aiGeneR 1.0: An Artificial Intelligence Technique for the Revelation of Informative and Antibiotic Resistant Genes in Escherichia coli.

BACKGROUND: There are several antibiotic resistance genes (ARG) for the Escherichia coli (E. coli) bacteria that cause urinary tract infections (UTI), and it is therefore important to identify these ARG. Artificial Intelligence (AI) has been used previously in the field of gene expression data, but never adopted for the detection and classification of bacterial ARG. We hypothesize, if the data is correctly conferred, right features are selected, and Deep Learning (DL) classification models are optimized, then (i) non-linear DL models would perform better than Machine Learning (ML) models, (ii) leads to higher accuracy, (iii) can identify the hub genes, and, (iv) can identify gene pathways accurately. We have therefore designed aiGeneR, the first of its kind system that uses DL-based models to identify ARG in E. coli in gene expression data. METHODOLOGY: The aiGeneR consists of a tandem connection of quality control embedded with feature extraction and AI-based classification of ARG. We adopted a cross-validation approach to evaluate the performance of aiGeneR using accuracy, precision, recall, and F1-score. Further, we analyzed the effect of sample size ensuring generalization of models and compare against the power analysis. The aiGeneR was validated scientifically and biologically for hub genes and pathways. We benchmarked aiGeneR against two linear and two other non-linear AI models. RESULTS: The aiGeneR identifies tetM (an ARG) and showed an accuracy of 93% with area under the curve (AUC) of 0.99 (p < 0.05). The mean accuracy of non-linear models was 22% higher compared to linear models. We scientifically and biologically validated the aiGeneR. CONCLUSIONS: aiGeneR successfully detected the E. coli genes validating our four hypotheses.

Temporal Trends in Use of Complementary Therapies Among Patients With Cardiovascular Disorders.

This study aimed to evaluate the use and frequency of complementary and integrative medicine (CIM) therapies in an outpatient cohort with cardiovascular disease (CVD) and compare trends over time. This cross-sectional point-of-care prospective study assessed patients attending a cardiology outpatient clinic. As in our 2009 cohort, data were collected with a 17-question survey on demographic characteristics, CVD history, current use and future interest in CIM. In total, 964 patients completed the survey. CIM use continues to be high (2009 vs 2018, 83.4% vs 81.8%) (p = 0.34), with dietary supplements the most common therapy (75% in both studies). We observed increased use of mind-body therapies (28.5% vs 23.9%, p = 0.02), especially meditation, yoga, and tai chi. Of the patients receiving CIM therapies, 41.9% reported using CIM for heart-related symptoms. Relaxation, stress management, and meditation were the top three mind-body therapies for CVD-related symptoms in both cohorts. Reporting of CIM use to clinicians is low (15%) and interest on future use is high (47%). In conclusion, CIM is highly used in cardiology patients-4 of 10 patients use CIM for CVD-related symptoms. Most take dietary supplements, with an increased use of mind-body therapies. Our data highlight the importance of documenting CIM use in practice and the need for research to document efficacy.

Preventiometer, a Novel Wellness Assessment Device, Used With Healthy Volunteers: A Phase 2 Study.

BACKGROUND: We previously reported on a pilot study to assess the incorporation of a novel wellness assessment device, the Preventiometer (iPEx5 GmbH, Greifswald, Germany), into an academic medical practice. The present follow-up study expands on those data and evaluates the acceptability of the assessment process in a larger sample population. OBJECTIVE: The aim of this study was to evaluate participant satisfaction with the Preventiometer wellness assessment. METHODS: A total of 60 healthy volunteers participated. Each participant underwent a comprehensive wellness assessment with the Preventiometer and received data from more than 30 diagnostic tests. A 32-question survey (with a numeric rating scale from 0 to 10) was used to rate the wellness assessment tests and participants' impressions of the wellness assessment. RESULTS: Each assessment had a significantly higher rating than 7 (P < .001), and the majority of participants agreed or strongly agreed that they were satisfied (98.3%), and they strongly agreed that they were engaged the entire time (93.2%), and liked the instant test results feature of the Preventiometer device (93.2%). CONCLUSION: This study confirms findings from our previous pilot study regarding the feasibility of the Preventiometer as a wellness assessment tool. The study further demonstrated that 98% of participants were satisfied with the assessment and that all of them would recommend it to others.

Lavender Aromatherapy to Reduce Anxiety During Intrauterine Insemination: A Randomized Controlled Trial.

