Interprofessional Education to Address Substance Use among Adults with Persistent Pain: A Pre-Post Program Evaluation.

BACKGROUND: Substance use disorders (SUDs) are highly prevalent among adults with persistent pain. Yet, standard competencies for integrating pain and SUD content are lacking across health science student curricula. Additionally, pharmacotherapies to treat SUDs are underutilized. AIM: To address these gaps, a team of health science faculty created an interprofessional simulation activity using a standardized patient and evaluated learner outcomes related to assessment and treatment of comorbid persistent pain and substance use. METHODS: A total of 304 health science students representing nursing, medicine, pharmacy, and social work programs attended virtual learning sessions. Interprofessional student teams developed a team-based care plan for an adult with musculoskeletal pain who takes prescribed opioids while using alcohol. Pre- and post-activity surveys assessing knowledge and confidence were matched for 198 students. Descriptive statistics summarized survey data with inferential analysis of paired data. RESULTS: The largest significant improvements between pre- and post-activity knowledge were observed in items specific to pharmacotherapy options for alcohol and opioid use disorders. Similar gains were noted in students' confidence regarding pharmacotherapies. No significant differences were noted on pre-post-activity knowledge scores between the three main profession groups (medicine, nursing, and pharmacy). CONCLUSIONS: Students attending this interprofessional simulation demonstrated improved knowledge and confidence, particularly in pharmacotherapies for alcohol and opioid use disorders. Replication of such programs can be used to provide consistent content across health science disciplines to heighten awareness and receptivity to medications available to treat SUDs in people treated for persistent pain. The curriculum is freely available from the corresponding author.

Hospice Core Professions' Views on Interdisciplinary Teams: A Qualitative Investigation.

The hospice interdisciplinary team (IDT) has been recognized as an ideal model for interprofessional collaboration. To address the manner in which interdisciplinary practices are perceived by team members, this study explored profession-based similarities and differences in perceptions among the four core hospice IDT members (physicians, nurses, social workers, and spiritual care providers) as well as experiences on the IDT. Semistructured interviews with 20 hospice professionals, 5 from each profession, were completed. Findings suggested that while hospice professions share some perceptions and experiences about hospice team membership, strengths of and barriers to teamwork, and individual members' contribution to the team, significant profession-based differences exist largely in the area of hospice team membership beyond the core members, type of language and descriptions used, perceptions of causes and effects of barriers to teamwork, and understandings of how team effectiveness is evaluated. Changes at the team-based, organizational, policy, and educational levels are needed to further maximize strengths of individual hospice IDT member and team qualities.

Linearity condition for orbital energies in density functional theory (III): benchmark of total energies.

This study presents a numerical assessment of total energy related physical quantities estimated using the orbital-specific (OS) global and range-separated hybrid functionals, designed to satisfy the linearity condition for orbital energies (LCOE). The numerical assessment demonstrates that accurate evaluation of the reaction energies, reaction barrier, and dissociation curve can be achieved via the OS hybrid functional, for systems in which self-interaction is expected to be dominant. Therefore, the LCOE offers an accurate description of orbital energies as well as total energies for self-interaction dominant systems.

Are children's grief camps effective?

Bereavement camps are one form of popular grief intervention for children. A review of the existing literature on child bereavement camps was conducted to examine effectiveness of these camps. An initial database search led to 187 entries. Selection criteria employed resulted in a total of eight studies for an in-depth examination. While camps had differences in their lengths, camper acceptance, restrictions, and theoretical frameworks used; many shared similar camp goals and objectives, activities, and outcome measures. Emerging evidence shows camps are promising venues to help bereaved children develop and build resilience in dealing with loss.

Impact of visceral fat on laparoscopy-assisted distal gastrectomy.

BACKGROUND: Obesity is known to be a preoperative risk factor for gastric cancer surgery. However, the influence of obesity on laparoscopy-assisted distal gastrectomy (LADG) remains controversial. In the present study, we evaluated several obesity parameters and investigated the influence of obesity on the surgical outcomes of LADG for gastric cancer. MATERIALS AND METHODS: Between January 2010 and July 2011, 84 patients who underwent LADG for gastric cancer were enrolled. Visceral fat area (VFA) and subcutaneous fat area (SFA) were measured in cross-sectional CT scan using SlimVision(®) software. Patients were classified into two groups by the degree of BMI or VFA. Surgery time and blood loss were compared between each two groups. Predictive factors for perioperative complications were assessed by univariate and multivariate analyses. RESULTS: There were no significant differences in surgery time or blood loss between patients with high and low BMIs. In contrast, high VFA patients had significantly longer surgery times (p=0.0047) and higher estimated blood loss (p=0.0034) than low VFA patients. By univariate and multivariate analyses, only a high VFA significantly predicted perioperative complications (p=0.0162, p=0.0288). CONCLUSIONS: We suggest that VFA is more accurate than BMI in predicting surgery time, blood loss, and perioperative complications associated with LADG for gastric cancer. The visceral fat area could be efficiently assessed before laparoscopic surgery for gastric cancer in obese patients.

