Potential Feasibility of an Online Hypnosis Intervention for Women with Persistent Pelvic Pain.

This study aimed to examine the potential feasibility of an online hypnotic intervention for women with persistent pelvic pain. The secondary aim was to explore the effect of the hypnosis intervention on anxiety, depression, pain severity, coping, pain catastrophizing, and pain disability in comparison to a no-intervention control. Twenty women with persistent pelvic pain completed assessment questionnaires and were recruited from a variety of social media sites related to persistent pelvic pain and randomized to either control or hypnotic intervention groups. The intervention group completed a 7-week online hypnotic intervention. Results found a 30% dropout rate and modest compliance (90%-40%) with practice of audio recordings. Comments from the 7 participants who completed the hypnosis intervention indicated it was acceptable. Significant reductions in screening measures of anxiety and depression were found; however, there were no significant effects shown for pain severity, avoidant coping, pain catastrophizing, or pain disability. The intervention is potentially feasible, but further refinement and optimization is needed to increase retention, compliance, and potential effects.

Laparoscopy is associated with decreased all-cause mortality in patients undergoing emergency general surgery procedures in a regional health system.

BACKGROUND: The aim of this study was to evaluate the use of laparoscopic surgery for common emergency general surgery (EGS) procedures within an integrated Acute Care Surgery (ACS) network. We hypothesized that laparoscopy would be associated with improved outcomes. METHODS: Our integrated health care system's EGS registry created from AAST EGS ICD-9 codes was queried from January 2013 to October 2015. Procedures were grouped as laparoscopic or open. Standard descriptive and univariate tests were performed, and a multivariable logistic regression controlling for open status, age, BMI, Charlson Comorbidity Index (CCI), trauma tier, and resuscitation diagnosis was performed. Laparoscopic procedures converted to open were identified and analyzed using concurrent procedure billing codes across episodes of care. RESULTS: Of 60,604 EGS patients identified over the 33-month period, 7280 (12.0%) had an operation and 6914 (11.4%) included AAST-defined EGS procedures. There were 4813 (69.6%) surgeries performed laparoscopically. Patients undergoing a laparoscopic procedure tended to be younger (45.7 ± 18.0 years vs. 57.2 ± 17.6, p < 0.001) with similar BMI (29.7 ± 9.0 kg/m2 vs. 28.8 ± 8.3, p < 0.001). Patients in the laparoscopic group had lower mean CCI score (1.6 ± 2.3 vs. 3.4 ± 3.2, p ≤ 0.0001). On multivariable analysis, open surgery had the highest association with inpatient mortality (OR 8.67, 4.23-17.75, p < 0.0001) and at all time points (30-, 90-day, 1-, 3-year). At all time points, conversion to open was found to be a statistically significant protective factor. CONCLUSION: Use of laparoscopy in EGS is common and associated with a decreased risk of all-cause mortality at all time points compared to open procedures. Conversion to open was protective at all time points compared to open procedures.

Realizing a learning health system through process, rigor and culture change.

While many healthcare organizations strive to achieve the patient care benefits of being a learning health system (LHS), myriad challenges stand in the way of successful implementation. The reality of creating a true LHS requires top-to-bottom commitment to culture change with the necessary vision, leadership, and investment. The Center for Outcomes Research and Evaluation (CORE) is a multidisciplinary research unit embedded within a large, vertically integrated healthcare system in the southeastern United States. We used a two-pronged approach to: a) methodically recruit a team of experts, while generating early wins that demonstrated real success; and b) build relationships and buy-in across organizational leadership. Building out a team with diverse expertise created the ability to deploy pragmatic, data-driven research designs that fit seamlessly into real-world care delivery, resulting in agile study execution that aligns with health system timelines. Case study examples from hospital readmissions and antibiotic stewardship illustrate how our LHS operationalizes practice-informed research and research-informed practice. Lessons from this experience can serve as a blueprint for other healthcare systems or networks seeking to expand the promise of the LHS framework to improve health for patients and communities.

The role of acceptance in mood improvement during Mindfulness-Based Stress Reduction.

OBJECTIVE: This study elucidates the association between acceptance, mindfulness, and psychological well-being in a community-based sample participating in a Mindfulness-Based Stress Reduction (MBSR) program. METHOD: Participants (n = 52) completed an 8-week MBSR program at an academic medical center. Participants completed the Profile of Mood States (POMS), Mindfulness Attention Awareness Scale (MAAS), and Acceptance and Action Questionnaire (AAQ-II) at pre- and post-MSBR programs. RESULTS: Serial mediation analysis suggested that changes in mindfulness preceded changes in acceptance, which improved well-being (indirect effect = -6.57, 95% confidence interval [CI; -13.38, -1.57]). Participants with low pre-MSBR acceptance significantly increased acceptance and well-being (p < .001). Moderated mediation models suggested that the pre-MBSR acceptance level moderated the mindfulness-acceptance and the acceptance-well-being link. CONCLUSIONS: Acceptance may be related to mindfulness and pre-MSBR acceptance may differentially affect outcomes. Limitations include a nonclinical sample and a lack of a control group. Future research may examine mindfulness "dose" and other mechanisms that facilitate improvements in outcomes.