BACKGROUND: Infertility is a global public health issue. Therapies such as intrauterine insemination (IUI) are effective but may be associated with considerable anxiety. Preliminary data suggest that decreasing this anxiety might lead to improved outcomes. OBJECTIVE: To determine whether lavender aromatherapy (LA) reduces anxiety during an IUI procedure. METHODS: A randomized controlled trial of women undergoing IUI at a hospital-based fertility clinic. The intervention and comparison were the use of LA vs water. Measurements were the change in anxiety level during an IUI procedure, with secondary assessment of pain scores, patient satisfaction, and pregnancy rates. RESULTS: In total, 67 women were screened, and 62 women randomly assigned to either placebo (n = 31) or LA (n = 31). No differences were observed in baseline demographic characteristics or visual analog scores for anxiety before IUI (mean [95% CI], 33.9 [25.2 to 45.6] mm vs 41.0 [33.0 to 49.0] mm) in the LA and placebo groups. However, a statistically significant change in anxiety was observed after LA inhalation during the procedure (mean [95% CI], -11.2 [-19.1 to -3.2]) compared with placebo (mean [95% CI], 1.3 [-5.6 to 8.2]; P = .02). No significant difference was observed in pain during IUI in the LA group vs placebo group. Patient satisfaction was high, with 93% of respondents in the LA group satisfied with the aromatherapy during their procedure. Additionally, 76% of participants who received placebo reported that they would prefer to use LA during their IUI. No statistically significant difference was detected in pregnancy rates between the 2 groups: 19.4% with LA vs 9.7% with placebo (P = .47). CONCLUSION: LA reduced anxiety and was preferred by women during IUI fertility treatments.

Complementary and Alternative Medicine Use by Patients From the Gulf Region Seen in the International Practice of a Tertiary Care Medical Center.

BACKGROUND: Patients from various countries may have unique patterns of using complementary and alternative medicine (CAM) and unique reasons for using it. OBJECTIVE: Our objective was to assess the use of CAM among patients from the Gulf region attending the Executive and International Health Program of the Department of General Internal Medicine at Mayo Clinic in Rochester, Minnesota. METHODS: This cross-sectional survey was administered to all patients who were from the Gulf region and were undergoing outpatient evaluation in the Executive and International Health Program. After their initial medical evaluation by a physician, the patients were invited to anonymously complete the modified International Complementary and Alternative Medicine Questionnaire. RESULTS: The survey was completed by 69 patients (41 women, 27 men; mean age, 45.4 years). The most frequently seen providers for CAM treatments were physicians (71.0% of patients), spiritual healers (29.0%), and chiropractors (20.3%). CAM treatments most frequently received from a physician were massage therapy (51.0%), hijama (38.8%), spiritual healing (24.5%), and acupuncture or herbs (16.3%). The most frequently used dietary supplements were ginger (42.0%), bee products (30.4%), and garlic (27.5%). The most common self-help therapies were prayers for health (68.1%), meditation (15.9%), and relaxation techniques (11.6%). CAM therapy, including visits to CAM providers, was used by 92.8% of patients. CAM was mainly used to improve well-being and long-term health conditions rather than for acute illnesses. CONCLUSION: The use of CAM was high among our patients from the Gulf region, and the CAM therapies used by this population differed from the ones used by US patients. Physicians providing care to patients from the Gulf region should be aware of how the use of CAM may affect the care needs of these patients.

Music Therapy for Anxiety and Pain After Spinal Cord Injury: A Pilot Study.

