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Few studies have investigated the influence of optimism-pessimism in breast cancer survivors. This study used a retrospective design with 268 adult women who completed the Minnesota Multiphasic Personality Inventory (MMPI) as part of their medical care approximately 10 years prior to their breast cancer diagnosis and Medical Outcome Study Short-Form General Health Survey (SF-36 or SF-12), on average, 8 years after diagnosis. MMPI pessimism scores were divided into quartiles, and t tests were used to determine differences between those highest and lowest in pessimism on health-related quality-of-life (QOL) measures, demographics, and disease status. The mean age at diagnosis of breast cancer was 63 years, and 74% had early-stage breast cancer. Patients age 65 years and older were significantly lower on physical health related QOL scales. There were no significant differences in health-related QOL scores by stage of disease. Patients with a pessimistic explanatory style were significantly lower on all of the health-related QOL scores, compared to those with a nonpessimistic style. Breast cancer survivors who exhibit a pessimistic explanatory style report lower health-related QOL for years after receiving a cancer diagnosis, compared to nonpessimistic women. [ABSTRACT FROM AUTHOR]

A learning needs assessment is an important component of developing effective patient education. In this comparative-descriptive study, researchers examined the perceived learning needs and preferred learning styles of patients with chronic obstructive pulmonary disease (COPD) and the topics care providers believe are important to teach patients with COPD. [ABSTRACT FROM AUTHOR]

Objective: To examine the association between depressive symptoms and exercise-related variables among patients with type 2 diabetes. Methods: Surveys were completed by 207 primary care patients diagnosed with type 2 diabetes (52% female; 95% white; mean age = 63 years). Multiple linear regression analyses were conducted. Results: Lower use of relapse prevention behavior was significantly associated with higher depression scores in a multivariate model. Conclusions: Patients with diabetes and depression have barriers to exercise (eg, fewer skills for relapse prevention) and may require additional support for exercise initiation and maintenance. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To assess the efficacy of a minimal cost and involvement educational intervention in improving women's knowledge about screening mammography and to explore patient perceptions of the educational intervention. PARTICIPANTS AND METHODS: During the study period (March 10, 2005, to July 1, 2005), 1446 participants in the Mayo Mammography Health Study scheduled for a mammogram within 4 weeks at the Mayo Clinic in Rochester, Minn, were randomized to 2 study groups and mailed surveys about mammograms. The 2 groups received separate surveys; both surveys contained knowledge-based questions about mammography, but the educational intervention group survey also contained qualitative questions that assessed the educational pamphlets. RESULTS: Of the 668 surveys returned (responders), 248 (34.4%) were from the control group, and 420 (58.3%) were from the intervention group. Approximately 80% of responders had had more than 7 prior mammograms. Significant increases in knowledge about mammography were found in the educational intervention compared with the control group on questions regarding age to begin screening mammography (67.9% vs 54.4%; P < .001), recommended frequency of mammograms (86.4% vs 75.4%; P < .001), overall reduction in mortality due to screening mammography (55.2% vs 8.9%; P < .001), and proportions of women who required follow-up mammograms (35.5% vs 14.9%; P < .001) or biopsy (59.5% vs 13.3%; P < .001). Qualitative data results indicated that most women who received the educational intervention found the pamphlets helpful and informative despite having had many previous mammograms. CONCLUSION: The results suggest that providing women scheduled for screening mammograms with physician-approved educational material before their appointment significantly increases knowledge about screening mammography, risks and benefits, and possible follow-up. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association of smoking and gender with body image satisfaction, perceived stress, and self-esteem in young adults. Methods: Respondents completed a survey consisting of Perceived Stress Scale, Body-Areas Satisfaction Scale, Rosenberg Self-Esteem Scale, and the Positive and Negative Affect Schedule. Current smokers (n = 483) and never smokers (n = 973) are included. Results: Smoking and female gender were independently associated with higher perceived stress (P < 0.001). Female gender was associated with lower body image satisfaction and lower self-esteem (P < 0.001). Current smoking was associated with lower self-esteem (P = 0.007). Conclusion: Smoking treatment should include stress management and self-esteem and body image improvement. [ABSTRACT FROM AUTHOR]

