The need for cannabis education in dental hygiene programs.

PURPOSE/OBJECTIVE: Cannabis and the endocannabinoid system (ESC) are rarely included in training programs for healthcare providers. Knowledge within the medical and dental health professionals is lacking regarding the treatment of patients using medical or recreational cannabis. Patients are unaware of the risks associated with cannabis use, and healthcare providers should be prepared to assess, educate, and treat the patients who use cannabis. With the increased legalization and use of cannabis for medical and recreational purposes across the US, this study demonstrated the lack of cannabis education provided in dental hygiene programs. METHODS: In 2021, an online survey was conducted with 327 dental hygiene program directors. Respondents were asked to answer 26 questions. RESULTS: With a 21% response rate and 100% completion rate, 60% of the participants responded that cannabis content was provided in their dental hygiene program, 38% responded with a "no," and one responded with "I do not know." No significant difference was found regardless of whether cannabis was legal in the state for medical or recreational use and whether the cannabis content was included in the dental hygiene curriculum. CONCLUSIONS: The results indicate that every dental hygiene program should provide cannabis content, and each patient should receive a cannabis assessment at every dental hygiene appointment. Further research is required to identify standardized educational content on cannabis and the ESC, which will enable educators to teach students. The development and implementation of a standardized cannabis use assessment and the creation of standardized recommendations for patients who use cannabis to alleviate adverse oral health effects are important.

Regulatory Experiences with Root Causes and Risk Factors for Nitrosamine Impurities in Pharmaceuticals.

N-Nitrosamines (also referred to as nitrosamines) are a class of substances, many of which are highly potent mutagenic agents which have been classified as probable human carcinogens. Nitrosamine impurities have been a concern within the pharmaceutical industry and by regulatory authorities worldwide since June 2018, when regulators were informed of the presence of N-nitrosodimethylamine (NDMA) in the angiotensin-II receptor blocker (ARB) medicine, valsartan.  Since that time, regulatory authorities have collaborated to share information and knowledge on issues related to nitrosamines with a goal of promoting convergence on technical issues and reducing and mitigating patient exposure to harmful nitrosamine impurities in human drug products. This paper shares current scientific information from a quality perspective on risk factors and potential root causes for nitrosamine impurities, as well as recommendations for risk mitigation and control strategies.

Promoting community stakeholder engagement in research on treatment for pregnant women with opioid use disorder.

Aim: Community stakeholder engagement in research (CSER) can improve research relevance and efficiency as well as prevent harmful practices, particularly for vulnerable populations. Despite potential benefits, researchers lack familiarity with CSER methods. Methods: We describe CSER strategies used across the research continuum, including proposal development, study planning and the first years of a comparative effectiveness study of care for pregnant women with opioid use disorder. Results: We highlight successful strategies, grounded in principles of engagement, to establish and maintain stakeholder relationships, foster bidirectional communication and trust and support active participation of women with opioid use disorder in the research process. Conclusion: CSER methods support research with a disenfranchised population. Future work will evaluate the impact of CSER strategies on study outcomes and dissemination.

Community stakeholder engagement in research on treatment for pregnant women with opioid use disorder builds and maintains stakeholder relationships, fosters communication and trust and supports active patient participation.

Quad-dimensional acculturation, cultural integration, and life satisfaction of South Sudanese refugee young adults in the United States: A quasilongitudinal qualitative study.

OBJECTIVE: This study aims to describe acculturation among South Sudanese refugees (SSRes) as young adults in the U.S. based on a tridimensional (3D) acculturation framework. METHOD: Aligning with a community-based participatory research (CBPR) approach, the present study was designed to investigate in-depth individual experiences of SSRes in two phases, conducting 19 interviews in 2007 and 11 interviews in 2014-2015. The data analysis employed a modified grounded theory approach. RESULTS: A grounded theory emerged indicating that, over time, SSRes experienced quad-dimensional acculturation that included South Sudanese, mainstream American, African American, and African cultures and orientations. Although bidimensional acculturation was prominent in Phase 1, quad-dimensional acculturation emerged and was salient in Phase 2. Furthermore, participants who demonstrated an integrated perspective toward their acculturation tended to report higher life satisfaction scores than those who expressed conflicted perspectives. CONCLUSIONS: The findings have theoretical and practical implications for African refugees' adjustment and psychological well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

MAF1, a repressor of RNA polymerase III-dependent transcription, regulates bone mass.