An Exploratory Study of a 3-Minute Mindfulness Intervention on Compassion Fatigue in Nurses.

This study shows that breathing mindfully for 3 minutes over a period of 4 weeks, positively affects compassion fatigue in nurses. A nonrandomized, pre/postintervention study was conducted using a 3-minute attentional breathing intervention. Thirty-two nurses participated over 4 weeks. The intervention demonstrated statistically significant reductions in compassion fatigue measures.

Inter-amphibian predation in the Early Cretaceous of China.

For most fossil taxa, dietary inference relies primarily on indirect evidence from jaw morphology and the dentition. In rare cases, however, preserved gut contents provide direct evidence of feeding strategy and species interaction. This is important in the reconstruction of food webs and energy flow through ancient ecosystems. The Early Cretaceous Chinese Jehol Biota has yielded several such examples, with lizards, birds, small dinosaurs, and mammals as both predator and prey. Here we describe an Early Cretaceous fossil frog specimen, genus Genibatrachus, that contains an adult salamander within its body cavity. The salamander is attributed to the hynobiid-like genus Nuominerpeton. The salamander skeleton is complete and articulated, suggesting it was caught and swallowed shortly before the frog itself died and was buried.

Enhanced platelet function in cold stored whole blood supplemented with resveratrol or cytochrome C.

BACKGROUND: Limited availability and use of whole blood (WB) following trauma is driven by perceptions that hemostatic function is limited by platelet dysfunction within 5 days storage. We sought to define the hemostatic function of WB stored at 4°C for up to 25 days, elucidate changes in metabolic parameters and mitochondrial dysfunction in platelets in WB, and the effect of supplementation using resveratrol (Res) or cytochrome c (Cyt c). METHODS: Whole blood was collected, aliquoted, and stored at 4°C without agitation. Resveratrol or Cyt c was supplemented before storage, or 10 days post-storage. Serial samples were collected and analyzed for hemostatic function by platelet mapping thromboelastography. Platelets isolated from WB were counted and mitochondrial function assessed by oxygen consumption, mitochondrial membrane potential, and biochemical parameters. RESULTS: Platelet function of WB was maintained up to 15 days at 4°C before a significant decrease was observed at 25 days. Resveratrol or Cyt c improved WB aggregation potential when supplemented 10 days post-storage. Platelet oxygen consumption was maintained until 10-day storage but significantly decreased thereafter in the absence of change in platelet count. Cytochrome c increased oxygen consumption on Day 15 and platelet mitochondrial membrane potential steadily decreased over time, an effect attenuated by Res or Cyt c supplementation 10 days post-storage. Potassium and lactate levels increased during storage, while pH levels decreased, with no observed effect following Res or Cyt c supplementation. CONCLUSION: Storing cold WB with Res or Cyt c supplementation enhances ex vivo aggregation by improving platelet function, thereby extending overall storage life. These findings have potential significance for improving WB availability in immediate trauma situations, including treatment in a battlefield trauma setting. LEVEL OF EVIDENCE: Translational study, diagnostic test or criteria, level II.

Indigenous message tailoring increases consumption of fresh vegetables by clients of community pantries.

This study tested whether message tailoring of recipes and food-use tips for low-income households is superior to providing a generic version of the material. The field experiment was conducted in the busy conditions found at community food pantries, and included 10 food distributions at each of six sites. We analyzed the consumption of fresh vegetables 6 days following distributions, and retention of print materials 6 weeks later. Self-determination and reactance theories guided the development of tailoring in an indigenous fashion, allowing each pantry client to choose recipes and food tips thought personally useful. This contrasted against paternalistic tailoring, common in health communication, where a motivational theory is used to regulate the health messages given to recipients. Results demonstrated benefits of tailoring over both generic and control conditions and uncovered the degree of tailoring that produced the largest effects. As suggested by construal level theory, the intervention addressed recipients' immediate and concrete decisions about healthy eating, instead of distant or abstract goals like prevention of illnesses. We documented per-client costs of tailored information. Results also suggested that benefits from social capital at sites offering a health outreach may exceed the impact of message tailoring on outcomes of interest.

Mindfulness-based stress reduction (MBSR) and distress in a community-based sample.

