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Background Physician distress is common and related to numerous factors involving physicians’ personal and professional lives. The present study was designed to assess the effect of a Stress Management and Resiliency Training (SMART) program for increasing resiliency and quality of life, and decreasing stress and anxiety among Department of Medicine (DOM) physicians at a tertiary care medical center. Participants Forty DOM physicians were randomized in a wait-list controlled clinical trial to either the SMART intervention or a wait-list control group for 8 weeks. The intervention involved a single 90 min one-on-one training in the SMART program. Primary outcome measures assessed at baseline and week 8 included the Connor Davidson Resilience Scale (CDRS), Perceived Stress Scale (PSS), Smith Anxiety Scale (SAS) and Linear Analog Self Assessment Scale (LASA). Results Thirty-two physicians completed the study. A statistically significant improvement in resiliency, perceived stress, anxiety, and overall quality of life at 8 weeks was observed in the study arm compared to the wait-list control arm: CDRS: mean ± SD change from baseline +9.8 ± 9.6 vs. -0.8 ± 8.2, t(30) = 3.18, p = 0.003; PSS: -5.4 ± 8.1 vs. +2.2 ± 6.1, t(30) = -2.76, p = 0.010; SAS: -11.8 ± 12.3 vs.+ 2.9 ± 8.9, t(30) = -3.62, p = 0.001; and LASA: +0.4 ± 1.4 vs. -0.6 ± 1.0, t(30) = 2.29, p = 0.029. Conclusions A brief training to enhance resilience and decrease stress among physicians using the SMART program was feasible. Further, the intervention provided statistically significant improvement in resilience, stress, anxiety, and overall quality of life. In the future, larger clinical trials with longer follow-up and possibly wider dissemination of this intervention are warranted.

To assess the impact of resilience, the ability to withstand and bounce back from adversity, on measures of well-being, self-reported stress, and mental health diagnoses. This study was a cross-sectional survey of participants seen at an executive health practice at Mayo Clinic, Rochester, Minnesota, from January 2012 through September 2016. Participants completed an anonymous survey that included demographic information and 3 validated survey instruments-the 10-item Connor-Davidson Resilience Scale (CD-RISC), the 12-item Linear Analogue Self-Assessment Scale (LASA), and the 14-item Perceived Stress Scale (PSS). Self-reported history of mental health diagnoses was also collected. CD-RISC scores were used to stratify participants into lower (<30), medium (30-34), or higher (≥35) resilience categories. Participants' LASA scores, PSS scores, and self-reported mental health diagnoses were compared among resilience categories. Of the 2,027 eligible participants, 1,954 met the study inclusion criteria as currently employed corporate-sponsored executive or business professionals (self-designated) who completed the CD-RISC survey. Most participants (62.5%) were aged 40 to 59 years. The majority were male (78.3%), white (95.3%), educated (86.2%), and in a committed relationship (89.7%). Among participants, 41.7% reported higher resilience, 34.3% had medium resilience, and 24.0% had lower resilience. The quality of life and overall LASA scores were positively associated with higher resilience (P < .001). PSS scores and self-reported mental health diagnoses were negatively associated with higher resilience (P < .001). These associations remained significant after adjusting for patient characteristics. In this cross-sectional survey of a large cohort of corporative executives, the lower-resilience cohort had a 4-fold higher prevalence of depression and an almost 3-fold higher prevalence of anxiety compared with the higher-resilience cohort. High resilience was positively associated with well-being and negatively associated with perceived stress. Our findings suggest that higher resilience in the executive workplace environment is associated with better mental health, reduced stress, and greater well-being.

