Extending weeknight sleep of delayed adolescents using weekend morning bright light and evening time management.

Study Objectives: Shift sleep onset earlier and extend school-night sleep duration of adolescents.

Methods: Forty-six adolescents (14.5-17.

Assessing Trauma History in Pregnant Patients: A Didactic Module and Role-Play for Obstetrics and Gynecology Residents.

Introduction: Assessing and addressing patient histories of trauma constitute a critical component of care for vulnerable populations such as pregnant patients, yet they often go unrecognized in obstetric care. Obstetric providers may feel poorly equipped to address this issue comfortably and effectively.

Methods: We designed this didactic module for obstetric residents with previous experience taking patient histories and delivering clinical care.

Breaking Bad News: A Small-Group Learning Module and Simulated Patient Case for Preclerkship Students.

Introduction: Breaking bad news is a difficult skill that can elicit significant distress among learners. As such, it is important for learners to practice this skill in a controlled environment, which affords time to address any distress that arises and the opportunity to receive supportive feedback on performance. This breaking bad news module was designed for preclerkship students with previous training in basic communication skills and served as capstone to the preclerkship portion of the communication skills curriculum.

An Adaptive Treatment to Improve Positive Airway Pressure (PAP) Adherence in Patients With Obstructive Sleep Apnea: A Proof of Concept Trial.

Despite the benefits of positive airway pressure (PAP) treatment, rates of adherence to treatment are suboptimal. This proof-of-concept study assessed the feasibility, acceptability, and clinical significance of an adaptive treatment strategy to improve adherence to PAP. All participants first completed a brief educational intervention.

Management of Obstructive Sleep Apnea and Comorbid Insomnia: A Mixed-Methods Evaluation.

The purpose of this study was to examine the process of care in an interdisciplinary sleep clinic for patients with obstructive sleep apnea (OSA) and comorbid insomnia. A mixed-methods approach was used to examine clinical and patient-centered measures for 34 patients who received positive-airway pressure for OSA or cognitive-behavior therapy for insomnia. The results revealed baseline-to-follow-up improvements on several self-reported sleep parameters and measures of daytime functioning.

The relationship between beliefs about sleep and adherence to behavioral treatment combined with meditation for insomnia.

This study examined beliefs about sleep, as measured by the Dysfunctional Beliefs and Attitudes about Sleep (DBAS) scale, as predictors of adherence to 3 specific insomnia treatment recommendations: restriction of time spent in bed, maintenance of a consistent rise time, and completion of daily meditation practice. Higher DBAS scores predicted poorer adherence to restriction of time spent in bed and to maintenance of a prescribed rise time. DBAS scores were not associated with completion of daily meditation.

Patient and physician beliefs about control over health: association of symmetrical beliefs with medication regimen adherence.

Background: Past work suggests that the degree of similarity between patient and physician attitudes may be an important predictor of patient-centered outcomes.

Objective: To examine the extent to which patient and provider symmetry in health locus of control (HLOC) beliefs was associated with objectively derived medication refill adherence in patients with co-morbid diabetes mellitus (DM) and hypertension (HTN).

Participants: Eighteen primary care physicians at the VA Iowa City Medical Center and affiliated clinics; 246 patients of consented providers with co-morbid DM and HTN.

Patient preference for and reports of provider behavior: impact of symmetry on patient outcomes.

Objective: Research has suggested that congruence between patient characteristics and contextual characteristics is a more robust predictor of outcomes than either patient or context characteristics alone. The goal of the present study was to examine the degree of congruence between patient preferences for the clinical encounter and reports of analogous dimensions of provider behavior and the effects of this congruence on patient outcomes.

Design: Two hundred eighteen patients with diabetes (predominately Type II) completed measures of preference for and ratings of perceived provider behavior in three domains (1) information sharing, (2) behavioral involvement, and (3) socioemotional support.

Measuring preferred role orientations for patients and providers in veterans administration and university general medicine clinics.

Background: Congruence between patients' and providers' preferred healthcare role orientations has been shown to be important for improved clinical outcomes and patient satisfaction. Thus, it is important to know how different patient and provider populations might vary in preferred role orientations.

Objective: To measure the range of role orientation preferences among patients and providers in two different general medicine clinic populations.

Preferences for a patient-centered role orientation: association with patient-information-seeking behavior and clinical markers of health.

Background: Few data exist examining how patients' preferred role orientation (patient-centered or provider-centered) is associated with "patient-centered" behavior and clinical markers of health.

Purpose: The purpose of the study is to investigate how patients' preferred role orientation is associated with information-seeking behavior and clinical markers of health in a chronically ill population.

Methods: Participants were 189 hypertensive patients, at two VA Medical Centers and four community-based clinics, who completed measures of preferred role orientation and medication information seeking.

Pediatric headache: an examination of process variables in treatment.

The goal of this article is to provide a rational methodological review of studies addressing the treatment of childhood headache. In particular, the goal is to provide a review of process variables that may be associated with the efficacy of behavioral and psychological treatments for childhood headache. A search for studies that examined the efficacy of treatment for headache among children younger than 12 years of age was conducted using Medline from 1966 to 2005.

Patient and physician attitudes in the health care context: attitudinal symmetry predicts patient satisfaction and adherence.

Background: There is increasing interest in the role that patient and physician health-related attitudes may play in predicting patient outcomes.

Purpose: This study examined the similarity of the attitudes held by patients and their physicians about the patient role in health care delivery and its relationship to patient outcomes.

Methods: Participants were 16 primary care physicians from a single academic medical center and 146 patients who had been seen by their respective physician at least twice during the prior 6 months.

The role of depression symptoms in dialysis withdrawal.

Among end-stage renal disease (ESRD) patients on hemodialysis, death from withdrawal from life-sustaining dialysis is increasingly common. The present study's objective was to examine depression as a potential risk factor for hemodialysis withdrawal. Two hundred forty ESRD hemodialysis (133 male and 107 female) patients were followed for an average of 4 years after depression symptom assessment.

Health locus of control and depression in chronic kidney disease: a dynamic perspective.

Participants in the present study were 207 patients with chronic kidney disease (CKD) who completed internal HLOC and depression measures at baseline and at an approximately 16-month follow-up period. Regression results indicated that after controlling for baseline level of depression, baseline internal HLOC was not a significant predictor of depression at follow-up. However, increases in internal HLOC over the 16-month follow-up were predictive of depression at follow-up.

The role of perceived control and preference for control in adherence to a chronic medical regimen.

Background: Poor patient adherence is a widespread problem among patients undergoing hemodialysis for end-stage renal disease.

Purpose: The goal of this study was to examine the joint role of perceived restriction of control and individual differences in preference for control in predicting adherence to the hemodialysis regimen.

Methods: Participants were 49 patients recruited from five hemodialysis centers affiliated with the University of Iowa Hospitals and Clinics.