Does Engaging Patients with Relevant Education About Long-Term Opioid Use Before Spine Surgery Affect Long-term Opioid Use? A Randomized Controlled Trial.

STUDY DESIGN: Parallel-arm randomized controlled trial. OBJECTIVE: To assess the effectiveness of an enhanced video education session highlighting risks of opioid utilization on longterm opioid utilization after spine surgery. SUMMARY OF BACKGROUND DATA: Long-term opioid use occurs in more than half of patients undergoing spine surgery and strategies to reduce this use are needed. METHODS: Patients undergoing spine surgery at Brooke Army Medical Center between July 2015 and February 2017 were recruited at their preoperative appointment, receiving the singlesession interactive video education or control at that same appointment. Opioid utilization was tracked for the full year after surgery from the Pharmacy Data Transaction Service of the Military Health System Data Repository. Self-reported pain also collected weekly for 1 and at 6months. RESULTS: A total of 120 participants (40 women, 33.3%) with a mean age of 45.9 ±â€Š10.6 years were randomized 1:1 to the enhanced education and usual care control (60 per group). In the year following surgery the cohort had a mean 5.1 (standard deviation [SD] 5.9) unique prescription fills, mean total days' supply was 88.3 (SD 134.9), and mean cumulative morphine milligrams equivalents per participant was 4193.0 (SD 12,187.9) within the year after surgery, with no significant differences in any opioid use measures between groups. Twelve individuals in the standard care group and 13 in the enhanced education group were classified with having long-term opioid utilization. CONCLUSION: The video education session did not influence opioid use after spine surgery compared to the usual care control. There was no significant difference in individuals classified as long-term opioid users after surgery based on the intervention group. Prior opioid use was a strong predictor of future opioid use in this cohort. Strategies to improve education engagement, understanding, and decision- making continue to be of high importance for mitigating risk of long-term opioid use after spine surgery.Level of Evidence: 1.

Smoking Cessation Messages for Pregnant Aboriginal and Torres Strait Islander Women: A Rapid Review of Peer-Reviewed Literature and Assessment of Research Translation of Media Content.

This review summarized literature about knowledge, attitudes, and beliefs of Aboriginal and Torres Strait Islander women from Australia who smoke during pregnancy, then examined the extent that existing health promotion materials and media messages aligned with evidence on smoking cessation for pregnant Aboriginal and Torres Strait Islander women. Knowledge, attitudes, and beliefs of pregnant Aboriginal women who smoke tobacco were identified in the literature. Health promotion campaigns were retrieved from a grey literature search with keywords and social and professional networks. Key themes from peer-reviewed papers were compared against the content of health promotion campaigns using the Aboriginal Social and Emotional Wellbeing Model, the Behavior Change Wheel and thematic analysis. Eleven empirical studies and 17 campaigns were included. Empirical studies highlighted women sought holistic care that incorporated nicotine replacement therapy, engaged with their family and community and the potential for education about smoking cessation to empower a woman. Health promotion campaigns had a strong focus on 'engagement with family and community', 'knowledge of risks of smoking,' 'giving up vs cutting down' and 'culture in language and arts'. There were similarities and variances in the key themes in the research evidence and promotion materials. Topics highly aligned included risks from smoking and quitting related issues.

Amidinate salt of hexafluoroacetone hydrate for the preparation of fluorinated compounds by the release of trifluoroacetate.

A powerful, new reagent, an amidinate salt of hexafluoroacetone hydrate, is an air-stable salt that can be used for the preparation of fluorinated organic molecules. Nucleophilic trifluoromethylation reactions are demonstrated following the base-promoted release of trifluoroacetate. This reagent is soluble in many polar organic solvents and produces fluoroform, following the release of trifluoroacetate. Reactions with this reagent and common electrophiles provide excellent yields of trifluoromethylated products.

Poly(glycerol sebacate)-engineered plugs to repair chronic tympanic membrane perforations in a chinchilla model.

OBJECTIVE: To evaluate the degree of neovascularization and efficacy of repair of chronic tympanic membrane perforations in a chinchilla model using poly(glycerol sebacate) (PGS), a novel bioengineered scaffold material. STUDY DESIGN: A feasibility study in which chinchilla ears with chronic perforations were randomly assigned to repair with PGS plugs or Gelfilm overlay myringoplasty. SETTING: Interventions were performed in the animal care facility of a tertiary care academic institution. SUBJECTS AND METHODS: Sixteen adult female chinchillas. Perforations were established under microscopic visualization with thermal cautery. The animals were examined six weeks later, and those ears with stable perforations were randomly assigned to repair with PGS or Gelfilm. All ears were evaluated six weeks after repair, and resected membranes underwent histological evaluation. RESULTS: Chronic perforations were established in 22 of 32 (69%) chinchilla tympanic membranes. Nineteen tympanic membranes were included in the study group (3 ears were excluded secondary to death from anesthesia during the repair); 11 were implanted with PGS, and eight underwent Gelfilm myringoplasty. Of the 11 tympanic membranes implanted with PGS, 10 were healed at six weeks, while six of the eight tympanic membranes repaired with Gelfilm had healed at six weeks. Imaging of the medial mucosal and lateral epithelial surfaces of the tympanic membranes revealed PGS plug incorporation with neovascularization. Histology demonstrated a confluent cell layer on both sides of the graft. CONCLUSIONS: PGS plugs are easily placed and allow for perforation closure and graft neovascularization in a chinchilla model.

