Medical Student Perspectives on Opioid Use Disorders: An Innovative MAT Waiver Training Integration during IM Clerkships

The opioid epidemic in the US has become a major issue in healthcare. In 2017, there was an estimated 72,306 drug overdose related deaths and Emergency Departments (ED) nationally saw a 30% increase in opioid related overdoses. Innovative programs can help ensure patients are offered optimal treatment options. Most primary care physicians self-report they lack the skills to identify and appropriately treat substance abuse disorders (SUDs). Studies have suggested that the best solution is to improve medical school curricula, which translates to better educated future physicians. Unfortunately, due to timing and exposure constraints, most medical school programs do not provide the necessary information to successfully manage and treat SUDs in practice. To prescribe buprenorphine, an 8-hour Medication Assisted Treatment (MAT) training must be completed. Only 35,604 of the approximate 800,000 US physicians (\u3c3%) are registered to prescribe buprenorphine. We implemented an innovative approach to provide students with the skills to understand how to prescribe buprenorphine and build confidence to medically manage opioid use disorders in the future. By completing the training students will be eligible for a their MAT waiver upon obtaining their permanent license. Prior to integrating the training into the internal medicine clerkship, a preliminary study similar in nature was performed that focused on first and second year medical students perspectives. The results were analyzed and presented, and based on the positive results of the study, it was decided to implement the study into the internal medicine clerkship during the third year of medical school

Genetic Markers of Toxicity From Capecitabine and Other Fluorouracil-Based Regimens: Investigation in the QUASAR2 Study, Systematic Review, and Meta-Analysis

Fluourouracil (FU) is a mainstay of chemotherapy, although toxicities are common. Genetic biomarkers have been used to predict these adverse events, but their utility is uncertain

Knowledge and Attitude Changes Towards Opioid Use Disorder and Naloxone Use Among Medical Students

Background: Overdose is the leading cause of preventable death in the USA. There have been efforts to distribute naloxone as a tool for harm reduction to those who need it; however, negative attitudes of healthcare workers and lack of knowledge may impact distribution. Medical schools have begun training students in opioid overdose prevention and treatment; initial studies found trainings improve student knowledge in responding to overdoses, but it remains unclear whether the traditional curriculum contributes to this knowledge. The present study aimed to evaluate baseline medical student knowledge about opioids, opioid overdoses, and naloxone use. Objective (Summary) – The present study aimed to evaluate baseline medical student knowledge about opioids, opioid overdoses, and naloxone use. As a point of focus, the study aimed to identify how people’s knowledge in areas and attitudes towards patients differed depending on their medical school training. Variables such as volunteering clinical experiences and whether students were in the pre-clinical or clinical portion of their training were noted with the aim of identifying the best way to complement the curriculum at Wayne State University School of Medicine for training professionals capable of understanding and treating a population dealing with SUDs. Methods: We distributed 15-minute online surveys via the email lists of all 4 classes at the Wayne State University School of Medicine as part of a wider initiative on Opioid Overdose Prevention and Response Training. Student participation was voluntary and confidential. These baseline surveys included questions about past experiences and knowledge of opioid use disorder (OUD) and overdoses, clinical experiences, and attitudes towards patients with OUD. These were assessed with the validated Opioid Overdose Knowledge (OOK), Opioid Overdose Attitudes, and Medical Conditions Regard Scales (adapted for Substance Use Disorders [SUDs]). Results: 252 students (29.0% M1, 25% M2, 21.8% M3, 24.2% M4) completed the survey. We found differences in total knowledge (OOKS) across class years (M1 44.68 ± 4.86, M2 48.05 ± 4.62, M3 47.24 ± 5.22, M4 49.37 ± 4.29; F(3,251)=11.8; pF(3,251)=4.2; p=.006). Notably, students in the final year of training scored lower on certain subscales of the Medical Conditions Regard Scale, indicating less willingness to work with patients with SUDs. We also identified interest in medication treatment and naloxone trainings should these opportunities arise. Conclusions: The results highlight how gradual exposure to knowledge and activities concerning OUD through clinical experience improve student knowledge and overall attitudes regarding opioid overdose. Improving this knowledge-base earlier in the undergraduate medical curriculum by complementing volunteering opportunities with additional training sessions such as the buprenorphine-waiver training program or in-house naloxone training is believed to improve attitudes, knowledge, and confidence prior to starting clinical rotations. Unfortunately, results also showed more negative attitudes among students with more clinical experience (M4s) towards patients with SUDs. This indicates a need for further training during clinical years and education of best ways to respond positively when working with this patient population. These findings support a continued, integrated curriculum on OUD and naloxone in medical education with a need for an improved focus on methods to improve students’ attitudes toward patients with OUD

