Using a single item to measure burnout in primary care staff: a psychometric evaluation.

BACKGROUND: Burnout affects nearly half of all U.S. nurses and physicians, and has been linked to poor outcomes such as worse patient safety. The most common measure of burnout is the well-validated Maslach Burnout Inventory (MBI). However, the MBI is proprietary and carries licensing fees, posing challenges to routine or repeated assessment. OBJECTIVE: To compare a non-proprietary, single-item burnout measure to a single item from the MBI Emotional Exhaustion (MBI:EE) subscale that has been validated as a standalone burnout measure. DESIGN: Cross-sectional online survey. PARTICIPANTS: A sample of primary care providers (PCPs), registered nurses, clinical associates (e.g., licensed practical nurses (LPNs), medical technicians), and administrative clerks in the Veterans Health Administration surveyed in 2012. MAIN METHODS: We compared a validated one-item version of the MBI:EE and a non-proprietary single-item burnout measure used in the Physician Work Life Study. We calculated kappa statistics, sensitivity and specificity, positive predictive (PPV) and negative predictive values (NPV), and area under the receiver operator curve (AUC). We conducted analyses stratified by occupation to determine the stability of the correlation between the two measures. KEY RESULTS: We analyzed responses from 5,404 participants, including 1,769 providers and 1,380 registered nurses. The prevalence of burnout was 36.7% as measured on the single MBI:EE item and 38.5% as measured on the non-proprietary single-item measure. Relative to the MBI:EE, the non-proprietary single-item measure had a correlation of 0.79, sensitivity of 83.2%, specificity of 87.4%, and AUC of 0.93 (se = 0.004). Results were similar when stratified by respondent occupation. CONCLUSIONS: A non-proprietary single-item measure served as a reliable substitute for the MBI:EE across occupations. Because it is non-proprietary and easy to interpret, it has logistical advantages over the one-item MBI.

Optimism and depression: a new look at social support as a mediator among women at risk for breast cancer.

OBJECTIVE: Breast cancer risk is a chronic stressor associated with depression. Optimism is associated with lower levels of depression among breast cancer survivors. However, to our knowledge, no studies have explored the relationship between optimism and depression among women at risk for breast cancer. We hypothesized that women at risk for breast cancer who have higher levels of optimism would report lower levels of depression and that social support would mediate this relationship. METHOD: Participants (N = 199) with elevated distress were recruited from the community and completed self-report measures of depression, optimism, and social support. Participants were grouped based on their family history of breast cancer. Path analysis was used to examine the cross-sectional relationship between optimism, social support, and depressive symptoms in each group. RESULTS: Results indicated that the variance in depressive symptoms was partially explained through direct paths from optimism and social support among women with a family history of breast cancer. The indirect path from optimism to depressive symptoms via social support was significant (ß = -.053; 90% CI = -.099 to -.011, p = .037) in this group. However, among individuals without a family history of breast cancer, the indirect path from optimism to depressive symptoms via social support was not significant. CONCLUSIONS: These results suggest that social support partially mediates the relationship between optimism and depression among women at risk for breast cancer. Social support may be an important intervention target to reduce depression among women at risk for breast cancer.

Cognitive Behavioral Stress Management for Healthy Women at Risk for Breast Cancer: a Novel Application of a Proven Intervention.

BACKGROUND: Women at risk for breast cancer report elevated psychological distress, which has been adversely associated with cancer-relevant behaviors and biology. PURPOSE: The present study sought to examine the effects of a 10-week cognitive behavioral stress management (CBSM) group intervention on distress among women with a family history of breast cancer. METHODS: Participants were randomly assigned to CBSM (N = 82) or a wait-list comparison group (N = 76). Baseline to postintervention effects of CBSM on depressive symptoms and perceived stress were examined using hierarchical regression. RESULTS: CBSM participants reported significantly lower posttreatment depressive symptoms (ß = -0.17, p < 0.05) and perceived stress (ß = -0.23, p < 0.05) than wait-list comparison participants. Additionally, greater relaxation practice predicted lower distress. CONCLUSIONS: Group-based CBSM intervention is feasible and can reduce psychological distress among women with a family history of breast cancer. The present findings represent an encouraging avenue for the future application of CBSM. ( Clinicaltrials.gov number NCT00121160).