MAF1, a key repressor of RNA polymerase (pol) III-mediated transcription, has been shown to promote mesoderm formation in vitro. Here, we show that MAF1 plays a critical role in regulating osteoblast differentiation and bone mass. Global deletion of MAF1 (Maf1-/- mice) produced a high bone mass phenotype. However, osteoblasts isolated from Maf1-/- mice showed reduced osteoblastogenesis ex vivo. Therefore, we determined the phenotype of mice overexpressing MAF1 in cells from the mesenchymal lineage (Prx1-Cre;LSL-MAF1 mice). These mice showed increased bone mass. Ex vivo, cells from these mice showed enhanced osteoblastogenesis concordant with their high bone mass phenotype. Thus, the high bone mass phenotype in Maf1-/- mice is likely due to confounding effects from the global absence of MAF1. MAF1 overexpression promoted osteoblast differentiation of ST2 cells while MAF1 downregulation inhibited differentiation, indicating MAF1 enhances osteoblast formation. However, other perturbations used to repress RNA pol III transcription, inhibited osteoblast differentiation. However, decreasing RNA pol III transcription through these perturbations enhanced adipogenesis in ST2 cells. RNA-seq analyzed the basis for these opposing actions on osteoblast differentiation. The different modalities used to perturb RNA pol III transcription resulted in distinct gene expression changes, indicating that this transcription process is highly sensitive and triggers diverse gene expression programs and phenotypic outcomes. Specifically, MAF1 induced genes known to promote osteoblast differentiation. Furthermore, genes that are induced during osteoblast differentiation displayed codon bias. Together, these results reveal a novel role for MAF1 and RNA pol III-mediated transcription in osteoblast fate determination, differentiation, and bone mass regulation.

Postextraction ridge preservation by using dense PTFE membranes: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: The use of dense polytetrafluoroethylene (dPTFE) membranes in alveolar ridge preservation may help reduce the risk of bacterial contamination and infection, maintaining the soft-tissue anatomy. However, systematic reviews on their efficacy in postextraction sites are lacking. PURPOSE: The purpose of this systematic review and meta-analysis was to assess the efficacy of alveolar ridge preservation with dPTFE membranes when used alone or in combination with bone grafting materials in postextraction sites. MATERIAL AND METHODS: An electronic search up to February 2021 was conducted by using PubMed, Embase, and the Cochrane library to detect studies using dPTFE membranes in postextraction sites. An additional manual search was performed in relevant journals. Clinical and radiographic dimensional changes of the alveolar ridge, histomorphometric, microcomputed tomography, implant-related findings, and rate of complications were recorded. One-dimensional meta-analysis was performed to calculate the overall means and 95% confidence intervals (α=.05). RESULTS: A total of 23 studies, 14 randomized controlled trials, 4 retrospective cohort studies, 3 case series, and 2 prospective nonrandomized clinical trials, met the inclusion criteria. Five studies were included in the quantitative analysis. The meta-analysis revealed that the use of dPTFE membranes resulted in a statistically significant (P=.042) increase in clinical keratinized tissue of 3.49 mm (95% confidence interval [CI]: 0.16, 6.83) when compared with extraction alone. Metaregression showed that the difference of 1.10 mm (95% CI: -0.14, 2.35) in the radiographic horizontal measurements was not significant (P=.082), but the difference of 1.06 mm (95% CI: 0.51, 1.62) in the radiographic vertical dimensional change between dPTFE membranes+allograft and extraction alone was statistically significant (P<.001). CONCLUSIONS: The use of dPTFE membranes was better than extraction alone in terms of keratinized tissue width and radiographic vertical bone loss.

The Flu Pandemic of 1918: A Nurse's Story.

ABSTRACT: In the spring of 1918, a virus swept across the world, killing approximately 50 million people by the summer of 1919. My grandmother, Kathryn ("Katie") Ann Darmody-an Irish immigrant who settled in New York State in 1904-was among the nurses who responded to this pandemic, which became known as the 1918 influenza pandemic (or, erroneously, the Spanish flu). Today, as the world contends with the COVID-19 pandemic, my grandmother's experiences resonate with new meaning-a reminder of how, then as now, nurses have been at the forefront of public health. Her story, transmitted across generations, is one I now share with a new generation of nurses.

Dental Hygienists' Interprofessional Education and Collaboration Experiences: A survey of current behaviors and attitudes.

