The Effects of a Standardized Patient Education Program on Self-Management Outcomes in Patients with HIV

The purpose of this pilot study was to determine the potential impact of a standardized HIV education program delivered during a provider visit on patient self-management of HIV as measured by adherence to care. Following a baseline assessment of HIV knowledge and adherence using validated tools, eligible patients were randomized to receive the standard of care normally provided in clinic, or the standard of care and a10-minute scripted educational presentation delivered during the clinic visit. Following the presentation, patients in the intervention group received the same knowledge assessment tool they received at baseline to identify knowledge changes. Patient adherence to care was then measured for both the intervention and control groups at the next scheduled visit 2-4 months later. Forty-five subjects were enrolled; 24 received the educational intervention and 21 were randomized to the control group. Baseline characteristics were similar between groups and included low rates of perfect adherence (medication, appointment and laboratory) and HIV knowledge. More specifically, only 29% and 33% had perfect adherence to care at baseline in the intervention and control groups, respectively (p = 0.763) and more than half in each group had imperfect HIV knowledge. Those with imperfect versus perfect HIV knowledge (23 versus 8) were more likely to be non-adherent to care at baseline (p = 0.042). Following the educational presentation, the number of subjects with perfect HIV knowledge improved in the intervention group (5/24 versus 16/24, p = 0.002). Additionally, at study visit two, subjects in the intervention group were more likely to have perfect adherence as compared to control patients (17/24 versus 5/21, p = 0.002). These findings while limited by a small number of patients and short duration of follow-up indicate a potentially positive impact of the educational intervention on both patient knowledge and overall adherence to care. 18 PowerPoint slides. (no audio

Development of an Inter-professional Root Cause Analysis Workshop within a Required Medication Safety Course

Purpose: To present the development/delivery of an Interprofessional Root Cause Analysis (RCA) Workshop by colleges of pharmacy and nursing at a health sciences university. Background: Hospitals and regulatory agencies emphasize the significance of patient safety and recommend that medication/patient safety principles be introduced in health care professions’ education. A college of pharmacy’s required Medication Safety course introduces essential content on principles including culture of medication safety, error reporting systems, medication error causes and technology’s influence on errors. One key course element is completing a team-based RCA. This assignment was completed solely by Pharm.D. students (fall 2009-2014). Given increased emphasis on IPE, pharmacy faculty partnered with nursing to deliver the program to both disciplines in fall 2015. Description of program: This 2-hour, interprofessional workshop was incorporated into the Medication Safety course for ~ 75 pharmacy students and a required Medical Surgical Clinical Management II course for ~ 125 nursing students. Preliminary findings: Overall performance during this RCA Workshop was high. Each team accurately identified the medication error present in their assigned case. Survey results illustrated that 98% of students agreed/strongly agreed that the workshop contributed to their learning by creating an experience emphasizing the importance of interprofessional teamwork in preventing medication errors. Relevance to interprofessional education or practice: Given the significant roles and responsibilities of pharmacists and nurses in the medication use process, this RCA Workshop was created to mimic a “real world” medication safety healthcare team. Participation enhanced student comprehension and application of medication safety principles and awareness of the roles and contributions of the different health professionals. Recommendations for future investigation and/or incorporation into education and/or practice settings: The faculty will conduct this program again to assess outcomes linked to core competencies for Interprofessional Collaborative Practice (i.e. values/ethics, communication). The long-term goal is to include additional health professions students. Session Learning Objectives: The audience will be able to describe how a novel, collaborative Inter-professional RCA Workshop was used to facilitate inter-professional learning. Describe how a RCA workshop may be able to assist students in meeting IPEC Core Competencies

Effects of a Game-Centered Health Promotion Program on Fall Risk, Health Knowledge, and Quality of Life in Community-Dwelling Older Adults

International Journal of Exercise Science 12(4): 1149-1160, 2019. Quality of life (QOL) is an important aspect of overall well-being in older adults and can be improved with increased physical activity. One in four older adults experiences a fall each year, making it necessary to focus public health interventions towards decreasing fall risk and improving QOL in older adults. The purpose of this study was to determine the effects of the health promotion program, Bingocize®, on QOL and fall risk in community-dwelling older adults (n = 36; mean age 73.63 ± 6.97). Participants were clustered and randomly assigned to (a) experimental (n = 19; participating in Bingocize® program, or (b) control (n = 17; only played normal bingo). Each group completed a 12-week intervention that consisted of two 45-60 minute sessions per week. There were no significant interactions for any of the variables, with the exception of positive affect (PA) (F (1,34) = 5.66, p = 0.02, = 0.15, power = 0.64) and handgrip strength (F (1,34) = 8.31, p = 0.007, = 0.196, power = 0.80). There was also a significant main effect for time for health knowledge. Participating in the Bingocize® health promotion program can produce a meaningful and detectable change in handgrip strength and PA in community-dwelling older adults

Multidrug-Resistant Acinetobacter baumannii Osteomyelitis from Iraq

Multidrug-Resistant Acinetobacter baumannii Osteomyelitis from Ira

Changes in Body Mass Index and Atherosclerotic Disease Risk Score After Switching From Tenofovir Disoproxil Fumarate to Tenofovir Alafenamide.

