Spiritual distress and spiritual care in advanced heart failure.

As patients face serious and chronic illness, they are confronted with the realities of dying. Spiritual and existential issues are particularly prominent near the end of life and can result in significant distress. It is critical that healthcare professionals know how to address patients' and families' spiritual concerns, diagnose spiritual distress and attend to the deep suffering of patients in a way that can result in a better quality of life for patients and families.

Short-term and long-term effectiveness of a post-hospital care transitions program in an older, medically complex population.

Background: Care transition programs can potentially reduce 30 day readmission; however, the effect on long-term hospital readmissions is still unclear.

Objective: We compared short-term (30 day) and long-term (180 day) utilization of participants enrolled in care transitions versus those matched referents eligible but not enrolled.

Design: This cohort study was conducted from January 1, 2011 until June 30, 2013 within a primary care academic practice.

Effect of insulin sensitizer therapy on amino acids and their metabolites.

Aims: Prior studies have reported that elevated concentrations of several plasma amino acids (AA), particularly branched chain (BCAA) and aromatic AA predict the onset of type 2 diabetes. We sought to test the hypothesis that circulating BCAA, aromatic AA and related AA metabolites decline in response to the use of insulin sensitizing agents in overweight/obese adults with impaired fasting glucose or untreated diabetes.

Methods: We performed a secondary analysis of a randomized, double-blind, placebo, controlled study conducted in twenty five overweight/obese (BMI ~30kg/m(2)) adults with impaired fasting glucose or untreated diabetes.

Effect of insulin sensitizer therapy on atherothrombotic and inflammatory profiles associated with insulin resistance.

Objective: To determine whether targeted pharmacological improvement of insulin sensitivity will normalize the associated elevations of thrombotic and inflammatory cardiovascular disease (CVD) biomarkers in individuals with insulin resistance.

Patients And Methods: Study 1 was a cross-sectional study of Asian Indians with and without diabetes mellitus and Northern European Americans without diabetes (n=14 each) conducted between December 11, 2003, and July 14, 2006. Study 2 was a secondary analysis of a double-blind randomized controlled study conducted between August 19, 2005, and August 24, 2010, that included 25 individuals with untreated diabetes or impaired fasting glucose who were randomized to receive placebo (n=13) or a combination of metformin, 1000 mg twice daily, and pioglitazone, 45 mg daily (n=12), for 3 months.

Stress ratings and health promotion practices among RNs: a case for action.

Objective: : The objective of this study was to investigate associations between RN perceptions of their stress levels, health-promoting behaviors, and associated demographic variables.

Background: : Stress and burnout are occupational hazards resulting in absenteeism, illness, and staff turnover, factors important to nurse administrators. Personal health behaviors among nurses have been linked to less stress and the delivery of health-promotion teaching.

Development and validation of a screening instrument to assess the types and quality of foods served at home meals.

Background: Although there is growing interest in assessing the home food environment, no easy-to-use, low cost tools exist to assess the foods served at home meals, making it difficult to assess the meal component of the food environment. The aim of this study was to develop and validate a user-friendly screener to assess the types of foods served at home meals.

Methods: Primary food preparing adults (n = 51) participated in a validation study in their own homes.

The Minnesota Diabetes Plan 2015: Stemming the tide on an epidemic and improving patient care.

The Minnesota Diabetes Steering Committee, a group of experts in diabetes care and prevention from around the state, in collaboration with the Minnesota Department of Health, is working to slow the incidence of diabetes and improve the care of Minnesotans who have the disease. The steering committee has developed a new five-year diabetes plan for the state that identifies nine areas around which stakeholders will focus energy and take action. This article describes that plan.

Effects of a worksite physical activity intervention for hospital nurses who are working mothers.

Hospital nurses who are working mothers are challenged to maintain their personal health and model healthy behaviors for their children. This study aimed to develop and test an innovative 10-week worksite physical activity intervention integrated into the work flow of hospital-based nurses who were mothers. Three volunteer adult medical-surgical nursing units participated as intervention units.

Should clinicians deliver decision aids? Further exploration of the statin choice randomized trial results.

Background: Statin Choice is a decision aid about taking statins. The optimal mode of delivering Statin Choice (or any other decision aid) in clinical practice is unknown.

Methods: To investigate the effect of mode of delivery on decision aid efficacy, the authors further explored the results of a concealed 2 x 2 factorial clustered randomized trial enrolling 21 endocrinologists and 98 diabetes patients and randomizing them to 1) receive either the decision aid or pamphlet about cholesterol, and 2) have these delivered either during the office visit (by the clinician) or before the visit (by a researcher).

Clinician's use of the Statin Choice decision aid in patients with diabetes: a videographic study nested in a randomized trial.

Objective: To describe how clinicians use decision aids.

Background: A 98-patient factorial-design randomized trial of the Statin Choice decision vs. standard educational pamphlet; each participant had a 1:4 chance of receiving the decision aid during the encounter with the clinician resulting in 22 eligible encounters.

A treatment decision aid may increase patient trust in the diabetes specialist. The Statin Choice randomized trial.

Aims: Decision aids in practice may affect patient trust in the clinician, a requirement for optimal diabetes care. We sought to determine the impact of a decision aid to help patients with diabetes decide about statins (Statin Choice) on patients' trust in the clinician.

Methods: We randomized 16 diabetologists and 98 patients with type 2 diabetes referred to a subspecialty diabetes clinic to use the Statin Choice decision aid or a patient pamphlet about dyslipidaemia, and then to receive these materials from either the clinician during the visit or a researcher prior to the visit.

Creating a conversation: insights from the development of a decision aid.

The authors share lessons learned from their development of a decision aid for patients with diabetes who are considering using statins to reduce their cardiovascular risk.

Helping patients with type 2 diabetes mellitus make treatment decisions: statin choice randomized trial.

Background: Poor quality of information transfer about the benefits and risks of statin drug use may result in patients not making informed decisions that they can act on in a timely fashion.

Methods: The effect of a decision aid about statin drugs on treatment decision making in 98 patients with diabetes was determined in a cluster randomized trial of decision aid vs control pamphlet, with concealed allocation, blinding of participants to study goals, and adherence to the intention-to-treat principle. Twenty-one endocrinologists conducted specialty outpatient metabolic consultations.

A pen-and-paper coronary risk estimator for office use with patients with type 2 diabetes.

Objective: To develop a pen-and-paper coronary heart disease (CHD) 10-year risk estimator for patients with type 2 diabetes based on the United Kingdom Prospective Diabetes Study (UKPDS) risk equation (based on 4000 patients with diabetes but only available electronically).

Patients And Methods: We used data collected from adults with type 2 diabetes from 6 primary care practices that participated in a randomized trial in Rochester, Minn; patients were enrolled in the study from July 2001 to December 2003, with follow-up through June 2004. We used multivariable linear regression of the CHD risk estimate to formulate prediction equations to estimate average (<15%), elevated, or high (>30%) 10-year CHD risk according to sex, age, diabetes duration, smoking, hemoglobin A1c level, systolic blood pressure, ratio of total cholesterol to high-density lipoprotein cholesterol, and microalbuminuria categories.