The Successes and Challenges of Program Development

Recognizing the benefits and values of interdisciplinary health care, Pacific University School of Occupational Therapy initiated collaboration with the School of Professional Psychology in 2012 to embrace interdisciplinary education. Two occupational therapy (OT) graduate students Ingrid Borland and Ariel Schiller, under the supervision of Assistant Professor Sean Roush, OTD, OTR/L, had successfully completed a needs analysis and conducted a pilot stress management group in the Pacific Psychology Clinic in Hillsboro. Their analysis revealed limited mental health groups led by healthcare professionals in the local community. Furthermore, there was a lack of groups co-led by OT and psychology (PSY) in the community and lack of or limited OT and PSY collaboration in the U.S. educational system (Borland & Schiller, 2012). Such findings justified their efforts to pilot an OT-led stress management group in the Pacific Psychology Clinic. Although their groups were well received, time constraints led to a low enrollment rate. Moreover, the groups were solely led by OT due to the limited availability of the PSY student therapists. In 2013 two OT graduate students Elizabeth Bair and Man Wa Eva Shing, again acting under the supervision of Professor Roush and in collaboration with Psychology Services Director Lisa Christiansen, Psy.D., continued the partnership between OT and PSY. The Pacific Psychology Clinic is one of several affordable mental health services in the local Washington County area. The Borland and Schiller (2012) needs analysis of the Pacific Psychology Clinic revealed several themes: 1) clients of the Pacific Psychology Clinic often have both mental and physical health conditions, 2) PSY student therapists have limited or lack of experience with OT, 3) PSY student therapists identified physical health issues, which are outside their scope of practice, as a barrier to their treatments, and 4) PSY student therapists listed a variety of health and safety management concerns that are within OT’s scope of practice. Bair and Shing aim to develop a more encompassing group to attract more participants and to invite PSY student therapists to co-lead the groups to increase involvement of PSY as well as initiate the interdisciplinary education approach. Upon reviewing Borland and Schiller’s need analysis of Pacific Psychology Clinic and the local community, the creation and collection of comprehensive health education materials and program planning for people with multiple health concerns was proposed to and approved by Professor Roush and Director Christiansen. Due to contractual obligations, implementation of an interdisciplinary pilot group was not carried out. The focus of this project shifted to creating a program development guide for healthcare professionals

Comorbid Chronic Pain and Depression: Patient Perspectives on Empathy

Clinician empathy is a well-documented component of effective patient/provider communication. Evidence surrounding the association between patient perspectives on clinician empathy and perception of pain management is currently limited, particularly among patients with chronic pain and depression. The aim of this study was to analyze patients’ perspectives on the emergent theme of empathy and describe how patients construct their experiences and expectations surrounding empathic interactions. A secondary analysis of focus group data was designed using grounded theory methodology. Veterans Affairs (VA) and University Primary Care Clinics. Respondents with chronic pain and comorbid depression (N = 18) were 27 to 84 years old (mean 54.8 years), 61% women, 22% black, and 74% white. Study participants highly valued empathy and two types of empathic interactions: empathic listening and empathic action. Patients who provided examples of empathic interactions claimed that others understood, valued, and cared for them. In contrast, patients who perceived a lack of empathy and empathic interactions felt frustrated and uncared for by others (including their physicians) physically and emotionally. Patients with chronic pain and depression claimed that empathy helped them feel understood, believed, taken seriously, and that their needs were met. In demonstrating empathy and engaging in empathic interactions with patients, providers relate better to patients, better understand their life experience, and provide patient-centered care that is meaningful for patients, providers, and the health care systems within which they interact. Future research is needed to purposefully study the effects of empathic interactions on outcomes for patients with chronic pain and comorbid depression

Contextualizing Naturalistic Driving Data in a Rural State Among Drivers With and Without Obstructive Sleep Apnea

In naturalistic studies, Global Positioning System (GPS) data and date/time stamps can link driver exposure to specific environments (e.g., road types, speed limits, night driving, etc.), providing valuable context for analyzing critical events, such as crashes, near crashes, and breaches of accelerometer limits. In previous work, we showed how to automate this contextualization, using GPS data obtained at 1 Hz and merging this with Geographic Information Systems (GIS) databases maintained by the Iowa Department of Transportation (DOT). Here we further demonstrate our methods by analyzing data from 80 drivers with obstructive sleep apnea (OSA) and 48 controls, and comparing the two groups with respect to several factors of interest. The majority of comparisons found no difference between groups, suggesting similar patterns of exposures to driving environments in OSA and control drivers. However, OSA drivers appeared to spend slightly more time on roads with annual traffic counts of 500-10,000 and less time driving on wider highways, during twilight, and on roads with 10,000-25,000 annual traffic counts

A Case Study: Autocatalytic Behavior and its Consideration for a Chemical Process with General application to Handling, Shipping, and Reactive Relief Design

