The Digital Classroom: How to Leverage Social Media for Infectious Diseases Education.

Social media (SoMe) platforms have been increasingly used by infectious diseases (ID) learners and educators in recent years. This trend has only accelerated with the changes brought to our educational spaces by the coronavirus disease 2019 pandemic. Given the increasingly diverse SoMe landscape, educators may find themselves struggling with how to effectively use these tools. In this Viewpoint we describe how to use SoMe platforms (e.g., Twitter, podcasts, and open-access online content portals) in medical education, highlight medical education theories supporting their use, and discuss how educators can engage with these learning tools effectively. We focus on how these platforms harness key principles of adult learning and provide a guide for educators in the effective use of SoMe tools in educating ID learners. Finally, we suggest how to effectively interact with and leverage these increasingly important digital platforms.

A single dose of pre-operative pregabalin reduces post-operative opioid use after orthotopic liver transplantation.

Multimodal pain management strategies including pregabalin (PGB) have been shown to reduce pain and opioid use after many types of surgeries. This was a single-center, retrospective study aimed to determine whether a single pre-operative dose of PGB reduces opioid requirements and post-operative pain after orthotopic liver transplantation (OLT). Outcomes included the mean morphine milligram equivalents used; the proportion of patients with no pain documented; and the maximum level of pain documented within the first 24h and in the 24-72h following OLT. A total of 44 patients received PGB vs 57 who received standard of care. Baseline demographics were comparable between groups. Patients who received PGB required 70% and 54% less opioids within the first 24h and subsequent 24-72h post-OLT, respectively (p-values < .001). In the first 24h post-OLT, there were more patients with no documented pain, and fewer with severe pain in the PGB group, but these were not significant. A greater proportion in the PGB group reported a maximum of mild pain (p = .039). This study demonstrated that a single dose of pre-operative PGB significantly reduced opioid use in the first 72 h after OLT. Larger studies will help determine the safety and efficacy of PGB in this setting.

Pulmonary arterial hypertension in the emergency department: A focus on medication management.

Pulmonary arterial hypertension (PAH) is a chronic progressive incurable condition associated with a high degree of morbidity and mortality. With over five drug classes FDA approved in the last decade, the significant advancements in the pharmacologic management of PAH has improved long-term outcomes. Drug therapies have been developed to directly target the underlying pathogenesis of PAH including phosphodiesterase type-5 inhibitors (PDE-5i), endothelin-receptor antagonists (ERAs), guanylyl-cyclase inhibitors, prostacyclin analogues, and prostacyclin receptor agonists. Although these agents offer remarkable benefits, there are significant challenges with their use such as complexities in medication dosing, administration, and adverse effects. Given these consequences, PAH medications are classified as high-risk, and the transitions of care process to and from the hospital setting are a vulnerable area for medication errors in this population. Thus, it is crucial for the emergency department provider to appropriately identify, manage, and triage these patients through close collaboration with a multidisciplinary team to ensure safe and effective medication management for PAH patients in the acute care setting.

Clinical strategies for optimizing infusion center care through a pandemic.

The national pandemic resulting from the novel coronavirus, COVID-19, has made the delivery of care for patients with cancer a challenge. There are competing risks of mortality from cancer versus serious complications and higher risk of death from COVID-19 in immunocompromised hosts. Furthermore, compounding these concerns is the inadequate supply of personal protective equipment, decreased hospital capacity, and paucity of effective treatments or vaccines to date for COVID-19. Guidance measures and recommendations have been published by national organizations aiming to facilitate the delivery of care in a safe and effective manner, many of which, are permanently adoptable interventions. Given the critical importance to continue chemotherapy, there remains additional interventions to further enhance patient safety while conserving healthcare resources such as adjustments in medication administration, reduction in laboratory or drug monitoring, and home delivery of specialty infusions. In this manuscript, we outline how to implement these actionable interventions of chemotherapy and supportive care delivery to further enhance the current precautionary measures while maintaining safe and effective patient care. Coupled with current published standards, these strategies can help alleviate the numerous challenges associated with this pandemic.

