Objective: Opioid-treated chronic low back pain (CLBP) is debilitating, costly, and often refract... more Objective: Opioid-treated chronic low back pain (CLBP) is debilitating, costly, and often refractory to existing treatments. This secondary analysis aims to pilot-test the hypothesis that mindfulness meditation (MM) can reduce economic burden related to opioid-treated CLBP.Design: Twenty-six-week unblinded pilot randomized controlled trial, comparing MM, adjunctive to usual-care, to usual care alone.Setting: Outpatient.Participants: Thirty-five adults with opioid-treated CLBP ( ≥ 30 morphine-equivalent mg/day) for 3 + months enrolled; none withdrew. Intervention: Eight weekly therapist-led MM sessions and at-home practice.Outcome Measures: Costs related to self-reported healthcare utilization, medication use (direct costs), lost productivity (indirect costs), and total costs (direct + indirect costs) were calculated for 6-month pre-enrollment and postenrollment periods and compared within and between the groups.Results: Participants (21 MM; 14 control) were 20 percent men, age 51.8 ...
Journal of alternative and complementary medicine (New York, N.Y.), 2016
Randomized and open-label studies assessing prolotherapy for knee osteoarthritis have found quant... more Randomized and open-label studies assessing prolotherapy for knee osteoarthritis have found quantitative improvement on the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC) compared with baseline status and control therapies. This study assessed the qualitative response of participants receiving prolotherapy, an injection-based complementary treatment for symptomatic knee osteoarthritis (OA). Qualitative study using semi-structured in-depth interviews at 52 weeks after enrollment; transcribed responses were discussed by coauthors to identify themes; disagreement was resolved by consensus. Outpatient. Twenty-two participants treated with prolotherapy for symptomatic knee OA who were exited from three randomized and open-label studies. Intra- and extra-articular hypertonic dextrose injection (prolotherapy). Patient narrative and composite WOMAC questionnaire (0-100 points) scores. Participants had baseline demographic and knee OA severity similar to those of ...
Healthcare teams consist of individuals communicating with one another during patient care delive... more Healthcare teams consist of individuals communicating with one another during patient care delivery. Coordination of multiple specialties is critical for patients with complex health conditions, and requires interprofessional and intraprofessional communication. We examined a communication network of 71 health professionals in four professional roles: physician, nurse, health management, and support personnel (dietitian, pharmacist, or social worker), or other health professionals (including physical, respiratory, and occupational therapists, and medical students) working in a burn unit. Data for this cross-sectional study were collected by surveying members of a healthcare team. Ties were defined by asking team members whom they discussed patient care matters with on the shift. We built an exponential random graph model to determine: (1) does professional role influence the likelihood of a tie; (2) are ties more likely between team members from different professions compared to bet...
Background and objectives: Some family medicine residents often doubt their ability to become com... more Background and objectives: Some family medicine residents often doubt their ability to become competent family physicians. Individuals who believe themselves to be less intelligent and less competent than others perceive them to be are described in the psychological literature as having the "impostor phenomenon." This study sought to determine the prevalence of the impostor phenomenon in family medicine residents. Methods: We conducted a mail survey of all 255 family medicine residents in Wisconsin. The survey included the Clance Imposter Scale and two scales measuring depression and anxiety. Results: A total of 185 surveys were returned, for a 73% response rate. Forty-one percent of women and 24% of men scored as "impostors." Impostor symptoms were highly correlated with depression and anxiety. Conclusions: About one third of family medicine residents believe they are less intelligent and less competent than others perceive them to be. These residents suffer psychological distress and do not believe they will be ready to practice family medicine after graduation. Teachers may assist these learners by letting them know such feelings are common and by providing regular, timely, and positive feedback.
This study consisted of 2 independent cross-sectional samples, with analysis of diet, physical ac... more This study consisted of 2 independent cross-sectional samples, with analysis of diet, physical activity, anthropometric and television (TV) viewing data at baseline and after 4 years of intervention. Subjects were 2 separate samples of children, Grades 4 to 6, in 1994 (n=140) and 1998 (n=139), in Kahnawake, a Mohawk community near Montreal, Quebec, Canada. The KSDPP aims to improve diet, increase physical activity and reduce obesity in children, with the long-term goal of reducing the prevalence of type 2 diabetes. A higher diet quality indicator was created: ≤19.6% sucrose of total daily energy intake and ≥3.5 servings fruit/vegetables per day. Other outcome measures included TV viewing ≤2 h/day, physical activity ≥30 min/day and body mass index (BMI).