Background: Switching from tenofovir disoproxil fumarate (TDF) to tenofovir alafenamide (TAF)-containing antiretroviral therapy (ART) can improve renal function and bone mineral density in people with human immunodeficiency virus (PWH). The switch can also negatively influence cholesterol, but changes in body mass index (BMI) and atherosclerotic cardiovascular disease (ASCVD) risk are unknown. Methods: This retrospective observational study evaluated BMI and ASCVD risk score changes in virologically suppressed PWH who switched from TDF to TAF without switching other ART regimen components. Adults on TDF for ≥1 year with 2 consecutive HIV ribonucleic acid values/mL before a TAF switch were included. Body weight, BMI, cholesterol, and ASCVD risk score were collected for the year before and after the switch. Pre- and postswitch values were compared with the Wilcoxon signed-rank test. Changes in BMI and ASCVD scores were modeled using generalized estimating equations regression. Results: One hundred ten patients were included. In unadjusted analyses, there were significant increases in weight, BMI, total cholesterol, LDL, HDL, and ASCVD risk score in the year after switching from TDF to TAF (each P ≤ .01). In regression models, switching from TDF to TAF was associated with a 0.45 kg/m2 increase in BMI (95% confidence interval [CI], 0.14-0.76) and a 13% increase in ASCVD risk score (95% CI, 4%-23%). Conclusions: We observed significant BMI and ASCVD score increases in PWH 1 year after switching from TDF to TAF. The mechanism of changes is unclear and requires additional study

Incidence and Severity of Drug Interactions Before and After Switching Antiretroviral Therapy to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Treatment-Experienced Patients.

Background: Switching antiretroviral therapy (ART) in people with HIV (PWH) can influence their risk for drug-drug interactions (DDIs). The purpose of this study was to assess changes in the incidence and severity of DDIs among PWH who switched their ART to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). Methods: This was a multicenter retrospective cohort study of PWH on ART and at least 1 concomitant medication (CM) who switched to BIC/FTC/TAF between 3/2018 and 6/2019. Using the University of Liverpool\u27s HIV Drug Interaction Database, 2 DDI analyses were performed for each patient. The first assessed patients\u27 preswitch ART regimens with their CM list. The second assessed the same CM list with BIC/FTC/TAF. Each ART-CM combination was given a score of 0 (no or potential weak interaction), 1 (potential interaction), or 2 (contraindicated interaction). A paired Results: Among 411 patients, 236 (57%) had at least 1 DDI present at baseline. On average, baseline DDI scores (SD) were 1.4 (1.8) and decreased by 1 point (95% CI, -1.1 to -0.8) after patients switched to BIC/FTC/TAF ( Conclusions: Treatment-experienced PWH eligible to switch their ART may experience significant declines in number and severity of DDIs if switched to BIC/FTC/TAF

Single Assay for Simultaneous Detection and Differential Identification of Human and Avian Influenza Virus Types, Subtypes, and Emergent Variants

For more than four decades the cause of most type A influenza virus infections of humans has been attributed to only two viral subtypes, A/H1N1 or A/H3N2. In contrast, avian and other vertebrate species are a reservoir of type A influenza virus genome diversity, hosting strains representing at least 120 of 144 combinations of 16 viral hemagglutinin and 9 viral neuraminidase subtypes. Viral genome segment reassortments and mutations emerging within this reservoir may spawn new influenza virus strains as imminent epidemic or pandemic threats to human health and poultry production. Traditional methods to detect and differentiate influenza virus subtypes are either time-consuming and labor-intensive (culture-based) or remarkably insensitive (antibody-based). Molecular diagnostic assays based upon reverse transcriptase-polymerase chain reaction (RT-PCR) have short assay cycle time, and high analytical sensitivity and specificity. However, none of these diagnostic tests determine viral gene nucleotide sequences to distinguish strains and variants of a detected pathogen from one specimen to the next. Decision-quality, strain- and variant-specific pathogen gene sequence information may be critical for public health, infection control, surveillance, epidemiology, or medical/veterinary treatment planning. The Resequencing Pathogen Microarray (RPM-Flu) is a robust, highly multiplexed and target gene sequencing-based alternative to both traditional culture- or biomarker-based diagnostic tests. RPM-Flu is a single, simultaneous differential diagnostic assay for all subtype combinations of type A influenza viruses and for 30 other viral and bacterial pathogens that may cause influenza-like illness. These other pathogen targets of RPM-Flu may co-infect and compound the morbidity and/or mortality of patients with influenza. The informative specificity of a single RPM-Flu test represents specimen-specific viral gene sequences as determinants of virus type, A/HN subtype, virulence, host-range, and resistance to antiviral agents