"Capturing your audience": analysis of Twitter engagements between tweets linked with an educational infographic or a peer-reviewed journal article.

Information represented through conventional text may fall short of capturing the attention and promoting engagement with today's digital audience. Transforming text into visual tools, such as infographics, has emerged as a simplified method of delivering information to attract a broader audience and enhance information dissemination. The first step to evaluate the potential value of infographics is to quantify their appeal and engagement rates over conventional text. This retrospective pilot analysis sought to evaluate the difference between engagement rates for tweets containing an of infographic compared to tweets containing a link to a peer-reviewed journal article. A total of 752 tweets were published within the study period; of these, 40 tweets met inclusion criteria. When engagement rates were compared, there was an increase in median engagement rates for tweets containing an infographic compared to a tweet linked to a peer-reviewed article at 10.97% (IQR 3.47%) and 5.33% (IQR 3.17%), respectively. This pilot study provides insight on the potential impact for infographics to enhance engagement rate, which may subsequently correlate with an increase in audience reach and readership. Prospective studies are needed to validate the utility of infographics in promoting scholarship publicity, learner engagement, and as a transferable pedagogical tool to educate medical practitioners.

Exploratory Randomized Clinical Trial of an Experimental Gel-to-Foam Fluoride Dentifrice Formulation Using an In Situ Caries Model.

OBJECTIVE: To evaluate the in situ caries performance and safety of two experimental fluoride dentifrice formulations (1450 ppm fluoride) with and without 2% isopentane as an excipient, in comparison to a positive control, currently marketed dentifrice (1450 ppm fluoride) and a negative control dentifrice (0 ppm fluoride). METHODS: This was a single-center, examiner-blind, randomized, controlled, four-treatment cross-over study. During each treatment period, the subject wore a modified mandibular partial denture fitted with two gauze-covered, partially demineralized human enamel specimens, and brushed at home for one timed minute, twice daily, for two weeks. At the end of each treatment period, the enamel specimens were removed from the dentures for analysis. During the week between treatment periods, subjects returned to their usual dental hygiene practices for four to five days, received a dental prophylaxis, and used a study-designated non-fluoride dentifrice for two to three days before starting the next treatment. Treatment effect on enamel specimen remineralization was assessed by surface microhardness (SMH). Enamel fluoride uptake was assessed using microdrill enamel biopsy. RESULTS: All fluoride-containing dentifrices demonstrated significant, superior SMH recovery and levels of fluoride uptake compared to the negative control dentifrice. No significant differences were observed for either efficacy variable between the experimental dentifrice formulations and the positive control dentifrice. No significant difference was observed between the 2% isopentane dentifrice and the 0% isopentane dentifrice for SMH recovery. CONCLUSION: The addition of 2% isopentane did not positively or negatively affect fluoride efficacy in this model.

The role of illness beliefs and coping in the adjustment to dentine hypersensitivity.

AIM: Dentine hypersensitivity is a common oral health problem, however, there has been little research on how people cope with this condition. This study aimed to quantify the effects of illness beliefs and coping strategies on the health outcomes of individuals with dentine hypersensitivity. MATERIALS AND METHODS: Participants were purposively sampled from students and staff in one large UK University and 101 self-diagnosed dentine hypersensitivity sufferers participated in the longitudinal study. Participants were required to complete questionnaires which assessed health anxiety, specific illness beliefs (control, consequences, illness coherence, timeline perspectives and emotional representations), coping strategies (passive and active coping) and oral health-related and health-related quality of life (OHRQoL and HRQoL) at baseline and 1 month follow-up. RESULTS: Over half of the participants (N = 56) experienced sensations in their teeth on a daily basis and the majority had experienced dentine hypersensitivity for at least 1 year (N = 87). Structural equation modelling indicated that predictors of OHRQoL and HRQoL impacts at follow-up were frequency of sensations, low levels of illness coherence, negative emotional representations, greater health anxiety and use of passive coping strategies at baseline. CONCLUSIONS: Illness beliefs and coping strategies predict oral and health-related quality of life outcomes in people with dentine hypersensitivity.

Derivation of a short form of the Dentine Hypersensitivity Experience Questionnaire.

