Search

BackgroundDespite pharmacological treatments, patients undergoing cardiac surgery experience severe anxiety and pain, which adversely affect outcomes. Previous work examining pediatric and nonsurgical adult patients has documented the effectiveness of inexpensive, nonpharmacological techniques to reduce anxiety and pain as well as health care costs and length of hospitalization. However, the impact of nonpharmacological interventions administered by a dedicated comfort coach has not been evaluated in an adult surgical setting. ObjectiveThis trial aims to assess whether nonpharmacological interventions administered by a trained comfort coach affect patient experience, opioid use, and health care utilization compared with usual care in adult cardiac surgery patients. This study has 3 specific aims: assess the effect of a comfort coach on patient experience, measure differences in inpatient and outpatient opioid use and postoperative health care utilization, and qualitatively evaluate the comfort coach intervention. MethodsTo address these aims, we will perform a prospective, randomized controlled trial of 154 adult cardiac surgery patients at Michigan Medicine. Opioid-naive patients undergoing first-time, elective cardiac surgery via sternotomy will be randomized to undergo targeted interventions from a comfort coach (intervention) versus usual care (control). The individualized comfort coach interventions will be administered at 6 points: preoperative outpatient clinic, preoperative care unit on the day of surgery, extubation, chest tube removal, hospital discharge, and 30-day clinic follow-up. To address aim 1, we will examine the effect of a comfort coach on perioperative anxiety, self-reported pain, functional status, and patient satisfaction through validated surveys administered at preoperative outpatient clinic, discharge, 30-day follow-up, and 90-day follow-up. For aim 2, we will record inpatient opioid use and collect postdischarge opioid use and pain-related outcomes through an 11-item questionnaire administered at the 30-day follow-up. Hospital length of stay, readmission, number of days in an extended care facility, emergency room, urgent care, and an unplanned doctor’s office visit will be recorded as the primary composite endpoint defined as total days spent at home within the first 30 days after surgery. For aim 3, we will perform semistructured interviews with patients in the intervention arm to understand the comfort coach intervention through a thematic analysis. ResultsThis trial, funded by Blue Cross Blue Shield of Michigan Foundation in 2019, is presently enrolling patients with anticipated manuscript submissions from our primary aims targeted for the end of 2020. ConclusionsData generated from this mixed methods study will highlight effective nonpharmacological techniques and support a multidisciplinary approach to perioperative care during the adult cardiac surgery patient experience. This study’s findings may serve as the foundation for a subsequent multicenter trial and broader dissemination of these techniques to other types of surgery. Trial RegistrationClinicalTrials.gov NCT04051021; https://clinicaltrials.gov/ct2/show/NCT04051021 International Registered Report Identifier (IRRID)DERR1-10.2196/21350

Older persons living with HIV (PLWH), often defined as age 50 years and older, are a rapidly growing population, with high rates of chronic pain, substance use, and decreased physical functioning. No interventions currently exist that address all three of these health outcomes simultaneously. An 8-week behavioral intervention combining cognitive-behavioral therapy and tai chi reinforced with text messaging (CBT/TC/TXT) was developed and pilot tested in a community-based AIDS service organization with substance using PLWH aged 50 years and older who experienced chronic pain. Fifty-five participants were enrolled in a three arm randomized controlled trial that compared the CBT/TC/TXT intervention (N = 18) to routine Support Group (SG) (N = 19) and Assessment Only (AO) (N = 18) to assess the intervention's feasibility, acceptability and preliminary efficacy to reduce pain and substance use and improve physical performance. Participants were assessed at baseline, treatment-end (week 8) and week 12. Feasibility and acceptability indicators showed moderate levels of participant enrollment (62% of those eligible), excellent 12-week assessment completion (84%) and high attendance at CBT and tai chi sessions (>60% attended at least 6 of 8 sessions). Efficacy indicators showed within-group improvements from baseline to week 12 in the CBT/TC/TXT group, including all four substance use outcomes, percent pain relief in the past 24 h, and in two physical performance measures. Observed between-group changes included greater reductions in days of heavy drinking in the past 30 days for both CBT/TC/TXT (19%) and SG (13%) compared to the AO group. Percent pain relief in the past 24 h improved in the CBT/TC/TXT group relative to SG, and the CBT/TC/TXT's physical performance score improved relative to both the SG and AO groups. Findings demonstrate that the CBT/TC/TXT intervention is feasible to implement, acceptable and has preliminary efficacy for reducing substance use and pain and improving physical performance among a vulnerable population of older PLWH.

