Park Nicollet Melrose Institute

Nicollet, MN, United States

Park Nicollet Melrose Institute

Nicollet, MN, United States

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Powers M.A.,International Diabetes Center at Park Nicollet | Richter S.,Park Nicollet Melrose Institute | Ackard D.,Park Nicollet Melrose Institute | Ackard D.,Offices of Diann M. Ackard LP | And 3 more authors.
International Journal of Eating Disorders | Year: 2012

Objectives: Describe characteristics of patients who have both an eating disorder and type 1 diabetes and compare their responses on psychological tests with those with an eating disorder and no diabetes at time of initial assessment to an eating disorder facility. Method: A chart audit conducted on all 48 patients with ED-DMT1 who were seen collaboratively by the diabetes and eating disorder treatment teams between 2005 and 2008 at Park Nicollet Health Services and 96 (1:2) matched eating disordered controls. Results: Diabetes was diagnosed an average of 10.2 years (SD = 9.4) before the diagnosis of an eating disorder; HbA1c at initial assessment was 11% (±3.2%). Those without diabetes reported greater depression (p =.048) and greater state and trait anxiety (p =.015 and p =.039, respectively) at initial assessment. Discussion: Persons with both an eating disorder and type 1 diabetes were less psychologically compromised than their matched cohorts with an eating disorder only. These findings may not remain constant during the course of treatment. © 2011 by Wiley Periodicals, Inc.


Kind E.A.,Park Nicollet Melrose Institute | Fowles J.B.,U.S. Peace Corps | Craft C.E.,Park Nicollet Melrose Institute | Kind A.C.,Park Nicollet Melrose Institute | Richter S.A.,Park Nicollet Melrose Institute
Mayo Clinic Proceedings | Year: 2011

OBJECTIVE: To determine whether physicians document office visits differently when they know their patients have easy, online access to visit notes. PATIENTS AND METHODS: We conducted a natural experiment with a pre-post design and a nonrandomized control group. The setting was a multispecialty group practice in Minnesota. We reviewed a total of 400 visit notes: 100 each for patients seen in a rheumatology department (intervention group) and a pulmonary medicine department (control group) from July 1 to August 30, 2005, before online access to notes, and 100 each for patients seen in these 2 departments 1 year later, from July 1 to August 30, 2006, when only rheumatology patients had online access to visit notes. We measured changes in visit note content related to 9 hypotheses for increased patient understanding and 5 for decreased frank or judgmental language. RESULTS: Changes occurred for 2 of the 9 hypotheses related to patient understanding, both in an unpredicted direction. The proportion of acronyms or abbreviations increased more in the notes of rheumatologists than of pulmonologists (0.6% vs 0.1%; P=.01), whereas the proportion of anatomy understood decreased more in the notes of rheumatologists than of pulmonologists (-5.9% vs -0.8%; P=.02). One change (of 5 possible) occurred related to the use of frank or judgmental terms. Mentions of mental health status decreased in rheumatology notes and increased in pulmonology notes (-8% vs 7%; P=.02). CONCLUSION: Dictation patterns appear relatively stable over time with or without online patient access to visit notes. © 2011 Mayo Foundation for Medical Education and Research.


Powers M.A.,International Diabetes Center at Park Nicollet | Richter S.,Minneapolis | Ackard D.,Park Nicollet Melrose Institute | Ackard D.,PhD LP | And 5 more authors.
Diabetes Educator | Year: 2013

Purpose: This research evaluated the level of influence that having type 1 diabetes (T1DM) has on responses to questions about food choices, eating concerns, dietary restraint, and others that are included on two widely used, validated eating disorder (ED) questionnaires and examined responses to these two questionnaires from patients with T1DM and an eating disorder (ED-T1DM) and an ED-no-diabetes. Method: An expert panel rated each item on the Eating Disorders Examination Questionnaire (EDE-Q) and Eating Disorders Inventory, version 3 (EDI-3) regarding T1DM level of influence on item interpretation. These questionnaires were completed by 2 matched samples (ED-T1DM, n = 48 and ED-no-diabetes, n = 96); responses were compared between the samples with particular attention to items of high T1DM influence. Results: The expert panel identified that 50% (19/38) of the items on the EDE-Q and 6.6% (6/91) on the EDI-3 could be highly influenced by having T1DM. Before Bonferroni correction, the 2 groups responded statistically different on 9 out of 38 items on the EDE-Q and 27 out of 91 items on the EDI-3; generally responses were healthier for those with ED-T1DM than ED-no-diabetes. Of these items, on the EDE-Q, 5 were rated high T1DM influence and on the EDI-3, 3 were rated high. Conclusion: Having T1DM influences responses on ED questionnaires developed for the general population. This influence may be greater when questionnaires focus on eating, weight, and shape and result in misinterpretation of total and subscale scores by even well-trained clinicians. A careful review of individual item responses by the treatment team is warranted. © 2013 The Author(s).