The Emergence of Clinically Relevant Babesiosis in Southwestern Wisconsin.

OBJECTIVE: To determine the frequency and characteristics of babesiosis cases, and to assess the impact of the introduction of a tick-borne infection diagnostic panel on babesiosis diagnosis in the region surrounding La Crosse, Wisconsin, where babesiosis in non-travelers was previously rare. METHODS: In the spring of 2013, we conducted a point-in-time survey of Ixodes scopuloris ticks for the presence of Babesia microti. We also conducted a retrospective study of all babesiosis cases diagnosed in our health system between January 1, 2004, and November 1, 2013. Finally, we compared the number of babesiosis cases diagnosed during the study period before and after the June 1, 2012, introduction of a tick-borne infection diagnostic panel in our organization. RESULTS: Babesia microti was present in 5% of ticks surveyed in our region. Twenty-two cases. of babesiosis were diagnosed in our organization during the study period-19 since 2010. The tick-borne infection diagnostic panel was used widely by clinicians, with an attendant increase in babesiosis diagnoses. CONCLUSION: Babesiosis should be considered endemic in southwestern Wisconsin, and testing should be considered for patients with compatible clinical and laboratory features.

Elements of team-based care in a patient-centered medical home are associated with lower burnout among VA primary care employees.

BACKGROUND: A high proportion of the US primary care workforce reports burnout, which is associated with negative consequences for clinicians and patients. Many protective factors from burnout are characteristics of patient-centered medical home (PCMH) models, though even positive organizational transformation is often stressful. The existing literature on the effects of PCMH on burnout is limited, with most findings based on small-scale demonstration projects with data collected only among physicians, and the results are mixed. OBJECTIVE: To determine if components of PCMH related to team-based care were associated with lower burnout among primary care team members participating in a national medical home transformation, the VA Patient Aligned Care Team (PACT). DESIGN: Web-based, cross-sectional survey and administrative data from May 2012. PARTICIPANTS: A total of 4,539 VA primary care personnel from 588 VA primary care clinics. MAIN MEASURES: The dependent variable was burnout, and the independent variables were measures of team-based care: team functioning, time spent in huddles, team staffing, delegation of clinical responsibilities, working to top of competency, and collective self-efficacy. We also included administrative measures of workload and patient comorbidity. KEY RESULTS: Overall, 39 % of respondents reported burnout. Participatory decision making (OR 0.65, 95 % CI 0.57, 0.74) and having a fully staffed PACT (OR 0.79, 95 % CI 0.68, 0.93) were associated with lower burnout, while being assigned to a PACT (OR 1.46, 95 % CI 1.11, 1.93), spending time on work someone with less training could do (OR 1.29, 95 % CI 1.07, 1.57) and a stressful, fast-moving work environment (OR 4.33, 95 % CI 3.78, 4.96) were associated with higher burnout. Longer tenure and occupation were also correlated with burnout. CONCLUSIONS: Lower burnout may be achieved by medical home models that are appropriately staffed, emphasize participatory decision making, and increase the proportion of time team members spend working to the top of their competency level.

Veterinarians' Self-Reported Behaviors and Attitudes toward Spectrum of Care Practices.

