Browsing by Author "Mantri, Sneha"
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Item Open Access Demographic Influences on the Relationship Between Fatigue and Quality of Life in Parkinson's Disease(Movement Disorders Clinical Practice) Mantri, Sneha; Chahine, Lana M; Nabieva, Karina; Feldman, Robert; Althouse, Andrew; Torsney, Benjamin; Albert, Steven M; Kopil, Catherine; Marras, ConnieItem Open Access Development of a curricular thread to foster medical students' critical reflection and promote action on climate change, health, and equity.(PloS one, 2024-01) Dalapati, Trisha; Alway, Emily J; Mantri, Sneha; Mitchell, Phillip; George, Ian A; Kaplan, Samantha; Andolsek, Kathryn M; Velkey, J Matthew; Lawson, Jennifer; Muzyk, Andrew JIntroduction
Due to the health consequences arising from climate change, medical students will inevitably interact with affected patients during their training and careers. Accordingly, medical schools must incorporate education on the impacts of climate change on health and equity into their curricula. We created a curricular thread called "Climate Change, Health, and Equity" in the first-year preclinical medical program to teach foundational concepts and foster self-reflection and critical consciousness.Methods
The authors developed a continuum of practice including administrators, educators and faculty members, students, and community partners to plan and design curricular activities. First-year medical students at Duke University School of Medicine participated in seven mandatory foundational lectures and two experiential learning opportunities in the local community. Following completion of activities, students wrote a critical reflection essay and completed a self-directed learning exercise. Essays were evaluated using the REFLECT rubric to assess if students achieved critical reflection and for thematic analysis by Bloom's Taxonomy.Results
All students (118) submitted essays. A random sample of 30 (25%) essays underwent analysis. Evaluation by the REFLECT rubric underscored that all students were reflecting or critically reflecting on thread content. Thematic analysis highlighted that all students (30/30, 100%) were adept at identifying new areas of medical knowledge and connecting concepts to individual experiences, institutional practices, and public health and policy. Most students (27/30; 90%) used emotionally laden words, expressing negative feelings like frustration and fear but also positive sentiments of solidarity and hope regarding climate change and effects on health. Many students (24/30; 80%) expressed actionable items at every level including continuing self-directed learning and conversing with patients, minimizing healthcare waste, and advocating for climate-friendly policies.Conclusion
After participating in the curricular thread, most medical students reflected on cognitive, affective, and actionable aspects relating to climate change, health, and equity.Item Open Access Identifying Moral Injury in Healthcare Professionals: The Moral Injury Symptom Scale-HP.(Journal of religion and health, 2020-10) Mantri, Sneha; Lawson, Jennifer Mah; Wang, ZhiZhong; Koenig, Harold GThis study aims to develop and assess the psychometric properties of a measure of moral injury (MI) symptoms for identifying clinically significant MI in health professionals (HPs), one that might be useful in the current COVID-19 pandemic and beyond. A total of 181 HPs (71% physicians) were recruited from Duke University Health Systems in Durham, North Carolina. Internal reliability of the Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP) was examined, along with factor analytic, discriminant, and convergent validity. A cutoff score was identified from a receiver operator curve (ROC) that best identified individuals with significant impairment in social or occupational functioning. The 10-item MISS-HP measures 10 theoretically grounded dimensions of MI assessing betrayal, guilt, shame, moral concerns, religious struggle, loss of religious/spiritual faith, loss of meaning/purpose, difficulty forgiving, loss of trust, and self-condemnation (score range 10-100). Internal reliability of the MISS-HP was 0.75. PCA identified three factors, which was confirmed by CFA, explaining 56.8% of the variance. Discriminant