Trait anxiety, depression, neuroticism, and pessimism were investigated as predictors of tobacco abstinence 6 months post-treatment for cigarette smoking. The sample included 1877 adult patients treated for cigarette smoking at Mayo Clinic who had previously completed the Minnesota Multiphasic Personality Inventory. Known predictors of tobacco abstinence were adjusted for in the final analyses (average cigarettes per day at the time of NDC consult, severity of nicotine dependence, stage of change at time of treatment, longest duration of previous abstinence, and gender). Results indicated that trait anxiety, neuroticism, and pessimism were significantly univariately associated with decreased likelihood of 6-month tobacco abstinence. Since prior evidence suggests that these traits are identifiable early in life and potentially modifiable, tobacco abstinence rates might be enhanced by offering treatment programs to smokers that are also designed to reduce symptoms related to their anxiety, neuroticism, and pessimism. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The five-factor model of personality was used to describe the correlates of smoking abstinence. METHODS: Following treatment in the Mayo Clinic Nicotine Dependence Center, the six month abstinence status was determined by self-report. Sixteen months to 2.4 years following the initial treatment evaluation, and 10 months to 1.9 years after the abstinence status was determined, 475 patients were mailed a Neuroticism, Extraversion, Openness, Five-Factor Inventory questionnaire. Ninety-nine abstinent and 151 smoking patients returned a completed questionnaire. RESULTS: Multivariate analysis showed that low scores on neuroticism and openness were associated with tobacco abstinence. In addition, high scores on neuroticism and low scores on agreeableness and conscientiousness were associated with predictors of poor outcome including greater number of cigarettes smoked per day, initiation of smoking prior to age 18, and a Fagerstrom Test for Nicotine Dependence score of > or = 6. CONCLUSIONS: Personality characteristics as predictors of smoking abstinence following treatment warrant further investigation in prospective clinical trails. Treatment matching using personality profiling as a guide may be a valuable tool for improving abstinence rates following treatment for nicotine dependence. [ABSTRACT FROM AUTHOR]

As an initial step in building gender-specific binge drinking intervention programs, the authors investigated the relation of potentially modifiable factors (physical activity level, weight concern, and depressive symptoms) to binge drinking while controlling for the effects of previously established correlates of binge drinking (tobacco and marijuana use, GPA, and perception of peer alcohol use). Four-hundred-twelve college women completed an in-class survey. Multivariate analyses revealed that tobacco and marijuana use, GPA, and physical activity were significantly associated with binge drinking, whereas tobacco use and perception of peers' alcohol use were associated with more frequent binge drinking. The findings suggested that the variables associated with any binge drinking and frequency of binge drinking may differ and that binge drinking can be associated with positive health behaviors (ie, greater physical activity) as well as risky health behaviors (eg, tobacco use). [ABSTRACT FROM AUTHOR]

AIMS: Spit tobacco use is prevalent in the United States and is associated with adverse health consequences. Health-care providers have neither evidence summaries nor evidence-based guidelines to assist them in treating patients who use spit tobacco. DESIGN: We completed a systematic review of the literature to determine the efficacy and safety of pharmacological and behavioral interventions for the treatment of spit tobacco use. FINDINGS: We found six randomized controlled trials testing pharmacological interventions and eight testing behavioral interventions. Using random-effects meta-analyses,bupropion sustained-release (SR) increased point prevalence tobacco abstinence at 12 weeks [odds ratio (OR) 2.1; 95% confidence interval (CI), 1.0-4.2]. Nicotine replacement therapy with patch or gum increased point prevalence tobacco abstinence at 6 months (OR 1.3; 95% CI, 1.0-1.6).Behavioral interventions increased long-term (6 month)point prevalence tobacco abstinence (OR 1.7; 95% CI, 1.1-2.9).Studies including an oral examination followed by feedback to the patient had the highest treatment effect. CONCLUSIONS: Behavioral interventions for ST users are effective for increasing ST abstinence rates. Bupropion SR is probably effective and nicotine replacement therapy may be effective. This evidence from randomized controlled trials provides health-care professionals with information necessary to effectively treat spit tobacco use. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To objectively measure the effect of a pass-fail grading system on stress, mood, group cohesion, and test anxiety in medical students. PARTICIPANTS AND METHODS: Beginning with the class of 2006, the Mayo Medical School, Rochester, Minn, changed the grading system for first-year courses from a 5-interval grading system to a pass-fail grading system. Students in the previous class of 2005, who were graded using a 5-interval system during their first year of medical school, were compared with students in the class of 2006. Using a prospective study design, the 2 groups were compared at the end of both the first year and the second year of medical school on the Perceived Stress Scale, Profile of Mood States, Perceived Cohesion Scale, Test Anxiety Inventory, and (after year 2) the United States Medical Licensing Examination Step 1. Data collection occurred in 2002 and 2003 with the class of 2005 and in 2003 and 2004 with the class of 2006. RESULTS: Students graded with the pass-fail system had less perceived stress (median, 15.0 vs 21.0; P-.01) and greater group cohesion (median, 34.5 vs 30.0; P=.02) at the end of their second year of coursework than their 5-interval graded peers. The pass-fail group had better mood (median, 46.5) than the graded group (median, 64.0), but this difference was not statistically significant (P=.07). No significant differences were found between the 2 groups in test-taking anxiety or in United States Medical Licensing Examination Step 1 board scores. CONCLUSION: Pass-fail grading may reduce stress and increase group cohesion in medical students compared with traditional 5-interval grading. [ABSTRACT FROM AUTHOR]

