Development and Implementation of an Online Pain Management Continuing Education Program.

BACKGROUND: Multiple studies indicate a lack of pain management training across a range of healthcare specialties. The online Joint Pain Education Program (OJPEP) was created to provide content covering various topics that range from general pain science to integrative care to pain management. The present study evaluates the feasibility of an interdisciplinary, self-guided, online pain management continuing education program, the OJPEP. PARTICIPANTS/SUBJECTS: A total of 228 learners participted in this study. Of the 228 learners, 58 learners identified as registered nurses and 12 learners identified as nurse practitioners. DESIGN: Prospective single-arm education feasibility study. METHODS: Potential learners were provided invitations to participate via emails from clinic leadership and postings to hospital intranet websites. Learners registered online and could select up to eight modules, based on the materials developed from a Department of Defense/Veterans Administration project. Learners evaluated their satisfaction with module quality and applicability. RESULTS: A variety of providers, predominately non-prescribers, across many health care specialties, registered for modules. Across all modules except one, less than half of participants who registered completed the selected module. Time stamps indicated many learners skipped module content. Of those who completed the continuing education evaluation to obtain certificates, the majority indicated the content was of high-quality, appropriate, and evidence-based. One-third to approximately one-half of learners indicated that they would apply content in their clinical practice. Completion of the intended 3-month follow-up survey was poor. CONCLUSIONS: Though modules were acceptable per learner responses, future work is needed to: develop modules that are more engaging (e.g., interactive) and applicable to learners; and improve implementation methods to include dissemination and evaluation metrics.

Changes in actigraphy metrics associated with PROMIS measures after orthopaedic surgery.

AIM: This study examined the feasibility of integrating actigraphy devices into orthopaedic surgical settings to assess the concurrent validity between objective actigraphy data and PROMIS measures. Additionally, the association between changes in actigraphy data and longitudinal changes in PROMIS measures was examined. METHODS: Data were collected from 17 participants using actigraphy devices the week prior to and after orthopaedic surgery from 02/2019 to 03/2020. Participants completed PROMIS measures (Physical Function, Sleep Disturbance, Pain Interference) preoperatively and up to 6 months postoperatively. Nonparametric correlations (rs ) assessed for concurrent validity. Linear mixed-effects models examined the association between changes in actigraphy data and PROMIS measures. RESULTS: Prolonged wake after sleep onset was associated with increased sleep disturbances (rs = 0.49; p = 0.045) and pain interference (rs = 0.51; p = 0.04). Changes in pain interference were correlated with increased awakenings (rs = 0.54; p = 0.03). Increased wake after sleep onset was associated with worsening sleep disturbance (ß = 0.12; p = 0.01) and pain interference scores over the postoperative period (ß = 0.12; p = 0.02). CONCLUSIONS: This study is among the first to examine changes in objective actigraphy data and longitudinal PROMIS measures following orthopaedic surgery and illustrates the feasibility of incorporating actigraphy into surgical settings to evaluate postoperative recovery.

App-Based Pain Management and Opioid Education Program for Patients in Clinic Waiting Rooms.

BACKGROUND: Best approaches to delivering patient education related to pain management and opioid safety are understudied. AIMS: This study assessed the feasibility, acceptability, and preliminary patient-reported impact of an app-based patient pain education program. DESIGN: Pilot study with data collection occurring on 43 weekdays between August 2019-February 2020. SETTING: Waiting rooms at the pain clinic and a primary care medical home within two military treatment facilities. PARTICIPANTS: Military health system beneficiaries seeking general care at the primary care medical home or pain-specific care at the pain clinic. METHODS: The Joint Pain Education and Project curriculum includes patient-focused videos describing the biopsychosocial aspects of pain and pain management, medication take-back and safe disposal, and multidimensional pain assessments. The app-based videos were available on tablets in the waiting rooms for patients to view and complete surveys on after. RESULTS: Overall, 152 patients viewed the videos and completed surveys. Most viewers were interested in receiving other tablet-based health education while in the waiting room (62%). Most viewers found videos to be moderately or very helpful (73%) and were satisfied or very satisfied with the information provided (85%). Participants at the primary care medical home were more likely to find videos helpful compared to participants at the pain clinic (OR = 2.11; 95% CI: 1.07, 4.20; p = .03). CONCLUSION: Implementing app-based pain management education is feasible across clinic settings and is well received by patients. Clinics should consider providing pain education across care setting, rather than just pain specialty clinics, to help foster discussions between clinicians and patients regarding pain management and opioid safety.