validity was demonstrated by modest correlations (r's = 0.25-0.37) with low religiosity, depression, and anxiety symptoms, whereas convergent validity was evident by strong correlations with clinician burnout (r = 0.57) and with another multi-item measure of MI symptoms (r = 0.65). ROC characteristics indicated that a score of 36 or higher was 84% sensitive and 93% specific for identifying MI symptoms causing moderate to extreme problems with family, social, and occupational functioning. The MISS-HP is a reliable and valid measure of moral injury symptoms in health professionals that can be used in clinical practice to screen for MI and monitor response to treatment, as well as when conducting research that evaluates interventions to treat MI in HPs.Item Open Access Initial Clinical Outcome With Bilateral, Dual-Target Deep Brain Stimulation Trial in Parkinson Disease Using Summit RC + S.(Neurosurgery, 2022-04-07) Mitchell, Kyle T; Schmidt, Stephen L; Cooney, Jeffrey W; Grill, Warren M; Peters, Jennifer; Rahimpour, Shervin; Lee, Hui-Jie; Jung, Sin-Ho; Mantri, Sneha; Scott, Burton; Lad, Shivanand P; Turner, Dennis ABackground
Deep brain stimulation (DBS) is an effective therapy in advanced Parkinson disease (PD). Although both subthalamic nucleus (STN) and globus pallidus (GP) DBS show equivalent efficacy in PD, combined stimulation may demonstrate synergism.Objective
To evaluate the clinical benefit of stimulating a combination of STN and GP DBS leads and to demonstrate biomarker discovery for adaptive DBS therapy in an observational study.Methods
We performed a pilot trial (n = 3) of implanting bilateral STN and GP DBS leads, connected to a bidirectional implantable pulse generator (Medtronic Summit RC + S; NCT03815656, IDE No. G180280). Initial 1-year outcome in 3 patients included Unified PD Rating Scale on and off medications, medication dosage, Hauser diary, and recorded beta frequency spectral power.Results
Combined DBS improved PD symptom control, allowing >80% levodopa medication reduction. There was a greater decrease in off-medication motor Unified PD Rating Scale with multiple electrodes activated (mean difference from off stimulation off medications -18.2, range -25.5 to -12.5) than either STN (-12.8, range -20.5 to 0) or GP alone (-9, range -11.5 to -4.5). Combined DBS resulted in a greater reduction of beta oscillations in STN in 5/6 hemispheres than either site alone. Adverse events occurred in 2 patients, including a small cortical hemorrhage and seizure at 24 hours postoperatively, which resolved spontaneously, and extension wire scarring requiring revision at 2 months postoperatively.Conclusion
Patients with PD preferred combined DBS stimulation in this preliminary cohort. Future studies will address efficacy of adaptive DBS as we further define biomarkers and control policy.Item Open Access Mindfulness based stress reduction in people with Parkinson's disease and their care partners.(Complementary therapies in clinical practice, 2021-05) Shah-Zamora, Deepal; Allen, Allison M; Rardin, Lacy; Ivancic, Margaret; Durham, Katie; Hickey, Patrick; Cooney, Jeffrey W; Scott, Burton L; Mantri, SnehaBackground
Parkinson's Disease (PD) leads to poor quality of life and caregiver burden. Mindfulness-based stress reduction (MBSR) may improve these symptoms. We assessed the impact of a 9-week MBSR course on people with PD (PwP) and their care partners (CPs).Methods
Participants completed questionnaires at screening, at the end of the course, and at 3-month follow-up: Parkinson's Disease Quality-39 (PDQ-39, PD only), Zarit Burden Inventory (ZBI, CP only) and Mindful Attention Awareness Scale (MAAS, both). The primary outcome measure was change in PDQ-39 (for PwP) or ZBI (for CP). Patient-reported scales were analyzed quantitatively; qualitative data on perceived effectiveness was collected.Results
53.8% PwP and 100% CPs completed the course. Among PwP, there was a significant reduction in MAAS(p < 0.001) and in PDQ-39 (p = 0.008). CPs experienced an increase in MAAS (p = 0.02) but no change in ZBI (p = 0.239). Qualitatively, both PwP and CPs expressed satisfaction with the course.Discussion
