Taking on a Community Solutions Process (Co-Solve) to the Pain and Opioid Epidemic: A Multi-disciplinary and Multi-institute Pain Panel and Community Response in Sacramento, California

America’s healthcare providers and patients are challenged by an overwhelming high prevalence of chronic pain and opioid misuse. Approximately 23.4 million adults suffer from daily pain and in 2014, nearly 61% of Americans who died from drug overdoses used an opioid analgesic. Unrecognized addiction, untreated psychiatric comorbidity, and lack of training/education for providers and patients are factors associated with chronic pain and opioid misuse. Communication strategies and structures are required to enhance collaboration between multidisciplinary providers and institutions. On September 28, 2017, an open panel discussion with pain specialists from three major academic and medical institutes in Sacramento, California initiated an integrative community solutions process to optimize pain education best practices and to protect public health. The attendees represented a wide range of healthcare disciplines. This commentary describes ideas derived from dialogue between community attendees and panelists, which considers both healthcare provider characteristics and patients’ cultural backgrounds. Providers of most disciplines underscored the need to share information and institute cross-disciplinary training on pain and behavioral health treatments. In conclusion, we outline an integrative community-based framework, namely the Community Solutions Process (Co-Solve), to help other communities to implement and derive their own action-oriented solutions unique to their population

Envisioning life : community-created sustainable livelihood analysis and development

Produced through the assistance of the European Community and BirdLife Internationa

Implementation of Virtual Multiple Mini-Interviews for Fellowship Recruitment

INTRODUCTION: The SARS-CoV Disease (COVID-19) pandemic has upended health care systems and one of the casualties has been the trainee recruitment process since social distancing and travel restrictions make an in-person experience improbable. At the University of California, Davis (UCD), our Pain Division transitioned our internally validated multiple mini-interview (MMI) process to a virtual environment METHODS: Applicants signed a confidentiality agreement prior to their interviews and were invited to watch a series of videos orienting them to the process and to the program itself. All faculty raters interviewed candidates using a total of 6 non-medical MMI scenarios with corresponding questions and scoring rubrics through the Zoom platform. Applicants were then welcomed to voluntary informal conversations with the current fellow trainees and faculty. An optional survey was sent to the applicants post-interview to assess their overall satisfaction with the virtual process. RESULTS: The survey analyzed the following using a 5 point Likert scale: Overall Satisfaction, Video Overview Program, Interview Day Details, Video Tour, Web-Based Interviews, Process was Fair, and finally a question on Informed Decision regarding receiving sufficient information to formulate their rank list. All respondents (80% response rate) reported being either satisfied or very satisfied with each of the aspects of the interview process detailed above. CONCLUSIONS: While technical difficulties and confidentiality issues are of concern when offering an entirely web based recruitment, our group was able to transition traditional in-person MMI to a virtual platform using a similar structure which was well-received by applicant

Potential Role for Stem Cell Regenerative Therapy as a Treatment for Degenerative Disc Disease and Low Back Pain: A Systematic Review.

Back pain is the single leading cause of disability worldwide. Despite the prevalence and morbidity of lower back pain, we still lack a gold-standard treatment that restores the physiological function of degenerated intervertebral discs. Recently, stem cells have emerged as a promising strategy for regenerative therapy for degenerative disc disease. In this study, we review the etiology, pathogenesis, and developing treatment strategies for disc degeneration in low back pain with a focus on regenerative stem cell therapies. A systematic search of PubMed/MEDLINE/Embase/Clinical Trials.gov databases was conducted for all human subject abstracts or studies. There was a total of 10 abstracts and 11 clinical studies (1 RCT) that met the inclusion criteria. The molecular mechanism, approach, and progress of the different stem cell strategies in all studies are discussed, including allogenic bone marrow, allogenic discogenic cells, autologous bone marrow, adipose mesenchymal stem cells (MSCs), human umbilical cord MSC, adult juvenile chondrocytes, autologous disc derived chondrocytes, and withdrawn studies. Clinical success with animal model studies is promising; however, the clinical outcomes of stem cell regenerative therapy remain poorly understood. In this systematic review, we found no evidence to support its use in humans. Further studies on efficacy, safety, and optimal patient selection will establish whether this becomes a viable, non-invasive therapeutic option for back pain

Topical Administration of Ibuprofen for Injured Athletes: Considerations, Formulations, and Comparison to Oral Delivery

Abstract Non-steroidal anti-inflammatory drugs (NSAIDs) are a class of drugs commonly used to treat both the acute and chronic injuries sustained by athletes during training and competition. In many parts of the world, NSAIDs can be purchased over-the-counter and used without any physician oversight. However, the chronic nature of overuse injuries requires NSAIDs to be taken orally for an extended period of time. As a result, they can have significant adverse effects on athletes, namely gastrointestinal (GI), renal, and cardiovascular damage. Dyspepsia and upper GI ulceration and bleeding are of great concern in chronic NSAID use, and as such oral NSAIDs are generally contraindicated in those with a history of peptic ulcers or irritable bowel disease. In the setting of chronic overuse soft tissue or joint disease, topically administered NSAIDs offer an alternate route of administration that has the potential to deliver a similar level of pain and anti-inflammatory relief while bypassing the harmful side effects associated with oral intake. Topically applied NSAIDs are able to achieve high concentrations within the targeted site of action while simultaneously keeping plasma concentrations low, offering several advantages over oral administration. One commonly used generic NSAID is ibuprofen (2-(4-isobutylphenyl)propanoic acid). First synthesized in the 1960s, ibuprofen has since become widely available as an over-the-counter pharmaceutical. In this review, we outline new and different techniques that have been used to deliver ibuprofen into diseased tissues, including supersaturations, microemulsions, gels, nanosystems, and microneedles. We also review relevant clinical trials comparing transdermally delivered ibuprofen to placebo and orally administered ibuprofen

Marine protected areas and fisheries : bridging the divide

1. Long-term and well-managed marine protected areas (MPAs) can, under the right circumstances, contribute to biodiversity conservation and fisheries management, thus contributing to food security and sustainable livelihoods. 2. This article emphasizes (1) the potential utility of MPAs as a fisheries management tool, (2) the costs and benefits of MPAs for fishing communities, and (3) the foundations of good governance and management processes for creating effective MPAs with a dual fisheries and conservation mandate. 3. This article highlights case studies from numerous regions of the world that demonstrate practical and often successful solutions in bridging the divide between MPA management and fisheries sustainability, with a focus on small-scale coastal fisheries in order to emphasize lessons learned. 4. To be an effective fisheries management tool, MPAs should be embedded in broader fisheries management and conservation plans. MPAs are unlikely to generate benefits if implemented in isolation. The spatial and temporal distribution of benefits and costs needs to be taken into account since proximal fishery-dependent communities may experience higher fishing costs over the short and long-term while the fisheries benefits from MPAs may only accrue over the long-term. 5. Key lessons for effectively bridging the divide between biodiversity conservation and fisheries sustainability goals in the context of MPAs include: creating spaces and processes for engagement, incorporating fisheries in MPA design and MPAs into fisheries management, engaging fishers in management, recognizing rights and tenure, coordinating between agencies and clarifying roles, combining no-take-areas with other fisheries management actions, addressing the balance of costs and benefits to fishers, making a long-term commitment, creating a collaborative network of stakeholders, taking multiple pressures into account, managing adaptively, recognizing and addressing trade-offs, and matching good governance with effective management and enforcement