Access to veterinary care for animal owners is an important part of keeping animals healthy and keeping pets and people together whenever that is appropriate. Insufficient financial and other resources to allocate to veterinary care are major barriers for pet owners to receiving preventative, sick, and emergency services. The veterinary community has begun to incorporate offering a range of diagnostic and treatment options more intentionally in response to clients' inability to pay and to a lesser extent to mitigate other barriers to care. Many veterinarians are nonetheless oriented toward providing specialized and more sophisticated care based on their training. This study sought to identify the self-reported behaviors, knowledge, attitudes, and beliefs of veterinarians about offering a spectrum of care options (SoC) to clients. The finding that many reported offering SoC is encouraging. However, veterinarians who report comfort and confidence in a variety of aspects of clinical care were most likely to offer SoC. Practitioners in the field for 20 or more years were less likely to offer SoC to clients with financial limitations. Rural veterinarians were more likely to offer SoC to any client compared to urban veterinarians. These results provide a point of reference and potential focus for veterinarians who are not currently offering SoC as well as an exploration of veterinarians' reported knowledge, behaviors, attitudes, perceptions, and concerns about SoC.

An investigation into the sensory properties of luffa (Luffa cylindrica (L.)) seeds and a comparison to other seeds (flax, sunflower, chia, and hemp).

Consumers are interested in new sustainable ingredients but are unwilling to accept undesirable sensory properties in their food products. Luffa (Luffa cylindrica) is mainly harvested and processed for its fibrous network, which is used as an exfoliator, while its seeds are usually discarded. However, the seeds have been found to have various nutritional benefits. As such, this study investigated the sensory properties of luffa seed powder added to yogurt and compared it to other seed powder (flax, sunflower, chia, and hemp). Consumers (n = 107) evaluated their liking of the different seeds added to yogurt using hedonic scales and the sensory properties using check-all-that-apply (CATA). The luffa seeds when mixed with yogurt were associated with off-colour, off-flavour, metallic, strong flavour, bitter, salty, earthy and decreased consumer liking. The flax and sunflower seeds were found to be sweet, nutty, cooked, mild flavour, and to have a smooth texture. The overall liking scores for the flax and sunflower seed samples were significantly higher than the luffa and hemp samples. Future studies should investigate different drying and roasting treatments to improve the sensory properties of the luffa seeds.

Investigation into the Sensory Properties of Plant-Based Eggs, as Well as Acceptance, Emotional Response, and Use.

Consumers have become interested in plant-based alternatives to animal-based products. One of the under-studied alternatives is plant-based eggs (PBEs). This research investigated PBEs relative to conventional eggs and tofu scramble-another plant-based alternative. Firstly, participants (n = 93) completed a word association task asking them about PBEs. Participants then evaluated the different food samples using hedonic scales, check-all-that-apply (CATA), and temporal check-all-that-apply (TCATA), as well as identified their emotional response and proposed use for PBEs. Participants were interested in plant-based alternatives, including PBEs, but they were concerned about the sensory properties. When they evaluated the different samples, the flavour and texture of the PBEs were disliked in comparison to the eggs. This result may be due to the beany, bitterness, and off-flavour attributes associated with the PBEs. Participants also associated the PBEs with negative emotions. The liking of tofu scramble was not significantly different from the eggs, and the eggs and tofu scramble were mainly associated with positive emotions. During the TCATA evaluation, the participants focused on the flavour attributes of PBEs, while their evaluation of the eggs was dominated by the textural attributes. Whether following a plant-based diet or not, consumers are interested in PBEs, but the sensory properties of PBEs need to be improved before they are willing to adopt them into their diet. This study is one of the first to evaluate the sensory properties of PBEs, as well as consumers' emotional response to them and their attitudes about PBEs.

Phylogeny and systematics of deep-sea sea pens (Anthozoa: Octocorallia: Pennatulacea).

Molecular methods have been used for the first time to determine the phylogeny of families, genera and species within the Pennatulacea (sea pens). Variation in ND2 and mtMutS mitochondrial protein-coding genes proved adequate to resolve phylogenetic relationships among pennatulacean families. The gene mtMutS is more variable than ND2 and differentiates all genera, and many pennatulacean species. A molecular phylogeny based on a Bayesian analysis reveals that suborder Sessiliflorae is paraphyletic and Subselliflorae is polyphyletic. Many families of pennatulaceans do not represent monophyletic groups including Umbellulidae, Pteroeididae, and Kophobelemnidae. The high frequency of morphological homoplasy in pennatulaceans has led to many misinterpretations in the systematics of the group. The traditional classification scheme for pennatulaceans requires revision.

