Motivating Residents to Change Communication: The Role of a Brief Motivational Interviewing Didactic

INTRODUCTION: Motivational interviewing (MI) is a patient-centered approach that encourages patients to change behaviors. MI training programs have increased residents\u27 knowledge and use of MI skills; however, many residency programs may not have the time to dedicate to lengthy MI programs. The purpose of this study was to evaluate the benefits of a brief MI didactic for residents in an academic internal medicine patient-centered medical home. METHODS: Thirty-two residents completed a 1-h MI training between October 2016 and June 2017 and completed measures on their knowledge of, confidence using, and utilization of MI skills prior to the training, immediately after the training, and at a 1-month follow-up. RESULTS: The residents\u27 knowledge of and confidence using MI skills increased from pre-test to post-test and also increased from pre-test to the 1-month follow-up. CONCLUSION: The utilization of MI skills increased from pre-test to the 1-month follow-up. A 1-h didactic offers benefits to residents

Motivating Residents to Change Communication: The Role of a Brief Motivational Interviewing Didactic

INTRODUCTION: Motivational interviewing (MI) is a patient-centered approach that encourages patients to change behaviors. MI training programs have increased residents\u27 knowledge and use of MI skills; however, many residency programs may not have the time to dedicate to lengthy MI programs. The purpose of this study was to evaluate the benefits of a brief MI didactic for residents in an academic internal medicine patient-centered medical home. METHODS: Thirty-two residents completed a 1-h MI training between October 2016 and June 2017 and completed measures on their knowledge of, confidence using, and utilization of MI skills prior to the training, immediately after the training, and at a 1-month follow-up. RESULTS: The residents\u27 knowledge of and confidence using MI skills increased from pre-test to post-test and also increased from pre-test to the 1-month follow-up. CONCLUSION: The utilization of MI skills increased from pre-test to the 1-month follow-up. A 1-h didactic offers benefits to residents

Motivating residents to change communication: the role of a brief motivational interviewing didactic

INTRODUCTION: Motivational interviewing (MI) is a patient-centered approach that encourages patients to change behaviors. MI training programs have increased residents\u27 knowledge and use of MI skills; however, many residency programs may not have the time to dedicate to lengthy MI programs. The purpose of this study was to evaluate the benefits of a brief MI didactic for residents in an academic internal medicine patient-centered medical home. METHODS: Thirty-two residents completed a 1-h MI training between October 2016 and June 2017 and completed measures on their knowledge of, confidence using, and utilization of MI skills prior to the training, immediately after the training, and at a 1-month follow-up. RESULTS: The residents\u27 knowledge of and confidence using MI skills increased from pre-test to post-test and also increased from pre-test to the 1-month follow-up. CONCLUSION: The utilization of MI skills increased from pre-test to the 1-month follow-up. A 1-h didactic offers benefits to residents

An assessment of psychiatric needs pre-and postmultivisceral transplant

Introduction: As intestinal transplant becomes a more viable treatment option, there has been increased interest in quality of life and other psychosocial metrics. Systematic review suggests that quality of life improves post-transplant. However, there is limited data regarding psychosocial issues present at initial evaluation and post-transplant. Given that psychiatric issues are associated with increased mortality in solid organ transplant, this study aims to highlight psychosocial patterns that are present at initial evaluation and post-transplant. Methods: This study was a retrospective chart review of 28 patients who received intestinal transplants between 8/3/10-1/3/17 at an academic hospital in the United States. Psychosocial variables from encounters with health psychology senior staff and trainees were extracted. Descriptive data were evaluated from pre and post-transplant encounters. Results: Pre-transplant, the most common initial diagnosis was adjustment disorder (68%) with more significant pathology occurring in the remaining patients. 3/28 patients had comorbid substance use issues. 12/28 patients were on psychotropic medications during initial evaluation with 50% of those on multiple medications. Figure 1 describes data from initial psychological assessment. Of those eventually transplanted, 8 required further intervention prior to psychosocial clearance. Among the 28 patients, psychology was consulted an average of 2.71 times. Of those that required follow-up, there was an average of 8.25 follow-ups. Most common reasons for consult were; depression, pain, anxiety, eating related issues, mental status concerns, or other. Of the 28 patients, 19 had post-transplant psychiatric diagnoses. Although adjustment disorders were the most prevalent (8/19), more significant pathology was found in remaining patients including opioid abuse (4/19), PTSD (3/19), and pain disorders (3/19). Conclusion: Present analysis suggests that many pre-transplant patients have significant psychopathology. Post-transplant a number of psychosocial issues persist and can emerge on an inpatient and outpatient basis. Development of behavioral health protocols for the most common consultations will be a valuable clinical service. These interventions may improve psychosocial outcomes, decrease patient noncompliance and reduce disease burden and cost. Future prospective studies, extending period of follow up, and assessing a wider range of predictors and outcomes are needed. (Figure Preseted)