PresentationAutocatalysis is a generally well understood phenomenon. However, since autocatalytic molecules do not have a fixed energy release rate for a given temperature, like nth order reactions, additional considerations are required to ensure safe shipping, handling and relief device sizing. Also, unlike nth order reactions, autocatalytic reactions have an induction time and it is associated with reaching a critical concentration of a catalytic species. Once the induction time is exhausted the reaction accelerates even under isothermal conditions (i.e. dT/dt = f (T,Ccat). Often a thermo- kinetic model is required for adequate hazard evaluation. During model development a first order reaction scheme is often used as a starting point. Such an approach typically leads to an unrealistically high apparent activation energy to get a reasonable fit to the data. Since time impacts the reaction rate, induction times need to be determined to build an accurate kinetic model. Once induction times are determined as a function of temperature, adequate layers of protection and operating discipline can be determined for safe handling. This paper describes: 1) Identification and confirmation of autocatalytic behavior, 2) Induction time model development, and 3) Application to storage, shipping, and reactive relief design. For reactive relief vent sizing, consideration is given not only to credible failure scenarios that may result in relief device activation, but also recovery from contained unplanned events

Addressing the Health Needs of Rural Native Veterans: Assessment and Recommendations

Native Veterans comprise unique populations within the VeteransAdministration (VA) system of care and represent a proud tradition of military service. Limited healthcare data available on rural Native veterans indicate significant disparities in access to care and health status compared with other populations. This article provides an assessment of current challenges, barriers, and issues related to addressing the healthcare needs of rural Native veterans and offers recommendations to improve healthcare for this special population. To meet the needs of rural Native veterans it will be important to: conduct needs assessments to gather important health data about rural Native veterans; develop a clearinghouse of information on and for rural Native veterans and disseminate this information widely; develop strategies to enhance transportation policies and provisions; expand the use of technology and outreach; work toward increasing cultural competence among VA employees; and improve the availability of traditional healing services

Association Between State Policies Using Medicaid Exclusions to Sanction Noncompliance With Welfare Work Requirements and Medicaid Participation Among Low-Income Adults

Twenty states have pursued community engagement requirements (ie, work requirements) as a condition for Medicaid eligibility among adults considered able-bodied. Work requirements seek to improve health by incentivizing work, but may result in coverage losses. The impact of work requirements on Medicaid coverage may extend beyond qualifying beneficiaries, by increasing confusion around benefit rules or deterring individuals from applying for coverage. However, the spillover effects of work requirements on individuals not directly subject to them are difficult to study because these programs have only recently been implemented. To examine this possibility, we studied Temporary Assistance for Needy Families (TANF), the cash welfare program enacted under welfare reform in 1996. The TANF program requires able-bodied beneficiaries to fulfill work requirements, and states can elect to terminate Medicaid benefits as a sanction for nonpregnant adult TANF participants who do not comply with them. In states adopting these sanctions, Medicaid eligibility for dual TANF-Medicaid enrollees was effectively conditional on meeting work requirements. This quasi-experimental cohort study examines whether TANF-Medicaid sanctions had spillover effects on Medicaid coverage among low-income adults who were not likely to participate in TANF and, therefore, were not directly subject to these sanctions

Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain

Importance: Limited evidence is available regarding long-term outcomes of opioids compared with nonopioid medications for chronic pain. Objective: To compare opioid vs nonopioid medications over 12 months on pain-related function, pain intensity, and adverse effects. Design, Setting, and Participants: Pragmatic, 12-month, randomized trial with masked outcome assessment. Patients were recruited from Veterans Affairs primary care clinics from June 2013 through December 2015; follow-up was completed December 2016. Eligible patients had moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use. Of 265 patients enrolled, 25 withdrew prior to randomization and 240 were randomized. Interventions: Both interventions (opioid and nonopioid medication therapy) followed a treat-to-target strategy aiming for improved pain and function. Each intervention had its own prescribing strategy that included multiple medication options in 3 steps. In the opioid group, the first step was immediate-release morphine, oxycodone, or hydrocodone/acetaminophen. For the nonopioid group, the first step was acetaminophen (paracetamol) or a nonsteroidal anti-inflammatory drug. Medications were changed, added, or adjusted within the assigned treatment group according to individual patient response. Main Outcomes and Measures: The primary outcome was pain-related function (Brief Pain Inventory [BPI] interference scale) over 12 months and the main secondary outcome was pain intensity (BPI severity scale). For both BPI scales (range, 0-10; higher scores = worse function or pain intensity), a 1-point improvement was clinically important. The primary adverse outcome was medication-related symptoms (patient-reported checklist; range, 0-19). Results: Among 240 randomized patients (mean age, 58.3 years; women, 32 [13.0%]), 234 (97.5%) completed the trial. Groups did not significantly differ on pain-related function over 12 months (overall P = .58); mean 12-month BPI interference was 3.4 for the opioid group and 3.3 for the nonopioid group (difference, 0.1 [95% CI, -0.5 to 0.7]). Pain intensity was significantly better in the nonopioid group over 12 months (overall P = .03); mean 12-month BPI severity was 4.0 for the opioid group and 3.5 for the nonopioid group (difference, 0.5 [95% CI, 0.0 to 1.0]). Adverse medication-related symptoms were significantly more common in the opioid group over 12 months (overall P = .03); mean medication-related symptoms at 12 months were 1.8 in the opioid group and 0.9 in the nonopioid group (difference, 0.9 [95% CI, 0.3 to 1.5]). Conclusions and Relevance: Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain

Natural History of Comorbid Orofacial Pain Among Women With Vestibulodynia

We evaluated the stability of the comorbidity between vulvodynia and orofacial pain (OFP) and its associated clinical characteristics over a two-year follow up period