Poor mental health places a burden on individuals and populations. Resilient persons are able to adapt to life's challenges and maintain high quality of life and function. Finding effective strategies to bolster resilience in individuals and populations is of interest to many stakeholders. To synthesize the evidence for resiliency training programs in improving mental health and capacity in 1) diverse adult populations and 2) persons with chronic diseases. Electronic databases, clinical trial registries, and bibliographies. We also contacted study authors and field experts. Randomized trials assessing the efficacy of any program intended to enhance resilience in adults and published after 1990. No restrictions were made based on outcome measured or comparator used. Reviewers worked independently and in duplicate to extract study characteristics and data. These were confirmed with authors. We conducted a random effects meta-analysis on available data and tested for interaction in planned subgroups. The standardized mean difference (SMD) effect of resiliency training programs on 1) resilience/hardiness, 2) quality of life/well-being, 3) self-efficacy/activation, 4) depression, 5) stress, and 6) anxiety. We found 25 small trials at moderate to high risk of bias. Interventions varied in format and theoretical approach. Random effects meta-analysis showed a moderate effect of generalized stress-directed programs on enhancing resilience [pooled SMD 0.37 (95% CI 0.18, 0.57) p = .0002; I2 = 41%] within 3 months of follow up. Improvement in other outcomes was favorable to the interventions and reached statistical significance after removing two studies at high risk of bias. Trauma-induced stress-directed programs significantly improved stress [-0.53 (-1.04, -0.03) p = .03; I2 = 73%] and depression [-0.51 (-0.92, -0.10) p = .04; I2 = 61%]. We found evidence warranting low confidence that resiliency training programs have a small to moderate effect at improving resilience and other mental health outcomes. Further study is needed to better define the resilience construct and to design interventions specific to it. PROSPERO #CRD42014007185.

The Institute of Medicine recommended in their landmark report \"From Cancer Patient to Cancer Survivor: Lost in Transition\" that services to meet the needs of cancer patients should extend beyond physical health issues to include functional and psychosocial consequences of cancer. However, no systems exist in the US to support state-level data collection on availability of support services for cancer patients. Developing a mechanism to systematically collect these data and document service availability is essential for guiding comprehensive cancer control planning efforts. This study was carried out to develop a protocol for implementing a statewide survey of all Commission on Cancer (CoC) accredited cancer centers in South Carolina and to implement the survey to examine availability of patient support services within the state. We conducted a cross-sectional survey of CoC-certified cancer centers in South Carolina. An administrator at each center completed a survey on availability of five services: 1) patient navigation; 2) distress screening; 3) genetic risk assessment and counseling, 4) survivorship care planning; and 5) palliative care. Completed surveys were received from 16 of 17 eligible centers (94%). Of the 16 centers, 44% reported providing patient navigation; 31% reported conducting distress screening; and 44% reported providing genetic risk assessment and counseling. Over 85% of centers reported having an active palliative care program, palliative care providers and a hospice program, but fewer had palliative outpatient services (27%), palliative inpatient beds (50%) or inpatient consultation teams (31%). This was a small, yet systematic survey in one state. This study demonstrated a practical method for successfully monitoring statewide availability of cancer patient support services, including identifying service gaps.

Work-related stressors take a toll on individuals’ health and well-being, a toll which is often heavier for under-resourced, low-paid segments of the essential workforce who serve our communities. Resilience programs have arisen as a promising workplace strategy to improve mental health and well-being. However, emerging programs are constrained by time and resource-intensive implementation strategies that are challenging to scale for marginalized segments of the workforce, including early childcare education (ECE) staff. The goal of this 15-month cluster randomized control trial is to compare change in resilience assets and resources for ECE staff in centers (n = 80 consisting of 640 ECE workers) randomly assigned to either a remotely delivered resilience (intervention) or physical activity (attention control) program. Measures will be collected at four timepoints: baseline (0 months), post-intervention (3 months), and long-term maintenance (9 and 15 months). Secondary outcomes will include changes in well-being, physical activity, organizational support, absenteeism, and turnover. Additionally, we will explore potential moderators of the treatment effects. The RE-AIM Framework will be used to determine the potential for individual (staff) and organizational (center) level reach, adoption, implementation, and maintenance of the two programs. Results will fill key gaps of prior resilience work by focusing on an underserved population in critical need of well-being resources with implications for the feasibility and impact of remote programming in other segments of the workforce. Trial Registration: This trial is registered with the ClinicalTrials.gov registry (NCT06919952) and approved by the Institutional Review Board (IRB) at the University of North Carolina at Chapel Hill (IRB# 25−0016).