AIM: To derive and evaluate a short form of the Dentine Hypersensitivity Experience Questionnaire. METHODS: Data from three previous studies of dentine hypersensitivity (n = 353) were pooled and randomly divided into half. Ten- and 15-item short forms were derived in the first half of the data using the item impact and regression methods. The four short forms were evaluated in the second half. RESULTS: The 10 and 15-item versions of the regression short form detected impacts in 37% and 61% of participants, respectively, compared to 68% and 93% using the item impact method. All short forms had internal consistency (Cronbach's α) >0.84 and test-retest reliability (ICC) >0.89. All correlated with the long form (all r > 0.93, p < 0.001) and with the effect of the mouth on everyday life (all r ≥ 0.73, p < 0.001). None of the short forms detected a treatment effect in two trials although all four showed a tendency to detect an effect in a trial where the long form had done so. CONCLUSIONS: The 15-item short form derived with the item impact method performed better than other short forms and appears to be sufficiently robust for use in individual patients.

The Dentine Hypersensitivity Experience Questionnaire: a longitudinal validation study.

AIM: To validate the Dentine Hypersensitivity Experience Questionnaire in terms of responsiveness to change and to determine the minimally important difference. MATERIALS AND METHODS: The study was a secondary analysis of data from three randomized controlled trials with 311 participants. Three aspects of responsiveness were examined: change within individuals, differences among people who improved, stayed the same or worsened using an external referent and change due to treatment. Responsiveness to treatments of differing efficacy was assessed in trials with negative and active controls. RESULTS: The measure showed excellent internal reliability, test-retest reliability and criterion validity. The measure was highly responsive to change within individuals (Cohen's effect sizes: 0.28, 0.56, 0.86) showing decreases in the total score (i.e. improvement in OHrQoL) across all trials. The effect sizes in participants whose self-reported QoL "improved" were large (0.73-1.31). Dentine Hypersensitivity Experience Questionnaire detected a treatment effect in one of two negative control trials (effect size: 0.47). Dentine Hypersensitivity Experience Questionnaire scores were similar in the test and control groups in the active control trial. The minimally important difference range was between 22 and 39 points. CONCLUSIONS: The measure is longitudinally reliable, valid and responsive and can discriminate between treatments of different efficacy.

Novel in-situ longitudinal model for the study of dentifrices on dental erosion-abrasion.

A novel longitudinal erosion-abrasion in-situ model was proposed. In an exploratory test (phase 1) toothbrushing effect was investigated using a parallel design, whereas in the main study (phases 1 + 2), a crossover design tested the effect of fluoride dentifrice. In phase 1, 16 subjects (n = 5-6 subjects per group) wore partial dentures with enamel specimens for 28 d and adhered to one of the following treatment regimens: regimen A, erosion only; regimen B, erosion + toothbrushing with fluoride-containing dentifrice [1,100 ppm of fluoride as sodium fluoride (NaF)]; and regimen C, erosion + toothbrushing with placebo dentifrice (0 ppm fluoride). Erosion consisted of the exposure of specimens to grapefruit juice. In regimens B and C, toothbrushing was performed with the test dentifrices 5 min after erosion. For the main study a second phase was carried out in which subjects initially treated with regimen B were treated with regimen C, and vice versa (crossover, n = 11), repeating the same experimental protocol. Enamel wear was measured by optical profilometry at baseline and every 7 d thereafter. In the exploratory test (phase 1), no significant differences were observed among regimens at any of the study time-points. In the main study (phases 1 + 2), higher enamel wear was observed for regimen C than for regimen B. A significant trend was observed for the increase of enamel wear over time. Fluoridated dentifrice reduced the development of erosive-abrasive lesions. The proposed longitudinal model provided adequate responses for erosion-abrasion frequency and fluoride effects.

Development of labeled magnitude scales for the assessment of pain of dentin hypersensitivity.