The effect of pre-transplant distress on immune reconstitution among adult autologous hematopoietic cell transplantation patients.

Myeloablative hematopoietic cell transplantation (HCT) is a common treatment for hematological malignancy. Delayed immune reconstitution following HCT is a major impediment to recovery with patients being most vulnerable during the first month after transplant. HCT is a highly stressful process. Because psychological distress has been associated with down regulation of immune function we examined the effect of pre-transplant distress on white blood cell (WBC) count among 70 adult autologous HCT patients during the first 3 weeks after transplant. The participants were on average 38 years old; 93% Caucasian, non-Hispanic and 55% male. Pre-transplant distress was measured 2-14 days before admission using the Cancer and Treatment Distress (CTXD) scale, and the Symptom Checklist-90-R (SCL-90-R) anxiety and depression subscales. WBC count was measured during initial immune recovery on days 5 through 22 post-transplant. Linear mixed model regression analyses controlling for gender and treatment-related variables revealed a significant effect of the mean pre-transplant SCL Anxiety-Depression score on WBC recovery. We found no significant effect of pre-transplant CTXD on WBC recovery. In general, higher levels of pre-treatment anxiety and depression were associated with slower WBC recovery. Psychological modulation of WBC recovery during HCT suggests a unique mechanism by which psychological distress can exert influence over the immune system. Given that WBC recovery is essential to survival for HCT patients, these data provide a rationale for treating anxiety and depression in HCT patients.

Owner-reported long-term outcomes, quality of life, and longevity after hospital discharge following surgical treatment of pyometra in bitches and queens.

OBJECTIVE: Investigate long-term complications, survival times, general health and quality of life (QoL) outcomes, and longevity in female dogs and cats (bitches and queens, respectively) following hospital discharge after ovariohysterectomy (OHE) for pyometra. ANIMALS: 306 pet-owner-completed surveys and corresponding medical records for 234 bitches and 72 queens treated with OHE for pyometra at the American Society for the Prevention of Cruelty to Animals Animal Hospital between January 1, 2017, and December 31, 2019. PROCEDURES: A telephone and online survey was conducted to gather data about pet owners' perception of pet health and QoL following OHE for pyometra, and potential associations between survey results and medical record data were evaluated. Median survival time at a given age at OHE for pyometra was calculated with the use of maximum likelihood estimation of a survival-time regression model. RESULTS: 72 of the 121 (60%) eligible owners of queens and 234 of the 390 (60%) eligible owners of bitches completed the survey. Most owners reported that at the time of the survey, their pet's health and QoL were better or the same as before pyometra. Reported health and QoL outcomes were similar for pets > 8 versus ≤ 8 years of age. CLINICAL RELEVANCE: Our findings indicated that bitches and queens undergoing OHE for pyometra at older ages and without other severe health issues can expect to live their full life span. Veterinarians in private practice could expect similar outcomes.

Incidence and Predictors of Canine Parvovirus Diagnoses in Puppies Relocated for Adoption.

