BACKGROUND: Burnout affects nearly half of all U.S. nurses and physicians, and has been linked to poor outcomes such as worse patient safety. The most common measure of burnout is the well-validated Maslach Burnout Inventory (MBI). However, the MBI is proprietary and carries licensing fees, posing challenges to routine or repeated assessment. OBJECTIVE: To compare a non-proprietary, single-item burnout measure to a single item from the MBI Emotional Exhaustion (MBI:EE) subscale that has been validated as a standalone burnout measure. DESIGN: Cross-sectional online survey. PARTICIPANTS: A sample of primary care providers (PCPs), registered nurses, clinical associates (e.g., licensed practical nurses (LPNs), medical technicians), and administrative clerks in the Veterans Health Administration surveyed in 2012. MAIN METHODS: We compared a validated one-item version of the MBI:EE and a non-proprietary single-item burnout measure used in the Physician Work Life Study. We calculated kappa statistics, sensitivity and specificity, positive predictive (PPV) and negative predictive values (NPV), and area under the receiver operator curve (AUC). We conducted analyses stratified by occupation to determine the stability of the correlation between the two measures. KEY RESULTS: We analyzed responses from 5,404 participants, including 1,769 providers and 1,380 registered nurses. The prevalence of burnout was 36.7 % as measured on the single MBI:EE item and 38.5 % as measured on the non-proprietary single-item measure. Relative to the MBI:EE, the non-proprietary single-item measure had a correlation of 0.79, sensitivity of 83.2 %, specificity of 87.4 %, and AUC of 0.93 (se=0.004). Results were similar when stratified by respondent occupation. CONCLUSIONS: A non-proprietary single-item measure served as a reliable substitute for the MBI:EE across occupations. Because it is non-proprietary and easy to interpret, it has logistical advantages over the one-item MBI.

OBJECTIVE -The ability of readily available clinical information to predict the occurrence of diabetic foot ulcer has not been extensively studied. We conducted a prospective study of the individual and combined effects of commonly available clinical information in the prediction of diabetic foot ulcer occurrence.RESEARCH DESIGN AND METHODS -We followed 1,285 diabetic veterans without foot ulcer for this outcome with annual clinical evaluations and quarterly mailed questionnaires to identify foot problems. At baseline we assessed age; race; weight; current smoking; diabetes duration and treatment; HbA 1c (A1C); visual acuity; history of laser photocoagulation treatment, foot ulcer, and amputation; foot shape; claudication; foot insensitivity to the 10-g monofilament; foot callus; pedal edema; hallux limitus; tinea pedis; and onychomycosis. Cox proportional hazards modeling was used with backwards stepwise elimination to develop a prediction model for the first foot ulcer occurrence after the baseline examination.RESULTS -At baseline, subjects were 62.4 years of age on average and 98% male. Mean follow-up duration was 3.38 years, during which time 216 foot ulcers occurred, for an incidence of 5.0/100 person-years. Significant predictors (P Յ 0.05) of foot ulcer in the final model (hazard ratio, 95% CI) included A1C (1.10, 1.06 -1.15), impaired vision (1.48, 1.00 -2.18), prior foot ulcer (2.18, 1.61-2.95), prior amputation (2.57, 1.60 -4.12), monofilament insensitivity (2.03, 1.50 -2.76), tinea pedis (0.73, 0.54 -0.98), and onychomycosis (1.58, 1.16 -2.16). Area under the receiver operating characteristic curve was 0.81 at 1 year and 0.76 at 5 years.CONCLUSIONS -Readily available clinical information has substantial predictive power for the development of diabetic foot ulcer and may help in accurately targeting persons at high risk of this outcome for preventive interventions. Diabetes Care 29:1202-1207, 2006D iabetic foot ulcer and amputation continue to cause considerable morbidity among persons with diabetes (1). Foot ulcer has been recognized as an important antecedent of lower extremity amputation in multiple studies (2,3). Progress has occurred in understanding the pathogenesis of these complications (4), and methods to assist in the prediction of these outcomes have also been developed using various modalities, including lower limb sensory testing (5), thermography (6), and assessment of peak plantar pressure (7). Some of these modalities are unavailable to the vast majority of primary care clinical practitioners who provide much of the preventive and acute care of persons with diabetes.Also, the use of multiple risk indicators in combination to assist in the future prediction of diabetes complications has not been thoroughly explored and reported in a manner that permits assessment of prediction accuracy.Given the need for a prediction model of diabetic foot ulcer that utilizes multiple risk indicators that would be available in all clinical encounters that take place between patients and primary care or n...

OBJECTIVE -To describe diet and exercise practices from a nationally representative sample of U.S. adults with type 2 diabetes.METHODS -We analyzed data from 1,480 adults older than 17 years with a self-reported diagnosis of type 2 diabetes in the Third National Health and Nutrition Examination Survey (NHANES III). Fruit and vegetable consumption was obtained from a food frequency questionnaire; the percentages of total calories from fat and saturated fat were obtained from a 24-h food recall. Physical activity was based on self report during the month before the survey.RESULTS -Of individuals with type 2 diabetes, 31% reported no regular physical activity and another 38% reported less than recommended levels of physical activity. Sixty-two percent of respondents ate fewer than five servings of fruits and vegetables per day. Almost two thirds of the respondents consumed Ͼ30% of their daily calories from fat and Ͼ10% of total calories from saturated fat. Mexican Americans and individuals over the age of 65 years ate a higher number of fruits and vegetables and a lower percentage of total calories from fat. Lower income and increasing age were associated with physical inactivity. Thirty-six percent of the sample were overweight and another 46% were obese.CONCLUSIONS -The majority of individuals with type 2 diabetes were overweight, did not engage in recommended levels of physical activity, and did not follow dietary guidelines for fat and fruit and vegetable consumption. Additional measures are needed to encourage regular physical activity and improve dietary habits in this population.