Joint Dysfunctionality Alleviation along with Systemic Inflammation Reduction Following Arthrocen Treatment in Patients with Knee Osteoarthritis: A Randomized Double-Blind Placebo-Controlled Clinical Trial.

Background and objectives: Many mediators and cytokines are involved in the pathogenesis of osteoarthritis (OA). Some of these cytokines are spontaneously expressed by cultured fibroblast-like synoviocytes. Therefore, using serum samples, the efficacy and the effects of avocado/soy unsaponifiables, ASU, (Arthrocen) on cytokine changes were assessed in patients with knee OA (KOA). Materials and Methods: Experimental procedure: A randomized, double-blind, placebo-controlled clinical trial was conducted on patients with a diagnosis of mild to moderate OA who received either Arthrocen 300 mg/day (n = 61) or placebo (n = 58) for 3 months. Data collection was performed using questionnaires including the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), 20-item short form survey (SF-20), Lequesne index of severity for osteoarthritis of the knee (LISOK), and three visual analog scales (VASs) as pain quality indices. The serum levels of interleukins 2 (IL-2), IL-4, IL-10, IL-17α, and TNF-α were measured using an ELISA reader. Results: Both quality of life indices, pain sensation and scored by specialists (as VASs), respectively, including WOMAC and SF-20, as well as joint dysfunctionality symptoms assessed by physicians were significantly improved (p < 0.05) in OA patients receiving Arthrocen. The serum levels of anti-inflammatory interleukins 4 and 10 were also augmented, while levels of inflammatory IL-17 and TNF-ɑ cytokines were decreased significantly (p < 0.05) compared with the control groups during the 3- and 6-month treatment. Conclusions: Arthrocen consumption may increase the quality of life in OA patients through amelioration of inflammation and improvement of functional activities without any adverse effects in the long term.

Dual BRAF/MEK therapy in BRAF V600E-mutated primary brain tumors: a case series showing dramatic clinical and radiographic responses and a reduction in cutaneous toxicity.

OBJECTIVE: BRAF V600E is a common oncogenic driver in a variety of primary brain tumors. Dual inhibitor therapy using dabrafenib (a selective oral inhibitor of several mutated forms of BRAF kinase) and trametinib (a reversible inhibitor of MEK1 and MEK2) has been used successfully for treatment of metastatic melanoma, anaplastic thyroid cancer, and other tumor types, but has been reported in only a few patients with primary brain tumors and none with pleomorphic xanthoastrocytoma. Here, the authors report on the substantial clinical response and reduction in cutaneous toxicity in a case series of BRAF V600E primary brain cancers treated with dual BRAF/MEK inhibitor therapy. METHODS: The authors treated 4 BRAF V600E patients, each with a different type of primary brain tumor (pilocytic astrocytoma, papillary craniopharyngioma, ganglioglioma, and pleomorphic xanthoastrocytoma) with the combination of dabrafenib and trametinib. RESULTS: The patients with pilocytic astrocytoma, pleomorphic xanthoastrocytoma, and papillary craniopharyngioma experienced near-complete radiographic and complete clinical responses after 8 weeks of therapy. A substantial partial response (by RANO [Response Assessment in Neuro-Oncology] criteria) was observed in the patient with ganglioglioma. The patient with craniopharyngioma developed dramatic, diffuse verrucal keratosis within 2 weeks of starting dabrafenib. This completely resolved within 2 weeks of adding trametinib. CONCLUSIONS: Dual BRAF/MEK inhibitor therapy represents an exciting treatment option for patients with BRAF V600E primary brain tumors. In addition to greater efficacy than single-agent dabrafenib, this combination has the potential to mitigate cutaneous toxicity, one of the most common and concerning BRAF inhibitor-related adverse events.

Re-envisioning clinical education for nurse practitioner programs: themes from a national leaders' dialogue.

As the need for primary care providers increases, nursing education programs face significant challenges to meet future workforce needs. A more resource-efficient approach for the clinical education of nurse practitioner students is needed. A think tank involving 20 thought leaders representing multiple disciplines was convened to discuss this issue. This article presents seven themes that emerged from this national leaders' dialog: academic practice co-design, standardized preclinical preparation, standardized student assessment, entrustable professional activities, immersive clinical experiences, interprofessional education for team-based care, and innovative education practices.

Comparison of waiting and consultation times in convenient care clinics and physician offices: a cross-sectional study.