Objective: Faculty development is designed to facilitate career advancement of junior faculty but there is limited empirical evidence on how to design an effective program., Methods: As a first step in the design of an effective program, a needs assessment was conducted. Participants were faculty members of an academic psychiatry department. Participants completed a quantitative and qualitative survey assessing their experience with mentors, academic self-efficacy, career burnout and satisfaction, academic productivity, and perceived barriers to scholarship., Results: Eighty percent (N = 104) of eligible faculty members completed the study survey (54% female; 81% White, 10% underrepresented in medicine). Less than half of the respondents (44%) reported having a current mentor. Number of mentors (r = .33; p < .01), mentorship meetings (r = .35; p < .01), and mentorship quality (r = .33; p < .01) were significantly correlated to a standardized measure of academic self-efficacy. Self-efficacy was significantly associated with academic productivity (r = .44; p < .001) and career satisfaction (r = .29; p < .05). The top barriers to scholarship productivity were time and lack of access to resources. Faculty members without a mentor endorsed more barriers to scholarship (p < .001) than those with a mentor. Themes that emerged from the qualitative data suggest that mentorship supports career advancement through coaching and professional development, invitations to collaborate and resource share, networking, and active teaching., Conclusion: Based on the relationship of mentoring to career outcomes, a robust faculty development program needs a formal academic mentorship program to improve career satisfaction and academic productivity., (© 2022. The Author(s), under exclusive licence to American Association of Chairs of Departments of Psychiatry, American Association of Directors of Psychiatric Residency Training, Association for Academic Psychiatry and Association of Directors of Medical Student Education in Psychiatry.)

Background: Despite widespread efforts to create wellness programming in medical schools, there is a paucity of literature examining students' perception of wellness and perceptions of these programs. With the inaugural class at the Arizona campus of Mayo Clinic Alix School of Medicine (MCASOM-AZ), an opportunity arose to establish an empirically evaluated wellness curriculum that most inclusively and effectively enables medical students to flourish for years to come. The initial wellness offerings included mental health, academic success, and disability services, curriculum-embedded seminars, wellness committee driven programming, and student-proposed wellness activities. We aimed to improve the relevance and impact of medical school wellness curricula by soliciting in-depth and longitudinal perspectives of medical students themselves. As MCASOM-AZ opened in 2017, the student body at the time of study consisted of first- and second-year medical students., Methods: Employing a mixed methods analysis of qualitative and longitudinal quantitative data, first- and second-year students at a MCASOM-AZ were invited to respond to an anonymous, online year-long survey (baseline, six months and 12 months) during the 2018-2019 academic year and participate in a structured, in-depth and in-person, peer-to-peer interview about their conceptions of wellness and the MCASOM-AZ wellness curriculum and resources. Qualitative data was coded for themes using thematic analysis strategies by independent raters., Results: Nearly half of eligible students completed the baseline survey,1/3 completed all 3 time-points, and 1/5 participated in an in-depth interview. Participant age, gender, and year of school were representative of the larger student body. Although individual conceptions varied, Wellness was consistently highly valued. Family, Academic Performance, and Friends emerged as most important to well-being across time-points. Academic work arose as the largest barrier to wellness. Analysis of qualitative data revealed five themes. Despite individual differences in approaches to wellness, wellbeing was interrelated to the learning environment; mandatory wellness efforts that didn't address the medical culture met with skepticism., Conclusions: Interview responses provided understanding and context by which to interpret questionnaire responses. Academics was critical to students' identity and wellness, while also the largest barrier. Suggested curricular improvements include restructuring academic work, seamlessly integrating wellness within coursework, and offering optional individualized approaches., (© 2022. The Author(s).)

The coronavirus pandemic quickly exposed the need for efficient and widespread implementation of telehealth services. Additionally, it further unveiled the impact of social and environmental barriers to healthcare in underserved, rural populations. This in-practice pilot study tested the utility of a geographically centralized social worker providing services between a patient and a primary care provider via telecommunication at two high volume rural outpatient family practice clinics. Outcome measures included patient and provider satisfaction. Twenty-two telehealth social work encounters occurred spanning both adult and pediatric patients. Data collected from patients, primary care providers, and social work staff revealed positive feedback. The data from our small pilot study demonstrated that social work triage delivered via a tablet was an acceptable and valued resource in busy primary care practices., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Fipps, Vickers, Bergstedt and Williams.)

Stress is a well-recognized phenomenon in the nursing profession, particularly for new nurses. This study (a) assessed nurse residents' experience with a stress management program and (b) informed adjustments to the program. Analysis of qualitative data revealed three themes: (a) enhanced personal and professional development, (b) sensitivity to learner needs, and (c) fostering the principles of mindfulness. A stress management program has the potential to positively enhance the new nurse's transition to work.