AIMS: To develop and test labeled magnitude (LM) scales that are sensitive to variations in pain associated with dentin hypersensitivity (DH). METHODS: Qualitative methods were used first to obtain words that describe the pain of DH. Magnitude estimation was then used to determine the position of these descriptive terms by relative magnitude along four vertical LM scales. To assess their DH, patients used the four LM scales following dentin stimulation with 4°C and 25°C water. The LM scales were then compared to visual analog scale (VAS) ratings by using eight pain scenarios of varying severity. Finally, participants with DH completed the four horizontal LM scales and VAS after dentin stimulation with 4°C and 25°C water. Within-subject t tests were used for comparisons between scales and water temperatures, and between-subject t tests were used for comparisons between participants with and without DH. RESULTS: Participants showed comparable differentiation between 4°C and 25°C water on VAS and three of the LM scale measures. Responses on the fourth LM scale showed better differentiation than VAS between the two water temperatures. Participants used a greater portion of the LM scales than VAS when rating low-level pain scenarios. CONCLUSION: LM scales were shown to provide some advantages compared to standard VAS when used to evaluate DH-associated pain. These advantages may be generalized to other low-level pain conditions.

Brain activation induced by dentine hypersensitivity pain--an fMRI study.

AIM: Dentine hypersensitivity (DH) is characterized by a short, sharp pain arising from exposed dentin. Most published literature reports on peripheral neural aspects of this pain condition. The current investigation focused on differential cerebral activity elicited by stimulation of sensitive and insensitive teeth by means of natural air stimuli. MATERIALS AND METHODS: Five graded stimulus strengths were randomly applied by means of a multi-injector air jet delivery system, each followed by an individual rating of perceived stimulus intensity. Brain activity was analysed by functional magnetic resonance imaging (fMRI). RESULTS: Stimulation of sensitive teeth induced significant activation in the thalamus, somatosensory cortices (SI & SII), anterior, middle and posterior insular cortices, anterior mid cingulate cortex, perigenual anterior cingulate cortex and frontal regions (BA10 and BA46). Differential responses to DH and painless perceptions were observed in the anterior insula and anterior midcingulate cortex. CONCLUSION: For the first time, this fMRI study demonstrates the feasibility of investigating cerebral processes related to DH evoked by natural (air) stimuli. Our neuroimaging data additionally provide evidence that differential activity in the anterior Insula (aIC) and anterior midcingulate cortex (aMCC) may represent clinically relevant pain experienced by DH patients.

Targeting the gut microbiome in the management of sepsis-associated encephalopathy.

Brain injury resulting from sepsis, or sepsis-associated encephalopathy (SAE), occurs due to impaired end-organ perfusion, dysregulated inflammation affecting the central nervous system (CNS), blood-brain barrier (BBB) disruption, mitochondrial dysfunction, oxidative stress, accumulation of toxic neuropeptides and impaired toxin clearance secondary to sepsis-induced hepatic and renal dysfunction. The gut microbiome becomes pathologically altered in sepsis, which likely contributes to the pathogenesis of SAE. Herein, we review the literature detailing dysregulation of microbiota-gut-brain axis (MGBA) in SAE and highlight potential therapeutic strategies to modulate the gut microbiome to mitigate sepsis-induced brain injury.

Variability among Online Opioid Conversion Calculators Performing Common Palliative Care Conversions.

Introduction: Online opioid conversion calculators (OOCCs) are commonly used to aid conversion between opioids to overcome tolerance, reduce adverse effects, or challenges related to administration. The purpose of this study was to describe and characterize variability among OOCC used by health care practitioners when converting common opioids and doses encountered in the hospice and palliative care setting. Methods: We collected 58 quantitative surveys and performed sentiment analysis on 62 qualitative responses from adult learners primarily practicing in the palliative care setting and enrolled in an online palliative care Master of Science program through the University of Maryland, Baltimore, who were asked to perform opioid conversion calculations using realistic patient cases. Results: OOCC have substantial variability leading to a wide range of outputs, which may put patients at risk for opioid-related harm. Assessing participant sentiment toward OOCC showed most participants held a "Negative Sentiment" toward these calculators after the activity. Conclusion: Overall, findings reveal that given the same information, clinicians can come to widely different opioid doses and these differences can be amplified by OOCC. These differences can be particularly dangerous given the higher opioid doses commonly used in the palliative care setting. Considering the significant harm that can arise from an error when converting between opioids, clinicians should avoid the routine use of OOCC in real-world patient care settings. If an OOCC is used, organizations should endorse a specific calculator, provide training and education about the algorithm that supports the calculations, and encourage clinicians to use it only after their own manual calculation, which should be documented in the medical record.

