Kavita Prasad

Stress Management and Resilience Training Among Department of Medicine Faculty: A Pilot Randomized Clinical Trial

BackgroundPhysician distress is common and related to numerous factors involving physicians’ personal and professional lives. The present study was designed to assess the effect of a Stress Management and Resiliency Training (SMART) program for increasing resiliency and quality of life, and decreasing stress and anxiety among Department of Medicine (DOM) physicians at a tertiary care medical center.ParticipantsForty DOM physicians were randomized in a wait-list controlled clinical trial to either the SMART intervention or a wait-list control group for 8 weeks. The intervention involved a single 90 min one-on-one training in the SMART program. Primary outcome measures assessed at baseline and week 8 included the Connor Davidson Resilience Scale (CDRS), Perceived Stress Scale (PSS), Smith Anxiety Scale (SAS) and Linear Analog Self Assessment Scale (LASA).ResultsThirty-two physicians completed the study. A statistically significant improvement in resiliency, perceived stress, anxiety, and overall quality of life at 8 weeks was observed in the study arm compared to the wait-list control arm: CDRS: mean ± SD change from baseline +9.8 ± 9.6 vs. -0.8 ± 8.2, t(30) = 3.18, p = 0.003; PSS: -5.4 ± 8.1 vs. +2.2 ± 6.1, t(30) = -2.76, p = 0.010; SAS: -11.8 ± 12.3 vs.+ 2.9 ± 8.9, t(30) = -3.62, p = 0.001; and LASA: +0.4 ± 1.4 vs. -0.6 ± 1.0, t(30) = 2.29, p = 0.029.ConclusionsA brief training to enhance resilience and decrease stress among physicians using the SMART program was feasible. Further, the intervention provided statistically significant improvement in resilience, stress, anxiety, and overall quality of life. In the future, larger clinical trials with longer follow-up and possibly wider dissemination of this intervention are warranted.

Stress Management and Resilience Training (SMART) Program to Decrease Stress and Enhance Resilience Among Breast Cancer Survivors: A Pilot Randomized Clinical Trial

UNLABELLED This randomized controlled trial assessed the effect of a SMART (Stress Management and Resiliency Training) program among 25 women diagnosed with breast cancer. Resilience, perceived stress, anxiety, and quality of life improved at 12 weeks in the active but not the control arm. A brief training in the SMART program can enhance resilience and quality of life and decrease stress and anxiety. INTRODUCTION Patients with breast cancer experience stress and anxiety related to their diagnosis, with resulting lower quality of life. The purpose of this study was to assess the effect of a SMART (Stress Management and Resiliency Training) program for increasing resiliency and for decreasing stress and anxiety among mentors who themselves were previously diagnosed with breast cancer. MATERIALS AND METHODS The program consisted of two 90-minute group training sessions, a brief individual session, and 3 follow-up telephone calls. Twenty-four mentors at Mayo Clinic in Rochester, Minnesota, were randomized in a single-blind, wait-list controlled clinical trial to either the SMART intervention or a control group for 12 weeks. Primary outcome measures assessed at baseline and at week 12 included the Connor Davidson Resilience Scale, Perceived Stress Scale, Smith Anxiety Scale, and Linear Analog Self Assessment Scale. RESULTS Twenty patients completed the study. A statistically significant improvement in resilience, perceived stress, anxiety, and overall quality of life at 12 weeks, compared with baseline was observed in the study arm. No significant difference in any of these measures was noted in the control group. CONCLUSION This study demonstrates that a brief, predominantly group-based resilience training intervention is feasible in patients with previous breast cancer; also, it may be efficacious.

