Home Care Nurses' Knowledge and Attitudes Regarding Telehealth to Promote Medication Compliance among Older Adults.

Medication noncompliance among older adults is a persistent problem resulting in morbidity, hospital readmissions, and decreased quality of life. Home care nurses are in a key position to assist older adults to employ medication compliance strategies that are tailor-made to fit their individual needs and abilities. The purpose of this study was to understand the knowledge and attitudes of home care nurses regarding telehealth practices to promote medication compliance of older adult patients and their perceived readiness to do so. We employed a qualitative research approach using semi-structured interviews. Individual interviews were conducted via Teams platform for a maximum of 60 minutes. Participants were home care nurses who use telehealth technology to advance medication compliance strategies. Ten interviews were conducted. Several themes emerged from the data which suggested home care nurses accept telehealth technology, are supportive of its continued use, and are willing to be educated on future advances in this technology to assist older adults with medication compliance strategies. Universities and home care agencies must provide opportunities to prepare nurses to utilize telehealth technologies to promote medication compliance among older adult home care patients.

Fecal microbiota transplantation plus anti-PD-1 immunotherapy in advanced melanoma: a phase I trial.

Fecal microbiota transplantation (FMT) represents a potential strategy to overcome resistance to immune checkpoint inhibitors in patients with refractory melanoma; however, the role of FMT in first-line treatment settings has not been evaluated. We conducted a multicenter phase I trial combining healthy donor FMT with the PD-1 inhibitors nivolumab or pembrolizumab in 20 previously untreated patients with advanced melanoma. The primary end point was safety. No grade 3 adverse events were reported from FMT alone. Five patients (25%) experienced grade 3 immune-related adverse events from combination therapy. Key secondary end points were objective response rate, changes in gut microbiome composition and systemic immune and metabolomics analyses. The objective response rate was 65% (13 of 20), including four (20%) complete responses. Longitudinal microbiome profiling revealed that all patients engrafted strains from their respective donors; however, the acquired similarity between donor and patient microbiomes only increased over time in responders. Responders experienced an enrichment of immunogenic and a loss of deleterious bacteria following FMT. Avatar mouse models confirmed the role of healthy donor feces in increasing anti-PD-1 efficacy. Our results show that FMT from healthy donors is safe in the first-line setting and warrants further investigation in combination with immune checkpoint inhibitors. ClinicalTrials.gov identifier NCT03772899 .

Real-World Experience of Vismodegib in Advanced Basal Cell Carcinoma at a Canadian Cancer Center.

BACKGROUND: Vismodegib is a novel Hedgehog pathway inhibitor that has revolutionized the treatment of patients with advanced basal cell carcinoma (BCC) who are poor candidates for surgery or radiation. Few studies have explored the use of vismodegib to facilitate further surgery or radiotherapy, and the optimal treatment duration to balance outcomes with adverse effects. OBJECTIVES: To characterize the disease response, progression, and recurrence outcomes of BCC patients, and to report the impact of subsequent therapies. METHODS: We performed a retrospective study of 46 adult patients with advanced basal cell carcinoma (aBCC), including both locally advanced (laBCC) and metastatic (mBCC) disease, treated with vismodegib at a single center from 2012 to 2019. RESULTS: Thirty-six had laBCC, and 10 had mBCC. Treatment was given over a mean of 21.9 months. Twenty-three (50%) had a complete response (CR), and 19 (41.3%) achieved partial response (PR). Median time to maximal response was 5.3 months. Eleven (23.9%) had resected disease at median 17.2 months, and 11 patients (23.9%) received radiotherapy. Thirty-two (69.6%) experienced progressive disease after achievement of CR or PR. Among 17 CR patients, who stopped treatment, 14 (82.3%) experienced subsequent relapse; 6 (85%) attained a repeat response. Twenty (43.5%) discontinued treatment at least once due to adverse effects. CONCLUSIONS: With a response rate of 91%, London Regional Cancer Center's (LRCP)'s experience with vismodegib supports its effectiveness in treatment of aBCC. Moreover, a significant number of patients treated with vismodegib became amenable to surgery or radiotherapy. Toxicity remained an important factor that limited treatment duration.

A Blueprint for Becoming a Successful Clinical Nursing Professor, Promoting Health and Wellness in the Clinical Environment to Produce Emerging Nurse Leaders.