Http Dx Doi Org 10 1300 J069v24n02_08, Oct 17, 2008
This study reports the prevalence and types of sexual dysfunction in a sample of men on methadone... more This study reports the prevalence and types of sexual dysfunction in a sample of men on methadone maintenance for opioid dependence, and describes factors which may contribute to sexual dysfunction. 92 opioid-dependent men were recruited from a methadone maintenance clinic and completed two questionnaires, a research interview and laboratory measures. Fourteen percent reported some sexual dysfunction. Erectile dysfunction (r = 0.24, p = 0.020), libido dysfunction (r = 0.30, p = 0.003), and global dysfunction (r = 0.26, p = 0.013) increased with increasing age of the patient. Methadone dose showed a significant direct correlation with increased orgasm dysfunction, both before and after adjusting for duration of treatment (p = 0.012). None of the sexual dysfunction subscales or global dysfunction were associated with plasma testosterone or plasma prolactin levels. The rate of global sexual dysfunction in methadonetreated men is similar to general population studies and should be evaluated using general population guidelines. Orgasm dysfunction is a special case and may respond to methadone dose reduction.
ABSTRACT Recognizing and helping patients at risk for a substance use disorder doesn't ha... more ABSTRACT Recognizing and helping patients at risk for a substance use disorder doesn't have to be time-consuming. Here's how to make screening and implementing a brief intervention a routine part of care.
Wmj Official Publication of the State Medical Society of Wisconsin, Feb 1, 2003
Background: Maternal and pediatric residential pesticide exposure has been identified as a risk f... more Background: Maternal and pediatric residential pesticide exposure has been identified as a risk factor for birth defects, pediatric cancers, and neurological damage, and it may play a role in other disease processes. Objective: To examine whether the use of a pamphlet with a brief educational message in a clinic setting would increase the knowledge and/or change the attitudes of pregnant women and mothers about pesticide use and alternatives, as well as promote pesticide safety. Methods: A group of 103 women currently pregnant and/or with children less than 6 years of age were recruited at 2 Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics for the study. Participants were given a 16-question true/false oral survey testing their baseline knowledge about pesticide safety and safer alternatives to pesticide use. Participants were then randomly assigned to a control group or to the intervention group, which received the pamphlet and a 2-minute scripted overview of its contents. Approximately 2 to 3 weeks later, all participants received a follow-up telephone call by a researcher blinded to the original group assignment, and the original survey questions were repeated. Results: Follow-up assessments were completed for 73 (71%) of the participants. The mean improvement in correct responses on the follow-up survey was +0.39 for the control group and +3.1 for the intervention group (P<.001). Item analysis revealed that the intervention produced a significantly higher number of correct answers to 9 of the 16 survey questions. Conclusions: Providing mothers and pregnant women with a pamphlet and a brief message about pesticide safety and safer alternatives to pesticides in a clinic setting may be effective in improving knowledge and beliefs about pesticides.
Alcoholism, clinical and experimental research, Jan 9, 2015
Identifying and engaging excessive alcohol users in primary care may be an effective way to impro... more Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. Teams (n = 31) whose registered nurses displayed more strong (at least daily...
ABSTRACT Adolescent binge drinking is a public health challenge. The study analyzes data from Add... more ABSTRACT Adolescent binge drinking is a public health challenge. The study analyzes data from Add Health, a longitudinal survey of seventh through eleventh grade students enrolled between 1995 and 1996. A stochastic actor-based model simulates the co-evolution of binge drinking and friendship connections. Selection effects play a significant role in the creation of peer clusters with similar binge drinking. Friendship nominations between two students with similar binge drinking frequency were 3.46 (95% CI: 2.38-5.01) times more likely than between otherwise identical students with differing alcohol use frequency. An adolescent who nominated binge drinkers as friends was 14% more likely to begin binge drinking than adolescents with non-binge drinking friends. The data demonstrate that strong family ties reduced the odds of adolescent binge drinking by 7%.
