Healthcare provider perspectives on emergency department-initiated buprenorphine/naloxone: a qualitative study.

BACKGROUND: Take-home buprenorphine/naloxone is an effective method of initiating opioid agonist therapy in the Emergency Department (ED) that requires ED healthcare worker buy-in for large-scale implementation. We aimed to investigate healthcare workers perceptions of ED take-home buprenorphine/naloxone, as well as barriers and facilitators from an ED healthcare worker perspective. METHODS: In the context of a take-home buprenorphine/naloxone feasibility study at a tertiary care teaching hospital we conducted a descriptive qualitative study. We conducted one-on-one in person or telephone interviews and focus groups with ED healthcare workers who cared for patients given take-home buprenorphine/naloxone in the feasibility study at Vancouver General Hospital from July 2019 to March 2020. We conducted 37 healthcare worker interviews from December 2019 to July 2020. We audio recorded interviews and focus groups and transcribed them verbatim. We completed interviews until we reached thematic saturation. DATA ANALYSIS: We inductively coded a sample of transcripts to generate a provisional coding structure and to identify emerging themes, which were reviewed by our multidisciplinary team. We then used the final coding structure to analyze the transcripts. We present our findings descriptively. RESULTS: Participants identified a number of context-specific facilitators and barriers to take-home buprenorphine/naloxone provision in the ED. Participants highlighted ED conditions having either facilitative or prohibitive effects: provision of buprenorphine/naloxone was feasible when ED volume was low and space was available but became less so as ED volume increased and space decreased. Similarly, participants noted that patient-related factors could have a facilitative or prohibitive effect, such as willingness to wait (willing to stay in the ED for study-related activities and buprenorphine/naloxone initiation activities), receptiveness to buprenorphine/naloxone, and comprehension of the instructions. As for staff-related factors, time was identified as a consistent barrier. Time included time available and time required to initiate buprenorphine/naloxone (including time building rapport). Healthcare worker familiarity with buprenorphine/naloxone was noted as either a facilitating factor or a barrier, and healthcare workers indicated that ongoing training would have been advantageous. Many healthcare workers identified that the ED is an important first point of contact for the target patient population. CONCLUSION: Integrating a buprenorphine/naloxone program into ED care requires organizational supports (e.g., for managing buprenorphine/naloxone within limitations of ED volume, space, and time), and ongoing education of healthcare workers to minimize identified barriers.

Promoting caregiver involvement at the public library: An evaluation of a math and science storytime program for young children.

Introduction: Public libraries are asset institutions that provide important spaces for families to engage in meaningful, authentic STEM learning. However, limited budgets and a model centered on open-access and broad inclusion makes conducting rigorous evaluations in these spaces, such as randomized control trials, challenging. There is a need to consider evaluation designs that consider both rigor and feasibility. The aims of the present study were to: (1) describe an innovative interactive parent-child interactive storytime program, Fun with Math and Science (FMS); and (2) conduct a preliminary evaluation of FMS in a large, urban public library setting, using a quasi-experimental static group comparison design. Methods and Results: Post-test scores for caregivers who completed the program in the fall or winter (n = 80) were compared to pre-test scores for caregivers who completed the program the following spring (n = 35); Fall/winter caregivers scored higher on program items related to concrete behaviors to support math and science learning, but significant differences were not found on items related to caregiving beliefs or general caregiving practices. Demographic differences were also found related to program outcomes. Discussion: Results are discussed both in terms of implications for the development and implementation of caregiver-child interactive programming, as well as the use of innovative analytic approaches to program evaluation in community settings.

Pups Assisting Wellness for Staff (P.A.W.S.): Evaluating the impact of canine-assisted interventions on critical care staff wellness.

Acute care settings can expose staff to job-related stressors. Pups Assisting Wellness for Staff (P.A.W.S.) has been designed as an innovative approach to support acute care staff in the emergency department and intensive care unit. Initially, P.A.W.S. was implemented as a Comfort Dog Pilot and then expanded into a Therapy Dog Model. The Therapy Dog Model incorporated learnings from the Comfort Dog Pilot to evaluate the impact of the following: more dogs, using certified therapy dogs, and visiting at different times of the day. Results throughout the project demonstrated a positive impact on staff morale, staff stress, overall and staff satisfaction, and a strong desire for the project to continue. As a result and with a collaborative effort between a multidisciplinary team, P.A.W.S. has now been operationalized as a permanent program to support staff in acute care.

