Purpose Motivational interviewing (MI), a patient-centered behavioral counseling style, is a common behavioral intervention strategy. Since intervention outcomes are highly dependent on patient responsiveness to intervention strategy, we evaluated MI perceptions among rural African American women with Type 2 diabetes prior to a physical activity intervention. Methods Four moderator-led focus groups were conducted with patients age 21–50 who had never participated in a MI intervention and who receive diabetes care in a rural community health center. Patients were asked to share their perceptions of an MI consultation after viewing a DVD-based example. They were also asked to discuss their physical activity perceptions and readiness. A comprehensive content analysis based on grounded theory was performed by two raters in order to identify main themes. Main Findings Though patients (n=31) had an appreciation for physical activity benefits and high levels of physical activity readiness, themes related to physical activity barriers and lack of motivation were pervasive. Patients regarded the MI consultation as an effective health communication but the patient-centeredness of the approach was negatively perceived. Compared to MI, patients agreed that more traditional paternalistic approaches (i.e. physician-led interactions) were more representative of “good counseling” and more familiar to them. Patients shared deeply about personal experiences and provided words of encouragement to one another. Conclusion Physical activity interventions including rural African American women should include activities that focus on barrier management and increasing motivation. MI might be an appropriate behavioral counseling model when added to a more traditional cognitive-behavioral physical activity intervention that is group-based and tailored to patients’ communication preferences and the clinical setting.

Purpose The purpose of this study was to explore physical activity-related experiences, perceptions, and counseling expectations among urban, underactive, African American women with type 2 diabetes. Methods Participants were recruited via flyers and endocrinologist referral. A professional, African American female moderator led two focus groups among 11 participants. Focus groups were conducted in a video- and audio-equipped focus group room in the evening hours. Using a content-based stepped analytic approach, two raters independently analyzed data and collaborated to compare results and finalize themes. Results Competing priorities and lack of motivation were perceived as significant barriers to physical activity. Physical activity-related counseling expectations (i.e. physician encouragement) and experiences (physician advice giving) were inconsistent. Participants expressed a high degree of physical activity-related health responsibility. Altruistic intentions were high relative to helping others incorporate healthy lifestyle changes. Conclusions When counseling women about physical activity, diabetes educators should acknowledge and provide support and resources to help women incorporate more physical activity into their regular routines and enhance motivation for physical activity. Educators should also couple physical activity-related advice with encouragement and support. Due to high levels of altruism, educators should consider implementing group- and/or peer-based physical activity interventions in this patient group.

No abstract

The quality improvement project, which was implemented in 2 phases, successfully increased the FCOTS rate in our neurosurgical ORs from 33% to 68%.

The surgical Apgar score predicts major 30-day postoperative complications using data assessed at the end of surgery. We hypothesized that evaluating the surgical Apgar score continuously during surgery may identify patients at high risk for postoperative complications. We retrospectively identified general, vascular, and general oncology patients at Vanderbilt University Medical Center. Logistic regression methods were used to construct a series of predictive models in order to continuously estimate the risk of major postoperative complications, and to alert care providers during surgery should the risk exceed a given threshold. Area under the receiver operating characteristic curve (AUROC) was used to evaluate the discriminative ability of a model utilizing a continuously measured surgical Apgar score relative to models that use only preoperative clinical factors or continuously monitored individual constituents of the surgical Apgar score (i.e. heart rate, blood pressure, and blood loss). AUROC estimates were validated internally using a bootstrap method. 4,728 patients were included. Combining the ASA PS classification with continuously measured surgical Apgar score demonstrated improved discriminative ability (AUROC 0.80) in the pooled cohort compared to ASA (0.73) and the surgical Apgar score alone (0.74). To optimize the tradeoff between inadequate and excessive alerting with future real-time notifications, we recommend a threshold probability of 0.24. Continuous assessment of the surgical Apgar score is predictive for major postoperative complications. In the future, real-time notifications might allow for detection and mitigation of changes in a patient's accumulating risk of complications during a surgical procedure.