Prerenal Transplant Education and Evaluation Positively Impacts Outcomes

Introduction: An outstanding question in kidney transplantation is how to prepare candidates and their social supports for optimal posttransplant outcomes. Project Aims: This program evaluation assessed whether a pretransplant quality improvement clinic improved clinical outcomes in the year posttransplant compared to recipients receiving standard of care. Design: The Countdown to Transplant Clinic was implemented with kidney transplant candidates expected to receive a transplant within the next few months. The clinic included an enhanced education session on posttransplant lifestyle management, confirmation of support (≥2 adults), and evaluations by transplant social work, psychology, and nephrology. Results: Seventy-five patients participated in the clinic and underwent a transplant. A retrospective chart review of posttransplant laboratory values, rehospitalizations (within 3-months posttransplant), biopsy-confirmed graft failure, and mortality (within 1-year posttransplant) were collected from both groups. Univariate and multivariate propensity score-weighted linear or logistic regression models were used to evaluate the association between clinic participation and outcomes. In models adjusting for relevant covariates, participation in The Countdown to Transplant Clinic (vs standard care) was associated with a lower coefficient of variation of serum tacrolimus (all values collected 3-12 months posttransplant), 30-day posttransplant white blood cell counts (but not 90-day), 90-day posttransplant potassium, and 30 and 31 to 90 days rehospitalizations. Clinic participation did not predict serum glucose levels at 30- or 90-days posttransplant. Due to low rates of rejection and mortality, meaningful comparisons were not possible. Conclusion: Participation in a pretransplant, multicomponent clinic may improve certain outcomes of interest posttransplantation. Pilot testing for feasibility for randomized controlled trials is a necessary next step

The shape of the hominoid proximal femur: a geometric morphometric analysis

As part of the hip joint, the proximal femur is an integral locomotor component. Although a link between locomotion and the morphology of some aspects of the proximal femur has been identified, inclusive shapes of this element have not been compared among behaviourally heterogeneous hominoids. Previous analyses have partitioned complex proximal femoral morphology into discrete features (e.g. head, neck, greater trochanter) to facilitate conventional linear measurements. In this study, three-dimensional geometric morphometrics are used to examine the shape of the proximal femur in hominoids to determine whether femoral shape co-varies with locomotor category. Fourteen landmarks are recorded on adult femora of Homo, Pan, Gorilla, Pongo and Hylobates. Generalized Procrustes analysis (GPA) is used to adjust for position, orientation and scale among landmark configurations. Principal components analysis is used to collapse and compare variation in residuals from GPA, and thin-plate spline analysis is used to visualize shape change among taxa. The results indicate that knucklewalking African apes are similar to one another in femoral shape, whereas the more suspensory Asian apes diverge from the African ape pattern. The shape of the human and orangutan proximal femur converge, a result that is best explained in terms of the distinct requirements for locomotion in each group. These findings suggest that the shape of the proximal femur is brought about primarily by locomotor behaviour