSEP national meetings from 1998 to 2008 received a questionnaire about scholarly dissemination outcomes. Descriptive statistics and chi-square analysis explored variables related to dissemination. Qualitative analysis of free text comments explored barriers to dissemination. Outcomes were determined for 81% of presentations (138/171). The dissemination rate was 67% (92/138 presentations), with 47 publications (34%). Dissemination rates did not vary by presentation type (poster vs. oral) or project type. There was no relationship between presentation type, project type, and dissemination method. Barriers included perceived inadequate time, mentorship, and methodological skills for scholarly work. Most projects were further disseminated. Additional resources including mentoring and protected time for scholarly work are needed by educators to optimize dissemination.
This study examined the effects of diagnosis (functional versus organic), physician practice orie... more This study examined the effects of diagnosis (functional versus organic), physician practice orientation (biomedical versus biopsychosocial), and maternal trait anxiety (high versus low) on mothers' responses to a child's medical evaluation for chronic abdominal pain. Mothers selected for high (n = 80) and low (n = 80) trait anxiety imagined that they were the mother of a child with chronic abdominal pain described in a vignette. They completed questionnaires assessing their negative affect and pain catastrophizing. Next, mothers were randomly assigned to view one of four video vignettes of a physician actor reporting results of the child's medical evaluation. Vignettes varied by diagnosis (functional versus organic) and physician practice orientation (biomedical versus biopsychosocial). Following presentation of the vignettes, baseline questionnaires were re-administered and mothers rated their satisfaction with the physician. Results indicated that mothers in all conditions reported reduced distress pre-to post-vignette; however, the degree of the reduction differed as a function of diagnosis, presentation, and anxiety. Mothers reported more post-vignette negative affect, pain catastrophizing, and dissatisfaction with the physician when the physician presented a functional rather than an organic diagnosis. These effects were significantly greater for mothers with high trait anxiety who received a functional diagnosis presented by a physician with a biomedical orientation than for mothers in any other condition. Anxious mothers of children evaluated for chronic abdominal pain may be less distressed and more satisfied when a functional diagnosis is delivered by a physician with a biopsychosocial rather than a biomedical orientation.
Measles is extremely contagious and is one of the leading causes of vaccine-preventable illness a... more Measles is extremely contagious and is one of the leading causes of vaccine-preventable illness and death in developing countries, claiming more than 100,000 lives each year. Measles was declared eliminated in the US in 2000 due to decades of successful vaccination for the measles. As a result, an increasing number of US healthcare professionals and the public have never seen the disease. Unfortunately, the Measles resurged in the US in 2019 with 1,282 confirmed cases. To assist in diagnosing measles, we collected more than 1300 images of a variety of skin conditions, with which we employed residual deep convolutional neural network to distinguish measles rash from other skin conditions, in an aim to create a phone application in the future. On our image dataset, our model reaches a classification accuracy of 95.2%, sensitivity of 81.7%, and specificity of 97.1%, indicating the model is effective in facilitating an accurate detection of measles to help contain measles outbreaks.
After completing this article, readers should be able to: 1. List the etiologic agents that commo... more After completing this article, readers should be able to: 1. List the etiologic agents that commonly cause urticaria, angioedema, and anaphylaxis. 2. Recognize the signs and symptoms of anaphylaxis and be able to deliver rapid,effective treatment for anaphylaxis. 3. Distinguish between acute and chronic urticaria, and recognize the differences in their evaluation and treatment. 4. List the causes of papular urticaria. 5. Discuss the acute management of stinging insect anaphylaxis.
Abstract Context.—The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 199... more Abstract Context.—The abrupt initiation of capitated Medicaid care in Tennessee (TennCare) in 1994 prompted many questions about changes in quality of care. Objective.—To evaluate the effect on perinatal outcomes of the transition to TennCare in 1994.
Journal of The Medical Library Association, Oct 2, 2017
Objectives: Multi-institutional research increases the generalizability of research findings. How... more Objectives: Multi-institutional research increases the generalizability of research findings. However, little is known about characteristics of collaborations across institutions in health sciences education research. Using a systematic review process, the authors describe characteristics of published, peer-reviewed multiinstitutional health sciences education research to inform educators who are considering such projects. Methods: Two medical librarians searched MEDLINE, the Education Resources Information Center (ERIC), EMBASE, and CINAHL databases for English-language studies published between 2004 and 2013 using keyword terms related to multi-institutional systems and health sciences education. Teams of two authors reviewed each study and resolved coding discrepancies through consensus. Collected data points included funding, research network involvement, author characteristics, learner characteristics, and research methods. Data were analyzed using descriptive statistics. Results: One hundred eighteen of 310 articles met inclusion criteria. Sixty-three (53%) studies received external and/or internal financial support (87% listed external funding, 37% listed internal funding). Forty-five funded studies involved graduate medical education programs. Twenty (17%) studies involved a research or education network. Eighty-five (89%) publications listed an author with a master's degree or doctoral degree. Ninety-two (78%) studies were descriptive, whereas 26 studies (22%) were experimental. The reported study outcomes were changes in student attitude (38%; n=44), knowledge (26%; n=31), or skill assessment (23%; n=27), as well as patient outcomes (9%; n=11). Conclusions: Multi-institutional descriptive studies reporting knowledge or attitude outcomes are highly published. Our findings indicate that funding resources are not essential to successfully undertake multiinstitutional projects. Funded studies were more likely to originate from graduate medical or nursing programs.
Objectives After completing this article, readers should be able to: 1. Describe the indications ... more Objectives After completing this article, readers should be able to: 1. Describe the indications for a tonsillectomy and adenoidectomy. 2. Know the complications of a tonsillectomy and adenoidectomy. 3. Recognize the serious outcomes that may be associated with tonsillar or adenoidal hypertrophy or both. 4. Discuss the importance of proper evaluation of velopharyngeal insufficiency in a child being considered for tonsillectomy, adenoidectomy, or both. Clinical Presentation Children who have abnormalities of the tonsils or adenoids usually have problems related to malignancy, obstruction, or infection. Malignancy Although most tonsillar asymmetry is benign, pharyngeal cancer, usually lymphoma, may present with asymmetric tonsillar hypertrophy. Children who have a malignancy often have other symptoms that distinguish their disease from benign tonsillar asymmetry, such as fevers, night sweats, weight loss, dysphagia, and adenopathy greater than 3 cm. Obstruction Children who have adenotonsillar hypertrophy often have airway obstruction that causes problems with sleep. Such problems range from primary snoring to OSAS. Accordingly,
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Papers by Joseph Gigante