Animal relocation programs seek to balance the animal population and resources between source and destination communities to promote positive outcomes, though little objective evidence has been reported on their physical and behavioral implications. The objective of the current report is to describe the incidence and predictors of canine parvovirus (CPV) diagnoses in 8- to 19-week-old puppies reported by destination shelters participating in a large scale, long-distance, structured animal relocation program. The incidence of post-transport CPV diagnoses in the study population of 4088 puppies was 2.3%. The number of pre-transport vaccinations, length of stay at the source shelter, and time between pre-transport vaccination and transport was not associated with the expected difference in count of post-transport CPV diagnoses (p > 0.05), and was lower in those 13-17 weeks of age (IRR = 0.08, 95% CI = 0.02-0.34, p = 0.001), 18-19 weeks of age (IRR = 0.11, 95% CI = 0.02-0.80, p = 0.029), transferred in to the source shelter (IRR = 0.31, 95% CI = 0.10-0.96, p = 0.043), and transported in the summer season (IRR = 0.07, 95% CI = 0.01-0.53, p = 0.010). When basic biosecurity practices and vaccination protocols were in place, post-transport CPV cases in puppies were few, suggesting that the timing of transport should take into account factors other than the number or timing of pre-transport vaccinations.

Pre-mortem risk factors for mortality in kittens less than 8 weeks old at a dedicated kitten nursery.

OBJECTIVES: Kittens have unique requirements for care in a shelter setting given their higher susceptibility to infectious disease and socialization needs. Significant time and resources are necessary to care for this vulnerable population and dedicated kitten nurseries are one way to meet the requirements of kittens too young for neutering and rehoming. However, young kittens remain at a higher risk of dying relative to adult cats, even in specialized settings. Efforts to investigate kitten mortality have focused on post-mortem findings and little is known about pre-mortem clinical signs that may be associated with death. The purpose of this study was to elucidate predictors of mortality in underage kittens. METHODS: The medical records of kittens aged <8 weeks reared in a kitten nursery in New York City during 2017 were examined. The data collected included signalment (estimated age and weight at intake, sex), physical findings (body condition score [BCS]), clinical signs (weight loss, anorexia, diarrhea, upper respiratory tract infection [URI]), diagnoses (panleukopenia, trauma), how early in the feline breeding season the kitten entered (April-November), and whether the kitten had died or was euthanized. The data were analyzed using Cox proportional hazard modeling with 1353 kittens to identify factors associated with any death or euthanasia. RESULTS: Elevated risk of dying was found for kittens in the lightest weight group (13 times greater), diagnosed with panleukopenia (13 times greater), exhibiting weight loss (>9 times greater), diagnosed with URI (almost four times greater), exhibiting anorexia (three times greater), identified with a low BCS at intake (two times greater) and experiencing diarrhea (almost two times greater). CONCLUSIONS AND RELEVANCE: These findings identify clinical signs and diagnoses that can serve as prognostic indicators for underage kitten survival in a shelter/rescue setting and can aid in enhancing protocols for monitoring, intervention and euthanasia decision-making.

Impact of the Timing of Spay-Neuter Related to Transport on Disease Rates in Relocated Dogs.

Companion animal relocation programs are an important method to address geographic and resource disparities in pet overpopulation through transport from areas with high homeless pet populations to areas with high adopter demand. Despite mitigation by following best practices, a potential risk of animal relocation is increased disease incidence related to infectious disease spread and the effects of stress during transport. Surgical sterilization may compound disease risk due to the impact of surgical stress on disease susceptibility and the potential for disease exposure from other patients. Our study aimed to provide information about disease and surgical complication incidence as relates to the timing of surgical sterilization in relocated dogs. A population of 431 dogs relocated to a shelter in Washington State was monitored for disease while at the destination shelter and immediately post-adoption. No increased disease incidence was identified for dogs altered within two weeks of transport at the destination shelter compared with those altered within two weeks prior to transport at the source shelter. Because of disparities addressed by relocation programs, surgical sterilization of relocated companion animals is typically best performed at the destination shelter. Our study indicates that disease incidence is not increased by spay-neuter at the destination shelter.

The Influence of Evidence on Animal Cruelty Prosecution and Case Outcomes: Results of a Survey.

