Clinical effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies for chronic knee pain: a cluster randomized trial.

OBJECTIVE: Chronic knee pain is a major cause of disability and health care expenditure, but there are concerns about efficacy, cost, and side effects associated with usual primary care. Conservative rehabilitation may offer a safe, effective, affordable alternative. We compared the effectiveness of a rehabilitation program integrating exercise, self-management, and active coping strategies (Enabling Self-management and Coping with Arthritic Knee Pain through Exercise [ESCAPE-knee pain]) with usual primary care in improving functioning in persons with chronic knee pain. METHODS: We conducted a single-blind, pragmatic, cluster randomized controlled trial. Participants age >/=50 years, reporting knee pain for >6 months, were recruited from 54 inner-city primary care practices. Primary care practices were randomized to continued usual primary care (i.e., whatever intervention a participant's primary care physician deemed appropriate), usual primary care plus the rehabilitation program delivered to individual participants, or usual primary care plus the rehabilitation program delivered to groups of 8 participants. The primary outcome was self-reported functioning (Western Ontario and McMaster Universities Osteoarthritis Index physical functioning [WOMAC-func]) 6 months after completing rehabilitation. RESULTS: A total of 418 participants were recruited; 76 (18%) withdrew, only 5 (1%) due to adverse events. Rehabilitated participants had better functioning than participants continuing usual primary care (-3.33 difference in WOMAC-func score; 95% confidence interval [95% CI] -5.88, -0.78; P = 0.01). Improvements were similar whether participants received individual rehabilitation (-3.53; 95% CI -6.52, -0.55) or group rehabilitation (-3.16; 95% CI -6.55, -0.12). CONCLUSION: ESCAPE-knee pain provides a safe, relatively brief intervention for chronic knee pain that is equally effective whether delivered to individuals or groups of participants

Trump-induced anxiety among Latina/os

During the 2016 election, Donald Trump castigated unauthorized immigrants as “murderers and rapists.” During his presidency, he continued the use of this rhetoric, explicitly linking unauthorized migrants to threatening narratives. Here, we consider three questions: Did Donald Trump and his immigration positions serve as an “anxiety trigger” for Latina/os? Are individuals with contextually stigmatized attributes especially sensitive to Trump and his policy proposals? Is Spanish language itself, an attribute negatively stigmatized in the context of the immigration issue, sufficient to increase deportation anxiety? Utilizing survey experiments of Latina/os, we demonstrate that exposure to a Trump immigration cue is sufficient to increase anxiety about deportation. We also demonstrate that stigmatized attributes predict anxiety, but do not moderate the effect of the Trump cue. Lastly, we provide evidence that survey language affects anxiety among Latina/os. In Studies 1 (n = 736) and 2 (n = 1,040), we show that exposure to information about Trump’s immigration agenda significantly increases reports about deportation anxiety. In Study 3 (n = 1,734), we show that the Trump exposure condition induces heightened anxiety but that Latina/o attributes (language proficiency and use, immigration status, assessed phenotype) and identity strength have an independent effect on deportation anxiety. In Study 4 (n = 775), we randomized bilingual respondents into Spanish or English language survey protocols and found that comparable bilinguals exposed to Spanish language report higher levels of anxiety compared to English-language survey takers

Use of a Decision Aid to Improve Decisional Comfort in College Students Treated for Respiratory Tract Infections

Decision aids have been shown to facilitate shared decision making, recognize and respect patient values, improve patient experience by designing care around those values and increase patient comfort with decisions made. The objective of the study was to determine the effectiveness of a decision aid to 1) increase decisional comfort with the appropriate use of antibiotics for respiratory tract infections and 2) maintain antibiotic prescribing rates at current levels. Participants were English-speaking college students age 18 and over diagnosed with a respiratory tract infection in the general medical clinic of a university health center from August 31, 2015-May 6, 2016. Pre- and post-intervention surveys were used to measure decisional conflict of students. Intervention included staff training in shared decision making and the use of a decision aid. Students who received routine care were 2.2 times [N=643; p

