Development of a Complex Care Transition Team to Improve the Transition of Patients With Complex Care Needs to the Community.

Purpose: Health care systems have historically struggled to provide adequate care for patients with complex care needs that often result in overuse of hospital and emergency department resources. Patients with complex care needs generally have increased expenses, longer length of hospital stays, an increased need for care management resources during hospitalization, and high readmission rates. Mayo Clinic in Arizona aimed to ensure successful transitions for hospitalized patients with complex care needs to the community by developing a complex care transition team (CCTT) program.

Resilience to Discrimination and Rejection Among Young Sexual Minority Males and Transgender Females: A Qualitative Study on Coping With Minority Stress.

Sexual minority and transgender status is associated with mental health disparities, which have been empirically and theoretically linked to stressors related to social stigma. Despite exposure to these unique stressors, many sexual minority and transgender individuals will not experience mental health disorders in their lifetime. Little is known about the specific processes that sexual minority and transgender youth use to maintain their wellbeing in the presence of discrimination and rejection.

Usability of a Culturally Informed mHealth Intervention for Symptoms of Anxiety and Depression: Feedback From Young Sexual Minority Men.

Background: To date, we are aware of no interventions for anxiety and depression developed as mobile phone apps and tailored to young sexual minority men, a group especially at risk of anxiety and depression. We developed TODAY!, a culturally informed mobile phone intervention for young men who are attracted to men and who have clinically significant symptoms of anxiety or depression. The core of the intervention consists of daily psychoeducation informed by transdiagnostic cognitive behavioral therapy (CBT) and a set of tools to facilitate putting these concepts into action, with regular mood ratings that result in tailored feedback (eg, tips for current distress and visualizations of mood by context).

Online Evaluative Conditioning Did Not Alter Internalized Homonegativity or Self-Esteem in Gay Men.

Objective: Internalized homonegativity is linked to psychological distress in sexual minorities and is thus a potential treatment target in this population. Previous studies have shown that evaluative conditioning (EC) can modify self-esteem, another self-directed attitude. The present study aimed to determine if EC deployed over the Internet could modify self-esteem and internalized homonegativity.

Management of a Concealable Stigmatized Identity: A Qualitative Study of Concealment, Disclosure, and Role Flexing Among Young, Resilient Sexual and Gender Minority Individuals.

Disclosure of a sexual or gender minority status has been associated with both positive and negative effects on wellbeing. Few studies have explored the disclosure and concealment process in young people. Interviews were conducted with 10 sexual and/or gender minority individuals, aged 18-22 years, of male birth sex.

Nurses' knowledge and attitudes towards pain assessment for people with dementia in a nursing home setting.

Aim: The aim of this study was to determine nurses' knowledge and attitudes towards pain assessment for people with dementia in a nursing home setting.

Background: Pain is highly prevalent among older people, yet is often under-recognised and undertreated in people with dementia. People with dementia can lose the ability to report pain and it is the role of the nurse to identify and appropriately assess pain, to provide effective treatment.

Palliative care in dementia: literature review of nurses' knowledge and attitudes towards pain assessment.

Background: Pain is prevalent among older people, yet is often under-recognised and undertreated in people with dementia. The nurse has a central role in identifying and appropriately assessing pain in order to provide effective treatment. Research however suggests there are significant deficits in this area.

The behavioral intervention technology model: an integrated conceptual and technological framework for eHealth and mHealth interventions.

A growing number of investigators have commented on the lack of models to inform the design of behavioral intervention technologies (BITs). BITs, which include a subset of mHealth and eHealth interventions, employ a broad range of technologies, such as mobile phones, the Web, and sensors, to support users in changing behaviors and cognitions related to health, mental health, and wellness. We propose a model that conceptually defines BITs, from the clinical aim to the technological delivery framework.

Initial design of culturally informed behavioral intervention technologies: developing an mHealth intervention for young sexual minority men with generalized anxiety disorder and major depression.

Background: To our knowledge, there is no well-articulated process for the design of culturally informed behavioral intervention technologies.

Objective: This paper describes the early stages of such a process, illustrated by the methodology for the ongoing development of a behavioral intervention technology targeting generalized anxiety disorder and major depression among young sexual minority men.

Methods: We integrated instructional design for Internet behavioral intervention technologies with greater detail on information sources that can identify user needs in understudied populations, as well as advances in the understanding of technology-specific behavioral intervention technology dimensions that may need to be culturally tailored.

A randomized controlled trial evaluating a manualized TeleCoaching protocol for improving adherence to a web-based intervention for the treatment of depression.

Background: Web-based interventions for depression that are supported by coaching have generally produced larger effect-sizes, relative to standalone web-based interventions. This is likely due to the effect of coaching on adherence. We evaluated the efficacy of a manualized telephone coaching intervention (TeleCoach) aimed at improving adherence to a web-based intervention (moodManager), as well as the relationship between adherence and depressive symptom outcomes.

Behavioral intervention technologies: evidence review and recommendations for future research in mental health.

Objective: A technical expert panel convened by the Agency for Healthcare Research and Quality and the National Institute of Mental Health was charged with reviewing the state of research on behavioral intervention technologies (BITs) in mental health and identifying the top research priorities. BITs refers to behavioral and psychological interventions that use information and communication technology features to address behavioral and mental health outcomes.

