Predictors of Chronic Pain 6 Months and 1 Year After Bariatric Surgery.

BACKGROUND: Obesity and chronic pain (CP) represent serious, interrelated global public health concerns that have a profound impact on individuals and society. Bariatric surgery is increasing in popularity and has been proven safe and efficacious, providing long-term weight loss and improvements in many obesity-related co-morbidities. A decrease in CP is often a motivation for bariatric surgery. The purpose of this study was to investigate the changes in CP postoperatively and to examine the relationship between psychosocial measures and pain. METHODS: A total of 155 adult bariatric surgery patients were recruited and completed self-report measures for CP severity and interference, neuropathic pain, anxiety, depression, emotion regulation and perceived social support at three timepoints preoperative and 6 and 12 months postoperative. RESULTS: Pain significantly decreased between preoperative and postoperative timepoints, and preoperative pain was the most significant predictor of postoperative pain. Preoperative CP was correlated with anxiety (p < 0.05) and depression (p < 0.01) at 6 months postoperatively and perceived social support (p < 0.01) at 1 year postoperatively. However, regression analyses with psychological variables were not significant. CONCLUSION: CP decreases after bariatric surgery, but further research with larger sample sizes is needed to establish whether psychosocial characteristics impact this outcome.

The distribution of sediment microplastics assemblages is driven by location and hydrodynamics, not sediment characteristics, in the Gulf of Maine, USA.

Microplastics (MP) are found in marine sediments across the globe, but we are just beginning to understand their spatial distribution and assemblages. In this study, we quantified MP in Gulf of Maine, USA sediments. MP were extracted from 20 sediment samples, followed by polymer identification using Raman spectroscopy. We detected 27 polymer types and 1929 MP kg-1 wet sediment, on average. Statistical analyses showed that habitat, hydrodynamics, and station proximity were more important drivers of MP assemblages than land use or sediment characteristics. Stations closer to one another were more similar in their MP assemblages, tidal rivers had higher numbers of unique plastic polymers than open water or embayment stations, and stations closer to shore had higher numbers of MP. There was little evidence of relationships between MP assemblages and land use, sediment texture, total organic carbon, or contaminants.

Qualitative assessment of the impact of restricting number of drug treatments for rheumatoid arthritis: Experience of prescribers and patients.

INTRODUCTION: In 2020, almost half of all Clinical Commissioning Groups in England were restricting the number of higher cost drugs (HCDs) that could be prescribed for Rheumatoid Arthritis (RA) before an Individual Funding Request was required. We were interested in qualitatively exploring the experiences of prescribers affected by these restrictions and the experiences of patients who required four or more of these drugs. METHODS: Semi-structured interviews were conducted with five prescribers in restricted areas and six patients from our own service who had received four or more HCDs. The interviews were analysed thematically. RESULTS: Prescribers reported feeling distressed and frustrated by the unsatisfactory service they were constrained to provide. Some prescribers continued partially effective treatments in order not to run out of options. They did not find Individual Funding Requests or the Blueteq High Cost Drug (HCD) System helpful in the management of these patients. The Blueteq HCD System is an electronic platform that allows health managers to monitor the prescribing of high-cost medicines and manage the complexities associated with their use. Patients expressed severe distress at the prospect of running out of options and anxiety around the process of gaining approval for their next treatment. CONCLUSIONS: Restricting drugs for RA by the number which can be prescribed results in persistence with partially effective treatments, which is unsatisfactory for prescribers and patients, further it does not save money. Patients need to travel in their journey with RA and be able to try the next drug even though they know that it may not work.

Viewpoint: Nurses educating patients about drugs.

Educating patients about the drugs they take is essential for them to take them safely and effectively. This education is now commonly given by nurses as part of the huge expansion in the nurse specialist role. However, training for this role has not kept pace with practice. Nurses have expressed variable confidence in this role and expressed a wish for more formal training. Current practice often puts the information rather than the patient at the centre of the consultation with the nurse dominating the conversation. Cues to address the patient agenda are commonly missed. An animated patient who interrupts is probably not having their educational needs met. Education of the professionals around how to perform this task in an optimal way is necessary and should result in better efficacy and safety of the drugs. This could be achieved by incorporating features of Shared Decision Making and the Calgary-Cambridge consultation techniques into training and the consultation. Personalisation by attention to patient preferences, language and health literacy is essential.

A commentary from the pioneers on the innovation of the relative motion concept: History, biologic considerations, and anatomic rationale.