Evidence-Based Skin Champion Program Reduces Pressure Injuries in a Pediatric Hospital

Prevention of pressure injuries (PIs) in pediatric patients is an important nurse-sensitive quality goal. The PI rate at a large urban pediatric hospital triggered a call to action by the Chief Nursing Officer to establish a Hospital Acquired PI (HAPI) Task Force which identified the Skin Champion program as a key improvement strategy. The goals of the Skin Champion program are to lower the rate of HAPIs, empower front line care providers to implement evidence-based care bundles, achieve consistency of practice, and provide resource availability at the point of care. The implementation of the Skin Champion quality improvement program achieved an 85% reduction in severe harm and “reportable HAPI incidence, which is lower than the HAPI national average in pediatric patients (Solutions for Patient Safety, 2018), and an increase in nurse compliance with the HAPI prevention bundle. The HAPI incidence rate has remained near 0.05 per 1000 patient days

Elucidating the Significance of Copper and Nitrate Speciation in Cu-SSZ-13 for N₂O Formation during NH₃-SCR

Unwanted N2O formation is a problem that has been noted in selective catalytic reduction (SCR) where copper zeolite catalysts are utilized. With its immense global warming potential and long-term stability, elevated atmospheric N2O has already been identified as a future challenge in the war on climate change. This paper explores the phenomenon of N2O formation during NH3-SCR over Cu-SSZ-13 catalysts, which are currently commercialized in automotive emissions control systems, and proposes a link between N2O production and the local copper environment found within the zeolite. To achieve this, a comparison is made between two Cu-SSZ-13 samples with different copper co-ordinations produced via different synthesis methods. A combination of synchrotron X-ray absorption near-edge spectroscopy, UV–vis, Raman, and density functional theory (DFT) is used to characterize the nature of copper species present within each sample. Synchrotron IR microspectroscopy is then used to compare their behavior during SCR under operando conditions and monitor the evolution of nitrate intermediates, which, along with further DFT, informs a mechanistic model for nitrate decomposition pathways. Increased N2O production is seen in the Cu-SSZ-13 sample postulated to contain a linear Cu species, providing an important correlation between the catalytic behavior of Cu-zeolites and the nature of their metal ion loading and speciation

The influence of 'significant others' on persistent back pain and work participation: a qualitative exploration of illness perceptions

Background Individual illness perceptions have been highlighted as important influences on clinical outcomes for back pain. However, the illness perceptions of 'significant others' (spouse/partner/close family member) are rarely explored, particularly in relation to persistent back pain and work participation. The aim of this study was to initiate qualitative research in this area in order to further understand these wider influences on outcome. Methods Semi-structured interviews based on the chronic pain version of the Illness Perceptions Questionnaire-Revised were conducted with a convenience sample of UK disability benefit claimants, along with their significant others (n=5 dyads). Data were analysed using template analysis. Results Significant others shared, and perhaps further reinforced, claimants' unhelpful illness beliefs including fear of pain/re-injury associated with certain types of work and activity, and pessimism about the likelihood of return to work. In some cases, significant others appeared more resigned to the permanence and negative inevitable consequences of the claimant's back pain condition on work participation, and were more sceptical about the availability of suitable work and sympathy from employers. In their pursuit of authenticity, claimants were keen to stress their desire to work whilst emphasising how the severity and physical limitations of their condition prevented them from doing so. In this vein, and seemingly based on their perceptions of what makes a 'good' significant other, significant others acted as a 'witness to pain', supporting claimants' self-limiting behaviour and statements of incapacity, often responding with empathy and assistance. The beliefs and responses of significant others may also have been influenced by their own experience of chronic illness, thus participants lives were often intertwined and defined by illness. Conclusions The findings from this exploratory study reveal how others and wider social circumstances might contribute both to the propensity of persistent back pain and to its consequences. This is an area that has received little attention to date, and wider support of these findings may usefully inform the design of future intervention programmes aimed at restoring work participation