This pilot study examined feasibility of an unsupervised, facility-based exercise programme for promoting exercise adherence among depressed adult outpatients. The potential effect of adding physical activity counselling on depressive symptoms and physical activity was also explored. Participants were randomly assigned to a 12-week programme comprising an orientation and access to fitness centre resources (control, n = 18) or that programme plus 6 physical activity counselling sessions (intervention, n = 18). Outcome measures were feasibility (fitness centre attendance over 12 weeks); Beck Depression Inventory (BDI-II) and International Physical Activity Questionnaire (IPAQ) completed at baseline and week 12; and qualitative programme feedback. Fitness centre attendance averaged only 12 days (14% of all possible days) with no differences between study groups. No group differences were found on IPAQ or BDI-II scores at week 12. Increases from baseline in IPAQ moderate/vigorous activity minutes were associated with decreases in BDI-II scores at week 12 (p < 0.001). The most helpful programme aspect reported was connecting participants to fitness centre resources. In this pilot study of depressed outpatients, an unsupervised fitness centre based program was not feasible for promoting exercise adherence and adding physical activity counselling was not useful for increasing physical activity levels or reducing depression.

Background: We recently demonstrated in a randomized study the feasibility and effectiveness of telephone-based health coaching using motivational interviewing on decreasing hospital readmissions and improving quality of life at 6 and 12 months after hospital discharge. In this qualitative study, we sought to explore the health-coaching intervention as seen from the perspective of the participants who received the intervention and the coaches who delivered it., Methods: Semistructured participant interviews ( n = 24) and a focus group of all health coaches ( n = 3) who participated in this study were conducted. Interviews and focus group were recorded and transcribed verbatim. Transcripts were analyzed using coding and categorizing techniques and thematic analysis. Mixed-method triangulation was used to merge quantitative and qualitative data., Results: Content analysis revealed 4 predominant themes of the coaching intervention: health-coaching relationship, higher participant confidence and reassurance (most related to improvement in physical quality of life), improved health-care system access (most related to decreased hospital readmissions), and increased awareness of COPD symptoms (most related to improvement in emotional quality of life). The strongest theme was the relationship with the health coach, including coach style and motivational interviewing approach. Health coaches' focus group also noted the importance of the coaching relationship as the most significant theme., Conclusions: This study provided themes to further inform the delivery and implementation of health-coaching interventions in patients with COPD after hospital discharge. Health coaching forged partnerships and created a platform for patient engagement, which was confirmed by both participants and health coaches., (Copyright © 2017 by Daedalus Enterprises.)

Background: Decision aids can increase patient involvement in decision-making about health care. The study goal was to develop and test a decision aid for use by clinicians in discussion options for changing smoking behavior before and after elective surgery., Methods: In formative work, a decision aid was designed to facilitate patient-clinician discussion regarding three options: continue smoking, attempt a period of temporary abstinence, and attempt to quit smoking for good. A randomized, two-group pilot study was then conducted in smokers evaluated in preparation for elective surgery in a preoperative clinic to test the hypothesis that the decision aid would improve measures of decisional quality compared with usual care., Results: The final decision aid consisted of three laminated cards. The front of each card included a colorful graphic describing each choice; the reverse including two to three pros and cons for each decision, a simple graphic illustrating the effects of smoking on the body, and a motivational phrase. In the randomized trial of 130 patients, the decision aid significantly (P < 0.05) improved measures of decisional quality and patient involvement in decision making (Cohen's d effect sizes of 0.76 and 1.20 for the Decisional Conflict Scale and Observing PatienT involvement In decisiON-making scale, respectively). However, the decision aid did not affect any aspect of perioperative smoking behavior, including the distribution of or adherence to choices., Conclusions: Although the use of a decision aid to facilitate clinician-patient discussions regarding tobacco use around the time of surgery substantially improved measures of decisional quality, it alone did not change perioperative tobacco use behavior.

Research Question: The aim of this study was to identify barriers, needs, and preferences of weight management intervention for women with fibromyalgia (FM)., Theoretical Framework: Obesity appears in higher rates in women with fibromyalgia compared to the population at large, and no study to date has taken a qualitative approach to better understand how these women view weight management in relation to their disease and vice versa., Methodology: We designed a qualitative interview study with women patients with FM and obesity., Context: Women (N = 15) were recruited by their participation in a fibromyalgia treatment program (FTP) within the year prior., Sample Selection: The women approached for the study met the following inclusion criteria: confirmed diagnosis of FM, age between 30 and 60 years (M = 51 ± 6.27), and body mass index (BMI) ≥ 30 (M = 37.88 ± 4.87)., Data Collection: Patients completed questionnaire data prior to their participation in focus groups (N = 3), including weight loss history, physical activity data, the Revised Fibromyalgia Impact Questionnaire (FIQR), and the Patient Health Questionnaire 9-item (PHQ-9). Three focus group interviews were conducted to collect qualitative data., Analysis and Interpretation: Consistent themes were revealed within and between groups. Patients expressed the complex relationships between FM symptoms, daily responsibilities, and weight management. Weight was viewed as an emotionally laden topic requiring compassionate delivery of programming from an empathetic leader who is knowledgeable about fibromyalgia. Patients view themselves as complex and different, requiring a specifically tailored weight management program for women with FM., Main Results: Women with FM identify unique barriers to weight management, including the complex interrelationships between symptoms of FM and health behaviors, such as diet and exercise. They prefer a weight management program for women with FM that consists of an in-person, group-based approach with a leader but are open to a tailored conventional weight management program. Feasibility may be one of the biggest barriers to such a program both from an institutional and individual perspective., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Objective: To determine the attitudes and beliefs of both parents and surgical clinicians regarding interventions to reduce secondhand smoke (SHS) exposure in children undergoing surgery., Methods: Structured interviews were conducted with 25 parents of children scheduled for elective procedures and 10 surgical clinicians., Results: Major themes identified in parent interviews included: (1) parents are receptive to learning about the surgical risks posed by SHS exposure; (2) many are already attempting to reduce SHS exposure, and; (3) parents are more accepting of SHS mitigation procedure than a recommendation to quit smoking. Clinicians were receptive to addressing perioperative SHS exposure., Conclusions: Both parents and clinicians are receptive to clinician-delivered interventions to reduce the SHS exposure of children scheduled for elective surgery.