Purpose: Interprofessional collaboration in health care is needed for comprehensive patient care and improved health outcomes. The purpose of this study was to assess dental hygienists' attitudes and behaviors on past interprofessional education experiences to determine how those experiences influence the ways they collaborate with other health care professionals.Methods: Licensed dental hygienists in the United States were recruited to participate in this mixed methods study via social media sites and through the constituents of the American Dental Hygienists' Association. The survey instrument consisted of 23 items incorporating quantitative Likert-style, multiple-choice and qualitative open-ended questions designed to measure participants' attitudes towards interprofessional collaboration (IPC) and interprofessional education (IPE), IPC behaviors in practice and previous IPE experiences.Results: Of the 184 participants who opened the survey, 165 respondents met the inclusion criteria and completed the survey (n=165). Most of the participants indicated the belief that IPC was important (90%, n=147) and felt confident collaborating with other health care professionals (81%, n=133). While two-thirds of the respondents did not report previous IPE experience (66%, n=109), the majority reported collaborating with other health care professionals within the past six months (63%, n=102). Respondents who reported prior IPE, collaborated with other health care professionals more frequently, on average, than those without IPE experience. Most IPE experiences were case studies and on- and off-campus clinical rotations.Conclusion: Findings suggest dental hygienists appreciate the importance of IPC and collaborate with other health care providers based on those attitudes, regardless of prior IPE experiences. Further research examining the best practices of IPE experiences could enrich the value of future collaborations between dental hygienists and other health care providers.

Are in-person scientific conferences dead or alive?

Given the disruption caused by the COVID-19 pandemic, life as we knew it has been turned upside down, but the need for science to go on has never been stronger. In the realm of scientific conferences, with the requirement for social distancing, the importance of wearing face coverings, and travel restrictions, only virtual meetings have been possible during the pandemic. But many are asking: What is the new post-pandemic normal likely to be? Do we still want to have in-person meetings when the restrictions are eased? Assuming we do, when will they be possible again, and under what conditions? Regardless of what the benefits of virtual symposia might be, are they here to stay? These questions, and many more that are being asked around the world today, are the subject of this perspective. Herein, we attempt to provide useful context and insight into where scientific meetings have been, where they are today, where they are going, and how they will get there. Our conclusion is that the pandemic has created an accelerated opportunity to make the world of future scientific conferences better in a "both/and" collaborative in-person/virtual scenario, not the more limited "pick one" choice.

Teleprecepting: A timely approach to clinical education during COVID-19.

ABSTRACT: Clinical training is a key component of nurse practitioner (NP) education. The rapid shift to telehealth necessitated by the pandemic has also created a need for socially distanced education and precepting. This article presents teleprecepting as a modality for clinical opportunities and connecting students to previously limited experiences, such as training in small specialties, in rural areas, and with interdisciplinary teams. Precepting NP students using telehealth follows similar principles as in-person teaching, but some modifications and additional considerations are needed to transition to the virtual environment. At a time when many NPs have swiftly adapted to telehealth in practice, this article will offer a brief "how-to" for teleprecepting. Prior to COVID-19, teleprecepting was piloted with less than 2% of NP students in the school's pilot teleprecepting project. Seven months after the initial surge of cases and restrictions, 72% of students (n = 151) in the family nurse practitioner, psychiatric mental health nurse practitioner, and pediatric nurse practitioner specialties had transitioned to teleprecepting. This project was implemented rapidly during the pandemic, and thus, evaluations comparing competency outcomes and experiences of students and preceptors are still in process. Additionally, feasibility of this educational model may change as telehealth regulations continue to evolve. COVID-19 poses challenges for both patient care and clinical training of NP students across specialties. With some adaptation, clinical placements can be transitioned to the virtual environment of telehealth. Future studies should examine student competencies based on teleprecepting experiences and preceptor training to support teleprecepting roles.

Attenuation of the Köhler Effect in Racially Dissimilar Partnered Exercise Reversed Using Team Identity Strategy.

The authors describe two research experiments exploring the influence of race on the Köhler motivation gain effect with exercise tasks. Experiment 1 tested whether partner racial dissimilarity affects individual performance. Experiment 2 created a team identity recategorization intervention to potentially counter the influence on performance observed in Experiment 1. White male participants were partnered with either a Black or Asian partner (Experiment 1) or with a Black partner utilizing team names and shirt colors as a team identity recategorization strategy (Experiment 2). Racially dissimilar dyads completed two sets of abdominal plank exercises with a Köhler conjunctive task paradigm (stronger partner; team performance outcome dependent upon the weaker-ability participant's performance). The results of Experiment 1 suggest attenuation of the previously successful group motivation gain effect in the racially dissimilar condition. The simple recategorization strategy utilized in Experiment 2 appeared to reverse motivation losses under conjunctive-task conditions in racially dissimilar exercise dyads.