The relative motion concept is simply recognition of the normal functional anatomic relationships that allow powerful extrinsic muscles, the extensor digitorum communis (EDC) and flexor digitorum profundus (FDP), to vary forces on individual finger joints and function in response to the relative position of adjacent metacarpophalangeal joints (MCPJs) in the hand, one to another. First identified as a cause of complications after surgery, a better understanding now allows us to harness these forces by way of differential metacarpophalangeal joint (MCPJ) positioning using an orthosis. This can reduce undesirable tension and allow immediate controlled active motion while permitting functional use of the hand. Tissue gliding with active motion prevents restrictive scarring, maintains joint mobility and avoids unnecessary limitations and stiffness on normal neighboring structures. The historical development of this concept is shared with explanation of the anatomic and biologic rationale for this approach. Acute and chronic hand conditions that may benefit from better understanding of relative motion are numerous and growing.

Comparison of two procedures for microplastics analysis in sediments based on an interlaboratory exercise.

Microplastics (MP) are distributed throughout ecosystems and settle into sediments where they may threaten benthic communities; however, methods for quantifying MP in sediments have not been standardized. This study compares two methods for analyzing MP in sediments, including extraction and identification, and provides recommendations for improvement. Two laboratories processed sediment samples using two methods, referred to as "core" and "augmentation", and identified particles with visual microscopy and spectroscopy. Using visual microscopy, the augmentation method yielded mean recoveries (78%) significantly greater than the core (47%) (p = 0.03), likely due to the use of separatory funnels in the former. Spectroscopic recovery of particles was lower at 42 and 54% for the core and augmentation methods, respectively. We suspect the visual identification recoveries are overestimations from erroneous identification of non-plastic materials persisting post-extraction, indicating visual identification alone is not an accurate method to identify MP, particularly in complex matrices like sediment. However, both Raman and FTIR proved highly accurate at identifying recovered MP, with 96.7% and 99.8% accuracy, respectively. Low spectroscopic recovery of spiked particles indicates that MP recovery from sediments is lower than previously assumed, and MP may be more abundant in sediments than current analyses suggest. To our knowledge, likely due to the excessive time/labor-intensity associated with MP analyses, this is the first interlaboratory study to quantify complete method performance (extraction, identification) for sediments, with regards to capabilities and limitations. This is essential as regulatory bodies move toward long-term environmental MP monitoring.

Carer-reported measures for a dementia registry: A systematic scoping review and a qualitative study.

OBJECTIVES: Informal carers play a critical role in supporting people with dementia. We conducted a scoping review and a qualitative study to inform the identification and development of carer-reported measures for a dementia clinical quality registry. METHODS: Phase 1-Scoping review: Searches to identify carer-reported health and well-being measures were conducted in three databases (MEDLINE, PsycINFO and Embase). Data were extracted to record how the measures were administered, the domains of quality-of-life addressed and whether they had been used in a registry context. Phase 2-Qualitative study: Four focus groups were conducted with carers to examine the acceptability of selected measures and to identify outcomes that were important but missing from these measures. RESULTS: Phase 1: Ninety-nine carer measures were identified with the top four being the Zarit Burden Interview (n = 39), the Short-Form12/36 (n = 14), the Brief Coping Orientation to Problems Experienced scale and the Sense of Coherence scale (both n = 9). Modes of administration included face-to-face (n = 50), postal (n = 11), telephone (n = 8) and online (n = 5). No measure had been used in a registry context. Phase 2: Carers preferred brief measures that included both outcome and experience questions, reflected changes in carers' circumstances and included open-ended questions. CONCLUSIONS: Carer-reported measures for a dementia clinical quality registry need to include both outcome and experience questions to capture carers' perceptions of the process and outcomes of care and services. Existing carer-reported measures have not been used in a dementia registry context and adaption and further research are required.

Quantitative interpretation of utterances and movements from videoed interactions between rheumatology nurses and patients commencing methotrexate: a pilot study.