BACKGROUND: Music therapy (MT) programs have been used in various health care settings to reduce patients' pain, anxiety, and stress. However, few studies have investigated its effects on patients with spinal cord injury (SCI), a frequently serious event requiring extensive rehabilitation. OBJECTIVE: This pilot study evaluated the feasibility of offering music-assisted relaxation (MAR) during rehabilitation for patients with SCI. We also measured the effect of MAR on the patients' pain, anxiety, and stress levels. METHODS: Patients were hospitalized at Mayo Clinic (Rochester, Minnesota) from September 2015 through September 2017 for rehabilitation of an SCI. Eligible patients received 2, 20-minute, personalized MAR sessions. Interventions were facilitated by a board-certified music therapist (MT-BC) and included diaphragmatic breathing, guided imagery, and passive muscle relaxation with live guitar accompaniment and spoken, improvised, or singing voice. Two surveys (Generalized Anxiety Disorder [GAD-7] and Perceived Stress Scale [PSS-10]) were used at the time of study consent and again upon hospital dismissal. Pain, anxiety, and relaxation were assessed before and after both MT sessions with visual analog scales (VASs), scored from 0 to 10. Participants completed a 7-question satisfaction survey after the second MAR session. RESULTS: Twenty patients were enrolled (12 men, 8 women); 13 (65%) completed the MAR interventions. The mean (SD) age was 53.7 (17.7) years. VAS scores for pain significantly improved after both sessions (P ≤ .02). VAS scores for anxiety also significantly improved after both sessions (P ≤ .02), as did VAS scores for relaxation (P ≤ .02 for both). The satisfaction survey indicated that patients generally believed that they benefited from MT. Rehabilitation staff indicated that MT did not interfere with routine clinical care. CONCLUSION: MT with live MAR is a feasible treatment for patients with SCI and may be effective for reducing their pain and anxiety.

Advanced Practice Providers' Knowledge, Attitudes, and Utilization of Complementary and Integrative Medicine at an Academic Medical Center.

CONTEXT: Complementary and integrative medicine comprises treatments used along with conventional medical care. Its use within care settings and communities has increased. OBJECTIVE: We aimed to assess baseline knowledge and use of complementary and integrative medicine among advanced practice providers at an academic medical center and their attitudes toward it. METHODS: A 50-question survey was sent to 1018 advanced practice providers at our academic medical center to evaluate their knowledge, attitudes, and utilization of complementary and integrative medicine therapies. RESULTS: The 556 respondents (54.6% response rate) included physician assistants, nurse practitioners, certified registered nurse anesthetists, clinical nurse specialists, and certified nurse midwives. Respondents reported a positive attitude toward complementary and integrative medicine and were likely to refer their patients to a complementary and integrative medicine practitioner (59%). They agreed that patients whose providers incorporate complementary and integrative medicine into their care have better clinical outcomes (nurse practitioners, 93%; certified registered nurse anesthetists, 87%; physician assistants, 85%; P = .002) and improved patient satisfaction (all respondents, 84%). Advanced practice providers, especially nurse practitioners, stated that they initiate the conversation to discuss the benefits and harms of complementary and integrative medicine with their patients (nurse practitioners, 93%; certified registered nurse anesthetists, 87%; physician assistants, 85%; P < .001). Respondents most frequently endorsed overall exercise, massage, and melatonin. Prospective randomized controlled trials were the most influential factor for attitude toward complementary and integrative medicine among physician assistants (50%), and personal experience was the most influential factor among nurse practitioners (52.9%) and certified registered nurse anesthetists (46.8%). CONCLUSIONS: Advanced practice providers generally have positive attitudes toward complementary and integrative medicine, but utilization appears limited by a self-report of low knowledge of benefits and risks of various therapies. For patient safety and satisfaction, advanced practice providers require a strong complementary and integrative medicine knowledge base to counsel patients.

Evaluation of a Novel Wellness Assessment Device (Preventiometer): A Feasibility Pilot Study.

BACKGROUND: Periodic wellness assessments can provide an estimate of a person's relative risks for major diseases, but wellness visits are underused. Our suggestion is to use a comprehensive device during a single visit. OBJECTIVE: The goal of this pilot study was to evaluate the feasibility of a novel one-stop wellness device (Preventiometer; iPEx5 GmbH, Greifswald, Germany) for performing multiple tests and providing a comprehensive wellness assessment in a short period. METHODS: A Preventiometer was used to provide wellness assessments for 10 healthy volunteers who then answered a 25-question survey to rate their satisfaction with the testing and their overall impression. RESULTS: All volunteers agreed or strongly agreed with the following: The assessment reports were easy to understand, the Preventiometer met their satisfaction, the participants were comfortable during the assessment, and all measurements and testing were well coordinated. Participants liked the instant test result feature. Most (90%) agreed that the machine was useful for a quick health assessment for busy people, and 70% felt that it was time efficient. CONCLUSION: In this feasibility pilot study, the Preventiometer performed multiple tasks and provided a comprehensive wellness assessment in a short period. Participants reported remarkably high satisfaction with the tests. A larger study is needed to prove that this is a pragmatic approach to help individuals improve their health.

Implementing a Palliative Medicine Music Therapy Program: A Quality Improvement Project.

