Therapy outcomes associated with prescription cannabidiol use at 12 months post-initiation.

OBJECTIVE: This study evaluated prescription cannabidiol (CBD) outcomes during the first 12 months of therapy. METHODS: A single-center, prospective cohort study was performed including patients prescribed CBD from January 2019 - April 2020, excluding clinical trial patients and those using external specialty pharmacy services. The primary outcome wasepilepsy-related emergency healthcare service (EHS) use within 12 months of initation. Secondary outcomes included prescription CBD discontinuation rate and reason and concomitant anti-seizure medication (ASM) use. A multiple logistic regression model evaluated the odds of EHS use, adjusting for initial concomitant ASM count, age, and insurance type. RESULTS: The 136 patients included were 85% white, 50% female, and 68% pediatric. EHS utilization occurred in 37% (n = 50) of patients; 29 patients (21%, n = 20 pediatric, n = 9 adult) had at least one emergency department (ED) visit, 9 patients (7%) had two or more; 30 patients (22%, n = 22 pediatric, n = 8 adult) had at least one hospitalizaion. Median time to first ED and hospitalization was 69 (IQR 31-196) and 104 (IQR 38-179) days, respectively. Prescription CBD was discontinued in 31 patients (23%, n = 18 pediatric, n = 13 adult), due to major side effects (n = 12, 39%), common side effects (n = 11, 36%), and unsatisfactory response (n = 11, 36%). There was no significant change in concomitant ASM use. CONCLUSION: Despite potential benefits of prescription CBD, many patients utilize EHSs in the first 12 months of treatment with minimal changes in concomitant ASM use.

TRAV26-2 T-Cell Receptor Expression Is Associated With Mucosal Lymphocyte Response to Wheat Proteins in Patients With Functional Dyspepsia.

INTRODUCTION: An association between functional dyspepsia (FD) and wheat-containing foods has been reported in observational studies; however, an adaptive response has not been demonstrated. We examined whether antigens present in wheat could provoke a response from FD duodenal lymphocytes. METHODS: Lamina propria mononuclear cells (LPMCs) were isolated from duodenal biopsies from 50 patients with FD and 23 controls. LPMCs were exposed to gluten (0.2 mg/mL) or gliadin (0.2 mg/mL) for 24 hours. Flow cytometry was performed to phenotype lymphocytes. Quantitative PCR was used to measure the expression of gliadin-associated T-cell receptor alpha variant ( TRAV ) 26-2. RESULTS: In response to gliadin (but not gluten) stimulation, the effector Th2-like population was increased in FD LPMCs compared with that in controls and unstimulated FD LPMCs. Duodenal gene expression of TRAV26- 2 was decreased in patients with FD compared with that in controls. We identified a positive association between gene expression of this T-cell receptor variant and LPMC effector Th17-like cell populations in patients with FD, but not controls after exposure to gluten, but not gliadin. DISCUSSION: Our findings suggest that gliadin exposure provokes a duodenal effector Th2-like response in patients with FD, supporting the notion that food antigens drive responses in some patients. Furthermore, these findings suggest that altered lymphocyte responses to wheat proteins play a role in FD pathogenesis.

Evaluation of a simulation-based learning activity for communicating about at-risk opioid behaviors in a community pharmacy setting.

INTRODUCTION: The purpose of our study was to evaluate a learning activity that included an objective structured learning examination (OSLE) focused on identifying and communicating at-risk opioid behaviors in a community pharmacy setting through student perceptions and OSLE performance. METHODS: The activity included a didactic lecture and an OSLE with two opioid use patient cases. Third-year pharmacy students' communication skills were evaluated using faculty-created rubrics. A voluntary, anonymous pre-/post-survey evaluated students' skills confidence and OSLE satisfaction. Responses were analyzed using independent t-tests. An inductive conventional content analysis identified the impact on students' perceptions and future behaviors from post-simulation reflections. RESULTS: One hundred forty-three and 111 students completed the pre- and post-surveys, respectively. Students self-reported confidence in their ability to identify red flags and assess at-risk opioid behaviors, counsel on opioid risk behaviors, refuse opioid prescription fills, and respond to patients' nonverbal responses, all significantly improved pre-to-post. Students reported the OSLE was beneficial to their learning. The mean overall OSLE score was 34.2 out of 45 points (SD ± 6.21). Identified student reflection themes included: importance of patient-centered care, pharmacists' role in patients with at-risk opioid behaviors, recognition of judgement against patients taking opioids, and importance of communication and empathy as strategies to mitigate conflict. CONCLUSIONS: Implementing a new learning activity focused on communication regarding at-risk opioid behaviors allowed students to engage in difficult conversations with standardized patients in a safe simulation environment. Students demonstrated competent skills, increased their self-reported confidence, and were highly satisfied with the learning activity.