BACKGROUND: Numerous studies have found Mindfulness-based stress reduction (MBSR) to be useful for a wide range of problems including anxiety, pain and coping with a medical illness. The primary goal of this study was to evaluate the effectiveness of an 8-week MBSR programme in relieving distress in a community based sample. METHODS: Subjects (n = 14) were participants in the MBSR programme at a major academic medical center and completed the Profile of Mood States (POMS) and the Mindful Attention Awareness Scale (MAAS) prior to starting the class and at the end of the 8-week course. Means and standard deviations were computed for the pre-and post-POMS total and subscale measures and the MAAS. Wilcoxon Signed Ranks Test was conducted. RESULTS: There were significant reductions on multiple dimensions of distress on the POMS as well as a significant increase in mindful awareness as measured by the MAAS. CONCLUSION: These results suggest that MBSR appears to be associated with a reduction of distress and increased awareness of everyday life experiences in a sample of residents living in a large urban community.

The effect of a novel botanical agent TBS-101 on invasive prostate cancer in animal models.

BACKGROUND: Traditional Botanical Supplement-101 (TBS-101) is a newly developed proprietary botanical agent containing seven standardized botanical extracts, including: Panax ginseng, cranberry, green tea, grape skin, grape seed, Ganoderma lucidum and chamomile. Each of the components has been consumed either in the regular diet or as natural supplement. When used as a single agent, each of these seven botanicals has been implicated in chemoprevention and therapy in various types of cancer. The anticancer effect of TBS-101, with the specific combination of these anti-cancer botanicals for the treatment of prostate cancer (PCa), has not been tested. MATERIALS AND METHODS: The IC(50) and the effect of TBS-101 on the proliferation and apoptosis of PC-3 cells were determined. Tumor xenograft mice were generated by subcutaneously implanting PC-3 cells into mice and tumors were allowed to grow to different sizes before starting the treatment. The effects of TBS-101 on tumor growth were assessed by measuring tumor size and by histological, pathological and immunohistochemical analyses. A basic toxicity study was performed to test the tolerance of the mice to high doses of TBS-101. RESULTS: Treatment of the PC-3 cells with TBS-101 resulted in a dose-dependent inhibition of cell growth, with an IC(50) of 1.4 microg/ml. A concomitant induction of apoptosis in PC-3 cells treated with TBS-101 was also observed. Upon the treatment with TBS-101, all three groups of mice bearing moderate or large tumors showed significant inhibition of tumor growth and invasion. In contrast, control mice treated with vehicle alone had significant tumor growth and lymph node metastasis. In the basic toxicity studies, high doses of TBS-101 exerted no toxicity in healthy or tumor-bearing mice. CONCLUSION: The natural botanical agent TBS-101 has a good safety profile and significant anticancer activities in hormone-refractory PC-3 cells and large aggressive PC-3 tumors in a xenograft mouse model and has great potential for the treatment of aggressive prostate cancer.

Mindfulness-based cognitive therapy for generalized anxiety disorder.

UNLABELLED: While cognitive behavior therapy has been found to be effective in the treatment of generalized anxiety disorder (GAD), a significant percentage of patients struggle with residual symptoms. There is some conceptual basis for suggesting that cultivation of mindfulness may be helpful for people with GAD. Mindfulness-based cognitive therapy (MBCT) is a group treatment derived from mindfulness-based stress reduction (MBSR) developed by Jon Kabat-Zinn and colleagues. MBSR uses training in mindfulness meditation as the core of the program. MBCT incorporates cognitive strategies and has been found effective in reducing relapse in patients with major depression (Teasdale, J. D., Segal, Z. V., Williams, J. M. G., Ridgeway, V., Soulsby, J., & Lau, M. (2000). Prevention of relapse/recurrence in major depression by mindfulness-based cognitive therapy. Journal of Consulting and Clinical Psychology, 6, 615-623). METHOD: Eligible subjects recruited to a major academic medical center participated in the group MBCT course and completed measures of anxiety, worry, depressive symptoms, mood states and mindful awareness in everyday life at baseline and end of treatment. RESULTS: Eleven subjects (six female and five male) with a mean age of 49 (range=36-72) met criteria and completed the study. There were significant reductions in anxiety and depressive symptoms from baseline to end of treatment. CONCLUSION: MBCT may be an acceptable and potentially effective treatment for reducing anxiety and mood symptoms and increasing awareness of everyday experiences in patients with GAD. Future directions include development of a randomized clinical trial of MBCT for GAD.

Measuring quality.

It is no longer sufficient for health care professionals to provide high quality health care, they must also be able to demonstrate that they are meeting and often exceeding quality targets. Quality indicators (QIs) provide a means of measuring and assessing quality, however there are advantages and disadvantages of indicator measurement. Further, the clinical perspective needs to be balanced against managerial control when developing valid, reliable, sensitive and specific QIs. While indicators do not represent a perfect measurement device, they may provide a useful tool for improving patient safety and meeting community expectations.