Use of Complementary Therapies in Cardiovascular Disease

The aim of the present study was to assess the use of complementary and alternative medicine (CAM) treatments in outpatients with cardiovascular disease and their interest in future use. The increasing popularity of CAM therapies highlights the need to explore their use among patients with cardiovascular disease. Data were collected with a prospective, point-of-care, anonymous, 17-question survey about basic medical information and previous use and interest in the future use of dietary supplements and other CAM interventions among patients undergoing outpatient cardiology evaluation at a Midwestern tertiary care center. The survey was completed by 1,055 patients (655 men, 351 women; mean age 63.5 years) of whom 98.1% were white. Of these, 36.8% had cardiac symptoms for >10 years, 48.2% had coronary artery disease, and 82.5% reported use of CAM therapies. Of these patients, 75.4% reported using dietary supplements, 31.5% chiropractic therapy, 23.9% mind-body therapies, and 19.2% massage. Only 14.4% had discussed the use of CAM treatments with their physicians. The top 4 treatments used for cardiac symptoms were relaxation techniques, stress management, meditation, and guided imagery. Also, 48.6% were interested in participating in a future clinical trial of an alternative treatment. The great majority of patients seen in current practice use CAM therapies, and a large proportion expressed an interest in participating in research with CAM therapies. In conclusion, research directed with an integrative approach to cardiovascular care might prove beneficial when designing future studies.

A Randomized Clinical Trial of St. John's Wort for Smoking Cessation

INTRODUCTION St. Johns wort (SJW) is a widely used herbal supplement. The predominant mechanism(s) accounting for the activity of SJW in vivo are, however, unclear. The purpose of this study was to investigate the efficacy of SJW for smoking cessation. METHODS We conducted a randomized, blinded, placebo-controlled, three-arm, dose-ranging clinical trial. A total of 118 subjects were randomly allocated to receive SJW 300 mg, 600 mg, or a matching placebo tablet 3 times a day combined with a behavioral intervention for 12 weeks. Self-reported smoking abstinence was biochemically confirmed with expired air carbon monoxide. RESULTS Mean age of the study participants was 37.6 +/- 12.4 years; they smoked an average of 20.0 +/- 6.6 cigarettes per day for 20 +/- 12.1 years. The study dropout rate was high (43%). By intention-to-treat analysis, no significant differences were observed in abstinence rates at 12 and 24 weeks between SJW dose groups and placebo. SJW did not attenuate withdrawal symptoms among abstinent subjects. Abstinence rates did not differ by study group among subjects who took at least 75% of their study medication. No significant side-effects were noted with SJW. CONCLUSIONS In this randomized trial, SJW did not increase smoking abstinence rates. Our data, in combination with data from other studies, suggest that SJW has little role in the treatment of tobacco dependence.

Bibliotherapy to decrease stress and anxiety and increase resilience and mindfulness: a pilot trial.

INTRODUCTION Interventions to decrease stress and enhance resiliency and mindfulness are more likely to be widely implemented if they can be offered without the need for in-person training. The purpose of this study was to assess effectiveness of a self-directed Stress Management and Resiliency Training (SMART) program delivered using only written material for improving stress, resiliency, and mindfulness. METHODS A total of 37 employees at a large medical center were recruited and given written material on the SMART program. Subjects were instructed to practice the skills presented in the written materials without any additional training. The skills included education about the neuropsychology of stress and resilience, training attention to focus in the present moment, and refining interpretations. Primary outcome measures assessed resilience, perceived stress, anxiety, and quality of life. RESULTS Out of 37 employees, 34 (89%) enrolled subjects completed the study and provided the baseline and follow-up data. A statistically significant improvement in perceived stress, resilience, mindfulness, anxiety, and quality of life was observed at 12 weeks. CONCLUSION This study demonstrated that a brief, self-directed program to decrease stress and enhance resilience and mindfulness provided excellent short-term effectiveness for enhancing resilience, mindfulness and quality of life, and decreasing stress and anxiety.

P02.197. Self help intervention to decrease stress and increase mindfulness: a pilot trial

Purpose The Stress Management and Resiliency Training (SMART) program has shown efficacy for reducing anxiety and perceived stress and increasing resilience and quality of life. SMART has traditionally consisted of an in-person training session with an instructor and follow up teleconferences over 12-24 weeks. The purpose of this study was to assess whether self-directed SMART training using only written material would have efficacy.