Clinical professors are a particularly important determinant of student success in becoming a proficient nurse. The clinical professor is responsible for helping students apply didactic knowledge to clinical skills. This article discusses strategies clinical professors can use to maximize undergraduate nursing students' skills and competencies and to raise awareness of healthy behaviors affecting patient care. Applying effective and fun strategies can help students decrease anxiety, apply critical thinking, develop autonomy, and learn time management. These applied strategies help students develop delegation skills required to be professional, competent nurses, while promoting health and well-being.

Prevalence and Factor Structure of PTSD in DSM-5 Versus DSM-IV in a National Sample of Sexual Minority Women.

The impact of changes to posttraumatic stress disorder (PTSD) diagnostic criteria from Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) to Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) within diverse communities is unclear. Young adult sexual minority women are at high risk for interpersonal violence and other forms of trauma exposure compared with heterosexual populations and sexual minority men. They are also at heightened risk of PTSD. As a result, young adult sexual minority women are a key population of interest when examining the impact of diagnostic criteria changes. The goal of the current study was to evaluate the impact of changes to PTSD diagnostic criteria in sexual minority women. Using an online survey, we administered both the original PTSD Symptom Checklist-S (based on DSM-IV criteria) and a version adapted to assess DSM-5 criteria to a national, nonclinical sample of young adult sexual minority women (N = 767). The DSM-5 symptom criteria fit the data well in confirmatory factor analysis. Current PTSD prevalence was higher under the DSM-5 diagnostic algorithm compared with DSM-IV (18.6% vs. 22.9%; d = 0.15). Compared with DSM-IV, associations between PTSD and depression were stronger using DSM-5 criteria, whereas associations between PTSD and high-risk drinking were reduced. Findings suggest that changes to PTSD diagnostic criteria do not have a major impact on prevalence of PTSD among sexual minority women but may have some impact on observed comorbidities.

A Marijuana Consequences Checklist for Young Adults with Implications for Brief Motivational Intervention Research.

Measures assessing marijuana-related consequences or problems experienced by young adults have typically been adapted from measures assessing alcohol consequences. These measures may not fully reflect the specific unwanted or perceived "not so good" effects of marijuana that are experienced by young adults. Thus, using these measures may present a gap, which needs to be addressed, given that reports of consequences are often utilized in brief motivational personalized feedback interventions. Data from three different studies of young adults were used to (1) examine self-reported "not so good" effects or consequences of marijuana use among frequent marijuana-using college students (Study 1), (2) create a new version of a marijuana consequences list and compare it to an existing marijuana consequences measure (Study 2), and (3) assess convergent and divergent validity between a finalized Marijuana Consequences Checklist (MCC, 26-items) and marijuana use and risk for cannabis use disorder (Study 3). The most frequently endorsed self-reported effects of marijuana included the impact on eating (the "munchies"), dry mouth, trouble concentrating, and acting foolish or goofy. Higher scores on the MCC were associated with more frequent use and a higher probability of meeting criteria for cannabis use disorder. The MCC represents a range of negative consequences of marijuana use derived from frequent users' own accounts and includes consequences not assessed by other measures. The MCC captures marijuana-specific negative consequences relevant for young adults, which can be incorporated in brief motivational personalized feedback interventions.

Genetic and clinical predictors of arthralgia during letrozole or anastrozole therapy in breast cancer patients.

PURPOSE: Female patients with breast cancer frequently develop arthralgia when treated with aromatase inhibitors (AI). Although the mechanism of AI-induced arthralgia is unknown, potential biomarkers have been identified. The purpose of this study was to investigate the clinical and genetic predictors of AI-induced arthralgia in a prospective cohort of patients with estrogen receptor-positive breast cancer. METHODS: One hundred and ninety-six patients were enrolled at initiation of AI therapy with either letrozole or anastrozole. Patients completed two validated self-report questionnaires assessing pain, stiffness, and physical function at baseline, and repeated the questionnaires at two and at six months after the initiation of treatment with an AI. Germline DNA of all patients was genotyped for seven single-nucleotide polymorphisms (SNPs) previously identified by genetic screens and genome-wide association studies as associated with AI-induced arthralgia. RESULTS: More than 50% of the study group experienced arthralgia symptoms. Genetic analysis revealed that four SNPs, in CYP19A1 (rs4775936) and ESR1 (rs9322336, rs2234693, rs9340799), were associated with the development of arthralgia (adjusted P = 0.016, 0.018, 0.017, 0.047). High body mass index (BMI) was also associated with the development of arthralgia symptoms (adjusted P = 0.001). Patients prescribed letrozole were significantly more likely to develop arthralgia than patients on anastrozole (P = 0.018), and also more likely to discontinue AI therapy due to arthralgia. The CYP19A1 (rs4775936) SNP was significantly associated with discontinuation of therapy due to intolerable arthralgia. CONCLUSIONS: Our results suggested that BMI and AI drug (letrozole versus anastrozole) were clinical predictors of arthralgia, while genetic variants rs4775936, rs9322336, rs2234693, and rs9340799 were genetic predictors of AI-induced arthralgia. Significantly, rs4775936 was also a predictor of discontinuation of therapy.