[Effectiveness of steroids for the rash side effect of pemetrexed].

Rash is a common side effect of pemetrexed(PEM). In clinical trials overseas, patients were prescribed with dexamethasone(DEX), as a prevention against skin rash. Four mg of DEX was orally administered twice daily on the day prior to, day of,and day after the infusion of pemetrexed. The results showed suppression of the incidence and severity of rash. However, the dosage and period of medication was not fully verified. A recent survey was conducted retrospectively, with 81 patients who started PEM monotherapy from May 2009 to August 2010, to study the effectiveness of steroid rash prevention. The patients were classified into the non-administered group(47 patients), who were not given DEX, and the prophylaxis group(34 patients), who were given a median dose of DEX(2mg×3 days). The incidence of rash in the non-administered group was 36.2%, and 23.5% for the prophylaxis group. The severity of rash for the non-administered group was G1: 27.7%, G2: 8.5%; and for the prophylaxis group it was G1: 20.6%, G2: 2.9%. The incidence and severity of rash of the prophylaxis group was statistically and significantly lower than that of the non-administered group. This study shows that a small dosage of steroid is a possible precautionary or preventive measure for rash. Therefore, in order to reduce the incidence and severity of rash, a study with higher doses of medication similar to the clinical trials overseas should be conducted.

An Interactive Online Interprofessional Opioid Education Training Using Standardized Patients.

Introduction: Opioid pain management is complex and requires a collaborative approach. To prepare health professions students to care for patients who have chronic pain, we developed an interprofessional education (IPE) session for delivery using a virtual platform that featured a standardized patient (SP) interaction. Methods: The SP case highlighted a patient on opioids for chronic low back pain resulting from a car accident. Despite no improvement in pain or function, the patient continued taking opioids and developed behaviors that could represent opioid misuse. During the synchronous, online session, interprofessional teams of students interviewed an SP and collaborated to develop a holistic care plan to address the patient's pain and potential opioid misuse. The session evaluation included pre- and postsession surveys. Results: Over 750 students from medicine, pharmacy, nursing, and social work programs participated in the virtual IPE sessions during a single year. Students rated the session positively. Matched survey responses suggested improved confidence in knowledge and skills, and learning through Zoom was rated favorably. Discussion: We successfully implemented a synchronous online IPE session involving SP interactions that allowed students to practice team-based care of a patient with chronic pain who was taking opioids. Based on the success of this IPE session, including the success of the online delivery model, future IPE sessions will continue virtually.

Preoperative assessment of perigastric vascular anatomy by multidetector computed tomography angiogram for laparoscopy-assisted gastrectomy.

PURPOSE: We aimed at investigating the efficacy of multidetector computed tomography (MDCT) angiogram reconstructed using the maximum intensity projection (MIP) technique for the assessment of perigastric vascular anatomy before laparoscopy-assisted gastrectomy (LAG) for gastric cancer. METHODS: Seventy-one patients who underwent LAG were enrolled in the study. Contrast-enhanced scans of the portal venous phase were performed by a MDCT scanner. The CT images were reconstructed using thin-slab MIP. The anatomic variations in the inflow and the location of the left gastric vein (LGV) were detected. The patterns of perigastric arterial origins were divided according to Michels' classification. The intraoperative blood loss on LAG was compared before and after MDCT angiography was introduced in the study. RESULTS: The LGV flowed into the portal vein in 31 patients; the splenic vein, 25 patients; and the junction of these two veins, 15 patients. The LGV passed to the dorsal and ventral sides of the common hepatic artery in 30 and 13 patients and to the dorsal and ventral sides of the splenic artery in 8 and 20 patients, respectively. Michels' type II was found in one patient; type V, in three patients; and type VI, in two patients. The LGV location detected by MDCT was confirmed during surgery in all cases. Intraoperative blood loss after introduction of the MDCT angiography was significantly less than that before its introduction (p = 0.0032). CONCLUSIONS: An MDCT angiogram reconstructed using the MIP technique is effective for assessing the perigastric vascular anatomy before LAG for gastric cancer.