Overview of the clinical evidence for the use of NovaMin in providing relief from the pain of dentin hypersensitivity.

Dentin hypersensitivity is a common condition that affects the adult population worldwide. NovaMin is technically described as amorphous sodium calcium phosphosilicate, and has been shown in laboratory studies to rapidly occlude dentin tubules and form a protective hydroxyapatite-like layer on the dentin surface. A number of clinical studies investigating the efficacy of NovaMin for the relief of pain from dentin hypersensitivity have been conducted in the United States, Ireland, China, and India. This article reviews the available literature and finds support based on randomized controlled clinical trials for the use of NovaMin in anhydrous toothpaste formulations in providing relief of pain from dentin hypersensitivity.

Using an Ordinal Approach to Compare Outcomes Between Vancomycin Versus Ceftaroline or Daptomycin in MRSA Bloodstream Infection.

INTRODUCTION: Vancomycin remains first-line therapy for methicillin-resistant Staphylococcus aureus (MRSA) blood stream infections (BSI); however, its toxicity and reported clinical failures are well established. Binary efficacy endpoints evaluating alternative anti-MRSA therapies leave clinicians deciphering between segregated clinical and safety outcomes and do not provide a comprehensive patient-centered picture of comparative therapies. This study aimed to apply a novel methodology, desirability of outcomes ranking (DOOR), to compare anti-MRSA therapies. METHODS: This was a single-centered, retrospective, cohort of adult patients with MRSA BSI that received vancomycin, daptomycin, or ceftaroline. A previously developed DOOR for S. aureus BSI was adjusted and applied to this cohort to compare vancomycin-treated versus daptomycin/ceftaroline-treated patients. The DOOR had five mutually exclusive ranks: (1) alive without treatment failure, infectious complications, or grade 4 adverse events (AEs); (2) alive with any one of treatment failure, infectious complications, or grade 4 AE; (3) alive with two of treatment failure, infectious complications, or grade 4 AE; (4) alive with all three treatment failure, infectious complications, or grade 4 AE; or (5) deceased. RESULTS: A total of 43 vancomycin-treated and 13 daptomycin/ceftaroline-treated patients were included. Baseline clinical characteristics were similar, except for higher median serum creatinine in the daptomycin/ceftaroline cohort (0.76 [IQR 0.57, 1.11] vs 1.36 [IQR 1.09, 1.91] mg/dL, P = 0.03). Patients in the daptomycin/ceftaroline cohort had a 92% probability of better outcome using DOOR methodology. Patients treated with daptomycin/ceftaroline experienced less MRSA BSI persistence (0% vs 13.9%), MRSA BSI recurrence (7.8% vs 25.6%), grade 4 AEs (23.1% vs 46.5%), and in-hospital mortality (0% vs 9.3%). CONCLUSIONS: Although limited by sample size, this study demonstrates the potential of DOOR to produce valuable, patient-centered results. Clinicians are encouraged to become familiar with appropriate use and interpretation of DOOR methodology as it will become an increasingly common endpoint in clinical trials.

Interventions to reduce polypharmacy and optimize medication use in older adults with cancer.

The use of polypharmacy and potentially inappropriate medications (PIMs) is an increasingly common, concerning public health issue in older adults, and a concurrent cancer diagnosis only further escalates the prevalence and complexity. Polypharmacy and PIM use has been associated with negative patient outcomes, including falls, chemotherapy toxicities and other adverse events, postoperative complications, frailty, functional impairment, and shortened survival. Despite the recognition of the harms, the prevalence of polypharmacy and PIM use continues to rise due to a lack of standardized identification and intervention methods. Efforts to reduce the prevalence have included use of explicit PIM screening tools (e.g., Beers criteria), comprehensive medication reviews, and deprescribing algorithms. However, these efforts are not widespread and the research on the effectiveness of such interventions is limited. To better understand what is known, this paper summarized available studies evaluating the effect of interventions on reducing the burden of polypharmacy/PIMs and provided recommendations to guide further practice models to reduce the negative consequences associated with polypharmacy and PIM use. Furthermore, we aim to establish a framework for clinical practice and to highlight areas for future intervention-based research to improve outcomes for older adults with cancer.

