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Jodie K Haselkorn

Publications and source records attributed to Jodie K Haselkorn.

7 recordsLinked to original sources
PubMed2006

Suicidal ideation in multiple sclerosis.

OBJECTIVE: To examine risk factors for suicidal ideation among people with multiple sclerosis (MS). DESIGN: Cohort study linking computerized medical records with a mailed self-report survey. SETTING: Veteran's Health Administration (VHA) region covering the northwestern United States. PARTICIPANTS: VHA patients with MS (N=445) who returned mailed surveys. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Suicidal ideation is assessed by the Patient Health Questionnaire (PHQ) suicide item with suicidal ideation more than half the days considered persistent. RESULTS: One hundred thirty-one (29.4%) of 445 respondents (95% confidence interval [CI], 25.4%-33.9%) endorsed suicidal ideation, and 35 (7.9%; 95% CI, 5.7%-10.8%) endorsed persistent suicidal ideation over the last 2 weeks. In bivariate analyses, suicidal ideation was associated with younger age, earlier disease course, progressive disease subtype, lower income, not being married, lower social support, not driving, higher levels of physical disability (mobility, bowel, bladder), and depression. Analyses on persistent suicidal ideation yielded similar results. In fully adjusted multivariate logistic regression, only depression severity and bowel disability were independently associated with suicidal ideation. Only depression severity was independently associated with persistent suicidal ideation. By using the 2-question depression screen (U.S. Preventive Services Task Force) consisting of the depression and anhedonia items from the PHQ-9, sensitivity and specificity were marginal for suicidal ideation (65.6% and 79.9%) but acceptable for persistent suicidal ideation (88.6% and 71.2%). CONCLUSIONS: Suicidal ideation is common among VHA patients with MS, and depression severity is the best risk marker. Brief screening for depression in MS should include the assessment of suicidal ideation.

Chi-Square Distribution↗
PubMed2005

Predictors of prescriptions for management of fatigue among veterans with multiple sclerosis.

OBJECTIVE: To determine predictors of fatigue-modifying medication use. DESIGN: Cross-sectional cohort. SETTING: Veterans Health Administration (VHA) facilities. PARTICIPANTS: Veterans with multiple sclerosis (MS) in the VHA in the northwestern United States from 1995 to 2000. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A self-administered survey distributed by mail sought information from veterans with MS about demographics, symptoms, barriers to care, and disease characteristics. The variables were compared with prescriptions for fatigue-modifying medications during the study period. RESULTS: Of 1032 patients, 451 (44%) completed the survey, and 306 (68%) reported moderate or high fatigue levels. Only 40% of the 306 were prescribed fatigue-modifying medications. Those using specialized fatigue services or who received care at tertiary centers were more likely to receive fatigue treatments. Patient-perceived barriers to accessing care and other patient characteristics were not associated with prescription rates. CONCLUSIONS: Fatigue is undertreated among veterans with MS. However, there is considerable variability in the provision of fatigue care. Interventions to improve the quality and uniformity of fatigue care are warranted.

Adult↗
PubMed2005

Multiple sclerosis and spasticity.

Spasticity is a common impairment in MS. It can result in significant medical complications and is associated with increased disability. Treatment strategies include skilled rehabilitation strategies, neuromuscular blocks, oral agents, intrathecal management, and surgery. Rehabilitation strategies are central, whereas other strategies are added based on the level of impairment and functional loss. Treatment strategies for spasticity management are far from optimal and are complicated in MS as a result of lesions in the brain and the spinal cord. Pharmaceutical management in MS is complicated by the numerous secondary impairments in MS and its associated polypharmacy.Head-to-head studies of the various agents are rare. The studies that exist are small and do not point to any one strategy over another. Although management is difficult, it is essential for the health, functional status, and well-being of the individual who has MS. Providers must use well-developed clinical skills to arrive at optimal individualized treatment programs and monitor them frequently. For spasticity that is unresponsive, referral to a MS Center with a spasticity program is ideal.

Exercise Therapy↗
PubMedDate not supplied

Complementary and alternative medicine use in veterans with multiple sclerosis: Prevalence and demographic associations.

The present study explored complementary and alternative medicine (CAM) use in veterans with multiple sclerosis (MS). We administered self-report questionnaires to 451 veterans who received healthcare from Veterans Health Administration facilities. CAM use among veterans with MS was widespread; 37% of respondents reported current or past use. Roughly 33% of CAM users reported using multiple interventions, and 40% of respondents desired interventions that they were not already using. Logistic regression suggested that CAM use was more likely among participants with graduate-level education, poor self-reported health over the past year, and a progressive relapsing MS subtype. Participants who used traditional medical services were also more likely to use CAM, which suggests that CAM services are used in addition to, as opposed to in place of, traditional services. As others have proposed, these results suggest that care providers who work with persons with MS would be well served to understand, routinely screen for, and make use of CAM when appropriate.

Adult↗
PubMedDate not supplied

Use of medical informatics for management of multiple sclerosis using a chronic-care model.

The mission of the Multiple Sclerosis Centers of Excellence (MSCoEs) is to optimize the services veterans with multiple sclerosis (MS) receive across the U.S. Veterans Health Administration. To accomplish this mission, the MSCoE West has adopted a collaborative chronic-disease management strategy along the lines of the model described by Wagner and colleagues. This model describes an organized, integrated, proactive, and population-based approach to patient care that includes healthcare delivery system change and patient-based self-management. While Wagner's model is described independent of information technology, the majority of actions called for in that model benefit tremendously from the application of a powerful and well-integrated informatics infrastructure designed to serve and support populations with chronic disease. Key elements such as goals and actions encourage high-quality care for those with chronic illnesses.

Chronic Disease↗
PubMedDate not supplied

Exploring educational needs of multiple sclerosis care providers: Results of a care-provider survey.

Our objective was to survey experienced multiple sclerosis (MS) care providers, determine their ongoing professional educational needs, and develop future education programs. We asked providers across a variety of disciplines to identify the areas in which clinical consultation and continuing medical education (CME) would most improve their ability to provide care to individuals with MS; their preferred education modalities; and their confidence in providing care related to disease-modifying agents (DMAs), fatigue, depression, spasticity, and bladder management. At a national meeting of MS professionals, 152 MS care providers completed a self-report survey that was designed for this cross-sectional cohort study. Areas of greatest interest for clinical consultation and CME were identical and included cognition, fatigue, DMA use, spasticity, pain, sex, diagnosis of MS, and depression. Participants expressed a preference for live and interactive CME modalities. Confidence in providing specific disease-related care sometimes differed between Veterans Health Administration (VHA) and non-VHA providers. The results indicate that clinical consultations and CME should be targeted to the topics of greatest interest identified by providers and delivered in a live or interactive modality whenever possible.

Clinical Competence↗