Microdosing and standard-dosing take-home buprenorphine from the emergency department: A feasibility study.

OBJECTIVE: Emergency department (ED)-initiated buprenorphine may prevent overdose. Microdosing is a novel approach that does not require withdrawal, which can be a barrier to standard inductions. We aimed to evaluate the feasibility of an ED-initiated buprenorphine/naloxone program providing standard-dosing and microdosing take-home packages and of randomizing patients to either intervention. METHODS: We broadly screened patients ≥18 years old for opioid use disorder at a large, urban ED. In a first phase, we provided consecutive patients with 3-day standard-dosing packages, and then we provided a subsequent group with 6-day microdosing packages. In a second phase, we randomized patients to standard dosing or microdosing. We attempted 7-day telephone follow-ups and 30-day in-person community follow-ups. The primary feasibility outcome was number of patients enrolled and accepting randomization. Secondary outcomes were numbers screened, follow-up rates, and 30-day opioid agonist therapy retention. RESULTS: We screened 3954 ED patients and identified 94 with opioid use disorders. Of the patients, 26 (27.7%) declined participation: 10 identified a negative prior experience with buprenorphine/naloxone as the reason, 5 specifically cited precipitated withdrawal, and none cited randomization. We enrolled 68 patients. A total of 14 left the ED against medical advice, 8 were excluded post-enrollment, 21 received standard dosing, and 25 received microdosing. The 7-day and 30-day follow-up rates were 9/46 (19.6%) and 15/46 (32.6%), respectively. At least 5/21 (23.8%) provided standard dosing and 8/25 (32.0%) provided microdosing remained on opioid agonist therapy at 30 days. CONCLUSIONS: ED-initiated take-home standard-dosing and microdosing buprenorphine/naloxone programs are feasible, and a randomized controlled trial would be acceptable to our target population.

Predictors of early growth in academic achievement: the head-toes-knees-shoulders task.

Children's behavioral self-regulation and executive function (EF; including attentional or cognitive flexibility, working memory, and inhibitory control) are strong predictors of academic achievement. The present study examined the psychometric properties of a measure of behavioral self-regulation called the Head-Toes-Knees-Shoulders (HTKS) by assessing construct validity, including relations to EF measures, and predictive validity to academic achievement growth between prekindergarten and kindergarten. In the fall and spring of prekindergarten and kindergarten, 208 children (51% enrolled in Head Start) were assessed on the HTKS, measures of cognitive flexibility, working memory (WM), and inhibitory control, and measures of emergent literacy, mathematics, and vocabulary. For construct validity, the HTKS was significantly related to cognitive flexibility, working memory, and inhibitory control in prekindergarten and kindergarten. For predictive validity in prekindergarten, a random effects model indicated that the HTKS significantly predicted growth in mathematics, whereas a cognitive flexibility task significantly predicted growth in mathematics and vocabulary. In kindergarten, the HTKS was the only measure to significantly predict growth in all academic outcomes. An alternative conservative analytical approach, a fixed effects analysis (FEA) model, also indicated that growth in both the HTKS and measures of EF significantly predicted growth in mathematics over four time points between prekindergarten and kindergarten. Results demonstrate that the HTKS involves cognitive flexibility, working memory, and inhibitory control, and is substantively implicated in early achievement, with the strongest relations found for growth in achievement during kindergarten and associations with emergent mathematics.

The addition of raspberries and blueberries to a starch-based food does not alter the glycaemic response.

It is now known that health benefits associated with diets rich in fruit and vegetables may be partly derived from intake of polyphenols. Berry polyphenols may influence carbohydrate metabolism and absorption and hence postprandial glycaemia. To date, studies related to polyphenol effects on the glycaemic response have been completed only in liquids using either monosaccharides or disaccharides. It remains to be determined whether berries known to be rich in polyphenols can reduce the glycaemic response (GR) to a solid polysaccharide meal. The aim of the present study was to investigate whether berries alter postprandial hyperglycaemia and consequently the GR to a starchy food. Blood glucose was tested on seven occasions, on three occasions using a reference food and on four occasions using pancakes supplemented with either raspberries or blueberries or control pancakes containing similar amounts of fructose and glucose. Results showed that there were no differences in GR (blueberry 51·3 (SEM 5·7); raspberry 54·7 (SEM 5·6); blueberry control 43·9 (SEM 4·2); raspberry control 41·8 (SEM 6·4)), GR area under the curve or satiety index between any of the tests. The present study indicates that the ability of berries to reduce blood glucose from starch-based foods is unsubstantiated.

