Behavior-based diabetes management: impact on care, hospitalizations, and costs.

Objectives: To (1) examine the impact of the Diabetes Care Rewards (DCR) program on adherence to care standards and (2) evaluate the economic impact of adherence to care standards.

Study Design: A retrospective observational cohort study design with propensity matching. Additional covariates adjustment was used to minimize residual imbalance.

Enhancing patient engagement and blood pressure management for renal transplant recipients via home electronic monitoring and web-enabled collaborative care.

Background: Effective management of hypertension in chronic kidney disease and renal transplantation is a clinical priority and has societal implications in terms of preserving and optimizing the value of scarce organs. However, hypertension is optimally managed in only 37% of people with chronic kidney disease, and poor control can contribute to premature graft loss in renal transplant recipients. This article describes a telehealth system that incorporates home electronic blood pressure (BP) monitoring and uploading to a patient portal coupled with a Web-based dashboard that enables clinical pharmacist collaborative care in a renal transplant clinic.

Clinical trial enrollers vs. nonenrollers: the Cardiac Arrhythmia Suppression Trial (CAST) Recruitment and Enrollment Assessment in Clinical Trials (REACT) project.

The Recruitment and Enrollment Assessment in Clinical Trials (REACT) was a National Heart, Lung, and Blood Institute (NHLBI)-sponsored substudy to the Cardiac Arrhythmia Suppression Trial (CAST). Two-hundred-sixty (260) patients who enrolled in CAST and 140 partially or fully eligible patients who did not enroll were compared across several parameters, including demographic variables, disease severity, psychosocial functioning, health beliefs, recruitment experience, and understanding of informed consent procedures used in CAST. Significant predictors of enrollment included several demographic variables (e.

Quality of life among patients post-myocardial infarction at baseline in the Survival and Ventricular Enlargement (SAVE) trial.

A quality of life ancillary study was incorporated into the Survival and Ventricular Enlargement (SAVE) trial of captopril versus placebo among patients who survived an acute myocardial infarction with compromised ventricular functioning, but no overt heart failure. Assessments included patient symptoms, health perceptions, emotional, cognitive, social and sexual levels of functioning, as well as potential covariates, such as life events and social support. The purpose of this study was to evaluate the psychometric properties of the quality of life measures in the SAVE at baseline, and provide a pre-randomization profile of the SAVE patients.

The relationship of work pace to back injury in a supermarket distribution center.

This is a retrospective case control study of the relationship between work pace of selectors at a food distribution center and the subsequent incidence of compensable back injuries. Subject employment records for 1 month were evaluated for degree of variation of actual-from-scheduled performance of weekly work pace as selectors, defined in terms of absolute values (either above or below criterion). Subjects were divided among those with no compensable claims for back injury (n=14) and those with multiple compensable claims (n=12) over a 2-year period of employment.

Attendance and outcome in a work site weight control program: processes and stages of change as process and predictor variables.

This naturalistic study assessed client changes during treatment and identified salient predictors of therapy attendance and outcome. Subjects were assessed on processes and stages of change, self-efficacy, social support, weight history (including expectations, goals, and reasons for losing weight), and demographics at the beginning, middle, and end of a 10-week, behaviorally oriented work site program for weight control. Significant shifts from contemplation to action occurred for clients remaining in treatment.

Lipid and lipoprotein responses to episodic occupational and academic stress.

We examined the effects of psychological stress on plasma lipid, lipoprotein, and apolipoprotein levels in three related studies. In the first study, tax accountants (N = 20) and a comparable control group (N = 20) were assessed during and after the tax season. In the second and third studies, first-year medical students (N = 24 and N = 16) were assessed at midsemester and immediately before the examinations.

Relation of psychosocial and stress reactivity variables to ventricular arrhythmias in the Cardiac Arrhythmia Pilot Study (CAPS).

Both animal and human data implicate psychosocial distress and cardiovascular reactivity in response to challenge in the etiology of sudden cardiac death. In this study, the relation of these biobehaviorial factors to frequency of ventricular premature complexes, a predictor of sudden death was investigated. The study population was made up of patients enrolled in the National Heart, Lung, and Blood Institute's Cardiac Arrhythmia Pilot Study (CAPS).

Correlation of chronic low-back pain behavior and muscle function examination of the flexion-relaxation response.

The relationship between videotape ratings of pain behavior and the flexion-relaxation phenomenon was evaluated in a sample of 39 chronic low-back pain patients. The results showed that guarded movement explained approximately 27% of the variability in the flexion-relaxation phenomenon, adjusting for pain intensity rating. There were no significant differences in sex observed.

Interdisciplinary perspectives on mechanisms and management of low back pain.

Chronic low back pain (CLBP) is one of the most pervasive and costly problems facing medicine today. In addition to personal suffering, CLBP accounts for a greatly disproportionate amount of consumer health care over-utilization, employee absenteeism, lowered work productivity, disability and compensation payments. Recent research in the area has called attention to the complex nature of the problem and the need for an interdisciplinary approach to identification and management.

A comparative evaluation of a restrictive smoking policy in a general hospital.