MBSR improves mindful awareness in CPs and improves health-related quality of life in PwP.Item Open Access Moral Injury and Burnout in Health Care Professionals During the COVID-19 Pandemic.(J Nerv Ment Dis, 2021-10-01) Mantri, Sneha; Song, Ye Kyung; Lawson, Jennifer M; Berger, Elizabeth J; Koenig, Harold GABSTRACT: The coronavirus pandemic (COVID-19) is predicted to increase burnout in health professionals (HPs), but little is known about moral injury (MI) in this context. We administered the Moral Injury Symptoms Scale for Health Professionals (MISS-HP) and the abbreviated Maslach Burnout Inventory via online survey to a global sample of 1831 HPs in April and October 2020. Mean MISS-HP increased from 27.4 (SD, 11.6) in April to 36.4 (SD, 13.8) in October (p < 0.001), with an accompanying increase in personal accomplishment (April: 4.7; SD, 3.1; October: 9.3; SD, 3.1; p < 0.001) and no change in other burnout subscales. In April, 26.7% of respondents reported at least moderate functional impairment from MI, increasing to 45.7% in October (p < 0.001). Predictors of MISS-HP included younger age and being a nurse. Odds of functional impairment were higher in respondents who were widowed, divorced, never married, or had direct experience caring for patients with COVID-19. COVID-19 has increased MI but not burnout in HPs; younger or unmarried individuals, nurses, and frontline workers may benefit from targeted outreach to reduce downstream effects of MI, depression, and/or posttraumatic stress disorder.Item Open Access Physical Activity in Early Parkinson Disease.(Journal of Parkinson's disease, 2018-01) Mantri, Sneha; Fullard, Michelle E; Duda, John E; Morley, James FPhysical activity and exercise improve outcomes in Parkinson disease (PD), however little is known about activity levels in early PD patients.We examined self-reported activity scores and examined associations with clinical characteristics in 383 PD subjects and 175 healthy controls from the Parkinson Progression Markers Initiative (PPMI).Activity scores were 8% lower for PD subjects than HC (162.6±86.2 vs 175.0±78.5, p = 0.10). Higher scores were associated with younger age and male sex. Only 47% of PD subjects and 44% of HC reported activity consistent with standard recommendations for adults.Our findings highlight the need to encourage exercise even in early PD.Item Open Access Reframing the Conversation Around Physician Burnout and Moral Injury: “We’re Not Suffering From a Yoga Deficiency(The Permanente Journal, 2021-09-21) Vaughn, John; Mantri, Sneha; Jooste, Karen; Quaranta, Brian; Lawson, JenniferItem Open Access State-level prevalence, health service use, and spending vary widely among Medicare beneficiaries with Parkinson disease.(NPJ Parkinson's disease, 2019-01-24) Mantri, Sneha; Fullard, Michelle E; Beck, James; Willis, Allison WState-level variations in disease, healthcare utilization, and spending influence healthcare planning at federal and state levels and should be examined to understand national disparities in health outcomes. This descriptive study examined state-level variations in Parkinson disease (PD) prevalence, patient characteristics, Medicare spending, out-of-pocket costs, and health service utilization using data on 27.5 million Medicare beneficiaries in the US in 2014. We found that 45.8% (n = 179,496) of Medicare beneficiaries diagnosed with PD were women; 26.1% (n = 102,205) were aged 85+. The District of Columbia, New York, Illinois, Connecticut, and Florida had the highest age-, race-, and sex-adjusted prevalence of Parkinson disease among Medicare beneficiaries in the US. Women comprised over 48.5% of PD patient populations in West Virginia, Kentucky, Mississippi, Louisiana, and Arkansas. More than 31% of the PD populations in Connecticut, Pennsylvania, Hawaii, and Rhode Island were aged 85+. PD patients who were "dual-eligible"-receiving both Medicare and Medicaid benefits-also varied by state, from <10% to >25%. Hospitalizations varied from 304 to 653 stays per 1000 PD patients and accounted for 26.5% of the 7.9 billion United States Dollars (USD) paid by the Medicare program for healthcare services delivered to our sample. A diagnosis of PD was associated with greater healthcare use and spending. This study provides initial evidence of substantial geographic variation in PD patient characteristics, health service use, and spending. Further study is necessary to inform the development of state- and federal-level health policies that are cost-efficient and support desired outcomes for PD patients.Item Open Access Transformative Learning and Critical Consciousness: A Model for Preclerkship Medical School Substance Use Disorder Education.(Academic psychiatry : the journal of the American Association of Directors of Psychiatric Residency Training and the Association for Academic Psychiatry, 2023-04) Muzyk, Andrew; Mantri, Sneha; Mitchell, Phillip; Velkey, J Matthew; Reisinger, Deborah; Andolsek, KathrynObjective