Objective: The objective of this investigation was to assess whether a new electronic health (e-health) platform, combining mobile computing and a content management system, could effectively deliver modular and "just-in-time" education to older patients following cardiac surgery., Subjects and Methods: Patients were provided with iPad(®) (Apple(®), Cupertino, CA) tablets that delivered educational modules as part of a daily "to do" list in a plan of care. The tablet communicated wirelessly to a dashboard where data were aggregated and displayed for providers., Results: A surgical population of 149 patients with a mean age of 68 years utilized 5,267 of 6,295 (84%) of education modules delivered over a 5.3-day hospitalization. Increased age was not associated with decreased use., Conclusions: We demonstrate that age, hospitalization, and major surgery are not significant barriers to effective patient education if content is highly consumable and relevant to patients' daily care experience. We also show that mobile technology, even if unfamiliar to many older patients, makes this possible. The combination of mobile computing with a content management system allows for dynamic, modular, personalized, and "just-in-time" education in a highly consumable format. This approach presents a means by which patients may become informed participants in new healthcare models.

Background: Chronic disease management in the primary care setting increasingly involves self-management support from a nurse care manager. Prior research had shown patient acceptance and willingness to work with care managers., Methods: This survey study evaluated patient-perceived satisfaction with care management and patient opinions on the effectiveness of care management in promoting self-management. Qualitative and quantitative survey responses were collected from 125 patients (79% female; average age 46; 94% Caucasian) enrolled in care management for depression. Qualitative responses were coded with methods of content analysis by 2 independent analysts., Results: Patients were satisfied with depression care management. Patients felt that care management improved their treatment above and beyond other aspects of their depression treatment (mean score, 6.7 [SD, 2]; 10 = Very much), increased their understanding of depression self-management (mean score, 7.2 [SD, 2]; 10 = Very much), and increased the frequency of self-management goal setting (mean score, 6.9 [SD, 3]; 10 = Very much). Predominant qualitative themes emphasized that patients value emotional, motivational, and relational aspects of the care manager relationship. Patients viewed care managers as caring and supportive, helpful in creating accountability for patients and knowledgeable in the area of depression care. Care managers empower patients to take on an active role in depression self-management. Some logistical challenges associated with a telephonic intervention are described., Conclusion: Care manager training should include communication and motivation strategies, specifically self-management education, as these strategies are valued by patients. Barriers to care management, such as scheduling telephone calls, should be addressed in future care management implementation and study.

Objectives: To identify client priorities prior to wellness coaching, and examine motivational improvements for health behaviors on follow-up., Methods: Clients completed a wellness questionnaire at baseline (before coaching) and at a 3-month follow-up. Overall, 177 participants (92% female, average age 42.9 (SD 11.2) years) were included in the analysis. Clients indicated priorities for coaching, and levels of importance, confidence, and readiness to change within each domain were compared between baseline and follow-up., Results: Participants identified weight management as their top priority and successfully reduced their BMI. Participants also demonstrated significant improvements in motivation and confidence in most health behavior domains., Conclusions: These results provide further support for the effectiveness of wellness coaching for weight management and for improving motivational readiness for behavior change.

The effectiveness of psychotherapies, such as interpersonal and social rhythm therapy (IPSRT), is supported by randomized controlled trials. These trials provide minimal direction regarding feasibility of psychotherapy delivery models. The study purpose was to identify factors facilitating implementation and sustainability of an IPRST group for patients with bipolar disorder. Qualitative data were assessed by the normalization process model (NPM). The results demonstrate feasibility of implementation with experienced clinicians, program coordination, and leadership support. Sustainability challenges include aftercare groups, space, and clinician time. The NPM provides a useful framework for evaluation of factors influencing the feasibility of psychotherapy delivery models., (© 2013.)