P02.154. Stress management and resilience training among Department of Medicine faculty: a pilot randomized clinical trial

Purpose Physician distress is common and related to numerous factors including loss of control over the practice environment, workload, specialty choice, experience with suffering, interpersonal relationships, debt, poor self-care, maladaptive coping strategies and stressful life events such as divorce. The current study was designed to assess the effect of a Stress Management and Resiliency Training (SMART) program, for increasing resiliency and quality of life, and decreasing stress and anxiety among Department of Medicine (DOM) Physicians at Mayo Clinic Rochester.

Patterns of Complementary and Alternative Medicine Use in Children With Common Neurological Conditions

Background: Recent literature suggests that one in nine children in the United States uses some type of complementary and alternative medicine (CAM). Children with challenging neurological conditions such as headache, migraine, and seizures may seek CAM in their attempts at self-care. Our objective was to describe CAM use in children with these conditions. Methods: We compared use of CAM among children aged 3 to 17 years with and without common neurological conditions (headaches, migraines, seizures) where CAM might plausibly play a role in their self-management using the 2007 National Health Interview Survey (NHIS) data. Results : Children with common neurological conditions reported significantly more CAM use compared to the children without these conditions (24.0% vs 12.6%, P< .0001). Compared to other pediatric CAM users, children with neurological conditions report similarly high use of biological therapies and significantly higher use of mind-body techniques (38.6% vs 20.5%, P<.007). Of the mind-body techniques, deep breathing (32.5%), meditation (15.1%), and progressive relaxation (10.1%) were used most frequently. Conclusions: About one in four children with common neurological conditions use CAM. The nature of CAM use in this population, as well as its risks and benefits in neurological disease, deserve further investigation.

S-Adenosyl-l-Methionine (SAMe) for Smoking Abstinence: A Randomized Clinical Trial

OBJECTIVES S-Adenosyl-L-methionine (SAMe) is a dietary supplement commonly used to treat depression. SAMe facilitates dopamine and norepinephrine synthesis in the central nervous system. This study investigated the efficacy of SAMe for increasing tobacco abstinence among cigarette smokers. DESIGN A randomized, blinded, placebo-controlled, three-arm, dose-ranging clinical trial was conducted. Subjects were randomly allocated to receive SAMe 1600 mg or 800 mg by mouth every day or a matching placebo for 8 weeks. All subjects received a behavioral smoking cessation intervention. Self-reported smoking abstinence was biochemically confirmed with exhaled-air carbon monoxide. SUBJECTS Subjects in the study comprised 120 adults. RESULTS One hundred and twenty (120) subjects with a mean age of 40.0±14.0 (SD) years were enrolled. Participants smoked an average of 19.6±8.6 cigarettes per day for 21±13.2 years. The study dropout rate was high (42.5%). By intention-to-treat analysis, no significant differences were observed in abstinence rates at 8 and 24 weeks between SAMe dose groups and placebo. SAMe did not attenuate withdrawal symptoms among abstinent subjects. Rates of gastrointestinal side-effects were higher with SAMe 1600 mg/d compared to placebo. CONCLUSIONS SAMe did not increase smoking abstinence rates. Abstinence and tobacco withdrawal data from this clinical trial suggest that SAMe holds little promise for the treatment of tobacco dependence.

Challenges Conducting Clinical Trials with Herbal Products in Oncology

Patients with cancer are increasingly using complementary and alternative medicine (CAM) therapies. As many as 90% of patients with cancer might use some form of CAM therapy [1]; over 50% initiate these treatments after the diagnosis of cancer [2]. Patients use these treatments despite substantial advances in conventional medicine and lack of evidence of efficacy of many CAM treatments. This ‘return to nature’ movement that is largely consumer driven is primarily directed to help relieve symptoms, improve quality of life, and prevent recurrence of the cancer and not for the cure of the primary tumor [3–5]. Because most natural cancer cures investigated in clinical trials to date have either shown no benefit (e.g., shark cartilage [6]) or have shown a potential for harm (e.g., Laetrile [7]), the use of these products as alternative treatments seems inappropriate; their use as complementary treatments should be judicious and individualized until further research data are available [8].