This study measures waiting times and consultation times at convenient care clinics (CCCs), and compares them with equivalent times in traditional, family practice, physician offices. The analysis was limited to conditions most commonly treated at CCCs. It was found that patients using CCCs had significantly shorter waiting times from check-in to seeing a clinician than the equivalent waiting times reported by patients at family practice physicians' offices and that CCC patients had significantly longer consultation times with the clinician than those reported by family practice patients. Applying a correction factor to adjust for potential differences between real waiting times and perceived waiting times did not substantially alter the conclusions. Shorter waiting times may increase satisfaction and thereby encourage patients to seek care; and spending additional time with the clinician may help ensure that all of a patient's concerns or questions are addressed. This study provides objective evidence from a large database that CCCs provide prompt, satisfying care.

Insights on allergic rhinitis from the patient perspective.

Although intranasal steroid sprays are the preferred treatment of the majority of health care providers, this opinion is not carried through to patient treatment. Approximately two-thirds of adults with nasal allergy symptoms report that they use over-the-counter, nonprescription medicines, and only one-third report that they use an intranasal steroid spray. Lack of familiarity and poor patient awareness are key barriers to intranasal steroid spray use. Dissatisfaction related to side effects among users of these medications leads some of those who are familiar with intranasal steroid sprays to discontinue use after it has been prescribed. Improved health care provider­patient communication and education is a vital step toward improving the long-term management of allergic rhinitis.

After-hours Access of Convenient Care Clinics and Cost Savings Associated With Avoidance of Higher-Cost Sites of Care.

This study examines the utilization of convenient care clinic services outside of typical physician office hours and estimates the cost savings from potentially avoided visits to the emergency room, urgent care center, and primary care physician associated with convenient care clinic encounters. The results show that 44.6% of convenient care clinic visits occurred on weekdays, 5 pm or later, or on weekends. Savings from avoided encounters with the emergency room, urgent care, and primary care physician were estimated at $135.53 million.

Convenient care clinics: the future of accessible health care--the formation years 2006-2008.

In the 2 years since the Convenient Care Association (CCA), a nonprofit organization representing the members of the Convenient Care industry, was founded, this new model has gained significant traction in the health care marketplace and in the awareness of health care consumers. When the CCA was formed, fewer than 200 clinics were in operation. Now, there are more than 1000 clinics seeing patients, and more than 3.5 million patient visits have been recorded across the country. As the industry has expanded, some challenges have arisen, mostly in the form of legislative and regulatory initiatives aimed at impeding clinic operation. The CCA and its members continue to undertake substantial efforts to build comprehensive quality processes into the convenient care model. The effect of these measures has been to mitigate the allegations of poor quality and inconsistent care that have been levied against the clinics. The media and public responses have been generally positive, and policy makers and other decision makers have been receptive to the benefits convenient care can offer to their constituents.

Perceived barriers to community-based health promotion program participation.

OBJECTIVES: To examine barriers and self-efficacy relative to attendance at a cardiovascular risk reduction program. METHODS: Subjects (N=161) represented 3 levels of program participation: full, minimum, and none. Survey scales for barriers to attendance and health behavior change, food security, and self-efficacy for nutrition and physical activity were administered. RESULTS: Minimum and no-exposure participants perceived significantly more barriers to attendance than did the full-exposure participants (P<0.05); barriers to health behavior change were not significantly different. Self-efficacy for nutrition and physical activity were not significantly different among the groups. CONCLUSIONS: Health promotion programs need to consider anytime, any place modes of program delivery to address "program day and time" and "no time to attend" barriers perceived by target audiences.

Convenient care clinics: the future of accessible health care.

The need for accessible, affordable, quality health care in the United States has never been greater. In response to this need, convenient care clinics (CCCs) are being launched across the country to help provide care to meet the basic health needs of the public. In CCCs, highly qualified health care providers diagnose and treat common health problems, triage patients to the appropriate level of care, advocate for a medical home for all patients, and reduce unnecessary visits to emergency rooms and Urgent Care Clinics. CCCs have been called a "disruptive innovation" because they are consumer driven. They serve as a response to many patients who are unhappy with the current conventional health care delivery system--a system that is challenged to provide access to basic health care services when people need it the most. CCCs are based in retail stores and pharmacies. They are primarily staffed by nurse practitioners (NPs). Some CCCs are staffed by physician assistants (PAs) and physicians. The authors acknowledge the important roles of both PAs and physicians in CCCs; however, this paper primarily provides education about the role of NPs in CCCs. CCCs have evolved at a time when our health care system is floundering, and the need for accessible, affordable health care is at its greatest. The CCC model provides an accessible, affordable entry point into the health care system for those who previously were restricted access.