Browsing by Author "Dalack, Gregory W."

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    Effectiveness of the Tobacco Tactics program in the Department of Veterans Affairs
    (European Publishing, 2014-06-06) Duffy, Sonia A.; Ronis, David; Karvonen-Gutierrez, Carrie A.; Ewing, Lee A.; Dalack, Gregory W.; Smith, Patricia M.; Carmody, Timothy P.; Hicks, Thomas; Hermann, Christopher; Reeves, Pamela; Flanagan, Petra; Medicine, School of Medicine
    Background: Smoking cessation interventions during hospitalization have been shown to be efficacious, yet are rarely incorporated into practice. The purpose of this study was to determine the effectiveness of the Tobacco Tactics program in three Veterans Affairs (VA) hospitals. Materials and methods: In this quasi-experimental pre- post- comparison effectiveness trial, inpatient nurses were educated to provide the Tobacco Tactics intervention in the Ann Arbor, MI and Detroit, MI VA hospitals, while the Indianapolis, IN VA hospital was the control site (N=1,070). The Tobacco Tactics nurse toolkit included: 1) one contact hour for training; 2) a PowerPoint presentation on behavioral and pharmaceutical interventions; 3) a pocket card “Helping Smokers Quit: A Guide for Clinicians”; 4) pharmaceutical and behavioral protocols; and 5) a computerized template for nurse documentation. The patient toolkit included: 1) a brochure; 2) a videotape “Smoking: Getting Ready to Quit;” 3) a Tobacco Tactics manual; 4) pharmaceuticals; 5) a 1-800-QUIT-NOW help line card; and 6) post-discharge telephone calls. Smoking patients were surveyed in the hospital and again six-months post-discharge. Urinary cotinine tests were used to verify six-month smoking status. Results: The average age was 55.3 years, most were male (94%) and not married (76%). After adjustment for the propensity of being assigned to treatment condition, there were significant improvements in 6-month quit rates in the pre- to post-intervention time periods in Ann Arbor (p=0.004) and Detroit (p<0.001) compared to the Indianapolis control site. The intervention was particularly effective in Detroit where pre-intervention quit rates were 4% compared to 13% post-intervention. Conclusions: This study showed that training staff nurses to integrate smoking cessation services into their routine care may increase quit rates. The Tobacco Tactics program, which meets the newly released (2011) Joint Commission standards that apply to all inpatient smokers, has the potential to significantly decrease smoking among patients admitted to VA hospitals.
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    The Patient Mania Questionnaire (PMQ-9): a Brief Scale for Assessing and Monitoring Manic Symptoms
    (Springer, 2022) Cerimele, Joseph M.; Russo, Joan; Bauer, Amy M.; Hawrilenko, Matt; Pyne, Jeffrey M.; Dalack, Gregory W.; Kroenke, Kurt; Unützer, Jürgen; Fortney, John C.; Medicine, School of Medicine
    Background: Measurement-based care is an effective clinical strategy underutilized for bipolar disorder partly due to lacking a widely adopted patient-reported manic symptom measure. Objective: To report development and psychometric properties of a brief patient-reported manic symptom measure. Design: Secondary analysis of data collected in a randomized effectiveness trial comparing two treatments for 1004 primary care patients screening positive for bipolar disorder and/or PTSD. Participants: Two analytic samples included 114 participants with varied diagnoses and test-retest data, and 179 participants with psychiatrist-diagnosed bipolar disorder who had two or more assessments with the nine-item Patient Mania Questionnaire-9 [PMQ-9]). Main measures: Internal and test-retest reliability, concurrent validity, and sensitivity to change were assessed. Minimally important difference (MID) was estimated by standard error of measurement (SEM) and by standard deviation (SD) effect sizes. Key results: The PMQ-9 had high internal reliability (Cronbach's alpha = 0.88) and test-retest reliability (0.85). Concurrent validity correlation with manic symptom measures was high for the Internal State Scale-Activation Subscale (0.70; p<0.0001), and lower for the Altman Mania Rating Scale (0.26; p=0.007). Longitudinally, PMQ-9 was completed at 1511 clinical encounters in 179 patients with bipolar disorder. Mean PMQ-9 score at first and last encounters was 14.5 (SD 6.5) and 10.1 (SD 7.0), a 27% decrease in mean score during treatment, suggesting sensitivity to change. A point estimate of the MID was approximately 3 points (range of 2-4). Conclusions: The PMQ-9 demonstrated excellent test-retest reliability, concurrent validity, internal consistency, and sensitivity to change and was widely used and acceptable to patients and clinicians in a pragmatic clinical trial. Combined with the Patient Health Questionnaire-9 (PHQ-9) measure of depressive symptoms this brief measure could inform measurement-based care for individuals with bipolar disorder in primary care and mental health care settings given its ease of administration and familiar self-report response format.