Knee osteoarthritis (OA) is a common, debilitating chronic disease. Prolotherapy is an injection ... more Knee osteoarthritis (OA) is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. Recent 52-week randomized controlled and open label studies have reported improvement of knee OA-specific outcomes compared to baseline status, and blinded saline control injections and at-home exercise therapy (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). However, long term effects of prolotherapy for knee OA are unknown. We therefore assessed long-term effects of prolotherapy on knee pain, function and stiffness among adults with knee OA. Post clinical-trial, open-label follow-up study. Outpatient; adults with mild-to-severe knee OA completing a 52-week prolotherapy study were enrolled. Participants received 3-5 monthly interventions and were assessed using the validated Western Ontario McMaster University Osteoarthritis Index, (WOMAC, 0-100 points), at baseline, 12, 26, 52 weeks, and 2.5 years. 65 participants (58±7.4 years old, 38 female) received 4.6±0.69 injection sessions in the initial 17-week treatment period. They reported progressive improvement in WOMAC scores at all time points in excess of minimal clinical important improvement benchmarks during the initial 52-week study period, from 13.8±17.4 points (23.6%) at 12 weeks, to 20.9±2.8 points, (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05; 35.8% improvement) at 2.5±0.6 years (range 1.6-3.5 years) in the current follow-up analysis. Among assessed covariates, none were predictive of improvement in the WOMAC score. Prolotherapy resulted in safe, significant, progressive improvement of knee pain, function and stiffness scores among most participants through a mean follow-up of 2.5 years and may be an appropriate therapy for patients with knee OA refractory to other conservative care.
Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 2006
The Trial for Early Alcohol Treatment, Project TrEAT, was a randomized controlled trial of screen... more The Trial for Early Alcohol Treatment, Project TrEAT, was a randomized controlled trial of screening and brief intervention in primary care clinics. One of the few such trials to be analyzed in terms of cost-effectiveness, Project TrEAT was examined from two perspectives. The analysis from the perspective of medical care providers focused on clinic and hospital costs, contrasting the benefits that directly reduced medical expenditures with the costs to providers. The analysis from the societal perspective took all of the intervention's costs and benefits into account. Both components of this study revealed that Project TrEAT led to a reduction in alcohol consumption by high-risk drinkers and a corresponding reduction in medical and societal costs. Overall, this study supported the cost-effectiveness of Project TrEAT, concluding that its costs were outweighed by its benefits.
Objective: Opioid-treated chronic low back pain (CLBP) is debilitating, costly, and often refract... more Objective: Opioid-treated chronic low back pain (CLBP) is debilitating, costly, and often refractory to existing treatments. This secondary analysis aims to pilot-test the hypothesis that mindfulness meditation (MM) can reduce economic burden related to opioid-treated CLBP.Design: Twenty-six-week unblinded pilot randomized controlled trial, comparing MM, adjunctive to usual-care, to usual care alone.Setting: Outpatient.Participants: Thirty-five adults with opioid-treated CLBP ( ≥ 30 morphine-equivalent mg/day) for 3 + months enrolled; none withdrew. Intervention: Eight weekly therapist-led MM sessions and at-home practice.Outcome Measures: Costs related to self-reported healthcare utilization, medication use (direct costs), lost productivity (indirect costs), and total costs (direct + indirect costs) were calculated for 6-month pre-enrollment and postenrollment periods and compared within and between the groups.Results: Participants (21 MM; 14 control) were 20 percent men, age 51.8 ...
Journal of alternative and complementary medicine (New York, N.Y.), 2016
Randomized and open-label studies assessing prolotherapy for knee osteoarthritis have found quant... more Randomized and open-label studies assessing prolotherapy for knee osteoarthritis have found quantitative improvement on the validated Western Ontario McMaster University Osteoarthritis Index (WOMAC) compared with baseline status and control therapies. This study assessed the qualitative response of participants receiving prolotherapy, an injection-based complementary treatment for symptomatic knee osteoarthritis (OA). Qualitative study using semi-structured in-depth interviews at 52 weeks after enrollment; transcribed responses were discussed by coauthors to identify themes; disagreement was resolved by consensus. Outpatient. Twenty-two participants treated with prolotherapy for symptomatic knee OA who were exited from three randomized and open-label studies. Intra- and extra-articular hypertonic dextrose injection (prolotherapy). Patient narrative and composite WOMAC questionnaire (0-100 points) scores. Participants had baseline demographic and knee OA severity similar to those of ...