Linearity condition for orbital energies in density functional theory: construction of orbital-specific hybrid functional.

This study proposes a novel approach to construct the orbital-specific (OS) hybrid exchange-correlation functional by imposing the linearity condition: ∂(2)E/∂f(i)(2)|(0≤f(i)≤1) = ∂ɛ(i)/∂f(i)|(0≤f(i)≤1) = 0, where E, ε(i), and f(i) represent the total energy, orbital energy, and occupation number of the ith orbital. The OS hybrid exchange-correlation functional, of which the OS Hartree-Fock exchange (HFx) portion is determined by the linearity condition, reasonably reproduces the ionization potentials not only from valence orbitals but also from core ones in a sense of Koopmans' theorem. The obtained short-range HFx portions are consistent with the parameters empirically determined in core-valence-Rydberg-Becke-3-parameter-Lee-Yang-Parr hybrid functional [Nakata et al., J. Chem. Phys., 124, 094105 (2006); ibid, 125, 064109 (2006)].

Association between personality traits and food stockpiling for disaster.

This study investigated the association between personality traits and food stockpiling for disasters in predicted high-risk areas of food shortages due to the Nankai Trough Earthquake. This survey was conducted between December 18 and 20, 2019, using a web-based questionnaire. The participants were 1,200 individuals registered with an online survey company. This study analyzed the association between the Big Five personality traits and food stockpiling status (n = 1192). The Big Five personality traits assess five basic dimensions of personality (i.e., extraversion, conscientiousness, agreeableness, neuroticism, and openness). To measure theses personality traits, we used the Japanese version of the Ten-Item Personality Inventory (TIPI-J). The Mann-Whitney test and a multivariable logistic regression analysis revealed that none of the Big Five personality traits were significantly associated with having or not having stockpile food. However, interestingly, considering the stages of behavior change regarding stockpiling, high extraversion was significantly positively related to initiating stockpiling. Moreover, high neuroticism was significantly positively related to interrupted stockpiling. Therefore, it is crucial to focus on personality traits (especially low extraversion and high neuroticism) to promote food stockpiling for disasters.

Association between Health Practice and Food Stockpiling for Disaster.

In this study investigated the association between health practices and food stockpiling for disasters in predicted areas with a high risk of food shortage due to the Nankai Trough earthquake. A survey was conducted during 18-20 December 2019 using a self-administered web-based questionnaire. In total, 1200 individuals registered with an online survey company participated in the study. The association between health practices and food stockpiling status was analyzed (n = 998). 59.1% of participants had a poor Breslow's seven health practice scores (BHPS), 32.9% had a moderate score, and 8.0% had a good score. Multivariable logistic regression analysis revealed that higher BHPS had a significantly higher prevalence of food stockpiling. Additionally, the interrupted group had the highest percentage of participants with low BHPS. Lower BHPS was significantly associated with interrupted stockpiled in the adjusted models. Among the seven health practices, the odds ratio of the "eating breakfast" practice was high. There was a significant positive association between higher health practice scores and food stockpiling for disasters in areas with a high risk of food shortage due to the predicted earthquake. Particularly, it was clarified that individuals who had fewer good health practices were associated with ending up interrupting food stockpiling.

Interprofessional education on opioid use and pain identifies team-based learning needs.

BACKGROUND: An interprofessional education (IPE) activity was designed for health professional students in pharmacy, medicine, nursing, social work, and addiction studies. The goals were to practice team-based collaboration for patients who are prescribed opioids for chronic pain and to evaluate student responses to the activity. INTERPROFESSIONAL EDUCATION ACTIVITY: Student teams were guided through an unfolding patient case that included evaluating the patient's history, screening tool results, morphine equivalent dose, prescription monitoring program report, and videos of a patient-provider interaction. The two-hour, in-person IPE activity culminated in creation of a patient-centered treatment plan. Surveys were administered to compare pre- and post-course opioid knowledge and post-course IPE attitudes among the healthcare professions. DISCUSSION: Pharmacy students' baseline opioid knowledge scores were similar to nursing students, significantly lower than medical students, and significantly higher than social work students. Pharmacy students reported significantly higher gains in opioid knowledge than medical students. Nursing and social work students showed significantly higher levels of agreement that the course enhanced attitudes toward interprofessional collaboration compared to medicine and pharmacy students. Students most frequently noted working with other professions as the most valuable aspect of the IPE activity. IMPLICATIONS: Training gaps can be met using novel IPE activities specific to chronic pain and opioid use. Depending on profession, students demonstrated varied baseline knowledge regarding opioid use for chronic pain. Comparing knowledge gains and attitudes on IPE collaboration among professions can detect areas for program refinement to address each professions' unique needs.