Implementation and evaluation of simulations in a required course to improve empathy of pharmacy students.

INTRODUCTION: It is essential for health care professionals to display empathy when communicating with patients. Therefore, empathy is an important skill to teach health care professional students. The objective of this study was to examine the effect of a course enhancement consisting of formal instruction and application-based simulations on empathy in pharmacy students. METHODS: The Jefferson Scale of Empathy for Health Profession Students (JSE-HPS) was administered at the start of the semester and again at the end of the 16-week required course for third-year pharmacy students. Differences in the mean scores were analyzed using a paired t-test. An inductive conventional content analysis approach was utilized to analyze end of the course reflections about empathy by two investigators. RESULTS: On the pre-survey (n = 140), the empathy scores ranged from 86 to 140 (mean 113.8). On the postsurvey (n = 73), scores ranged from 93 to 137 (mean 117.5). A statistically significant increase in students' empathy scores on the JSE-HPS was observed following the completion of the course (P = .006). The main themes that emerged from the students' reflections were the impact of empathy on patient-centered care and the importance of patient-provider relationships. Students also discussed the development and use of empathy skills. CONCLUSIONS: A combination of didactic and skills-based training led to an improvement in empathy in third-year pharmacy students. Student comments highlighted the value of practicing empathy skills in a simulated environment.

Acceptability of extending HPV-based cervical screening intervals from 3 to 5 years: an interview study with women in England.

OBJECTIVES: The introduction of primary Human Papillomavirus (HPV) testing in the National Health Service (NHS) Cervical Screening Programme in England means the screening interval for 25-49 years can be extended from 3 to 5 years. We explored women's responses to the proposed interval extension. METHODS: We conducted semi-structured phone/video interviews with 22 women aged 25-49 years. Participants were selected to vary in age, socioeconomics and screening history. We explored attitudes to the current 3-year interval, then acceptability of a 5-year interval. Interviews were transcribed verbatim and analysed using framework analysis. RESULTS: Attitudes to the current 3-year interval varied; some wanted more frequent screening, believing cancer develops quickly. Some participants worried about the proposed change; others trusted it was evidence based. Frequent questions concerned the rationale and safety of longer intervals, speed of cancer development, the possibility of HPV being missed or cell changes occurring between screens. Many participants felt reassured when the interval change was explained alongside the move to HPV primary screening, of which most had previously been unaware. CONCLUSIONS: Communication of the interval change should be done in the context of broader information about HPV primary screening, emphasising that people who test negative for HPV are at lower risk of cell changes so can safely be screened every 5 years. The long time needed for HPV to develop into cervical cancer provides reassurance about safety, but it is important to be transparent that no screening test is perfect.

Testing key messages about extending cervical screening intervals.

OBJECTIVES: We tested the impact of different messages about the rationale for extended cervical screening intervals on acceptability of an extension. METHODS: Women in England aged 25-49 years (n = 2931) were randomised to a control group or one of 5 groups given different messages about extending cervical screening intervals from 3 to 5 years. Outcome measures were general acceptability and six components from the Theoretical Framework of Acceptability (TFA). RESULTS: The groups who saw additional messages (47-63%) were more likely to find the change acceptable than controls (43%). Messages about interval safety, test accuracy and speed of cell changes resulted in more positive affective-attitudes, higher ethicality beliefs, a better understanding of the reasons for extended intervals and greater belief in the safety of 5-year intervals. Being up-to-date with screening and previous abnormal results were associated with finding 5-yearly screening unacceptable. CONCLUSIONS: Emphasising the slow development of cell changes following an HPV negative result and the safety of longer intervals, alongside the accuracy of HPV primary screening is important. PRACTICAL IMPLICATIONS: Campaigns explaining the rationale for extended cervical screening intervals are likely to improve acceptability. Though women who feel at increased risk, may remain worried even when the rationale is explained.