BACKGROUND: Educating patients about methotrexate is a core role of rheumatology nurses. We have previously reported the scoring of videoed interviews of rheumatology nurses educating patients prior to commencing methotrexate in comparison with the Calgary-Cambridge consultation model, and the qualitative analysis of the transcripts (Robinson et al. Musculoskeletal Care 2021). We were interested to investigate what could be learned from a more quantitative analysis of utterances and movements in these consultations and how they related to the qualitative interpretations. AIM: To investigate the frequency of utterances and body movements during interactions between rheumatology nurses and patients commencing methotrexate and to relate these to the qualitative interpretations of the interviews. METHODS: Video-recordings of ten patients receiving methotrexate education from four different rheumatology nurses were available from the previous study. They were analysed using the Medical Interaction Process System (MIPS). This involved coding all utterances and body movements minute-by-minute by multiple inspections of the recordings. The first 10 min of each consultation was coded. The utterances and movements of the nurses and patients were compared. The thematic analysis based on the structure and content of the Calgary-Cambridge (C-C) consultation model was available from the previous study. This enabled the results from the MIPS to be compared between the interviews that scored higher on the C-C model and those scoring lower. RESULTS: The inter-rater reliability between 2 raters for one video was satisfactory (80-100% agreement). Numerically, giving information dominated the nurse contribution and assent by positive utterances and head nodding dominated for the patients. The results were consistent with the nurse agenda dominating the interaction with little opportunity for patient involvement. Nurses in high-scoring interviews made more illustrative gestures and fewer batonic movements while patients did the opposite. Nurses in high-scoring consultations asked more open questions, with more checking of understanding and summarising but fewer interruptions. Patients in low-scoring consultations were much more animated with head movements and illustrative gestures. Patients also checked and interrupted more. CONCLUSIONS: In this pilot study, the MIPS was usable and demonstrated verbal and non-verbal behaviours consistent with the qualitative assessments. It also showed some behaviours that are not intuitive but may indicate how effectively the interview was progressing. Some nurse behaviours identified that were associated with the higher scoring interviews may be useful indictors for training including making illustrative rather than batonic gestures and checking understanding. Patient behaviours, such as greater animation, were exhibited in low-scoring consultations, and could indicate that the interview was not addressing the patient perspective. Quantification of utterances and movements can be done and may give insights into the consultation process.

Real-world single-centre experience of rheumatoid arthritis patients requiring four or more higher cost drugs: response and duration of treatment.

The cost-effectiveness of higher cost drugs (HCDs) after several failures is disputed by some purchasers of services for people with rheumatoid arthritis (RA). We were interested to explore our service experience of using HCDs beyond the third choice to document response rates and duration of treatments. METHOD: Records from our multi-disciplinary team meeting (MDT) that is used to decide on the use of HCDs were used to identify all RA patients who had been exposed to four or more HCDs. Notes were scrutinised for sequence of treatments, duration and response to treatments and reasons for stopping at each choice point. RESULTS: From a total of 2648 RA patients in our service, 49 (< 2%) had been exposed to four or more HCDs. Response rates based on descriptive assessments for fourth to sixth choices were between 50 and 55% as well as some partial responders. There were responders and failures to all drugs at every choice point. Patients who had responded to one drug were more likely to respond to the next. Patients often responded to drugs for approximately 2 years. Only four patients had stopped looking for the next HCD. CONCLUSION: Patients often respond to late choice HCDs. There are responders and failures at each time point and they are difficult to predict. There is no justification for restricting the number of HCDs that can be tried for RA. Key Points • Less than 2% of our RA patients required 4 or more higher cost drugs. • Fourth to sixth choice drugs still worked in 50 to 55% of patients. • There is no justification for CCGs restricting the number of drugs that can be tried.

Quantification of microplastics in sediments from Narragansett Bay, Rhode Island USA using a novel isolation and extraction method.

Microplastics are small plastic particles found ubiquitously in marine environments. In this study, a hybridized method was developed for the extraction of microplastics (45-1000 µm) from sediments using sodium bromide solution for density separation. Method development was tested using spiked microplastics as internal standards. The method was then used to extract microplastics from sediments in Narragansett Bay, Rhode Island, USA. Suspect microplastics were analyzed with Raman spectroscopy. Microplastic abundance ranged from 40 particles/100 g sediment to 4.6 million particles/100 g sediment (wet weight). Cellulose acetate fibers were the most abundant microplastic. These results are some of the first data for microplastics in Rhode Island sediments.

Hot, cold, or both? A person-centered perspective on death awareness during the COVID-19 pandemic.