Two hundred prosecuting attorneys completed a survey concerning priorities in taking on animal cruelty cases and the factors that help or hinder prosecuting such cases. Respondents commented on the priority given such cases. Questions also addressed specific kinds of evidence that had been used to decide whether to take on a cruelty case and were used in court. Results showed that prosecutors most frequently relied upon "traditional" sources of evidence, including detailed medical and crime scene reports and good quality photographic evidence. Other sources of forensic evidence such as DNA, computer forensics, forensic accounting, blood, and trace evidence were rarely employed. Veterinary forensic evidence, including forensic necropsies and detailed medical reports, was viewed as an important factor by a majority of prosecutors in deciding whether to accept a case for prosecution and in achieving a successful outcome, but a need for additional training for investigators was indicated.

Are Underweight Shelter Dogs More Likely to Display Food Aggression toward Humans?

It is commonly believed that underweight or emaciated dogs are predisposed to food aggression toward humans. Each year, the American Society for the Prevention of Cruelty to Animals (ASPCA) receives hundreds of dogs from criminal cruelty cases. The dogs range from emaciated to overweight. We analyzed existing data from 900 such dogs to examine the relationship between body condition score and food and chew item aggression toward humans. Across all types of cruelty cases, 9.2% of dogs were aggressive over the food, chew, or both, which is a lower prevalence than that previously reported among shelter dogs. Dogs from cruelty cases originating in New York City were more likely to show aggression over food (z = 3.91, p < 0.001) and chew items (z = 2.61, p = 0.01) than dogs from large-scale cruelty cases, although it is unclear why. Female dogs were less likely to show food (z = -3.75, p < 0.001) and chew item (z = -2.25, p = 0.02) aggression compared to males. Underweight dogs were not more likely to display food aggression, but when they did, the aggression was no more severe than that of normal-weight dogs (Fisher's exact tests = 0.41 and 0.15 for the Food Bowl and Chew Item scenarios, respectively). Breed type was not a significant predictor of aggression. Canine food aggression does not appear to be an aberrant behavior caused by a history of food scarcity but may be related to biological factors such as sex. These findings could prove useful for animal behavior subject matter experts testifying in court or consulting on cruelty cases, as they could speak with scientific validity to the question of whether there is a link between previous food scarcity and the likelihood of food aggression in dogs.

Medical Student Wellness in Wisconsin: Current Trends and Future Directions.

INTRODUCTION: The goal of this study is to describe the state of mental health of Wisconsin medical students. METHODS: Online wellness surveys were distributed to students at the University of Wisconsin School of Medicine and Public Health (UWSMPH) and Medical College of Wisconsin (MCW) during the 2016-2017 school year. RESULTS: Of UWSMPH respondents, 40.0% and 12.5% reported experiencing depression/other mood changes and suicidal ideation during medical school, respectively. Twelve percent of MCW respondents screened positive for depression using the Patient Health Questionnaire-2, and 7.8% reported experiencing suicidal ideation in the last 2 weeks. DISCUSSION: Similar to results shown worldwide, Wisconsin medical students experience diminished mental health relative to nonmedical peers. Changes in medical education are needed to improve student mental well-being.

The Impact of Excluding Food Guarding from a Standardized Behavioral Canine Assessment in Animal Shelters.

Many shelters euthanize or restrict adoptions for dogs that exhibit food guarding while in the animal shelter. However, previous research showed that only half the dogs exhibiting food guarding during an assessment food guard in the home. So, dogs are often misidentified as future food guarders during shelter assessments. We examined the impact of shelters omitting food guarding assessments. Nine shelters conducted a two-month baseline period of assessing for food guarding followed by a two-month investigative period during which they omitted the food guarding assessment. Dogs that guarded their food during a standardized assessment were less likely to be adopted, had a longer shelter stay, and were more likely to be euthanized. When the shelters stopped assessing for food guarding, there was no significant difference in the rate of returns of food guarding dogs, even though more dogs were adopted because fewer were identified with food guarding behavior. Additionally, the number of injuries to staff, volunteers, and adopters was low (104 incidents from a total of 14,180 dogs) and did not change when the food guarding assessment was omitted. These results support a recommendation that shelters discontinue the food guarding assessment.