Healthcare teams consist of individuals communicating with one another during patient care delive... more Healthcare teams consist of individuals communicating with one another during patient care delivery. Coordination of multiple specialties is critical for patients with complex health conditions, and requires interprofessional and intraprofessional communication. We examined a communication network of 71 health professionals in four professional roles: physician, nurse, health management, and support personnel (dietitian, pharmacist, or social worker), or other health professionals (including physical, respiratory, and occupational therapists, and medical students) working in a burn unit. Data for this cross-sectional study were collected by surveying members of a healthcare team. Ties were defined by asking team members whom they discussed patient care matters with on the shift. We built an exponential random graph model to determine: (1) does professional role influence the likelihood of a tie; (2) are ties more likely between team members from different professions compared to bet...
Background and objectives: Some family medicine residents often doubt their ability to become com... more Background and objectives: Some family medicine residents often doubt their ability to become competent family physicians. Individuals who believe themselves to be less intelligent and less competent than others perceive them to be are described in the psychological literature as having the "impostor phenomenon." This study sought to determine the prevalence of the impostor phenomenon in family medicine residents. Methods: We conducted a mail survey of all 255 family medicine residents in Wisconsin. The survey included the Clance Imposter Scale and two scales measuring depression and anxiety. Results: A total of 185 surveys were returned, for a 73% response rate. Forty-one percent of women and 24% of men scored as "impostors." Impostor symptoms were highly correlated with depression and anxiety. Conclusions: About one third of family medicine residents believe they are less intelligent and less competent than others perceive them to be. These residents suffer psychological distress and do not believe they will be ready to practice family medicine after graduation. Teachers may assist these learners by letting them know such feelings are common and by providing regular, timely, and positive feedback.
This study consisted of 2 independent cross-sectional samples, with analysis of diet, physical ac... more This study consisted of 2 independent cross-sectional samples, with analysis of diet, physical activity, anthropometric and television (TV) viewing data at baseline and after 4 years of intervention. Subjects were 2 separate samples of children, Grades 4 to 6, in 1994 (n=140) and 1998 (n=139), in Kahnawake, a Mohawk community near Montreal, Quebec, Canada. The KSDPP aims to improve diet, increase physical activity and reduce obesity in children, with the long-term goal of reducing the prevalence of type 2 diabetes. A higher diet quality indicator was created: ≤19.6% sucrose of total daily energy intake and ≥3.5 servings fruit/vegetables per day. Other outcome measures included TV viewing ≤2 h/day, physical activity ≥30 min/day and body mass index (BMI).
Http Dx Doi Org 10 1300 J069v24n02_08, Oct 17, 2008
This study reports the prevalence and types of sexual dysfunction in a sample of men on methadone... more This study reports the prevalence and types of sexual dysfunction in a sample of men on methadone maintenance for opioid dependence, and describes factors which may contribute to sexual dysfunction. 92 opioid-dependent men were recruited from a methadone maintenance clinic and completed two questionnaires, a research interview and laboratory measures. Fourteen percent reported some sexual dysfunction. Erectile dysfunction (r = 0.24, p = 0.020), libido dysfunction (r = 0.30, p = 0.003), and global dysfunction (r = 0.26, p = 0.013) increased with increasing age of the patient. Methadone dose showed a significant direct correlation with increased orgasm dysfunction, both before and after adjusting for duration of treatment (p = 0.012). None of the sexual dysfunction subscales or global dysfunction were associated with plasma testosterone or plasma prolactin levels. The rate of global sexual dysfunction in methadonetreated men is similar to general population studies and should be evaluated using general population guidelines. Orgasm dysfunction is a special case and may respond to methadone dose reduction.
ABSTRACT Recognizing and helping patients at risk for a substance use disorder doesn&#39;t ha... more ABSTRACT Recognizing and helping patients at risk for a substance use disorder doesn&#39;t have to be time-consuming. Here&#39;s how to make screening and implementing a brief intervention a routine part of care.