Design of a Novel Intervention Model to Address Cardiovascular Health Disparities in the Rural Underserved Community of Phillips County Arkansas.

Devastating health-related disparities driven by an entanglement of factors disproportionately impact the underserved, low-wealth, and minority community of Phillips county (PC) in the Arkansas Delta Region (ADR). Cardiovascular disease continues to increase with widespread consequences on the local economy, health care systems, and population. Health care and community-based systems have been unsuccessful in reducing out-of-hospital cardiac death, particularly in the ADR, for many reasons. Herein, we share the strategy behind, planning, and goals of The Arkansas Lincoln Project, a novel neighborhood-based strategy bridging the gap between residents, social resources, and health care services in PC.

Patient-reported experiences and views on the Cytosponge test: a mixed-methods analysis from the BEST3 trial.

OBJECTIVES: The BEST3 trial demonstrated the efficacy and safety of the Cytosponge-trefoil factor 3, a cell collection device coupled with the biomarker trefoil factor 3, as a tool for detecting Barrett's oesophagus, a precursor of oesophageal adenocarcinoma (OAC), in primary care. In this nested study, our aim was to understand patient experiences. DESIGN: Mixed-methods using questionnaires (including Inventory to Assess Patient Satisfaction, Spielberger State-Trait Anxiety Inventory-6 and two-item perceived risk) and interviews. OUTCOME MEASURES: Participant satisfaction, anxiety and perceived risk of developing OAC. SETTING: General practices in England. PARTICIPANTS: Patients with acid reflux enrolled in the intervention arm of the BEST3 trial and attending the Cytosponge appointment (N=1750). RESULTS: 1488 patients successfully swallowing the Cytosponge completed the follow-up questionnaires, while 30 were interviewed, including some with an unsuccessful swallow.Overall, participants were satisfied with the Cytosponge test. Several items showed positive ratings, in particular convenience and accessibility, staff's interpersonal skills and perceived technical competence. The most discomfort was reported during the Cytosponge removal, with more than 60% of participants experiencing gagging. Nevertheless, about 80% were willing to have the procedure again or to recommend it to friends; this was true even for participants experiencing discomfort, as confirmed in the interviews.Median anxiety scores were below the predefined level of clinically significant anxiety and slightly decreased between baseline and follow-up (p < 0.001). Interviews revealed concerns around the ability to swallow, participating in a clinical trial, and waiting for test results.The perceived risk of OAC increased following the Cytosponge appointment (p<0.001). Moreover, interviews suggested that some participants had trouble conceptualising risk and did not understand the relationships between test results, gastro-oesophageal reflux and risk of Barrett's oesophagus and OAC. CONCLUSIONS: When delivered during a trial in primary care, the Cytosponge is well accepted and causes little anxiety. TRIAL REGISTRATION NUMBER: ISRCTN68382401.

E-Cigarette or Vaping Associated Lung Injury: Evolving Threat to Healthy Teens.

Vaping quickly rose in popularity once introduced to the market in 2003. Devices heat liquid to produce an aerosol that is inhaled by the user, an aerosol that can contain nicotine, heavy metals, volatile organic compounds, ultrafine particles, cancer-causing chemicals, and flavoring. Teenagers commonly use these products to smoke cannabinoids including delta-9-tetrahydrocannabinol (THC), cannabidiol (CBD), and butane hash oil (BHO). Liquids placed in the devices can be commercial or homemade. As popularity increased, more cases of vaping-related lung injury have been reported. We report a case of a 17-year-old female patient with delayed diagnosis of e-cigarette or vaping associated lung injury.

T-helper 22 cells develop as a distinct lineage from Th17 cells during bacterial infection and phenotypic stability is regulated by T-bet.