The COVID-19 pandemic-as an omnipresent mortality cue-heightens employees' awareness of their mortality and vulnerability. Extant research has identified two distinct forms of death awareness: death anxiety and death reflection. Because researchers have exclusively examined death anxiety and death reflection as independent and unique variables across individuals while overlooking their interplay and co-existence within individuals, we know little about whether and why employees can have different combined experiences of two forms of death awareness over a certain period of time (e.g., during the pandemic), and how these different employee experiences relate to theoretically and practically important work-relevant consequences. To address this gap in our knowledge, we adopted a person-centered approach using latent profile analysis to consider death anxiety and death reflection conjointly within employees during the COVID-19 pandemic. Across two studies, we identified three distinct death awareness profiles-the disengaged, calm reflectors, and anxious reflectors-and found membership in these profiles systematically varied according to health- (e.g., risk of severe illness from COVID-19), work- (e.g., job-required human contact), and community-related (e.g., the number of regional infections) factors influencing the self-relevance of COVID-19 as a mortality cue. In addition, we found that these death awareness profiles differentially predicted important employee outcomes, including well-being (i.e., depression and emotional exhaustion) and prosocial behaviors at work (i.e., organizational citizenship behaviors and pro-diversity behavior). (PsycInfo Database Record (c) 2021 APA, all rights reserved).

An exploratory study using video analysis of rheumatology specialist nurses conducting methotrexate education consultations with patients.

BACKGROUND: Prior to commencing methotrexate, patients routinely attend an education consultation with a rheumatology nurse. The purpose of the consultation is to discuss the patients' expectations and concerns related to commencing methotrexate, the benefits of treatment, potential side effects and monitoring requirements. The aim of this study was to use video analysis to assess the structure, content and mode of delivery of the consultation. METHODS: Video recordings of 10 patient-nurse consultations, involving four specialist rheumatology nurses, were analysed and transcribed. The consultations were compared with the Calgary-Cambridge (CC) consultation model. Transcripts were thematically analysed. Data were quantitatively assessed for verbal and non-verbal behaviours. FINDINGS: Assessment of the video data using the CC model demonstrated good structure, content and flow of the consultation, influenced by the use of an information leaflet. Consultations generally consisted of communication from nurse to patient rather than a dialogue; the nurse spoke for 69%-86% of the time; clarification of the patient's understanding of the information did not take place in any of the consultations. Thematic analysis also showed that the nurse agenda dominated and the nurse was aware of 'overloading' the patient with information. Cues from the patients to discuss items of importance were often missed. CONCLUSION: Video analysis can be used to identify the aspects of the consultation that work well and those areas of the consultation that could be improved with specific training.

Development of Survey Scales for Measuring Exposure and Behavioral Responses to Disruptive Intraoperative Behavior.

OBJECTIVES: Disruptive intraoperative behavior has detrimental effects to clinicians, institutions, and patients. How clinicians respond to this behavior can either exacerbate or attenuate its effects. Previous investigations of disruptive behavior have used survey scales with significant limitations. The study objective was to develop appropriate scales to measure exposure and responses to disruptive behavior. METHODS: We obtained ethics approval. The scales were developed in a sequence of steps. They were pretested using expert reviews, computational linguistic analysis, and cognitive interviews. The scales were then piloted on Canadian operating room clinicians. Factor analysis was applied to half of the data set for question reduction and grouping. Item response analysis and theoretical reviews ensured that important questions were not eliminated. Internal consistency was evaluated using Cronbach α. Model fit was examined on the second half of the data set using confirmatory factor analysis. Content validity of the final scales was re-evaluated. Consistency between observed relationships and theoretical predictions was assessed. Temporal stability was evaluated on a subsample of 38 respondents. RESULTS: A total of 1433 and 746 clinicians completed the exposure and response scales, respectively. Content validity indices were excellent (exposure = 0.96, responses = 1.0). Internal consistency was good (exposure = 0.93, responses = 0.87). Correlations between the exposure scale and secondary measures were consistent with expectations based on theory. Temporal stability was acceptable (exposure = 0.77, responses = 0.73). CONCLUSIONS: We have developed scales measuring exposure and responses to disruptive behavior. They generate valid and reliable scores when surveying operating room clinicians, and they overcome the limitations of previous tools. These survey scales are freely available.

Patient-Reported Outcome Measures to Inform Care of People With Dementia-A Systematic Scoping Review.