Integrating addiction medicine into rural primary care: Strategies and initial outcomes.

OBJECTIVE: This retrospective study describes the role of behavioral health in an addiction medicine program integrated in a primary care clinic, and evaluates retention, substance use, and mental health symptoms for patients in a rural underserved community. METHOD: Data were abstracted from records of patients referred for buprenorphine treatment of opioid use disorder (N = 101; 45% female, 23% Native Hawaiian or Pacific Islander, Mage = 42.5, SD = 12.75). Among patients prescribed buprenorphine (n = 61), most had comorbid substance-related diagnoses (72% with tobacco use, 75% with at least one other substance use disorder) and non-substance-related mental health diagnoses (77%), most commonly depression and anxiety. Integrated sessions with a behavioral health provider and a buprenorphine-waivered prescriber occurred weekly to monthly. Participants completed depression and anxiety questionnaires (Patient Health Questionnaire-9 and Generalized Anxiety Disorder Scale-7) and provided urine samples at each visit. RESULTS: Most patients (72%) were retained for at least 3 months, with early dropout associated with higher initial depression and anxiety scores. Inconsistent urine drug tests (i.e., those positive for illicit/nonprescribed substances) were significantly more common at treatment initiation (74%) than during the most recent visit (43%, p < .001), and were associated with baseline substance and other mental health factors, as well as shorter treatment duration. Generalized estimating equations models suggested time-based improvements in depression and anxiety symptoms, especially for patients retained for at least 3 months. CONCLUSIONS: Integrating wraparound addiction treatment within a rural primary care setting is feasible and associated with improved mental health and retention outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Transition From Hospital to Home: The Role of the Nurse Case Manager in Promoting Medication Adherence in the Medicare Population.

Lack of adherence to medication plans is a factor in costly hospital readmissions. Adherence to medication plans in the home care setting in relation to hospital readmission is a major issue among the Medicare population. Nurse case managers are in a key position to provide care after hospital discharge to promote medication adherence and thus reduce the chance of hospital readmission. This article discusses barriers to taking medications as prescribed and directed, the importance of ongoing medication reconciliation at home, and strategies to promote adherence to medication plans.

Letrozole concentration is associated with CYP2A6 variation but not with arthralgia in patients with breast cancer.

PURPOSE: The aromatase inhibitor (AI) letrozole is a first-line drug in the adjuvant treatment of breast cancer in postmenopausal women. Adherence to AI therapy, including letrozole, remains problematic due to the development of debilitating AI-induced arthralgia. Letrozole is metabolized in the liver by CYP2A6. It remains unknown if plasma letrozole levels or CYP2A6 genetic variation is associated with the development of arthralgia. METHODS: We enrolled 126 female breast cancer patients initiated on letrozole therapy and prospectively collected blood samples at baseline and two follow-up time points to determine letrozole plasma concentrations and CYP2A6 genotype. At each visit, participants completed two validated questionnaires to assess the severity of arthralgia symptoms. RESULTS: More than half (55%) of patients experienced a significant increase in their arthralgia symptoms after initiation of treatment. The clinical variables of body mass index (P = 0.0003) and age (P = 0.0430) were negatively and positively associated with plasma letrozole concentrations, respectively. CYP2A6 genotype was significantly associated with letrozole levels (P < 0.0001), and increased plasma letrozole levels were observed in patients with CYP2A6 reduced-function genotypes. Plasma levels of letrozole and CYP2A6 genotype were not significantly associated with a change in pain score from baseline. CONCLUSIONS: CYP2A6 genotype was a significant predictor of letrozole plasma levels, but was not associated with the development of arthralgia.

Do As I Say, Not As I Do.