A Randomized Controlled Trial to Compare 2 Scalable Interventions for Lower Urinary Tract Symptom Prevention: Main Outcomes of the TULIP Study.

PURPOSE: We compared 2-year urinary incontinence and urgency scores of older women who attended a 2-hour bladder health class vs those who viewed a 20-minute abbreviated class video for the purpose of urinary incontinence prevention. MATERIALS AND METHODS: A randomized, 2-arm, parallel design study was done to test the superiority of the 20-minute video over the 2-hour class. Outcomes at baseline, and 3, 12 and 24 months were the scores on questions 1 to 3 of ICIQ-SF (International Consultation on Incontinence Short Form) as the primary outcome and on IUSS (Indevus Urgency Severity Scale). Intent to treat analysis was done to compare the change from baseline in each intervention group across time and also with each other. Multiple imputation was used for missing data. RESULTS: A total of 647 women participated in the study. Mean age was 63 years and approximately 28% of the participants were African American, primarily from an urban setting. The 2 arms were balanced on body mass index at baseline, age, race/ethnicity, education, employment status, income and marital status. No differences in primary or secondary outcomes were demonstrated between the 2 groups from baseline to the 3, 12 or 24-month visits. CONCLUSIONS: The absence of significant differences in the outcome measures of ICIQ-SF and IUSS between the 2-hour class and the 20-minute video groups demonstrates that the 2 interventions were comparable. As urinary incontinence and urgency tend to rise annually in older women, instruction in bladder health self-care provided through either the 2-hour class or the 20-minute video format is a useful intervention to prevent urinary incontinence in older women.

Voices from the street: exploring the realities of family homelessness.

Homelessness threatens the health and well-being of thousands of families in the United States, yet little is known about their specific needs and how current services address them. To fill this knowledge gap, we explored the experiences of homelessness families in Detroit, Michigan. We targeted homeless mothers and their caseworkers for study to see if the perceptions of needs and services were in alignment. Using focus groups and content analysis, we identified four overarching themes that illustrate homeless mothers' experience with homelessness. We then analyzed data from caseworkers to look specifically for similarities and differences in their perceptions. Key findings included reports of family histories of violence, poverty, social isolation, and a lack of informal support as contributing to homelessness. The differing perspectives of mothers and their caseworkers regarding how best to move forward highlight how current programs and services may not be meeting the needs of this growing and vulnerable cohort.

Self-Regulatory Coping Behaviors and Stress Reactivity: Exploring the Environmental Affordance Model of Health Disparities.

OBJECTIVES: To explore the relationship between self-regulatory coping behaviors (SRCB) and hypothalamic pituitary adrenal (HPA) stress reactivity. METHODS: Data came from the Richmond Stress and Sugar Study (n=125, median age: 57 years, 46% non-Hispanic White, 48% African American). The relationships between 11 SRCB ("health-harming" [e.g., smoking] and "health-promoting" [e.g., exercising]) with HPA stress reactivity, indicated by salivary cortisol response to the Trier Social Stress Test, was assessed using multi-level modeling. RESULTS: Health-harming and health-promoting SRCB were positively correlated (+0.33, p<0.001). Several individual behaviors were related to HPA stress reactivity, for example, smoking and meditation were associated with shallower increases in cortisol (smoking: -13.0%, 95%CI: -20.9% to -4.3%; meditation: -14.0%, 95%CI: -22.0% to -5.1%). However, SRCB summary measures were unrelated to stress reactivity. DISCUSSION: Health-harming and health-promoting SRCB are inter-related. Specific behaviors, rather than groupings as health-harming versus -promoting, are related to HPA stress reactivity.

Theory and empiricism: A comment on "Interrogating the environmental affordances model" by Pamplin and colleagues.