OBJECTIVES: Recent evidence suggests that music therapy, a holistic method of care, potentially is beneficial for symptom management. This quality improvement project aimed to evaluate the effect of music therapy on symptom management and coping skills of patients receiving palliative care and to measure patient satisfaction with the therapy. A secondary aim was to evaluate staff perception of patient outcomes of music therapy services. METHODS: Palliative care clinicians attended a 30-minute education session on music therapy before the project was initiated. Study participants were patients and their families who were cared for by the inpatient palliative care consulting service at Mayo Clinic (Rochester, Minnesota) from June 1 through December 31, 2016. Patients were eligible if they required ongoing management of pain and anxiety or needed adaptive coping strategies. Patients and families were asked to complete a survey after each music therapy session. Staff were asked to complete a survey after completion of the project. RESULTS: Music therapy was provided to 57 patients and 53 family members. Patient surveys indicated a decrease in anxiety and pain. All patients reported that music therapy facilitated stress relief, relaxation, pain relief, spiritual support, emotional support, and a general feeling of wellness. All participants recommended music therapy services for others. Palliative care clinicians reported that music therapy added value as a holistic service. CONCLUSIONS: In this quality improvement project, music therapy positively affected multiple domains of well-being for patients receiving palliative care.

Stress Management and Resilience Intervention in a Women's Heart Clinic: A Pilot Study.

Background: In general, women report higher stress levels than men. High baseline anxiety, depression, and stress levels are associated with greater risk of cardiovascular diseases. Current evidence for efficacy of stress management interventions for women is limited. This study aimed at assessing the effect of a stress management and resiliency training (SMART) program for decreasing stress, anxiety, and depressive symptoms. Methods: Fifty moderately or severely stressed Women's Heart/Preventive Cardiology Clinic patients consented to the SMART intervention delivered online (n = 36) or in-person (n = 9). Primary outcome measures were the observed changes between baseline and at 12 weeks for the following psychometric tools: General Anxiety Disorder-7 (GAD-7), Patient Health Questionnaires (PHQ-9), Perceived Stress Scale (PSS), and Brief Resiliency Scale (BRS). Results: Forty-five patients completed the study. We observed significant improvements in PSS and GAD-7, but not in PHQ-9 or BRS, after the SMART intervention. When assessing outcomes among those with depressive symptoms at baseline (PHQ-9 > 15), we observed significant changes in PSS, GAD-7, and PHQ-9. No differences between online and in-person program delivery methods were found (all p-values >0.05). Conclusions: Training exposure using the SMART program to decrease stress and anxiety in women seeking preventive cardiology services was feasible and similarly effective, whether delivered online or in a single in-person session. Impacts on depression and resilience likely require a more intensive approach. In the future, larger randomized clinical trials with additional training and longer follow-up are warranted.

A cross-sectional study of learning styles among continuing medical education participants.

PURPOSE: Experiential learning has been suggested as a framework for planning continuing medical education (CME). We aimed to (1) determine participants' learning styles at traditional CME courses and (2) explore associations between learning styles and participant characteristics. MATERIALS AND METHODS: Cross-sectional study of all participants (n = 393) at two Mayo Clinic CME courses who completed the Kolb Learning Style Inventory and provided demographic data. RESULTS: A total of 393 participants returned 241 surveys (response rate, 61.3%). Among the 143 participants (36.4%) who supplied complete demographic and Kolb data, Kolb learning styles included diverging (45; 31.5%), assimilating (56; 39.2%), converging (8; 5.6%), and accommodating (34; 23.8%). Associations existed between learning style and gender (p = 0.02). For most men, learning styles were diverging (23 of 63; 36.5%) and assimilating (30 of 63; 47.6%); for most women, diverging (22 of 80; 27.5%), assimilating (26 of 80; 32.5%), and accommodating (26 of 80; 32.5%). CONCLUSIONS: Internal medicine and psychiatry CME participants had diverse learning styles. Female participants had more variation in their learning styles than men. Teaching techniques must vary to appeal to all learners. The experiential learning theory sequentially moves a learner from Why? to What? to How? to If? to accommodate learning styles.

Use of Complementary and Integrative Therapies by Fibromyalgia Patients: A 14-Year Follow-up Study.