Contribution of viral infection to risk for cancer in systemic lupus erythematosus and multiple sclerosis.

Patients with autoimmune disorders (AD) have altered cancer risks compared to the general population. Systemic lupus erythematosus and multiple sclerosis lead to a heightened risk for hematological malignancies and decreased risk for breast, ovarian, and prostate malignancies. Often patients with autoimmune disease have dysregulated antiviral immune responses, including against oncogenic viruses. To uncover the relationship between viral incidence and cancer risk in the context of autoimmune disease, we extracted electronic health records (EHR) from Vanderbilt University. ICD-9/10 codes and laboratory values were collected for hematological, lung, anal-vaginal, thyroid, hepatobiliary, bladder, prostate, and breast cancers; and viruses including Epstein Barr virus (EBV), Human papilloma virus (HPV), and Hepatitis A/B/C (Hep). Only viral infections that led to a physician visit or laboratory test were entered into the EMR; therefore, only clinically relevant cases were noted and considered positive in this study. The relationship between virus infection and cancer in an SLE cohort (SLE-cases n = 2,313, and SLE-controls n = 5,702) and an MS cohort (MS-case n = 7,277, MS-control n = 7,277) was examined by multilinear logistic regression. Viral infection was strongly associated with increased risk for cancer overall. SLE and MS patients were more susceptible to all viral infections. MS patients trended toward increased risk for cancers overall, while decreased risk for hormone-based cancers in SLE patients non-significantly reduced their risk for overall cancer. Both SLE and MS patients had increased clinically relevant EBV infection, which was associated with risk for hematological cancers. Preventing viral infections by vaccination may be especially helpful in controlling risk for cancer in SLE and MS patients.

Exploring Readiness for Teleprecepting in Psychiatric Mental Health Nurse Practitioner Training.

OBJECTIVE: Telehealth offers a solution to many challenges in health care, including the shortage of psychiatric providers. Recently the need to limit patient and provider exposure to coronavirus disease 2019 (COVID-19) has escalated implementation of telehealth across the globe. As telehealth utilization expands, its role in nursing education and training requires systematic evaluation. Since publication of the National Organization of Nurse Practitioner Faculty white paper supporting telehealth in health care delivery and nurse practitioner education, several studies have demonstrated successful didactic instruction and training in telehealth. However, a recent literature review found no studies evaluating the use of telehealth technology as a means of precepting in clinical training. METHODS: This small-scale qualitative study investigates the readiness of one behavioral health clinic to provide teleprecepting to psychiatric mental health nurse practitioner students. Two preceptors and one student were interviewed using a peer-reviewed semistructured interview guide using video chat. Responses were reviewed, coded, and categorized into themes. RESULTS: Thematic analysis of the interviews revealed three categories for consideration in establishing teleprecepting. Clinical factors, logistics, and comparison with traditional precepting are discussed. Interviewees viewed teleprecepting as a viable method of increasing access to clinical training. CONCLUSIONS: This project supports teleprecepting as a feasible strategy for improving access to clinical training and as a technological resource that merits systematic evaluation. Practice guidelines are needed for teleprecepting of advanced practice registered nurse students, and both preceptors and students may benefit from training to support best practices prior to implementation.

Private well water testing promotion in pediatric preventive care: A randomized intervention study.

Over 43 million U.S. residents rely on private unregulated wells for their drinking water, raising public health concerns, particularly in regions like northern New England where widespread groundwater arsenic contamination is now recognized. Children are particularly vulnerable to adverse health effects from arsenic exposure. Despite AAP Guidelines, approaches to engage pediatric clinicians in promoting private well testing have not been previously described. We sought to determine the most effective practice approaches to achieve successful well water testing in routine pediatric care. 12 primary care clinics were block randomized to one of four study arms. Two intervention variables were assessed: (1) test results access (parent only vs. parent and clinic) and (2) follow up approaches (yes/no). Parents of children under 12 months using a private well were eligible. Prepaid water tests were provided. Primary outcome was parental water test completion. Eleven clinics successfully implemented processes identifying well users. 240 testing kits were dispensed. Completion rates averaged 29% (range 10 to 61%). The study arm with both clinic results access and staff follow up system was 2.3 times more likely to achieve test completion than other arms (95% CI 1.12-4.86, p = .03). Kit distribution by clinicians versus nursing staff, irrespective of study arm, had 2.4 times greater completion (95% CI 1.13-5.11, p = .02). Systematic drinking water source screening can be improved in pediatric care. Higher testing completion was found in practices randomized to reminders and structured follow up versus single visit discussion, but clinician involvement was the most predictive factor.