Little is known about the drinking behaviors and perceptions of the peers facilitating campus alcohol interventions. The current study examined these trajectories in peer counselors ( N = 12) providing personalized normative feedback interventions to undergraduates mandated to clinical services. Peer counselors completed four monthly self-assessments. In spite of facilitating interventions to reduce drinking and associated harms, peer drinking behaviors and expectancies did not change, although significant between subjects effects suggest various trajectories. Peer counselors did correct overestimates of binge drinking but progressively underestimated abstinence norms. Despite the lack of change in the peer counselor behaviors, the mandated clients significantly reduced their drinking, suggesting it may be more important to "Do as I Say" rather than as the facilitator does.

Current intimate relationship status, depression, and alcohol use among bisexual women: The mediating roles of bisexual-specific minority stressors.

Current intimate relationship characteristics, including gender and number of partner(s), may affect one's visibility as a bisexual individual and the minority stressors they experience, which may in turn influence their health. The current study tested four hypotheses: 1) minority stressors vary by current intimate relationship status; 2) higher minority stressors are associated with higher depressive symptoms and alcohol-related outcomes; 3) depressive symptoms and alcohol-related outcomes vary by current intimate relationship status; and 4) minority stressors will mediate differences in these outcomes. Participants included 470 self-identified bisexual women (65% Caucasian, mean age: 21) from a sample of sexual minority women recruited from different geographic regions in the United States through advertisements on social networking sites and Craigslist. Participants completed a 45 minute survey. Respondents with single partners were first grouped by partner gender (male partner: n=282; female partner: n=56). Second, women were grouped by partner gender/number (single female/male partner: n = 338; women with multiple female and male partners: n=132). Women with single male partners and women with multiple male and female partners exhibited elevated experienced bi-negativity and differences in outness (H1). Experienced and internalized bi-negativity were associated with health outcomes, but not outness (H2). Differences in outcomes emerged by partner number and partner number/gender (H3); these differences were mediated by experienced bi-negativity (H4). These results suggest that experiences of discrimination may underlie differences in health related to bisexual women's relationship structure and highlight the importance of evaluating women's relational context as well as sexual identification in understanding health risk behaviors.

The impact of defensiveness and incident reactions on post-sanction drinking behaviors among mandated students.

INTRODUCTION: Prior studies with mandated students (students referred for an intervention following violation of a campus alcohol policy) have suggested that decreases in drinking behaviors may occur before clinical intervention. Others studies have suggested that greater reductions were associated with lower defensiveness and stronger incident reactions, such as responsibility and aversiveness. The current study sought to integrate these findings and examine the influence of pre-sanction drinking and perceptions on mandated students' post-sanction drinking levels prior to attending a brief intervention. METHODS: Data were collected as part of a longitudinal study of brief interventions in a mandated student sample (N=61, 43% female, 97% White). Participants completed demographic measures, scales measuring incident reactions and defensiveness, and a Time Line Follow Back assessing drinking quantity and frequency both pre- and post-sanction. RESULTS: Analyses revealed significant post-sanction decreases in quantity (average total drinks per month) and frequency (number of monthly drinking days). Pre-sanction drinking quantity and frequency significantly predicted post-sanction quantity and frequency, respectively. Interaction effects suggest higher post-sanction quantities among moderate and heavier drinkers with higher defensiveness and lower aversiveness perceptions, while perceptions did not influence outcomes among light drinkers. None of the interactions involving blame or responsibility, or predicting post-sanction frequency, were significant. CONCLUSIONS: These findings suggest a complex relationship between pre-sanction drinking and student reactions. Implications for mandated student interactions and future research directions are discussed.

Use of drinking protective behavioral strategies and sexual perceptions and behaviors in U.S. college students.

Alcohol use among college students is linked to an increased likelihood of engaging in risky sexual behaviors, including casual sex and unprotected sex. These behaviors increase college students' risks for negative social and health-related consequences. This study examined the relationship between drinking behaviors and protective behavioral strategies (PBS), expectancies and perceptions of sexual risk, and actual alcohol-related sexual behaviors and consequences. Sexually active college students completed Web-based self-report measures of drinking behaviors and use of PBS, alcohol expectancies and perceptions of risk, and sexual behaviors and related consequences (n = 524; 57.1% women). Findings indicated that PBS were related to lower expectancies of sexual risk and sexual disinhibition, and among lighter drinkers, lower expectancies of sexual enhancement from alcohol. PBS were also related to decreased perceptions of sexual-related risks, some alcohol-related sexual behaviors, including number of drinks before/during sex, and number of sexual consequences, but were not related to abstaining during sex, frequency of alcohol-related sexual behaviors, or general condom use. These findings demonstrate a disconnect between perceived and actual risks among college students, such that decreased perceptions of risk may not be associated with protective behaviors. Prevention and intervention implications are discussed.