Antioxidant Capacity of Tempura Deep-Fried Products Prepared Using Barley, Buckwheat, and Job's Tears Flours.

Tempura is a dish of battered and deep-fried foods, and wheat flour is typically used; however, barley, buckwheat, and Job's tears have an antioxidant capacity. This study investigated whether replacing wheat flour with flours from these three crops in tempura affects the antioxidant capacity and deterioration of frying oil. Radical scavenging activity and polyphenol content of tempura were measured by chemiluminescence-based assay and the Folin-Denis method, respectively. The peroxide value, p-anisidin value, acid value, and polar compound of the oil used in frying were measured as indexes of oil deterioration post-frying due to oxidation. Although the frying oil of barley showed higher p-anisidin value than that of wheat, the oil samples' deterioration level measured in this study was low. The antioxidant capacity and polyphenol content in the three flours samples were higher than those in wheat sample, with buckwheat producing the greatest values, followed by Job's tears, and then barley. Thus, deep-fried products prepared using the three flours demonstrated superior antioxidant capacity owing to the abundance of antioxidant components. Therefore, tempura can be enjoyed in a healthier manner by using batter prepared using those flours, and substituting wheat flour with the three flours can increase the antioxidant capacity of deep-fried products.

Changes of immunological parameters reflect quality of life-related toxicity during chemotherapy in patients with advanced colorectal cancer.

UNLABELLED: Anticancer drugs may frequently induce host immunosuppression and symptomatic toxicities. Once symptomatic toxicity occurs, the patient's quality-of-life (QOL) is reduced. Since little is known of the relationship between host immunity and the toxicity of chemotherapy, the host immunity before and after chemotherapy was compared to assess whether it is related to symptomatic toxicity during chemotherapy. PATIENTS AND METHODS: Fourteen patients with colorectal cancer underwent leucovorin /5-fluorouracil (LV/5-FU) treatment, or S-1/irinotecan (CPT-11). Host immunity (cytokine production of peripheral blood mononuclear cell (PBMC), serum soluble interleukin-2 receptor (sIL-2R) levels and phenotypic analyses of PBMC were measured before and after the first chemotherapy. RESULTS: An increase of sIL-2R, CD4+CD25+ T-cells and the CD4/8 ratio in patients with symptomatic adverse reactions were found. These changes in the first chemotherapy were significantly different (p = 0.0211, p = 0.0087, p = 0.0234). CONCLUSION: The current study indicated that there are some parameters correlated with toxicity during chemotherapy which effect QOL. In such patients, negative influences on host immunity, such as an increase of sIL-2R and regulatory T-cells, and a decrease of cytotoxic T-cells could occur.

Low-dose chemotherapy with leucovorin plus 5-fluorouracil for colorectal cancer can maintain host immunity.

BACKGROUND: Anticancer drugs may frequently show host immunosuppression. Low-dose chemotherapy has been used for unresectable cancer as a tumor dormancy therapy, and it has been reported that the patients treated this way demonstrated favorable survival without toxicity. In this study, host immunity before and after a low-dose leucovorin plus 5-fluorouracil regimen (low-dose LV/5-FU) and S-1 plus irinotecan regimen (S-1/CPT-11) was compared to assess whether low-dose chemotherapy can maintain host immunity. PATIENTS AND METHODS: Fourteen patients with recurrent or metastatic colorectal cancer underwent low-dose LV/5-FU, or S-1/CPT-11 treatment. The host immunity (cytokine production of the peripheral blood mono-nuclear cells (PBMC), serum soluble interleukin-2 receptor (sIL-2R) levels and phenotypic analyses of the PBMC) was measured before and after the first chemotherapy treatment. RESULTS: An increase of sIL-2R and CD4+CD25+ T cells with S-1/CPT-11 treatment, and a decrease with low-dose LV/5-FU treatment were observed and these changes in the first course were significantly different (p =0.0722 for the slL-2R, p=0. 0187for the CD4+CD25+ T cells). CONCLUSION: The current study indicated that there is no change or an improvement in host immunity with the low-dose LV/5-FU treatment as compared with the S-1/CPT-11 treatment. Low-dose LV/5-FU treatment should be considered for metastatic colorectal cancer in order to maintain a host immunity during chemotherapy.