Ackard D.M.,Park Nicollet Melrose Institute | Cronemeyer C.L.,Park Nicollet Melrose Institute | Franzen L.M.,Park Nicollet Melrose Institute | Richter S.A.,Park Nicollet Melrose Institute | Norstrom J.,Park Nicollet Foundation
Eating Disorders | Year: 2011

The objective of this study was to examine differences between a number of different purging behaviors used and outcome measures among eating disorder patients. Among 211 females who received inpatient or partial hospitalization eating disorder treatment, analyses of covariance and cross-tabulations identified associations among a number of different purging behaviors (vomiting, laxative use, diuretic use) used and psychological, behavioral, self-efficacy and quality of life measures at follow-up. Most patients (80.1%) reported purging for weight control. Use of different purging behaviors was significantly associated at follow-up with lower self-esteem, greater depression, higher state and trait anxiety, higher BMI, poorer self-efficacy for normative eating and body image, compromised quality of life, greater dietary restraint, and eating, shape and weight concerns. Furthermore, a higher percentage of those who used purging behaviors met criteria for a subthreshold or threshold eating disorder at follow-up compared to their non-purging peers. Eating disorder patients who use different purging behaviors are more compromised at follow-up than patients who do not purge. Due to the severe medical complications associated with different purging behaviors, future research should address best practices for clinical intervention and prevention. © Taylor & Francis Group, LLC.


Ackard D.M.,5101 Olson Memorial Highway | Ackard D.M.,Park Nicollet Melrose Institute | Richter S.,Park Nicollet Melrose Institute | Frisch M.J.,Excelsior | And 2 more authors.
Journal of Psychosomatic Research | Year: 2013

Objectives: There is limited information on the prevalence of middle-aged women seeking specialized treatment for an eating disorder and whether middle-aged patients are significantly different from young-adult patients. This two-part study sought to identify changes in the past two decades in the prevalence of middle-aged (MA; 40. + years) and young-adult (YA; 18-39. years) women seeking treatment for an eating disorder (ED) and to identify differences and similarities between both groups. Methods: For Study 1, all unique female inpatient admissions from 1989 to 2006 were reviewed (. n=. 1,040). For Study 2, women admitted to any treatment level from January-May 2007 were compared, based on age at intake admission, on psychological questionnaires and factors relevant to an eating disorder. Results: In Study 1, the overall percent of MA women who presented for inpatient ED treatment increased significantly from an average of 4.7% (1989-2001) to an average of 11.6% (2002-2006). In Study 2, at intake, MA women were more likely than YA to be married, be older at ED onset and report a longer duration of illness. Self-esteem, depression, anxiety, ED psychopathology, and BMI were not significantly different between groups. Conclusions: Findings indicate an increase in the prevalence of inpatient admissions among middle-aged women, but few differences between middle-aged and younger-aged women at treatment admission. However, the longer duration of illness among MA warrants in-depth investigation of factors related to resistance to seeking treatment and to existing treatments failing patients, and consideration of tailoring treatment to course of illness. © 2012 Elsevier Inc.


PubMed | Park Nicollet Melrose Institute
Type: Journal Article | Journal: Journal of psychosomatic research | Year: 2013

There is limited information on the prevalence of middle-aged women seeking specialized treatment for an eating disorder and whether middle-aged patients are significantly different from young-adult patients. This two-part study sought to identify changes in the past two decades in the prevalence of middle-aged (MA; 40+ years) and young-adult (YA; 18-39 years) women seeking treatment for an eating disorder (ED) and to identify differences and similarities between both groups.For study 1, all unique female inpatient admissions from 1989 to 2006 were reviewed (n=1,040). For study 2, women admitted to any treatment level from January-May 2007 were compared, based on age at intake admission, on psychological questionnaires and factors relevant to an eating disorder.In study 1, the overall percent of MA women who presented for inpatient ED treatment increased significantly from an average of 4.7% (1989-2001) to an average of 11.6% (2002-2006). In study 2, at intake, MA women were more likely than YA to be married, be older at ED onset and report a longer duration of illness. Self-esteem, depression, anxiety, ED psychopathology, and BMI were not significantly different between groups.Findings indicate an increase in the prevalence of inpatient admissions among middle-aged women, but few differences between middle-aged and younger-aged women at treatment admission. However, the longer duration of illness among MA warrants in-depth investigation of factors related to resistance to seeking treatment and to existing treatments failing patients, and consideration of tailoring treatment to course of illness.


PubMed | Park Nicollet Melrose Institute
Type: Journal Article | Journal: Journal of sport & exercise psychology | Year: 2011

In this study, we tested Petrie and Greenleafs (2007) model of bulimic symptoms in two independent samples of female collegiate swimmers/divers and gymnasts. Structural equation modeling revealed support for the model, although it also suggested additional pathways. Specifically, general societal pressures regarding weight and body were related to the internalization of those ideals and, subsequently, to increases in body dissatisfaction. Pressures from the sport environment regarding weight and appearance were associated with more body dissatisfaction and more restrictive eating. Body dissatisfaction was related to more feelings of sadness, anger, and fear among the athletes. Negative affect, body dissatisfaction, and dietary restraint were related directly to bulimic symptoms, accounting for 55-58% of its variance. These results suggest that general sociocultural pressures are influential, but weight and appearance pressures in the sport environment may be even more pervasive and negative for female athletes.

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