Objective The Stress Management and Resilience Training (SMART) program is an evidence-based intervention designed to build resilience in physicians in clinical practice. The objective of the current study was to assess the impact of the SMART program on academic physicians' levels of resilience, subjective happiness, stress, and anxiety, and specifically during the implementation of a new hospital-wide Health Information System (HIS). Methods A total of 40 physicians in a tertiary care academic hospital were randomized (allocation ratio 1:1) to either the SMART intervention or the control condition. The SMART intervention consisted of one mandatory two-hour in-person workshop and an optional 24-week online program, designed to support the materials delivered in the workshop. Outcome measures were assessed using validated scales administered online at baseline and at 3-months and 6-months follow-up. Results After adjusting for baseline levels of each outcome, no statistically significant intervention effect was observed for resilience, subjective happiness, stress or anxiety at 3-months or 6-months follow-up. However, physicians in the intervention group demonstrated improvements in resilience, stress and anxiety at follow-up that were within the range of clinically relevant differences. Conclusions The findings of this exploratory study provide modest support that the SMART intervention may be beneficial for proactively addressing physician wellness during the implementation of a new HIS and that larger randomized trials are warranted. Trial registration NCT04384861.

OBJECTIVE To estimate the association between antioxidant use and primary cancer incidence and mortality and to evaluate these effects across specific antioxidant compounds, target organs, and participant subgroups. METHODS Multiple electronic databases (MEDLINE, Cochrane Controlled Clinical Trials Register, EMBASE, Science Citation Index) were searched from their dates of inception until August 2005 to identify eligible randomized clinical trials. Random effects meta-analyses estimated pooled relative risks (RRs) and 95% confidence intervals (CIs) that described the effect of antioxidants vs placebo on cancer incidence and cancer mortality. RESULTS Twelve eligible trials, 9 of high methodological quality, were identified (total subject population, 104,196). Antioxidant supplementation did not significantly reduce total cancer incidence (RR, 0.99; 95% CI, 0.94-1.04) or mortality (RR, 1.03; 95% CI, 0.92-1.15) or any site-specific cancer incidence. Beta carotene supplementation was associated with an increase in the incidence of cancer among smokers (RR, 1.10; 95% CI, 1.03-1.10) and with a trend toward increased cancer mortality (RR, 1.16; 95% CI, 0.98-1.37). Selenium supplementation was associated with reduced cancer incidence in men (RR, 0.77; 95% CI, 0.64-0.92) but not in women (RR, 1.00; 95% CI, 0.89-1.13, value for interaction, P <.001) and with reduced cancer mortality (RR, 0.78; 95% CI, 0.65-0.94). Vitamin E supplementation had no apparent effect on overall cancer incidence (RR, 0.99; 95% CI, 0.94-1.04) or cancer mortality (RR, 1.04; 95% CI, 0.97-1.12). CONCLUSION Beta carotene supplementation appeared to increase cancer incidence and cancer mortality among smokers, whereas vitamin E supplementation had no effect. Selenium supplementation might have anticarcinogenic effects in men and thus requires further research. Beta carotene supplementation appeared to increase cancer incidence and mortality among smokers, whereas vitamin E supplementation had no effect; selenium supplementation might have anticarcinogenic effects.