Background and aimsNo effective pharmacotherapy for methamphetamine (MA) use disorder has yet been found. This study evaluated sustained-release methylphenidate (MPH-SR) compared with placebo (PLA) for treatment of MA use disorder in people also undergoing behavioral support and motivational incentives.DesignThis was a randomized, double-blind, placebo-controlled design with MPH-SR or PLA provided for 10 weeks (active phase) followed by 4 weeks of single-blind PLA. Twice-weekly clinic visits, weekly group counseling (CBT) and motivational incentives (MI) for MA-negative urine drug screens (UDS) were included.SettingTreatment sites were in Los Angeles, California (LA) and Honolulu, Hawaii (HH), USA.ParticipantsA total of 110 MA-dependent (via DSM-IV) participants (LA = 90; HH = 20).MeasurementsThe primary outcome measure is self-reported days of MA use during the last 30 days of the active phase. Included in the current analyses are drug use (UDS and self-report), retention, craving, compliance (dosing, CBT, MI), adverse events and treatment satisfaction.FindingsNo difference was found between treatment groups in self-reported days of MA use during the last 30 days of the active phase (P = 0.22). In planned secondary outcomes analyses, however, the MPH group had fewer self-reported MA use days from baseline through the active phase compared with the PLA group (P = 0.05). The MPH group also had lower craving scores and fewer marijuana-positive UDS than the PLA group in the last 30 days of the active phase. The two groups had similar retention, other drug use, adverse events and treatment satisfaction.ConclusionsMethylphenidate may lead to a reduction in concurrent methamphetamine use when provided as treatment for patients undergoing behavioral support for moderate to severe methamphetamine use disorder, but this requires confirmation.

Transformative social change occurred in the Chesapeake region with the intensification of oyster harvesting and the establishment of central places in estuarine settings at the outset of the Middle Woodland period (ca. A.D. 200). Accompanying the pivot toward estuarine living was the spread of shelltempered ceramics indexing regional social networks from the Delaware Bay to the mouth of the Chesapeake Bay. Survey and excavation data from the Naval Weapons Station Yorktown (NWSY) on the York River trace this process on Virginia's lower York River. Here, Middle Woodland populations established central places around the lower embayed portions of tidal creeks. Communal shell middens anchoring these central places offer evidence of intensive oyster harvesting and a history of periodic overharvesting, adjustment, and long-term sustainability. We hypothesize that common pool resource management, i.e., collective action and stewardship in the management of the oyster fishery, was an important part of Native societies' settling down in this region. [ABSTRACT FROM AUTHOR]

In response to the 2016 election of Donald J. Trump and calls for antiracist action from activists and communities of color, our Bachelor of Social Work (BSW) program embarked on a process of curriculum revision. In this article, we describe our efforts to center critical and Black, Indigenous, and people of color (BIPOC) scholarship and to better align our curriculum with the experiences of students of color. While we have drawn from feminist and critical race theories, we have also borrowed concepts from literatures not typically associated with antiracism work, such as policy implementation and leadership/management. We present our ongoing work as a case study of, and methodology for, systematic social work curriculum change to promote racial equity and justice. [ABSTRACT FROM AUTHOR]

This collection of letters serves to explore the narratives of a collective of women of color in academia by examining individual, collective, spiritual, and institutional strategies for surviving and transforming our institutional spaces and the ways that White Supremacy has shaped our journeys. Multiple perspectives are viewed, and we have written to our children, our future social work students, our future selves, our BIPOC faculty siblings, and our feared enemies to envision and embody more liberatory futures. [ABSTRACT FROM AUTHOR]