We strongly support efforts to generate, rigorously test, and falsify hypotheses derived from the Environmental Affordances (EA) Model of Health Disparities, as originated by the late Dr. James S. Jackson (1940-2020). Such efforts are critical to establishing robust, theoretically grounded scientific frameworks that explain the fundamental causes of racial disparities in health and wellbeing. Pamplin et al. (2021) fundamentally misrepresents the EA Model as a framework that (falsely) reifies the role of race as a determinant of health behaviors and health outcomes. Further, both their study design and analytic approach are inappropriate for testing predictions of this framework. We address these issues with the goal of recentering the scholarly conversation about how stress contributes to health, and disparities in health, over the life course.

Influence of Spirituality on Depression-Induced Inflammation and Executive Functioning in a Community Sample of African Americans.

African Americans (AAs) are disproportionately affected by cerebrovascular pathology and more likely to suffer from premature cognitive decline. Depression is a risk factor for poorer cognitive functioning, and research is needed to identify factors that serve to mitigate its negative effects. Studies have demonstrated positive influences of spirituality within the AA community. Determining whether spirituality attenuates the effects of depressive symptoms on cognitive functioning and the pathophysiological mechanisms that explain these relationships in AAs is paramount. This study examines the influence of daily spiritual experiences on the relationship between depressive symptoms and cognitive functioning, and how inflammatory markers may partially explain these associations. A sample of 212 (mean age= 45.6) participants completed the Daily Spiritual Experience Scale (DSES), Beck Depression Inventory-II (BDI-II), Trail Making Test A and B (TMT) and Stroop Color and Word Test (Stroop). Blood samples were collected to measure inflammatory mediators (IL-6, IL-1a, TNF-a). Linear regression analyses were used to evaluate associations. Higher BDI-II scores were associated with poorer psychomotor speed and visual scanning, measured by TMT A (B=1.49, P=.01). IL-6 explained a significant amount of variance in this relationship (B=.24, CI 95% [.00, .64]). IL-6 also significantly mediated the relationship between depressive symptoms and psychomotor speed and mental flexibility, measured by TMT B performance (B=.03, CI 95% [.003, .095]). Frequent spiritual experiences among AAs may ameliorate the negative influence of depressive symptoms on cognitive functioning.

Costs and Sustainability of a Behavioral Intervention for Urinary Incontinence Prevention.

INTRODUCTION: Many women choose behavioral interventions as first line treatment for urinary incontinence. We developed a 20-minute abbreviated video, which proved to be similar to a 2-hour in-person class in a randomized trial. This study examines economic end points for the 20-minute video relative to the 2-hour class. METHODS: We randomized 332 participants to the 2-hour class and 315 to the 20-minute video. We estimated the cost for the 2-hour class, the 20-minute video and followup health care utilization. Participants were followed for 3, 12 and 24 months, and asked about health care utilization, quality of life and lost productivity. To measure perceived value, we queried each participant regarding willingness to pay. Regression analysis was used for statistical comparisons. RESULTS: The estimated per participant cost for a 2-hour class was $38, which was more than the marginal cost of the video ($0). We found no significant differences between the treatment groups at each followup for quality of life, lost productivity or health care utilization. Women were willing to pay $26, $21 and $30 for a copy of the DVD, video on the Web and in-person class, respectively, all of which were less than the average cost of the in-person class ($38). CONCLUSIONS: Poor adherence remains a challenge for many behavioral interventions designed to prevent urinary incontinence. The 20-minute video is less expensive than the 2-hour class and is equally effective. Distributing the video on the Internet will improve access and will be easier to sustain than in-person classes.

Overcoming: a concept analysis.

BACKGROUND: Nurses often work with individuals and populations striving to improve or maintain the quality of their lives. Many, struggling from complex health and social problems, are challenged to surmount barriers to achieve this goal. The growing number of homeless families in the United States represent one such cohort. AIMS: To develop an operational definition of overcoming and explicate its meaning, attributes, and characteristics as it relates to homeless families. METHODS: Using the concept analysis method described by Walker and Avant, along with an extensive literature review, and sample cases pertaining to family homelessness, we delineated the defining attributes, antecedents, consequences, and empirical referents of the concept, overcoming. CONCLUSION: The results of this concept analysis, particularly the relationship of overcoming to family homelessness, provide guidance for further conceptualization and empirical testing, as well as for clinical practice.