OBJECTIVE: To reevaluate the frequency and pattern of complementary and integrative medicine (CIM) use in patients with fibromyalgia (FM). PATIENTS AND METHODS: Consecutive patients with FM who were referred to the Mayo Clinic fibromyalgia treatment program from January 5 through July 27, 2017, were invited to complete a survey about their use of CIM therapies in the preceding 6 months. The survey asked about 3 primary CIM domains: treatments and techniques, vitamins and minerals, and herbs and other dietary supplements. For direct comparative purposes, we reused the survey instrument from our prior analogous study of CIM use, performed in 2003. RESULTS: Of the 310 patients who completed the survey, 304 (98.1%) reported using some form of CIM, similar to the percentage reported in our 2003 study (98%). The most frequently used CIM therapies in the current cohort were spiritual healing (54.0% [163 of 302]), massage therapy (50.0% [152 of 304]), chiropractic treatments (39.3% [118 of 300]), aromatherapy (39.0% [117 of 300]), exercise for a specific medical problem (38.6% [117 of 303]), melatonin (37.9% [77 of 203]), magnesium (36.3% [107 of 295]), green tea (36.1% [73 of 202]), and fish oil (34.5% [68 of 197]). We noted numerous substantial differences from the 2003 data in terms of the pattern of CIM use. CONCLUSION: The use of CIM therapies among patients with FM continues to be extremely common for adult patients of all ages. Given the continued high prevalence of CIM use, health care professionals must have awareness and knowledge of these various modalities and their potential incorporation into a multifaceted FM treatment regimen.

The Stressed Executive: Sources and Predictors of Stress Among Participants in an Executive Health Program.

BACKGROUND: Stress is highly prevalent in the U.S. society, especially in executives, and is a well-documented risk factor for a wide range of medical disorders. Knowledge of common sources of stress and predictive factors may help identify executives at risk of high stress and allow us to appropriately refer them for stress management treatment. OBJECTIVE: The primary aim of this study was to identify common sources of stress, predictors of high stress, and other correlates among executives. METHODS: This was a cross-sectional survey of executives who requested a stress management consult at our institution. We abstracted the data from a 14-item intake survey as well as from the patient interview. RESULTS: Of the 839 executives, 827 executives (98.6%) who were referred for individual stress management consults completed the stress-related questions of the survey; 51.3% of these executives reported having a high stress level. Study participants mostly struggled with the well-being measures of sleep, anxiety, energy level, and diet. The majority reported that their main stressor was work related (n = 540, 64.4%) followed by family related (n = 371, 44.2%), health related (n = 170, 20.3%), and work-life balance (n = 62, 7.4%). In unadjusted analysis, high stress was associated with younger age (P = .006), lower quality-of-life scores (P < .001), and less physical activity (P < .001). In multivariable analyses, the strongest predictors for high stress level were younger age (odds ratios [OR] = 0.84, P = .045) and worse quality-of-life indicators such as anxiety (OR = 2.72, P < .001), diet (OR = 0.78, P = .02), and sleep (OR = 0.74, P < .003). CONCLUSION: These findings suggest that executives with a high level of stress might be best helped through a multimodality stress management program. Our findings merit replication in larger studies and more definitive confirmation with prospective clinical trials.

Validation of a clinical rotation evaluation for physician assistant students.

BACKGROUND: We conducted a prospective validation study to develop a physician assistant (PA) clinical rotation evaluation (PACRE) instrument. The specific aims of this study were to 1) develop a tool to evaluate PA clinical rotations, and 2) explore associations between validated rotation evaluation scores and characteristics of the students and rotations. METHODS: The PACRE was administered to rotating PA students at our institution in 2016. Factor analysis, internal consistency reliability, and associations between PACRE scores and student or rotation characteristics were determined. RESULTS: Of 206 PACRE instruments sent, 124 were returned (60.2% response). Factor analysis supported a unidimensional model with a mean (SD) score of 4.31 (0.57) on a 5-point scale. Internal consistency reliability was excellent (Cronbach α=0.95). PACRE scores were associated with students' gender (P = .01) and rotation specialty (P = .006) and correlated with students' perception of being prepared (r = 0.32; P < .001) and value of the rotation (r = 0.57; P < .001). CONCLUSIONS: This is the first validated instrument to evaluate PA rotation experiences. Application of the PACRE questionnaire could inform rotation directors about ways to improve clinical experiences. The findings of this study suggest that PA students must be adequately prepared to have a successful experience on their rotations. PA programs should consider offering transition courses like those offered in many medical schools to prepare their students for clinical experiences. Future research should explore whether additional rotation characteristics and educational outcomes are associated with PACRE scores.