Alcohol interventions for mandated students: behavioral outcomes from a randomized controlled pilot study.

OBJECTIVE: This study investigated the effectiveness of three single-session interventions with high-risk mandated students while considering the influence of motivational interviewing (MI) microskills. METHOD: This randomized, controlled pilot trial evaluated single-session interventions: Alcohol Skills Training Program (ASTP), Brief Alcohol Screening and Intervention for College Students (BASICS) feedback sessions, and treatment-as-usual Alcohol Diversion Program (ADP) educational groups. Participants were 61 full-time undergraduates at a southern U.S. campus sanctioned to a clinical program following violation of an on-campus alcohol policy (Mage = 19.16 years; 42.6% female). RESULTS: RESULTS revealed a significant effect of time for reductions in estimated blood alcohol concentration (eBAC) and number of weekly drinks but not in alcohol-related consequences. Although ASTP and BASICS participants reported significant decreases in eBAC over time, ADP participant levels did not change (with no intervention effects on quantity or consequences). MI microskills were not related to outcomes. CONCLUSIONS: RESULTS from this study suggest equivalent behavioral impacts for the MI-based interventions, although individual differences in outcome trajectories suggest that research is needed to further customize mandated interventions. Given the overall decrease in eBAC following the sanction, the lack of reduction in the ADP condition warrants caution when using education-only interventions.

Response of colleges to risky drinking college students.

Heavy drinking and related consequences continue to affect college campuses due to fatalities, assaults, serious injuries, and arrests that occur among students. Several approaches aimed at reducing the harm incurred by students and the college communities as a result of heavy drinking are being used with varying success. A review of interventions including educational, individual, and environmental approaches are described, as well as new, promising, strategies. Despite some success, elevated and risky drinking patterns continue. As such, concerns over implementation of evidence-based treatments and areas in need of further study are discussed. [Full text available at http://rimed.org/rimedicaljournal-2014-10.asp, free with no login].

"Seems I'm not alone at being alone:" contributing factors and interventions for drinking games in the college setting.

Alcohol use among college students is prevalent and sometimes takes the form of drinking games, in which players are required to drink in accordance with a set of pre-defined rules. Drinking games are typically associated with elevated alcohol consumption and risk to the individual. This perspective piece considers the potential role of social anxiety in motivating participation in drinking games, perceived norms surrounding drinking games (including ways they are portrayed and discussed in popular media), and the role of competitiveness. Implications for skills training-based prevention and intervention efforts are discussed.

Rose-colored beer goggles: the relation between experiencing alcohol consequences and perceived likelihood and valence.

Although experiencing alcohol-related consequences has some influence on future drinking, this effect may be stronger based on the degree to which the consequence is viewed as positive versus negative, either by the individual or predefined by researchers. This study explored the relationship between experiencing positive and negative alcohol-related consequences and college students' perceptions of how likely those consequences were to occur in the future (i.e., likelihood), and their view of how positive or negative experiencing those consequences would be if they did experience them as a result of drinking (i.e., valence). Data were collected from 491 college students (mean age = 19.26; 56.4% female; 55.0% Caucasian; 33.2% Asian/Pacific Islander) through a computerized survey. Results indicated that experiencing more positive consequences in the past year was associated with viewing those consequences as both more likely to occur and more positive, while experiencing more negative consequences was associated with viewing them as less negative and no more likely to occur, except for those who had experienced the highest levels of negative consequences. These findings suggest that finding ways to reduce both perceptions as well as consequences themselves may be effective intervention tools.

Reducing the Harms of College Student Drinking: How Alan Marlatt Changed Approaches, Outcomes, and the Field.

In this article, we discuss Alan Marlatt's contributions to the prevention and reduction of alcohol-related harms among college students. We consider Alan's early research that later led to the development and evaluation of college student drinking programs, and examine Alan's impact, both directly and indirectly through those he mentored and trained, as a scientist-practitioner. We review the recognition of the efficacy of Alan's programs, including the Alcohol Skills Training Program (ASTP) and Brief Alcohol Screening and Intervention for College Students (BASICS), in addition to extensions of these interventions in more recent studies. Finally, we discuss how Alan's work influences interventions with college student drinkers today, and how future directions will continue to be informed by his vision and values.