Propranolol and survival from breast cancer:A pooled analysis of European breast cancer cohorts

BACKGROUND: Preclinical studies have demonstrated that propranolol inhibits several pathways involved in breast cancer progression and metastasis. We investigated whether breast cancer patients who used propranolol, or other non-selective beta-blockers, had reduced breast cancer-specific or all-cause mortality in eight European cohorts. METHODS: Incident breast cancer patients were identified from eight cancer registries and compiled through the European Cancer Pharmacoepidemiology Network. Propranolol and non-selective beta-blocker use was ascertained for each patient. Breast cancer-specific and all-cause mortality were available for five and eight cohorts, respectively. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (CIs) for cancer-specific and all-cause mortality by propranolol and non-selective beta-blocker use. HRs were pooled across cohorts using meta-analysis techniques. Dose–response analyses by number of prescriptions were also performed. Analyses were repeated investigating propranolol use before cancer diagnosis. RESULTS: The combined study population included 55,252 and 133,251 breast cancer patients in the analysis of breast cancer-specific and all-cause mortality respectively. Overall, there was no association between propranolol use after diagnosis of breast cancer and breast cancer-specific or all-cause mortality (fully adjusted HR = 0.94, 95% CI, 0.77, 1.16 and HR = 1.09, 95% CI, 0.93, 1.28, respectively). There was little evidence of a dose–response relationship. There was also no association between propranolol use before breast cancer diagnosis and breast cancer-specific or all-cause mortality (fully adjusted HR = 1.03, 95% CI, 0.86, 1.22 and HR = 1.02, 95% CI, 0.94, 1.10, respectively). Similar null associations were observed for non-selective beta-blockers. CONCLUSIONS: In this large pooled analysis of breast cancer patients, use of propranolol or non-selective beta-blockers was not associated with improved survival

Radical prostatectomy or watchful waiting in early prostate cancer

BACKGROUND: Radical prostatectomy reduces mortality among men with localized prostate cancer; however, important questions regarding long-term benefit remain. METHODS: Between 1989 and 1999, we randomly assigned 695 men with early prostate cancer to watchful waiting or radical prostatectomy and followed them through the end of 2012. The primary end points in the Scandinavian Prostate Cancer Group Study Number 4 (SPCG-4) were death from any cause, death from prostate cancer, and the risk of metastases. Secondary end points included the initiation of androgen-deprivation therapy. RESULTS: During 23.2 years of follow-up, 200 of 347 men in the surgery group and 247 of the 348 men in the watchful-waiting group died. Of the deaths, 63 in the surgery group and 99 in the watchful-waiting group were due to prostate cancer; the relative risk was 0.56 (95% confidence interval [CI], 0.41 to 0.77; P = 0.001), and the absolute difference was 11.0 percentage points (95% CI, 4.5 to 17.5). The number needed to treat to prevent one death was 8. One man died after surgery in the radical-prostatectomy group. Androgen-deprivation therapy was used in fewer patients who underwent prostatectomy (a difference of 25.0 percentage points; 95% CI, 17.7 to 32.3). The benefit of surgery with respect to death from prostate cancer was largest in men younger than 65 years of age (relative risk, 0.45) and in those with intermediate-risk prostate cancer (relative risk, 0.38). However, radical pros-tatectomy was associated with a reduced risk of metastases among older men (relative risk, 0.68; P = 0.04). CONCLUSIONS: Extended follow-up confirmed a substantial reduction in mortality after radical prostatectomy; the number needed to treat to prevent one death continued to decrease when the treatment was modified according to age at diagnosis and tumor risk. A large proportion of long-term survivors in the watchful-waiting group have not required any palliative treatment. (Funded by the Swedish Cancer Society and others.