Validation of a Teaching Effectiveness Assessment in Psychiatry Continuing Medical Education.

OBJECTIVE: Little is known about factors associated with effective continuing medical education (CME) in psychiatry. The authors aimed to validate a method to assess psychiatry CME teaching effectiveness and to determine associations between teaching effectiveness scores and characteristics of presentations, presenters, and participants. METHODS: This cross-sectional study was conducted at the Mayo Clinic Psychiatry Clinical Reviews and Psychiatry in Medical Settings. Presentations were evaluated using an eight-item CME teaching effectiveness instrument, its content based on previously published instruments. Factor analysis, internal consistency and interrater reliabilities, and temporal stability reliability were calculated. Associations were determined between teaching effectiveness scores and characteristics of presentations, presenters, and participants. RESULTS: In total, 364 participants returned 246 completed surveys (response rate, 67.6%). Factor analysis revealed a unidimensional model of psychiatry CME teaching effectiveness. Cronbach α for the instrument was excellent at 0.94. Item mean score (SD) ranged from 4.33 (0.92) to 4.71 (0.59) on a 5-point scale. Overall interrater reliability was 0.84 (95% CI, 0.75-0.91), and temporal stability was 0.89 (95% CI, 0.77-0.97). No associations were found between teaching effectiveness scores and characteristics of presentations, presenters, and participants. CONCLUSIONS: This study provides a new, validated measure of CME teaching effectiveness that could be used to improve psychiatry CME. In contrast to prior research in other medical specialties, CME teaching effectiveness scores were not associated with use of case-based or interactive presentations. This outcome suggests the need for distinctive considerations regarding psychiatry CME; a singular approach to CME teaching may not apply to all medical specialties.

Hand Massage for Cancer Patients Undergoing Chemotherapy as Outpatients: A Pilot Study.

CONTEXT: There are no studies on the effect of volunteer-provided hand massage in a busy chemotherapy outpatient practice. OBJECTIVE: To assess the feasibility of introducing hand massage therapy into an outpatient chemotherapy unit and to evaluate the effect of the therapy on various symptoms experienced by cancer patients. DESIGN: A pilot, quasi-experimental, pretest-posttest study. SETTING: Chemotherapy outpatient clinic of a large tertiary care academic medical center. PATIENTS/PARTICIPANTS: Forty chemotherapy outpatients. INTERVENTION: After being approached by a trained volunteer from a hand massage team, patients consented to receive a 20-minute hand massage before chemotherapy that was individualized according to patient preference and expressed needs. MAIN OUTCOME MEASURES: The visual analog scale (VAS) was used to measure pain, fatigue, anxiety, muscular discomfort, nervousness, stress, happiness, energy, relaxation, calmness, and emotional well-being (on a scale from 0-10) before and after the intervention; a satisfaction survey was administered after the therapy. Patients' demographic data were summarized with descriptive statistics, and VAS total scores were compared between groups at each time point with the two-group t test. Feasibility was evaluated from the number of patients who were approached, received a hand massage, and completed the study surveys. RESULTS: Of the 40 participants, 19 were men (mean age, 59.5 years). Significant improvement after hand massage was indicated by VAS scores for fatigue, anxiety, muscular discomfort, nervousness, stress, happiness, energy, relaxation, calmness, and emotional well-being (P < .05). Pain scores also improved, but the difference was not statistically significant (P = .06). All patients indicated that they would recommend hand massage to other patients, and 37 were interested in receiving it during their next chemotherapy treatment.

Incorporation of integrative medicine education into undergraduate medical education: a longitudinal study.

OBJECTIVE: Integrative medicine (IM) combines complementary medical approaches into conventional medicine and considers the whole person. We implemented a longitudinal IM short-course curriculum into our medical school education. This study aimed to evaluate the feasibility and effectiveness of the curriculum via knowledge and attitude surveys regarding IM among students. METHODS: A mandatory short IM curriculum across all years of medical school was created and taught by IM professionals and physician faculty members with expertise in integrative therapies. Graduating classes of 2015 and 2016 completed the same survey in their first and third years of medical school. Paired data analysis was done, and only students who completed surveys at both time points were included in final analyses. RESULTS: Of 52 students in each class, 17 (33%) in the class of 2015 and 22 (42%) in the class of 2016 completed both surveys. After the IM curriculum, students' knowledge of and comfort with several IM therapies-biofeedback, mindfulness, and the use of St. John's wort-improved significantly. Students' personal health practices also improved, including better sleep, exercise, and stress management for the class of 2015. Students graduating in 2016 reported decreased alcohol use in their third year compared with their first year. CONCLUSION: It is feasible to incorporate IM education into undergraduate medical education, and this is associated with improvement in students' knowledge of IM and personal health practices.