No observable differences in glycemic response to maltitol in human subjects from 3 ethnically diverse groups.

Consumption of a low glycemic index (GI) diet may be helpful in the management and prevention of diabetes and cardiovascular disease. The investigation of GI has been predominantly confined to white subjects. We hypothesized that differences in glycemic response (GR) may be observable in subjects of different ethnic origin. The objective of the present study was to determine GR to a high GI (glucose) and low GI (maltitol) test drink in subjects of different ethnic origin. In a randomized, single-blind crossover trial, 10 whites, 10 South Indians and 10 Chinese subjects consumed either glucose or maltitol test drink containing 50 g of one of the test products on different occasions. Capillary blood glucose samples were taken at 15 and 10 minutes before and 0, 15, 30, 45, 60, 90, 120, 150, and 180 minutes after consumption of the test drink. The incremental area under the curve of glucose and maltitol were not significantly different between the 3 groups. The mean GR for maltitol was 33.5% in whites, 32.9% in Chinese, and 23.1% in South Indians. The results presented here confirmed that there are no observable differences noted in GR to a high-GI or low-GI test drink between the 3 ethnically diverse groups. We conclude that different ethnic groups exhibit similar GR to low- and high-GI drinks, and GR to maltitol is similar irrespective of ethnic background.

Glycemic response and glycemic index of semolina spaghetti enriched with barley ß-glucan.

OBJECTIVE: The postprandial glycemic response and glycemic index (GI) of spaghetti made with semolina and the addition of two ß-glucan barley concentrates, Glucagel (GG) and Barley Balance (BB), was studied. METHODS: For each type of ß-glucan concentrate, six spaghetti samples containing increasing percentages (0%, 2%, 4%, 6%, 8%, and 10%) of ß-glucan were made. Nine healthy subjects were recruited for measuring the glycemic response and GI. Subjects were served portions of the test foods (50 g of available carbohydrates) and a reference food (50 g of glucose) on separate occasions. Capillary blood glucose was measured up to 120 min after consuming the spaghetti. The total glycemic response was calculated geometrically as the incremental areas under the curve (IAUC) using the trapezoid rule. The GI was calculated geometrically by expressing the IAUC for the test food as a percentage of each subject's average IAUC for the glucose. RESULTS: The IAUC for spaghetti with and without ß-glucan was significantly less compared with glucose. The GG spaghetti had IAUC values similar to the spaghetti without ß-glucan concentrate. The BB spaghetti showed IAUC values lower than that of the spaghetti without ß-glucan. In particular, the spaghetti with 10% BB had an IAUC 52% lower (P ≤ 0.017) than the spaghetti with ß-glucan. The GI values for spaghetti with GG were statistically similar to the control. The GI of BB spaghetti decreased with increasing BB concentrations. In particular, the GI of 10% BB spaghetti was 54% lower (P ≤0.02; GI = 29) than that of the control (GI = 64). CONCLUSION: The BB concentrate significantly decreases the IAUC and GI of spaghetti at a dose of 10%. GI at the same concentrations does not.

Degree of habitual mastication seems to contribute to interindividual variations in the glycemic response to rice but not to spaghetti.

Previous work by our group showed that the degree of particle breakdown of rice during mastication affects in vitro glycemic potency. The objective of this study was to confirm these in vitro findings in an in vivo model. We hypothesized that the degree of habitual mastication will influence individuals' in vivo blood glucose response (glycemic response, or GR) to carbohydrate foods. Eleven participants came in on six nonconsecutive days to the laboratory and evaluated 2 test foods (rice and spaghetti). Their GR was measured for the subsequent 120 minutes. Mastication parameters were determined using surface electrode electromyography. The particle size distribution of individuals' masticated food was also determined. The intraindividual number of chews per mouthful did not significantly differ for rice and spaghetti (29.9 and 33, respectively), although masticated particle size distribution did (P < .001). Significant correlations between the degree of breakdown during mastication and the GR were observed for rice, but none for spaghetti. Individuals' peak GR (at 45 minutes) correlated significantly with the particles size distribution of their masticated rice (P = .002), and also with the total incremental area under the curve for the GR (r = -0.72; P = .012) and the incremental area under the curve for the first 45 (r = -0.74; P = .010) and 60 minutes (r = 0.73; P = .010) postconsumption. The results suggest that individual differences in mastication may be one of the causes for interindividual differences in the GR to rice but not spaghetti.