Preparing medical students to provide compassionate person-centered care for people with substance use disorders (SUD) requires a re-envisioning of preclerkship SUD education to allow for discussions on stigma, social determinants of health, systemic racism, and healthcare inequities. The authors created a curricular thread that fosters the development of preclerkship medical students' critical consciousness through discussion, personal reflection, and inclusion of lived experiences.Methods
The authors used transformative learning theories to design and implement this thread in the 2021-2022 academic year in the Duke University School of Medicine preclerkship curriculum. Content included lectures, person-centered workshops, case-based learning, motivational interviewing of a standardized patient, and an opioid overdose simulation. Community advocates and people with SUD and an interdisciplinary faculty were involved in the thread design and delivery and modeled their lived experiences. Students wrote a 500-word critical reflection essay that examined their personal beliefs in the context of providing care for people with SUD.Results
One hundred and twenty-two students submitted essays and 30 (25%) essays were randomly selected for a qualitative analysis. Seven major themes emerged: race/racism, systemic barriers, bias and stigma, personal growth/transformation, language or word usage, future plans for advocacy, and existing poor outcomes. Students were able to link material with prior knowledge and experiences, and their attitudes towards advocacy and goals for future practice were positively influenced.Conclusion
By aligning the thread design with the principals of transformative learning, students developed their critical consciousness toward people with SUD and cultivated a holistic understanding of SUD.Item Open Access Understanding the Lexicon of Fatigue in Parkinson's Disease.(Journal of Parkinson's disease, 2020-06-15) Mantri, Sneha; Klawson, Emily; Albert, Steven; Nabieva, Karina; Lepore, Madeline; Kahl, Stephen; Daeschler, Margaret; Mamikonyan, Eugenia; Kopil, Catherine; Marras, Connie; Chahine, Lana MBACKGROUND:Fatigue in Parkinson's disease (PD) is multifaceted and associated with reduced quality of life. In turn, the language used by people with PD to describe fatigue is variable and poorly understood. We sought to elucidate the lexicon of fatigue using a qualitative grounded theory approach. OBJECTIVE:The objective of this study was to understand how patients with PD describe fatigue. METHODS:A pre-study phase of online journaling (Phase 1) provided information regarding topics of importance to patients. Following this, two independent samples of fatigued subjects were studied. Individuals with PD participated in a telephone interview (Phase 2); interview transcripts were analyzed to develop a detailed codebook. To ensure trustworthiness of the findings, an online survey (Phase 3) was administered to individuals with self-reported PD participating in the online study Fox Insight. The survey included the following question: "How do you define fatigue? Please provide your definition in the space below." The codebook developed from Phase 2 was applied to the Phase 3 responses. RESULTS:Fifteen individuals participated in Phase 2 and 413 individuals completed Phase 3. Fatigue was subdivided into three domains: cognitive, emotional, and physical. Nearly all individuals experienced more than one domain of fatigue. The most common themes included tiredness, lack of energy, and negative motivation. CONCLUSION:Fatigue in PD is multidimensional. Questionnaires that only assess the physical impact of fatigue may not be adequate to capture the broad range of experiences of fatigue among people with PD.