Construction and validation of the quality of life measure for dentine hypersensitivity (DHEQ).

AIM: To develop and validate a condition specific measure of oral health-related quality of life for dentine hypersensitivity (Dentine Hypersensitivity Experience Questionnaire, DHEQ). MATERIALS AND METHODS: Questionnaire construction used a multi-staged impact approach and an explicit theoretical model. Qualitative and quantitative development and validation included in-depth interviews, focus groups and cross-sectional questionnaire studies in a general population (n=160) and a clinical sample (n=108). RESULTS: An optimized DHEQ questionnaire containing 48 items has been developed to describe the pain, a scale to capture subjective impacts of dentine hypersensitivity, a global oral health rating and a scale to record effects on life overall. The impact scale had high values for internal reliability (nearly all item-total correlations >0.4 and Cronbach's α=0.86). Intra-class correlation coefficient for test-retest reliability was 0.92. The impact scale was strongly correlated to global oral health ratings and effects on life overall. These results were similar when DHEQ was validated in a clinical sample. CONCLUSIONS: DHEQ shows good psychometric properties in both a general population and clinical sample. Its use can further our understanding of the subjective impacts of dentine sensitivity.

Public attitudes toward sex offenders and their relationship to personality traits and demographic characteristics.

The present study examined public attitudes toward the sentencing, treatment, management, and perceived dangerousness of sex offenders. Seventy-eight university undergraduates completed a 25-item attitude toward sex offenders survey developed for the present study, along with a five-factor measure of personality (NEO Personality Inventory - Revised), a demographic questionnaire, and the Paulhus Deception Scale, to control for social desirability. While participants most frequently endorsed the belief that sentences were not sufficiently severe, they tended to espouse treatment and risk management alternatives to longer sentences and eschewed exceptionally severe punishments (e.g., surgical castration). Participants estimated high rates of sexual recidivism (59%), although they also estimated significantly lower recidivism rates for treated offenders. Results of a principle components analysis suggested that participant attitudes comprised two broad domains: systems attitudes (e.g., law enforcement, corrections, justice) and rehabilitative attitudes. Although few demographic differences emerged in participant attitudes, 'openness to experience' and 'agreeableness' each significantly predicted more rehabilitative attitudes, while contrary to expectations, 'extraversion' was significantly associated with more negative systems-related attitudes. The results provide support that personality traits may be linked to important social attitudes, including those toward sex offenders.

Intravenous Fluid Management in Critically Ill Adults: A Review.

TOPIC: This article reviews the management of intravenous fluids and the evaluation of volume status in critically ill adults. CLINICAL RELEVANCE: Intravenous fluid administration is one of the most common interventions in the intensive care unit. Critically ill patients have dynamic fluid requirements, making the management of fluid therapy challenging. New literature suggests that balanced salt solutions may be preferred in some patient populations. PURPOSE OF PAPER: The bedside critical care nurse must understand the properties of various intravenous fluids and their corresponding impact on human physiology. The nurse's clinical and laboratory assessments of each patient help define the goals of fluid therapy, which will in turn be used to determine the optimal patient-specific selection and dose of fluid for administration. Nurses serve a vital role in monitoring the safety and efficacy of intravenous fluid therapy. Although this intervention can be lifesaving, inappropriate use of fluids has the potential to yield detrimental effects. CONTENT COVERED: This article discusses fluid physiology and the goals of intravenous fluid therapy, compares the types of intravenous fluids (isotonic crystalloids, including 0.9% sodium chloride and balanced salt solutions; hypotonic and hypertonic crystalloids; and colloids) and their adverse effects and impact on hemodynamics, and describes the critical care nurse's essential role in selecting and monitoring intravenous fluid therapy.