Background: Acoustic trauma is the sudden hearing loss that results following exposure to a single intense sound. Military environments inherently expose its personnel to very high levels of noise. Early detection of temporary or permanent hearing damage in soldiers following acoustic trauma and identification of their susceptibility to noise exposure is of utmost importance to better protect and prevent hearing deterioration. Conventionally, pure-tone audiometry (PTA) has been used as a screening method to detect hearing threshold shift following noise exposure. However, research now suggests distortion product otoacoustic emission (DPOAE) as a more sensitive tool to detect early changes in hearing thresholds following acoustic trauma. The aim of this study is to compare PTA and DPOAE for the early detection of acoustic trauma in soldiers. Methods: A prospective cohort multicentric study was conducted over a 2-year duration at 5 military hospitals on 1500 newly inducted recruits with no previous exposure to firing. After a thorough history taking and a comprehensive ENT examination, PTA and DPOAE tests were conducted at three intervals: before firing (initial evaluation), 2 h after firing (mid-evaluation), and 7 days after firing (final evaluation). The symptoms presented by the recruits were also analyzed. Statistical analysis between the two modalities of investigation to detect early acoustic trauma was done using Chi-square test. Results: Four hundred and eighty-seven recruits (36.07%) developed temporary threshold shifts and 103 (7.6%) had permanent threshold shifts. The most common symptom at mid-evaluation was tinnitus (501; 37.11%) while the least common symptom reported was isolated dizziness (10; 0.74%). At final evaluation, the most common symptom was found to be tinnitus (132; 9.77%). Conclusion: PTA and DPOAE can both be effectively used as a tool of measurement for the detection of early acoustic trauma, though being an objective test DPOAE has the advantage of eliminating subjective variation.

Background Lack of insurance has been shown to lead to delays in seeking care as well as fewer preventive medicine visits and poorer overall health status. Purpose To investigate the effects of insurance status on the timing and treatment of patients with bucket-handle meniscus tears. Study Design Cohort study; Level of evidence, 3. Methods Charts from 2004 to 2013 were retrospectively reviewed for patients diagnosed with bucket-handle meniscus tears. Patients were divided into 2 groups: insured or underinsured. The insured group included patients with commercial insurance or Medicare. The underinsured group included patients with Medicaid or Charity Care. Time intervals were categorized as <6 weeks or ≥6 weeks. Results A total of 52 patients were included in this study: 15 (29%) insured and 37 (71%) underinsured. Underinsured patients experienced delays in initial presentation to an orthopaedic surgeon (P = .004), time from magnetic resonance imaging to surgery (P = .01), and time from injury to surgery (P = .007). Repair rates were 40% and 38% (P > .999) for the insured and underinsured, respectively. Repair rates for <6 weeks from injury to surgery were 75% for insured (P = .007) and 100% for underinsured patients (P = .001). Repair rates for ≥6 weeks from injury to surgery were 0% for insured and 30% for underinsured patients. Overall, patients with an injury-to-surgery time of <6 weeks had a significantly higher repair rate (87%) than those managed >6 weeks (19%) (P < .001). Conclusion Underinsured patients experience significant delays in time to presentation and overall time to surgery. However, the overall repair rate between the insured and underinsured is similar. Regardless of insurance status, patients undergoing arthroscopy within 6 weeks of injury have a significantly higher repair rate than those after 6 weeks. Clinical Relevance Patients undergoing arthroscopy within 6 weeks of injury have a significantly higher repair rate than those after 6 weeks.

OBJECTIVE To assess attitudes of patients about participation in clinical trials. PATIENTS AND METHODS This is a self-report survey of 400 patients who underwent general medical evaluations between September and November 2006 at a tertiary care academic medical center in Rochester, MN. We measured knowledge of access to clinical trials, attitudes toward participation, recruitment preferences, and beliefs about research integrity. RESULTS Of 485 consecutive patients, 400 (82%) completed the survey. Previous participation in clinical trials was reported by 112 patients (28%). Most were unaware of online information about clinical trials (330 [82%]), were satisfied with their current knowledge (233 [58%]), expected their treating physician to inform them about current trials (304 [76%]), and showed equal interest in participating in conventional or complementary intervention trials (174 [44%]). Of the 400 respondents, 321 (80%) found it appropriate to be contacted by mail and 253 (63%) by telephone regarding study participation. Most patients (364 [91%]) wanted to be informed about research findings or else would not participate in future clinical trials (272 [68%]). The most frequently expected compensation was free parking (234 [58%]). Most thought that their safety (373 [93%]) and privacy (376 [94%]) would be guarded. CONCLUSION Patients are interested in participating in clinical trials but commonly lack adequate information. If patients received more information (through their treating physicians), enrollment might improve. This single-site study has limited generalizability. Future studies involving a diverse group of patients from a broader geographic distribution will help provide more definitive results.