BACKGROUND AND OBJECTIVES: Patient-reported outcome measures (PROMs) captures the patient's perspective regarding quality of life, daily functioning, symptom severity, and overall health, and how these may be impacted by health care or other interventions. PROMs are used in clinical quality registries (CQRs) for a number of diseases to assess the patient's perspective of the impact of clinical care on quality-of-life. This scoping review aimed to identify dementia-specific PROMs, determine how the PROMs are being used, and whether they are used within dementia registries. RESEARCH DESIGN AND METHODS: Three electronic databases were searched using Medical Subject Heading terms for dementia, quality of life, and patient-reported outcomes. Data were extracted on the PROMs used and the methods and mode of administering the PROM. RESULTS: Seven dementia-specific PROMs were identified, however none were used in a dementia registry. All the PROMs were used at the patient level to identify patient needs and health service impacts. Three PROMs were also used at a system level to examine difference in care models. The majority of the PROMs were administered via a researcher or clinician and were predominantly completed by a proxy. DISCUSSION AND IMPLICATIONS: PROMs provide an opportunity for a patient with dementia to share experiences and perspectives of care. A number of dementia-specific PROMs exist, yet none are used in dementia registries and the majority of studies utilize PROMs via a proxy. The use of PROM for patients with dementia, particularly in the context of dementia registries, requires further exploration and consideration.

Comparison of microplastic isolation and extraction procedures from marine sediments.

Microplastics (MPs) are small (<5 mm) plastic particles which pose a threat to marine ecosystems. Identifying MPs is crucial for understanding their fate and effects. Many MP extraction methods exist, but procedural differences prevent meaningful comparisons across datasets. This method comparison examines the efficiency of five methods for extracting MPs (40-710 µm) from marine sediments. Known quantities of MPs were spiked into sediments. The MPs were extracted and enumerated to demonstrate percent recovery. Findings determined that sediment matrix, MP properties, and extraction method affect the percent recovery of MPs from sediments. Average recoveries of spiked microplastics were between 0 and 87.4% and varied greatly by sediment type, microplastic, and method of extraction. In general, larger particle and lower density MPs were more effectively recovered. Marine sediments low in organic matter and with larger grain size also had higher percent recoveries of MPs. These findings support the need for method optimization and unified procedures.

What Do Adult Surgical Patients Speaking Primarily Cantonese, Italian, or Portuguese Really Want to Know About Pain and Pain Management?

BACKGROUND: Surgical patients consider information about pain and pain management to be highly important (Apfelbaum, 2003). At the same time, evidence indicates that members of racial and ethnic minorities are more likely to experience inadequate pain management (Green, Anderson, Baker, Campbell, Decker, Fillingim, & Todd, 2003; Mossey, 2011). AIMS: This study investigated the needs of general day surgery patients who spoke primarily Cantonese, Italian, or Portuguese at home for information about postoperative pain. DESIGN: This was a mixed methods, descriptive study. SETTING: The day surgery unit of a large, quaternary care hospital in downtown Toronto. PARTIPANTS/SUBJECTS: Inclusion criteria were day patients who were at least 18 years of age or older and spoke primariy Cantonese, Italian or Portugues at home. and were able to read and write in their primary language. METHODS: Participants who had undergone a day surgery procedure completed a telephone information needs survey in their primary language (Cantonese, Italian, Portuguese) within 72 hours after discharge. Composite mean scores were calculated for each item. Chi-squared analyses were used to probe for intergroup differences and compare with English-fluent participants from phase 1 of this study (Kastanias, Denny, Robinson, Sabo, & Snaith, 2009). RESULTS: Sixty-three participants in total completed the survey: 21% Cantonese, 41% Italian, and 38% Portuguese. The mean age of the sample was 70 years old; 89% were born outside of Canada, and 52% were male. For the combined group, the average importance rating score range for the information items was 6.2-8.9 out of a possible score of 10. All items were rated as moderate (5-6 out of 10) to high (≥7out of 10) importance. Surgical subtype, health status, and age had no effect on the importance of any information item. There were no significant differences between the three language groups on any of the information items. This lack of difference may have been a result of a lack of power due to the small sample size of the individual language groupings. Overall, the top-ranked information items were "the plan for which drugs to take and when," "what I can do if I still have pain or side effects," and "side effects I was most likely to get." CONCLUSIONS: Similar to English-fluent participants (Kastanias et al., 2009), participants who primarily spoke either Cantonese, Italian, or Portuguese at home placed moderate to high importance on all of the information items. and neither surgical subtype, health status nor age had any effect on the importance of any item. The multilingual sample in this study placed more importance than English-fluent participants on information regarding help with paying for pain medication (p = .001) and the side effects they were most likely to experience (p < .05). Due to a paucity of literature in this area, further research is warranted. Results may assist with evaluating and improving current approaches to surgical patient pain management education.