Wmj Official Publication of the State Medical Society of Wisconsin, Feb 1, 2003
Background: Maternal and pediatric residential pesticide exposure has been identified as a risk f... more Background: Maternal and pediatric residential pesticide exposure has been identified as a risk factor for birth defects, pediatric cancers, and neurological damage, and it may play a role in other disease processes. Objective: To examine whether the use of a pamphlet with a brief educational message in a clinic setting would increase the knowledge and/or change the attitudes of pregnant women and mothers about pesticide use and alternatives, as well as promote pesticide safety. Methods: A group of 103 women currently pregnant and/or with children less than 6 years of age were recruited at 2 Special Supplemental Nutrition Program for Women, Infants and Children (WIC) clinics for the study. Participants were given a 16-question true/false oral survey testing their baseline knowledge about pesticide safety and safer alternatives to pesticide use. Participants were then randomly assigned to a control group or to the intervention group, which received the pamphlet and a 2-minute scripted overview of its contents. Approximately 2 to 3 weeks later, all participants received a follow-up telephone call by a researcher blinded to the original group assignment, and the original survey questions were repeated. Results: Follow-up assessments were completed for 73 (71%) of the participants. The mean improvement in correct responses on the follow-up survey was +0.39 for the control group and +3.1 for the intervention group (P<.001). Item analysis revealed that the intervention produced a significantly higher number of correct answers to 9 of the 16 survey questions. Conclusions: Providing mothers and pregnant women with a pamphlet and a brief message about pesticide safety and safer alternatives to pesticides in a clinic setting may be effective in improving knowledge and beliefs about pesticides.
Alcoholism, clinical and experimental research, Jan 9, 2015
Identifying and engaging excessive alcohol users in primary care may be an effective way to impro... more Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. Teams (n = 31) whose registered nurses displayed more strong (at least daily...
ABSTRACT Adolescent binge drinking is a public health challenge. The study analyzes data from Add... more ABSTRACT Adolescent binge drinking is a public health challenge. The study analyzes data from Add Health, a longitudinal survey of seventh through eleventh grade students enrolled between 1995 and 1996. A stochastic actor-based model simulates the co-evolution of binge drinking and friendship connections. Selection effects play a significant role in the creation of peer clusters with similar binge drinking. Friendship nominations between two students with similar binge drinking frequency were 3.46 (95% CI: 2.38-5.01) times more likely than between otherwise identical students with differing alcohol use frequency. An adolescent who nominated binge drinkers as friends was 14% more likely to begin binge drinking than adolescents with non-binge drinking friends. The data demonstrate that strong family ties reduced the odds of adolescent binge drinking by 7%.
Knee osteoarthritis (OA) is a common, debilitating chronic disease. Prolotherapy is an injection ... more Knee osteoarthritis (OA) is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. Recent 52-week randomized controlled and open label studies have reported improvement of knee OA-specific outcomes compared to baseline status, and blinded saline control injections and at-home exercise therapy (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05). However, long term effects of prolotherapy for knee OA are unknown. We therefore assessed long-term effects of prolotherapy on knee pain, function and stiffness among adults with knee OA. Post clinical-trial, open-label follow-up study. Outpatient; adults with mild-to-severe knee OA completing a 52-week prolotherapy study were enrolled. Participants received 3-5 monthly interventions and were assessed using the validated Western Ontario McMaster University Osteoarthritis Index, (WOMAC, 0-100 points), at baseline, 12, 26, 52 weeks, and 2.5 years. 65 participants (58±7.4 years old, 38 female) received 4.6±0.69 injection sessions in the initial 17-week treatment period. They reported progressive improvement in WOMAC scores at all time points in excess of minimal clinical important improvement benchmarks during the initial 52-week study period, from 13.8±17.4 points (23.6%) at 12 weeks, to 20.9±2.8 points, (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.05; 35.8% improvement) at 2.5±0.6 years (range 1.6-3.5 years) in the current follow-up analysis. Among assessed covariates, none were predictive of improvement in the WOMAC score. Prolotherapy resulted in safe, significant, progressive improvement of knee pain, function and stiffness scores among most participants through a mean follow-up of 2.5 years and may be an appropriate therapy for patients with knee OA refractory to other conservative care.
Alcohol research & health : the journal of the National Institute on Alcohol Abuse and Alcoholism, 2006
The Trial for Early Alcohol Treatment, Project TrEAT, was a randomized controlled trial of screen... more The Trial for Early Alcohol Treatment, Project TrEAT, was a randomized controlled trial of screening and brief intervention in primary care clinics. One of the few such trials to be analyzed in terms of cost-effectiveness, Project TrEAT was examined from two perspectives. The analysis from the perspective of medical care providers focused on clinic and hospital costs, contrasting the benefits that directly reduced medical expenditures with the costs to providers. The analysis from the societal perspective took all of the intervention's costs and benefits into account. Both components of this study revealed that Project TrEAT led to a reduction in alcohol consumption by high-risk drinkers and a corresponding reduction in medical and societal costs. Overall, this study supported the cost-effectiveness of Project TrEAT, concluding that its costs were outweighed by its benefits.
Uploads
Papers by Marlon Mundt