Older adults with multiple comorbidities are often undernourished or at high risk for becoming so, especially after a recent hospitalization. Randomized controlled trials of effective, innovative interventions are needed to support evidence-based approaches for solving nutritional problems in this population. Self-management approaches where participants select their own behavioral goals can enhance success of interventions. The purpose of this study was to evaluate the feasibility and efficacy of a multilevel self-management intervention to improve nutritional status in a group of high-risk older adults. The Behavioral Nutrition Intervention for Community Elders (B-NICE) trial used a prospective randomized controlled design to determine whether the intervention, compared to standard care, maintained or increased caloric intake (depending on baseline body mass index) and, consequently, stabilized or increased body weight. Participants were 34 Medicare-eligible, age 65 years old or older, homebound adults who were consuming insufficient calories and/or had a history of weight loss ≥2.5% over 6 months. The intervention took place within participants' homes. Outcome measures, including energy intake (based on collection of three 24-hour dietary recalls) and body weights were assessed at baseline and at 60 days post randomization. The primary analyses included analyses of covariance and Pearson's χ(2). We hypothesized that the intervention would result in increased caloric intake and weight gain in underweight older adults and increased or stabilized caloric intake and weight for everyone else. The intervention was feasible; however, it did not result in differences between groups for desired outcomes of either caloric intake or body weight. Future interventions might either deliberately involve caregivers or reduce burden for both patients and caregivers., (Copyright © 2013 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Objectives: To assess modifiable cognitive and behavioral factors following cardiac events and their association to patients' 3-month survival expectations., Methods: Patients (N = 233, 71% male; mean age 68years) hospitalized following cardiac events completed study packets assessing mood, behavior change, health behavior domains, and medical recommendation adherence at hospital discharge and 3 months later., Results: In univariate analyses, baseline depression, health distress, behavior change, and adherence were associated with positive expectations at follow-up. Multivariate regression analysis found (Adj. R²=0.43) baseline expectations and adherence were significant predictors of expectations for recovery and survival at follow-up (p < .01)., Conclusion: Patients' perception of adherence following a cardiac event is a potent predictor of later expectations.

Objective: This evaluation assessed the opinions and experiences of primary care providers and their support staff before and after implementation of expanded on-site mental health services and related system changes in a primary care clinic., Method: Individual semistructured interviews, which contained a combination of open-ended questions and rating scales, were used to elicit opinions about mental health services before on-site system and resource changes occurred and repeated following changes that were intended to improve access to on-site mental health care., Results: In the first set of interviews, prior to expanding mental health services, primary care providers and support staff were generally dissatisfied with the availability and scheduling of on-site mental health care. Patients were often referred outside the primary care clinic for mental health treatment, to the detriment of communication and coordinated care. Follow-up interviews conducted after expansion of mental health services, scheduling refinements and other system changes revealed improved provider satisfaction in treatment access and coordination of care. Providers appreciated immediate and on-site social worker availability to triage mental health needs and help access care, and on-site treatment was viewed as important for remaining informed about patient care the primary care providers are not delivering directly., Conclusions: Expanding integrated mental health services resulted in increased staff and provider satisfaction. Our evaluation identified key components of satisfaction, including on-site collaboration and assistance triaging patient needs. The sustainability of integrated models of care requires additional study., (© 2013.)

Providing concise, consistent, and individually relevant patient education is critical. At one institution, patients and families attended a chemotherapy education class consisting of an 11-minute DVD and an oncology nurse-facilitated group discussion. Postclass and eight-week follow-up surveys assessing understanding of treatment side effects, self-care management, and confidence in managing side effects were administered. Quantitative and qualitative data suggested the DVD and oncology nurse-facilitated group discussion provided consistent information, flexibility, and expert knowledge in empowering patients and families to self-manage chemotherapy side effects.

Background: The increasing prevalence of heart failure (HF) and high associated costs have spurred investigation of factors leading to adverse outcomes in patients with HF. Studies to date report inconsistent evidence on the link between depression and outcomes with only limited data on emergency department and outpatient visits., Methods and Results: Olmsted, Dodge, and Fillmore county, Minnesota residents with HF were prospectively recruited between October 2007 and December 2010 and completed a 1-time 9-item Patient Health Questionnaire for depression categorized as: none to minimal (Patient Health Questionnaire score, 0-4), mild (5-9), or moderate to severe (≥10). Andersen-Gill models were used to determine whether depression predicted hospitalizations and emergency department visits, whereas negative binomial regression models explored the association of depression with outpatient visits. Cox proportional hazards regression characterized the relationship between depression and all-cause mortality. Among 402 patients with HF (mean age, 73±13 years; 58% men), 15% had moderate to severe depression, 26% mild, and 59% none to minimal depression. During a mean follow-up of 1.6 years, 781 hospitalizations, 1000 emergency department visits, 15 515 outpatient visits, and 74 deaths occurred. After adjustment, moderate to severe depression was associated with nearly a 2-fold increased risk of hospitalization (hazard ratio, 1.79; 95% confidence interval, 1.30-2.47) and emergency department visits (hazard ratio, 1.83; 95% confidence interval, 1.34-2.50), a modest increase in outpatient visits (rate ratio, 1.20; 95% confidence interval, 1.00-1.45), and a 4-fold increase in all-cause mortality (hazard ratio, 4.06; 95% confidence interval, 2.35-7.01)., Conclusions: In this prospective cohort study, depression independently predicted an increase in the use of healthcare resources and mortality. Greater recognition and management of depression in HF may optimize clinical outcomes and resource utilization.