CD4+ T-helper 22 (Th22) cells are a phenotypically distinct lymphocyte subset that produces high levels of interleukin (IL)-22 without co-production of IL-17A. However, the developmental origin and lineage classification of Th22 cells, their interrelationship to Th17 cells, and potential for plasticity at sites of infection and inflammation remain largely undefined. An improved understanding of the mechanisms underpinning the outgrowth of Th22 cells will provide insights into their regulation during homeostasis, infection, and disease. To address this knowledge gap we generated 'IL-17A-fate-mapping IL-17A/IL-22 reporter transgenic mice' and show that Th22 cells develop in the gastrointestinal tract and lung during bacterial infection without transitioning via an Il17a-expressing intermediate, although in some compartments alternative transition pathways exist. Th22-cell development was not dependent on T-bet; however, this transcription factor functioned as a promiscuous T-cell-intrinsic regulator of IL-17A and IL-22 production, in addition to regulating the outgrowth, phenotypic stability, and plasticity of Th22 cells. Thus, we demonstrate that at sites of mucosal bacterial infection Th22 cells develop as a distinct lineage independently of Th17 cells; though both lineages exhibit bidirectional phenotypic flexibility within infected tissues and their draining lymph nodes, and that T-bet plays a critical regulatory role in Th22-cell function and identity.

Determining the impact of an interprofessional simulation focused on social determinants of health among pharmacy students.

INTRODUCTION: The purpose of this study was to determine the impact on pharmacy students' self-perception of knowledge, skills, collaborative behavior, and satisfaction after participating in an interprofessional (IP) simulation focused on social determinants of health (SDOH) and substance use. METHODS: Pharmacy students completed a voluntary questionnaire after participating in an IP simulation focused on SDOH and substance use where they collaborated with social work (SW) students. Questions assessed the students' understanding and knowledge of SDOH and students' confidence in asking patients about their substance use, willingness to refer patients to SW, and satisfaction with the simulation. The data were analyzed using a Wilcoxon signed-rank test. RESULTS: Results of pharmacy students' (N = 68) self-reported knowledge of SDOH and skills addressing and counseling on SDOH were improved following an IP simulation. No statistically significant change was observed in students' confidence when asking about or advising a patient on their substance use. There was a positive, significant change in how likely pharmacy students would refer patients to SW (P < .001) in their future practice. CONCLUSIONS: This simulation proved to be an effective way to improve pharmacy students' self-reported knowledge of SDOH and skills for assessing and counseling on resources for SDOH. The simulation was effective in exposing pharmacy students to the role of social workers on the team and how they address SDOH and substance use issues.

Visceral fat reduction and increase of intracellular fluid in weight loss participants on antihypertension medication.

OBJECTIVES: Complex physiological interactions between hypertension and obesity contribute to and perpetuate a heightened morbidity and mortality. With the prevalence of both hypertension and obesity reaching epidemic proportions, we asked whether antihypertensive medications affect the ability of participants to achieve the same level of body composition improvements as other participants in a comprehensive weight loss program focused on reduction of visceral adipose tissue. METHODS: Data was analyzed from 2200 subjects completing a commercially available, expert supervised weight loss program including ~6 weeks of a proprietary, nutritionally complete, very low-calorie diet (VLCD) followed by a ~3-week structured transition back to a normal dietary intake. Overall, 33% of the subjects reported taking at least one prescription antihypertensive medication. RESULTS: Our data show participants in both groups (± antihypertensive drugs) achieved clinically relevant and statistically significant improvements in standard measures of weight loss and endpoints directly related to inflammation and hypertension. CONCLUSION: A nonpharmacologic, nonsurgical VLCD-based weight loss and metabolic health program is capable of producing clinically meaningful improvements in body composition and physiological endpoints, including those linked to hypertension, cardiovascular disease and inflammation, and is as equally effective for adults taking prescription antihypertensives as it is for those participants who are not.

Leveraging goals to incentivize healthful behaviors across adulthood.

Despite abundant evidence for the benefits of physical activity on aging trajectories, older Americans remain largely inactive. The present study was designed to examine age differences in responsiveness to financial incentives to increase walking. Grounded in socioemotional selectivity theory, we examined the effectiveness of financial incentives that varied in prosociality. Three types of incentives were presented to community-residing adults 18-92 years of age (N = 450). Participants were randomly assigned to 1 of 5 conditions: personal, loved one, charity, choice, or a no-incentive control group. Average daily step counts were measured using pedometers during a baseline week, during the incentivized period, and after the incentivized period ended. Overall, financial incentives significantly increased walking compared to a control group. Whereas personal incentives were effective regardless of age, incentives to earn for charities were starkly more effective in older adults than younger adults. Moreover, 1 week after the incentivized period ended, older participants were more likely to maintain increased step counts, whereas younger people reverted to baseline step counts. Findings suggest that financial incentives can increase walking in a wide age range and that charitable incentives may be especially effective in health interventions targeting older adults. The importance of aligning incentives with age-related goals is discussed. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Age Advantages in Emotional Experience Persist Even Under Threat From the COVID-19 Pandemic.