Method: This study on the findings of the technical expert panel.

Prospective examination of anxiety and depression before and during confirmed and pseudoexacerbations in patients with multiple sclerosis.

Objective: This study was designed to determine whether pseudoexacerbations and confirmed MS exacerbations are preceded by or concurrent with increased anxiety or depressive symptoms.

Methods: This was a secondary analysis of 121 patients with MS who were observed for 48 weeks during a randomized controlled trial. Participants completed monthly self-reports on depressive and anxiety symptoms.

Effect of telephone-administered vs face-to-face cognitive behavioral therapy on adherence to therapy and depression outcomes among primary care patients: a randomized trial.

Context: Primary care is the most common site for the treatment of depression. Most depressed patients prefer psychotherapy over antidepressant medications, but access barriers are believed to prevent engagement in and completion of treatment. The telephone has been investigated as a treatment delivery medium to overcome access barriers, but little is known about its efficacy compared with face-to-face treatment delivery.

The resolution of pituitary mass in neurosarcoidosis.

Sarcoidosis is a multisystem disease that primarily affects the sinuses, lungs, skin, and eyes. In our case, a young female was referred for evaluation of post partum galactorrhea. Initial magnetic resonance imaging revealed a pituitary mass.

Development of the brief inventory of perceived stress.

Objectives: To provide a measure of perceived stress that is psychometrically superior to existing instruments and novel in dimensionality.

Design: At 4-week intervals over 48 weeks, patients with multiple sclerosis (N = 138) completed 26 items from the Perceived Stress Scale (PSS) and the Perceived Stress Questionnaire (PSQ).

Results: Extant factor analytic models of the PSS fit poorly.

Minority stress in same-sex male relationships: when does it impact relationship satisfaction?

The minority stress model (Meyer, 2003) has been proposed to explain higher rates of psychopathology in lesbian, gay, and bisexual individuals. However, studies of minority stress have rarely taken into account the interface between minority stress and same-sex relationship processes. In the current study, 142 gay men in romantic relationships completed an online survey assessing minority stress constructs, relationship features, and relationship satisfaction.

Attributions for discriminatory events and satisfaction with social support in gay men.

Attributions modulate the impact of stressful events on mental health. However, little is known about attributions for discriminatory events and their relationship to psychosocial outcomes in sexual minority individuals. Relationships were examined between gay men's attributions for discrimination and their satisfaction with social support, a variable critical to mental health in this population.

Harnessing context sensing to develop a mobile intervention for depression.

Background: Mobile phone sensors can be used to develop context-aware systems that automatically detect when patients require assistance. Mobile phones can also provide ecological momentary interventions that deliver tailored assistance during problematic situations. However, such approaches have not yet been used to treat major depressive disorder.

Comorbid anxiety disorders and treatment of depression in people with multiple sclerosis.

Objective: Anxiety is highly comorbid with depression, but little is known about the impact of anxiety disorders on the effectiveness of empirically supported psychotherapies for depression. We examined such outcomes for people with Multiple Sclerosis (MS) and depression, with versus without comorbid anxiety disorders.

Design: Participants with MS (N = 102) received 16 weeks of telephone-administered psychotherapy for depression and were followed for one year post-treatment.

Generation of ramoplanin-resistant Staphylococcus aureus.

Ramoplanin is a lipoglycodepsipeptide antimicrobial active against clinically important Gram-positive bacteria including methicillin-resistant Staphylococcus aureus. To proactively examine ramoplanin resistance, we subjected S. aureus NCTC 8325-4 to serial passage in the presence of increasing concentrations of ramoplanin, generating the markedly resistant strain RRSA16.

Do PTSD symptoms and course predict continued substance use for homeless individuals in contingency management for cocaine dependence?

Homeless individuals (n=187) entering contingency management (CM) for cocaine dependence were assessed for PTSD diagnosis, and a subset of 102 participants reporting traumatic exposure also periodically completed a self-report measure of PTSD symptoms. Patients with PTSD in full remission at 6 months (end of active treatment) and 12 months (end of aftercare) used substances much less frequently during aftercare than those with no PTSD diagnosis. Those whose PTSD diagnosis improved to full remission status during active treatment, and remained in full remission at 12 months, also had superior substance use outcomes.

Attention training in individuals with generalized social phobia: A randomized controlled trial.

The authors conducted a randomized, double-blind placebo-controlled trial to examine the efficacy of an attention training procedure in reducing symptoms of social anxiety in 44 individuals diagnosed with generalized social phobia (GSP). Attention training comprised a probe detection task in which pictures of faces with either a threatening or neutral emotional expression cued different locations on the computer screen. In the attention modification program (AMP), participants responded to a probe that always followed neutral faces when paired with a threatening face, thereby directing attention away from threat.

Attention modification program in individuals with generalized anxiety disorder.

Research suggests that individuals with generalized anxiety disorder (GAD) show an attention bias for threat-relevant information. However, few studies have examined the causal role of attention bias in the maintenance of anxiety and whether modification of such biases may reduce pathological anxiety symptoms. In the present article, the authors tested the hypothesis that an 8-session attention modification program would (a) decrease attention bias to threat and (b) reduce symptoms of GAD.