Objectives: To determine the effect of using the diagnosis of metabolic syndrome (MetSx) on risk perception., Methods: We randomized 74 participants to receive either the diagnosis of MetSx or the diagnosis of individual cardiovascular risk factors. The MetSx group was subdivided into those receiving written patient education material or written patient education plus educational videos., Results: At 6 weeks, participants receiving the diagnosis of MetSx were more likely to increase their health concerns, perceived risk of myocardial infarction, and their motivation toward health behavior., Conclusion: Sharing the diagnosis of MetSx increases risk perception and motivation toward a healthier behavior.

Context: Patients with primary hyperparathyroidism (PHP) often report nonspecific symptoms including mood disturbances., Objective: The objective of the study was to determine the frequency of depression in PHP and assess its response to parathyroidectomy., Methods: A case-control study at a referral center in Rochester, MN, performed Patient Health Questionnaire-9 (PHQ-9) assessments in observed (n = 81) and surgical (n = 88) PHP and benign nontoxic surgical thyroid disease (n = 85) at baseline and 1, 3, 6, and 12 months after surgery or the initial questionnaire in observed PHP. Baseline PHQ-9 scores and their response to surgery were evaluated., Results: The groups were similar in gender and depression history, but PHP patients were older. Baseline PHQ-9 scores were 1.71 points higher in PHP than controls after adjusting for age and gender (P = .004). Clinically significant PHQ-9 scores (≥10) were twice as common in PHP (31.4%) compared with thyroid subjects (15.3%). Parathyroidectomy resulted in significant and sustained reductions in PHQ-9 scores, which were greater than observed PHP at all time points (P < .001). PHP patients with clinically significant PHQ-9 scores dropped to 7.4% (P < .001) and 7.6% (P < .001) at 1 month and 1 yr after parathyroidectomy. There were greater declines in PHQ-9 scores after parathyroidectomy at 1, 3, and 6 months (P < .001) and 1 yr (P = .061) compared with thyroid surgery., Conclusions: Depression is common in patients with PHP. Parathyroidectomy results in greater improvement in PHQ-9 scores compared with thyroid surgery or observation of PHP.

Although previous studies suggest that the clinical setting of an interdisciplinary pain treatment program may provide an optimal environment to promote smoking cessation, currently available smoking cessation interventions may be less effective for adults with chronic pain due, in part, to unrecognized clinical factors related to chronic pain. The specific aim of this qualitative study was to solicit information from adult smokers with chronic pain participating in an interdisciplinary pain treatment program regarding their perceptions of how smoking affects pain symptoms, and how these beliefs, cognitions, and emotions may either impede or facilitate smoking cessation. Similar information was solicited from a group of pain specialty physicians. The study involved 18 smokers with chronic pain, and seven physicians. Patients reported that smoking was an important coping strategy for pain and distress, primarily by offering an opportunity for distraction and avoidance, respectively. The majority of patients using opioids reported that opioid consumption stimulated smoking. Important barriers were identified toward making a quit attempt during pain treatment including quitting smoking while making changes in opioid use, and perceived difficulty managing multiple treatment-related stressors. Several pain-related benefits of smoking cessation were identified by physicians, but important barriers to providing smoking cessation services were recognized including lack of time and knowledge about how to help patients quit smoking. The findings of this study identified several novel and important clinical factors that should be incorporated into a targeted smoking cessation intervention for adults with chronic pain., (© 2011 Mayo Clinic. Pain Practice © 2011 World Institute of Pain.)

Objective: To determine the risk of hospitalization and death in relation to preexisting depression and anxiety among patients with cardiovascular disease (CVD)., Patients and Methods: The cohort consisted of 799 Olmsted County, MN, residents diagnosed with CVD (myocardial infarction or heart failure) from January 1, 1979, to December 31, 2009, who completed a Minnesota Multiphasic Personality Inventory (MMPI) prior to their event. The MMPI was used to identify depression and anxiety, and participants were followed up for hospitalizations and death during an average of 6.2 years., Results: Depression and anxiety were identified in 282 (35%) and 210 (26%) participants, respectively. After adjustment, depression and anxiety were independently associated with a 28% (95% confidence interval [CI], 8%-51%) and 26% (95% CI, 3%-53%) increased risk of being hospitalized, respectively. Depression also conferred an increased risk of all-cause mortality of similar magnitude, whereas the hazard ratio for anxiety was not statistically significant. The combined occurrence of depression and anxiety led to a 35% (95% CI, 8%-71%) increase in the risk of hospitalizations., Conclusion: Among patients with CVD, both preexisting depression and anxiety, occurring on average 17 years before the CVD event, independently predict hospitalizations. In addition, the 2 conditions may act synergistically on increasing health care utilization in patients with CVD.