Phosphoglycerate dehydrogenase diverts glycolytic flux and contributes to oncogenesis

Most tumors exhibit increased glucose metabolism to lactate, however, the extent to which glucose-derived metabolic fluxes are used for alternative processes is poorly understood [1, 2]. Using a metabolomics approach with isotope labeling, we found that in some cancer cells a relatively large amount of glycolytic carbon is diverted into serine and glycine metabolism through phosphoglycerate dehydrogenase (PHGDH). An analysis of human cancers showed that PHGDH is recurrently amplified in a genomic region of focal copy number gain most commonly found in melanoma. Decreasing PHGDH expression impaired proliferation in amplified cell lines. Increased expression was also associated with breast cancer subtypes, and ectopic expression of PHGDH in mammary epithelial cells disrupted acinar morphogenesis and induced other phenotypic alterations that may predispose cells to transformation. Our findings show that the diversion of glycolytic flux into a specific alternate pathway can be selected during tumor development and may contribute to the pathogenesis of human cancer.National Institutes of Health (U.S.)National Cancer Institute (U.S.)Smith Family FoundationDamon Runyon Cancer Research FoundationBurroughs Wellcome Fun

Elevated Plasma IL-6 Associates with Increased Risk of Advanced Fibrosis and Cholangiocarcinoma in Individuals Infected by Opisthorchis viverrini

Opisthorchis viverrini is considered among the most important of the food-borne trematodes due to its strong association with advanced periductal fibrosis and bile duct cancer (cholangiocarcinoma). We investigated the relationship between plasma levels of Interleukin (IL)-6 and the risk of developing advanced fibrosis and bile duct cancer from chronic Opisthorchis infection. We show that IL-6 circulates in plasma at concentrations 58 times higher in individuals with advanced fibrosis than age, sex, and nearest-neighbor matched controls and 221 times higher in individuals with bile duct cancer than controls. We also observed a dose-response relationship between increasing levels of plasma IL-6 and increasing risk of advanced fibrosis and bile duct cancer; for example, in age and sex adjusted analyses, individuals with the highest quartiles of plasma IL-6 had a 19 times greater risk of developing advanced periductal fibrosis and a 150 times greater risk of developing of bile duct cancer than individuals with no detectable level of plasma IL-6. Finally, we show that a single plasma IL-6 measurement has excellent positive predictive value for the detection of both advanced bile duct fibrosis and bile duct cancer in regions with high O. viverrini transmission. These data support our hypothesis that common mechanisms drive bile duct fibrosis and bile duct tumorogenesis from chronic O. viverrini infection. Our study also adds a unique aspect to the literature on circulating levels of IL-6 as an immune marker of hepatobiliary pathology by showing that high levels of circulating IL-6 in plasma are not related to infection with O. viverrini, but to the development of the advanced and often lethal pathologies resulting from chronic O. viverrini infection

Costs and advance directives at the end of life: a case of the ‘Coaching Older Adults and Carers to have their preferences Heard (COACH)’ trial

Background Total costs associated with care for older people nearing the end of life and the cost variations related with end of life care decisions are not well documented in the literature. Healthcare utilisation and associated health care costs for a group of older Australians who entered Transition Care following an acute hospital admission were calculated. Costs were differentiated according to a number of health care decisions and outcomes including advance directives (ADs). Methods Study participants were drawn from the Coaching Older Adults and Carers to have their preferences Heard (COACH) trial funded by the Australian National Health and Medical Research Council. Data collected included total health care costs, the type of (and when) ADs were completed and the place of death. Two-step endogenous treatment-regression models were employed to test the relationship between costs and a number of variables including completion of ADs. Results The trial recruited 230 older adults with mean age 84 years. At the end of the trial, 53 had died and 80 had completed ADs. Total healthcare costs were higher for younger participants and those who had died. No statistically significant association was found between costs and completion of ADs. Conclusion For our frail study population, the completion of ADs did not have an effect on health care utilisation and costs. Further research is needed to substantiate these findings in larger and more diverse clinical cohorts of older people