The impact of a restrictive smoking policy on the behavior and attitudes of smokers and non-smokers was assessed by surveying random cross-sectional samples of hospital employees before, six months after and 12 months after the policy was implemented, and comparing responses with those of employees of a hospital with no restrictive policy. Effectiveness of policy implementation was also evaluated. Results indicated that the policy was well-publicized and was approved by virtually all the non-smokers and the majority of the smokers.

Evaluating worksite smoking policies. Methodologic issues.

This paper discusses the methodologic issues one confronts when studying the impact of worksite smoking policies, using one such study as an example. Topics covered include defining the research questions, deciding on timing of measurements in relation to policy implementation, advantages and disadvantages of cohort versus cross-sectional research designs, and alternative measurement techniques. The sample study examined changes over one year in the smoking-related behaviors and attitudes of employees of a hospital that initiated a restrictive smoking policy, in relation to employees of a comparable hospital without a restrictive policy.

Effects of behavioral skills training and schedule of nicotine gum administration on smoking cessation.

Eighty-nine smokers were randomly assigned to four nicotine gum treatments for smoking cessation: behavioral treatment plus a fixed schedule of nicotine gum, behavioral treatment plus an ad lib schedule, education plus a fixed schedule, and education plus an ad lib schedule. The four treatment conditions produced similar rates of abstinence (40.9% to 58.

The effects of a transtelephonic surveillance and prehospital emergency intervention system on the 1-year course following acute myocardial infarction.

We evaluated the effect on morbidity and mortality of a post-myocardial infarction management and intervention system. One thousand four patients were prospectively randomized to an intervention group that included routine and emergency transtelephonic follow-up and ECG monitoring or to control; all subjects were followed for 1 year. For symptoms suggestive of myocardial ischemia, intervention patients telephoned the project emergency office, were instructed by a project nurse to self-administer intramuscular lidocaine with an auto-injector, and were then transported to the nearest emergency facility.

Chronic pain and functional impairment: assessing beliefs about their relationship.

Many chronic pain patients believe that they cannot function normally because of their pain. The Pain and Impairment Relationship Scale (PAIRS) was developed to assess the extent to which chronic pain patients endorse this belief, and the relationship of this belief to functional impairment, measured both subjectively and objectively. The PAIRS was administered to 56 patients in a chronic pain treatment program.

Comparison of lumbar paravertebral EMG patterns in chronic low back pain patients and non-patient controls.

According to myogenic models that relate abnormal EMG patterns to the experience of pain, lumbar paravertebral muscle activity has been considered to play an important role in chronic low back pain. In the present study, 40 chronic low back pain patients and 40 matched non-patient controls were compared on lumbar paravertebral EMG during mechanically stabilized static and dynamic postures. Differences between groups in lumbar curvature and spinal range of motion were determined using a dual goniometer technique.

Psychological distress as a predictor of ventricular arrhythmias in a post-myocardial infarction population.

A prospective study examining the relationship between psychological distress and ventricular ectopy was conducted with 125 post-myocardial infarction patients equipped with a transtelephonic ECG monitor. Subjects were subsequently grouped according to the occurrence (n = 59) or nonoccurrence (n = 65) of ventricular arrhythmias over a 1-year period. Results indicated a direct relationship between self-reported distress levels and occurrence of ectopic beats.

Expectancies and functional impairment in chronic low back pain.

Perceived self-efficacy [2] and pain response expectancies [13] were examined as correlates of movement limitations and impaired functioning in a sample of 40 patients with chronic low back pain. Self-efficacy was operationalized as patients' ratings of their ability to perform movements, while response expectancies were operationalized as ratings of the degree of pain expected to accompany the movements. Patients predicted their ability to perform 10 simple movements and the degree of pain that would accompany each movement; on a separate occasion, subjects' actual performance of the movements was assessed.

Quality of life post-myocardial infarction: effects of a transtelephonic coronary intervention system.

The impact of an outpatient, risk-management system, including a transtelephonic electrocardiographic monitor and lidocaine injector, on the quality of life in post-myocardial infarction patients was examined. Patients (n = 238) were assigned randomly to either the system or to standard medical care (control). Quality of life was defined in terms of psychological status, return to work, and social functioning.

Saliva cotinine as a measure of smoking status in field settings.

The accuracy and reliability of saliva cotinine as an objective measure of smoking status was examined in two field studies. In Study I, saliva was collected from smokers and nonsmokers with repeated samples taken from a randomly selected subset of the smokers. Results indicated perfect classification of smokers versus nonsmokers and acceptable reliability of repeated samples.

The Framingham Type A Scale and severity of coronary artery disease.

The relationship between scores on the Framingham Type A Scale (FTAS) and angiographic severity of coronary artery disease (CAD) was examined in a sample of 50 patients undergoing diagnostic cardiac catheterization. Age and family history of coronary heart disease (CHD) were positively related to CAD severity. Contrary to prediction, the FTAS demonstrated a non-significant, inverse relationship with CAD.

Reliability of lumbar paravertebral EMG assessment in chronic low back pain.

The reliability of lumbar paravertebral EMG assessment was investigated in a sample of 70 patients with chronic low back pain, (CLBP). Dual-site EMG monitoring was employed during both static postures and movements. Flexion and rotation indices were divided to assess the reliability of patterning of paravertebral EMG during movement.