Introduction: Telemonitoring is being increasingly used for chronic disease monitoring. Understanding elderly patients' feelings and perspectives toward telemonitoring is important to minimize any barriers to implementation in this population., Methods: Twenty Tele-Era Trial participants completed qualitative interviews assessing opinions about their telemonitoring experience. Participants also rated telemonitoring on burden, communication with clinicians, impact on medical condition knowledge, and confidence in using the monitor., Results: On an average, participants rated telemonitoring as minimally burdensome, rated themselves confident in using the monitor, and positively rated telemonitoring for clinical communication. Qualitative analysis revealed a predominant theme that telemonitoring increases patient awareness of their health and also that telemonitoring prompts action., Conclusion: Elderly patients find home telemonitoring to be an acceptable and satisfying experience that can increase their awareness of their health and provide a sense of safety in their home. Home telemonitoring can lead to earlier evaluation of decline in health status.

Physicians are often unable to guide patients through the advance care planning (ACP) process due to cost and time constraints. We conducted a retrospective analysis in the primary care setting targeting older adults without an advance medical directive (AMD). An ACP educational packet was sent to intervention patients before their health maintenance examination (HME). Additionally, their physicians had access to a computerized clinical decision support system on AMD completion at the time of the HME. Control participants' physicians had access to the computerized decision support system and traditional resources only. All participants who received the packet were sent a follow-up survey. In all, 21.6% of intervention participants completed an AMD, compared with 4.1% of control participants. Combining clinical decision support systems and standardized processes enhances the ACP process.

Objective: To assess impact of exercise education intervention on exercise frequency and attitudes., Methods: Cardiovascular outpatients (N=509) were randomized to receive an education DVD or standard care. Outcome measures (baseline and 6 weeks) assessed exercise frequency and cognitive variables., Results: There was no difference between groups on exercise frequency change from baseline, but DVD group reported greater exercise outcome expectations than control group (P=0.01). There was a greater increase in relapse-prevention behavior in the DVD group, compared to control, for those with low relapse-prevention behavior at baseline (P=0.02)., Conclusion: A minimal intervention improves outcome expectations for exercise.

We conducted a study designed to evaluate the efficacy and feasibility of a multilevel self-management intervention to improve nutritional intake in a group of older adults receiving Medicare home health services who were at especially high risk for experiencing undernutrition. The Behavioral Nutrition Intervention for Community Elders (B-NICE) trial used a prospective randomized controlled design to determine whether individually tailored counseling focused on social and behavioral aspects of eating resulted in increased caloric intake and improved nutrition-related health outcomes in a high-risk population of older adults. The study was guided by the theoretical approaches of the Ecological Model and Social Cognitive Theory. The development and implementation of the B-NICE protocol, including the theoretical framework, methodology, specific elements of the behavioral intervention, and assurances of the treatment fidelity, as well as the health policy implications of the trial results, are presented in this article.

Past sexual trauma is frequently linked to the development of behavioral spells, present among 30% of patients admitted for video/EEG monitoring. Current attempts to verify and explore mechanisms in this reported association revealed that patients with epilepsy (n=58) and those with behavioral spells (n=38) did not differ in their self-report of past sexual trauma (among approximately 38% in each group). Ninety percent (90%) of men with behavioral spells endorsed past physical abuse, however, compared with 45% of men with epilepsy, and 40% of men with spells likely met current criteria for posttraumatic stress disorder. Among all patients, the presence of past physical, but not sexual, abuse positively predicted the diagnosis of spells rather than epilepsy. Current findings do not support a preponderance of sexual trauma in behavioral spells, yet within the subset of men with spells, greater exposure to physical abuse and current symptoms of posttraumatic stress disorder may be important etiological and sustaining factors., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Purpose: The collaborative care model, using care managers, has been shown to be effective in achieving sustained treatment outcomes in chronic disease management. Little effort has been made to find out patient preferences for chronic disease care, hence, we conducted a study aimed at identifying these., Methods: A 20-item questionnaire, asking for patients' and providers' preferences and perceptions, was mailed out to 1000 randomly selected patients in Olmsted County, Minnesota, identified through a diabetes registry to have type 2 diabetes mellitus, a prototypical prevalent chronic disease. Surveys were also sent to 42 primary care providers., Results: There were 254 (25.4%) patient responders and 28 (66%) provider responders. The majority of patients (>70%) and providers (89%) expressed willingness to have various aspects of diabetes care managed by a care manager. Although 75% of providers would be comfortable expanding the care manager role to other chronic diseases, only 39.5% of patient responders would be willing to see a care manager for other chronic problems. Longer length of time from initial diagnosis of diabetes was associated with decreased patient likelihood to work with a care manager., Conclusion: Despite study limitations, such as the lack of validated measures to assess perceptions related to care management, our results suggest that patients and providers are willing to collaborate with a care manager and that both groups have similar role expectations of a care manager.