The COVID-19 pandemic is creating unprecedented, sustained, and unavoidable stress for the entire population, and older people are facing particularly heightened risk of contracting the virus and suffering severe complications, including death. The present study was conducted when the pandemic was spreading exponentially in the United States. To address important theoretical questions about age differences in emotional experience in times of crisis, we surveyed a representative sample of 945 Americans between the ages of 18 and 76 years and assessed the frequency and intensity of a range of positive and negative emotions. We also assessed perceived risk of contagion and complications from the virus, as well as personality, health, and demographic characteristics. Age was associated with relatively greater emotional well-being both when analyses did and did not control for perceived risk and other covariates. The present findings extend previous research about age and emotion by demonstrating that older adults' relatively better emotional well-being persists even in the face of prolonged stress.

Trainee Research Related to the Opioid-Related Activities Database Abstracts Presented at the 121st Virtual Annual Meeting of the American Association of Colleges of Pharmacy, July 13-31, 2020: Implementing an Activity to Identify and Communicate about At-Risk Opioid Behaviors in a Community Pharmacy.

Objective. To evaluate the effectiveness of an opioid objective structured learning experience (OSLE) focused on identifying and communicating about at-risk opioid behaviors in a community practice setting. Methods. A literature search included a review of the AACP Opioid-Related Activities Database that identified and evaluated educational activities, such as the RESPOND program (Oregon State University), that focused on communication surrounding opioids. A lack of activities emphasizing how to convey concerns about at-risk behaviors and refuse to fill opioid prescriptions in the AACP database was noted. With permission, aspects of the RESPOND program were utilized to develop a new opioid activity that included a didactic lecture and OSLE. The OSLE included two cases where students refused to fill an opioid prescription and counseled a patient demonstrating at-risk opioid behaviors on an opioid prescription. Student communication was evaluated by rubrics that were created and adapted from other activities included in the AACP database. A voluntary and anonymous survey that utilized a Likert scale (strongly agree to strongly disagree) evaluated student confidence in their skills and satisfaction with the activity before and after the OSLE. Results. One hundred forty-four and one hundred nine students completed the pre- and post- surveys, respectively. After the OSLE, student confidence in their ability to assess at-risk opioid behaviors, counsel a patient demonstrating at-risk behaviors, refuse to fill an opioid prescription, and respond to a patient's nonverbal responses improved by 67%, 37%, 49%, 46%, respectively. A majority of students (81%) felt that practicing these skills in an OSLE was beneficial. Conclusion. Incorporating an opioid OSLE allowed students to practice engaging in difficult conversations with patients demonstrating at-risk opioid behaviors and improved student's self-reported confidence. A majority of students agreed the OSLE was beneficial.

Resolution of Metabolic syndrome with reduction of visceral adipose tissue in a 47 year old patient with Type 2 Diabetes Mellitus.

BACKGROUND AND AIMS: Metabolic syndrome (MetS), defined as a cluster of metabolic abnormalities including visceral adiposity, insulin resistance, hypertension, and dyslipidemia, now affects more than a third of adults in the United States highlighting the need for effective complementary approaches to current treatments. METHODS: We present a case report of a 47-year-old man with a history of MetS and poorly controlled Type 2 Diabetes Mellitus (T2D) who completed a 20Lighter program (20L) including a very low calorie diet (VLCD). At the time of enrollment his BMI was 32.7, HbA1c was 9.6%, and prescription medication history included lisinopril, lovastatin, and metformin, glimepiride, and combination sitagliptin/metformin. RESULTS: Fifteen weeks after beginning 20L (6 weeks after program completion) marked reduction of weight, visceral adipose tissue and normalization of HbA1C was seen, and all medications were withdrawn. CONCLUSIONS: While longer follow-up is required, this case report shows that a comprehensive program including a relatively short period of nutritionally complete VLCD, followed by gradual return to moderate dietary lifestyle is capable of producing clinically significant improvements in health and quality of life in individuals with MetS and poorly controlled T2D.