Patient feedback for acupuncture practice improvement: A survey from Mayo Clinic.

OBJECTIVE: To understand patient satisfaction with acupuncture appointment duration for the first and subsequent appointments in the plan of care, time spent with the acupuncture provider, willingness to pay for longer duration appointments, and lack of insurance coverage. METHODS: Patients who were referred for an acupuncture consult to the Center for Integrative Medicine at Mayo Clinic were asked to participate in the survey in August 2014. Patients were given paper survey at time of appointment check-in and entered into Research Electronic Data Capture Survey database tool to reveal patient-reported outcomes. RESULTS: In total, 104 of 329 patients receiving acupuncture treatment responded to the survey with a 32% response rate. Insight and recommended changes to the duration of the initial and subsequent appointments were obtained. Most patients reported that time spent with the provider (76 cases, 74%) and appointment length (74 cases, 68%) were "just right". Seventy cases (70%) of respondents indicated that they wanted longer treatment. Patients reported return appointments with duration of 30 min was not enough. Fifty-three patients (62%) were willing to pay for additional costs not covered by insurance. CONCLUSIONS: We used patient feedback to assess the acupuncture practice in a complementary and integrative medicine program. Most patients referred for the acupuncture consult appeared to be satisfied with the current level of practice. These findings were used to establish a quality improvement plan that may be implemented to improve patient satisfaction with the acupuncture practice.

Associations between teaching effectiveness and participant self-reflection in continuing medical education.

Effective medical educators can engage learners through self-reflection. However, little is known about the relationships between teaching effectiveness and self-reflection in continuing medical education (CME). We aimed to determine associations between presenter teaching effectiveness and participant self-reflection in conference-based CME. This cross-sectional study evaluated presenters and participants at a national CME course. Participants provided CME teaching effectiveness (CMETE) ratings and self-reflection scores for each presentation. Overall CMETE and CME self-reflection scores (five-point Likert scale with one as strongly disagree and five as strongly agree) were averaged for each presentation. Correlations were measured among self-reflection, CMETE, and presentation characteristics. In total, 624 participants returned 430 evaluations (response, 68.9%) for the 38 presentations. Correlation between CMETE and self-reflection was medium (Pearson correlation, 0.3-0.5) or large (0.5-1.0) for most presentations (n = 33, 86.9%). Higher mean (SD) CME reflection scores were associated with clinical cases (3.66 [0.12] vs. 3.48 [0.14]; p = 0.003) and audience response (3.66 [0.12] vs. 3.51 [0.14]; p = 0.005). To our knowledge, this is the first study to show a relationship between teaching effectiveness and participant self-reflection in conference-based CME. Presenters should consider using clinical cases and audience response systems to increase teaching effectiveness and promote self-reflection among CME learners.

Use of the pause procedure in continuing medical education: A randomized controlled intervention study.

During lectures, a pause procedure (the presenter pauses so students can discuss content) can improve educational outcomes. We aimed to determine whether (1) continuing medical education (CME) presentations with a pause procedure were evaluated more favorably and (2) a pause procedure improved recall. In this randomized controlled intervention study of all participants (N = 214) at the Mayo Clinic Internal Medicine Board Review course, 48 lectures were randomly assigned to an intervention (pause procedure) or control (traditional lecture) group. The pause procedure was a 1-min pause at the middle and end of the presentation. Study outcomes were (1) presentation evaluation instrument scores and (2) number of recalled items per lecture. A total of 214 participants returned 145 surveys (response rate, 68%). Mean presentation evaluation scores were significantly higher for pause procedure than for traditional presentations (70.9% vs 65.8%; 95%CI for the difference, 3.5-6.7; p < .0001). Mean number of rapid recall items was higher for pause procedure presentations (0.68 vs 0.59; 95%CI for the difference, 0.02-0.14; p = .01). In a traditional CME course, presentations with a pause procedure had higher evaluation scores and more content was recalled. The pause procedure could arm CME presenters with an easy technique to improve educational content delivery.