Incretin levels and effect are markedly enhanced 1 month after Roux-en-Y gastric bypass surgery in obese patients with type 2 diabetes.

OBJECTIVE: Limited data on patients undergoing Roux-en-Y gastric bypass surgery (RY-GBP) suggest that an improvement in insulin secretion after surgery occurs rapidly and thus may not be wholly accounted for by weight loss. We hypothesized that in obese patients with type 2 diabetes the impaired levels and effect of incretins changed as a consequence of RY-GBP. RESEARCH DESIGN AND METHODS: Incretin (gastric inhibitory peptide [GIP] and glucagon-like peptide-1 [GLP-1]) levels and their effect on insulin secretion were measured before and 1 month after RY-GBP in eight obese women with type 2 diabetes and in seven obese nondiabetic control subjects. The incretin effect was measured as the difference in insulin secretion (area under the curve [AUC]) in response to an oral glucose tolerance test (OGTT) and to an isoglycemic intravenous glucose test. RESULTS: Fasting and stimulated levels of GLP-1 and GIP were not different between control subjects and patients with type 2 diabetes before the surgery. One month after RY-GBP, body weight decreased by 9.2 +/- 7.0 kg, oral glucose-stimulated GLP-1 (AUC) and GIP peak levels increased significantly by 24.3 +/- 7.9 pmol x l(-1) x min(-1) (P < 0.0001) and 131 +/- 85 pg/ml (P = 0.007), respectively. The blunted incretin effect markedly increased from 7.6 +/- 28.7 to 42.5 +/- 11.3 (P = 0.005) after RY-GBP, at which it time was not different from that for the control subjects (53.6 +/- 23.5%, P = 0.284). CONCLUSIONS: These data suggest that early after RY-GBP, greater GLP-1 and GIP release could be a potential mediator of improved insulin secretion.

Obese subjects respond to the stimulatory effect of the ghrelin agonist growth hormone-releasing peptide-2 on food intake.

OBJECTIVE: The administration of the growth hormone (GH) secretagogue GH-releasing peptide (GHRP)-2, like ghrelin, increases food intake (FI) in lean healthy men. The aim of this study was to investigate whether this effect occurs in obese subjects and whether it is dose-dependent. RESEARCH METHODS AND PROCEDURES: Nineteen subjects (10 lean and nine obese), all healthy and weight stable, received a double-blind randomized subcutaneous infusion of GHRP-2 at high dose (HD; 1 mug/kg per hour), low dose (0.1 microg/kg per hour), or placebo for 270 minutes over three study visits. Blood for hormone assays was collected through an intravenous forearm catheter. Hunger and fullness were rated on visual analog scales before and after a fixed breakfast (320 kcal at 120 minutes) and a buffet lunch at 240 minutes. Before lunch, subjects received taped instructions to eat as much as they wanted. RESULTS: GHRP-2 infusion significantly increased ad libitum FI in a dose-dependent manner by 10.2 +/- 3.9% at low dose (p = 0.011) and by 33.5 +/- 5.8% at HD (p = 0.000) compared with placebo. Obesity status did not influence the effect of GHRP-2 on FI. All subjects had greater ratings of appetite before but similar levels of fullness after the meal with the HD GHRP-2. Serum GH levels increased dose dependently in all subjects. DISCUSSION: The dual stimulatory effect of GHRP-2 on FI and human GH is dose dependent. Obese individuals retain their ability to respond to GHRP-2 both in terms of FI and human GH.

Inhibiting endogenous cortisol blunts the meal-entrained rise in serum leptin.

CONTEXT: Administration of glucocorticoids increases serum leptin levels in lean and obese individuals. A morning meal produces an increase in insulin, a cortisol peak, and an increase in leptin; these changes do not occur during fasting. OBJECTIVE: The objective of this study was to investigate whether inhibiting endogenous cortisol secretion with metyrapone decreases 24-h serum leptin levels and to determine whether a meal-related midmorning surge in cortisol is a prerequisite for the meal-entrained nocturnal rise in leptin. DESIGN: This was a randomized, cross-over study. SETTING: The study was performed at the General Clinical Research Center. PARTICIPANTS: Lean males were studied. INTERVENTION: In study 1, seven lean men were studied for 24 h while their endogenous cortisol secretions were manipulated as follows: 1) CONTROL; 2) cortisol suppression by metyrapone (MET); and 3) MET and oral hydrocortisone (at 0900 h) (MET + CORT). Subjects were all fed a eucaloric diet (two meals at 1100 and 1700 h). In study 2, six men were studied without pharmacological intervention for 24 h on two occasions: once under a complete fast (FAST) and once in a feeding condition (one meal at 1100 h; FED). MAIN OUTCOME MEASURE: The main outcome measure was serum leptin. RESULTS: MET significantly suppressed serum cortisol at 0800 h, midmorning, and over the 24-h period. As a result of cortisol suppression, 24-h serum leptin levels were decreased vs. control values despite similar insulin responses to meals. Administering a single dose of hydrocortisone to MET subjects potently stimulated serum leptin compared with the effect of MET alone. CONCLUSIONS: Our data demonstrate that endogenous cortisol secretion is necessary for the maintenance of serum leptin levels over 24 h in lean, normally fed males.