Subdural hematoma associated with dural metastasis of gastric carcinoma: report of two cases.

We treated two cases of a subdural hematoma associated with dural metastasis of gastric cancer, from which both patients died. Case 1: A 60-year-old female patient was hospitalized with a diagnosis of type 4 gastric cancer of the antrum. The patient suddenly collapsed, and, subsequently, left hemiplegia and a depressed level of consciousness were noted. A head computed tomography (CT) scan revealed a subdural hematoma with midline shift. The patient was diagnosed with chronic subdural hematoma and underwent emergency burr hole irrigation. Case 2: A 73-year-old man was diagnosed with type 4 gastric cancer and a total gastrectomy plus splenectomy were performed together with dissection of the N1 and N2 lymph node groups (D2 dissection) in March 2006 (T3, N2, P0, H0, INFgamma, ly3, v0, por2). Postoperative adjuvant chemotherapy was performed using oral TS-1; following tests revealed no recurrence in the abdomen. In December 2006, gingival bleeding was noted with disseminated intravascular coagulation (DIC) and 10 days later, the patient was hospitalized with chief complaints of impaired consciousness and anorexia. CT scan revealed a right subdural hematoma with a midline shift. The patient was diagnosed with chronic subdural hematoma and underwent emergency burr hole irrigation and drainage. The dural biopsy of the two cases revealed adenocarcinoma noted in the dural blood vessel. Special staining revealed CEA-positive adenocarcinoma, and a diagnosis of the dural metastasis of gastric cancer was made. These patients' level of consciousness significantly improved postoperatively. However, DIC developed concurrently, and the patients died on the 13th and 14th postoperative day, respectively.

[A short-term outcome of endoscopic submucosal dissection (ESD) for early gastric cancer].

In this study, we investigated a short-term outcome of 56 cases of ESD for early gastric cancer performed in our department concerning the tumor diameter within or over 20 mm. Seventeen lesions were larger than 21 mm (large group), and 39 lesions were within 20 mm (indication group). There was no significant difference in the background factors between the two groups. The mean operating time and median of post operative hospital stay of the large group were longer than those of the indication group, and those differences were statistically significant. On the other hand, no significant difference was seen in the rate of one-piece resection, the incidence of complications and curability. With a further improvement of our skills, an ESD application in a case where the tumor diameter is larger than 21 mm may be extended.

Construction of epidermal growth factor fusion protein with cell adhesive activity.

A novel protein for controlling cellular functions was constructed by combining functional units of various proteins. The Arg-Gly-Asp (RGD) sequence functioning as a cell adhesive function, an epidermal growth factor (EGF) as a cell growth function, and a hydrophobic sequence (E12) as an efficient assembling function, were combined and incorporated into one molecule. The fusion protein, designated ERE-EGF, was produced in Escherichia coli and purified with affinity chromatography using a His-tag. The ERE-EGF coated on an unmodified hydrophobic surface of a cell-culture plate (through the hydrophobic E12 moiety) retained both cell adhesive activity (through the RGD sequence) and cell growth activity (through the EGF moiety).

[Host immunity in colorectal cancer patients treated with TS-1 plus CPT-11].

TS-1/CPT-11 treatment for the patients with advanced colorectal cancer is expected to be equal to FOLFOX and FOLFIRI regimen. The aim of this study was to investigate the relationship between host immunity and this regimen. Four patients were enrolled in this study. Host immunity was investigated before and after chemotherapy. PHA response, serum IAP level and the productions of any cytokines did not change significantly before and after the chemotherapy. Although these changes were not significant: both Th1/Th2 ratio and NK cells ratio were decreased, and the ratio of suppressor T cells was increased. These results suggest that TS-1/CPT-11 regimen may influence host immunity a little bit worse.

National Guard service members' perceptions of informal and formal supports: an exploratory study.

Much of the research on military families has focused on active duty service members. Little is known about informal and formal supports that National Guard service members use. Using an ecological systems perspective, this exploratory pilot study assessed awareness, access, use, satisfaction, and perceptions of effectiveness of informal and formal supports in a small group of National Guard service members. Results indicate that although service members are aware of many formal and informal supports, use of many of the supports is limited. Additionally, satisfaction and perceptions of effectiveness of many supports is neutral. The implications of these results are discussed.