Adolescent Patient Engagement Through Telepsychiatry: A Case Report Application.

The COVID-19 pandemic has changed psychopharmacological prescribing and management of patients around the world. Social distancing requirements led to a transition from face-to-face patient visits to telepsychiatry. Relaxed federal reimbursement policies during the COVID-19 pandemic expanded patient awareness and access to virtual care. For many psychiatric advanced practice RNs (APRNs), the transition to telepsychiatry was intended as a temporary solution until it is possible to return to in-person patient care. Instead, virtual care has become an expectation of patients and agencies. The current article presents a case study example of an adolescent psychiatric patient, exploring the challenges of therapeutic alliance, patient engagement, psychiatric evaluation, laboratory orders, deprescribing, and psychopharmacological adherence. The case study discusses considerations for APRNs who use telemental health in child and adolescent psychiatry and resources for clinical practice. [Journal of Psychosocial Nursing and Mental Health Services, 58(11), 9-12.].

Clinical practice guideline for primary care providers in the management of antidepressant-induced hyperhidrosis: A quality improvement project.

BACKGROUND: Antidepressant-induced excessive sweating (ADIES) is a side effect that occurs in approximately 22% of patients taking antidepressant medications and can negatively affect patient medication adherence. LOCAL PROBLEM: Primary care providers may not have adequate knowledge of ADIES management. The aims of this project were to increase primary care provider's overall perceived knowledge related to ADIES, improve confidence in the management of ADIES, and gather input on the perceived usefulness of the initial clinical practice guideline (CPG) for ADIES management. METHODS: This quality improvement (QI) project consisted of two phases. Phase 1 included the development of a CPG for the pharmacologic management of ADIES based on processes recommended by the Institute of Medicine. INTERVENTIONS: Phase 2 of the project consisted of a pretest-posttest design pilot of the guideline via a "Lunch and Learn" educational session at a Federally Qualified Health Care Center located in the Northern California. RESULTS: The results indicated that after exposure to the CPG and participation in the educational program about the guideline, there was an overall significant improvement in provider knowledge and confidence about identification and management of ADIES in their practice. CONCLUSIONS: Although small in scope, this QI project provides important avenues for further implementation and dissemination of the guideline to manage ADIES. The potential for improved patient care and medication adherence support the usefulness of the implementation of this guideline in other locations.

Increasing collaboration on substance use disorder research with primary care practices through the National Drug Abuse Treatment Clinical Trials Network.

BACKGROUND: The National Drug Abuse Treatment Clinical Trials Network (CTN) called for its national nodes to promote the translation of evidence-based interventions from substance use disorder (SUD) research into clinical practices. This collaborative demonstration project engaged CTN-affiliated practice-based research networks (PBRNs) in research that describes aspects of opioid prescribing in primary care. METHODS: Six PBRNs queried electronic health records from a convenience sample of 134 practices (84 participants) to identify the percent of adult patients with an office visit who were prescribed an opioid medication from October 1, 2015, to September 30, 2016, and, of those, the percent also prescribed a sedative in that year. Seven PBRNs sent an e-mail survey to a convenience sample of 108 practices (58 participants) about their opioid management policies and procedures during the project year. RESULTS: Of 561,017 adult patients with a visit to one of the 84 clinics in the project year, 22.9% (PBRN range 3.1%-25.4%) were prescribed opioid medications, and 52.1% (PBRN range 8.5%-60.6%) of those were prescribed a sedative in the same year. Of the 58 practices returning a survey (45.3% response rate), 98.1% had formal written treatment agreements for chronic opioid therapy, 68.5% had written opioid prescribing policies, and 43.4% provided reports to providers with feedback on opioid management. Only 24.1% were providing buprenorphine for OUD. CONCLUSION: CTN-affiliated PBRNs demonstrated their ability to collaborate on a project related to opioid management; results highlight the important role for PBRNs in OUD treatment, research, and the need for interventions and additional policies addressing opioid prescribing in primary care practice.