Healthcare provider knowledge, attitudes, beliefs, and practices surrounding the prescription of opioids for chronic non-cancer pain in North America: protocol for a mixed-method systematic review

Background Evidence from diverse areas of medicine (e.g., cardiovascular disease, diabetes) indicates that healthcare providers (HCPs) often do not adhere to clinical practice guidelines (CPGs) despite a clear indication to implement recommendations—a phenomenon commonly termed clinical inertia. There are a variety of reasons for clinical inertia, but HCP-related factors (e.g., knowledge, motivation, agreement with guidelines) are the most salient and amenable to intervention aimed to improve adherence. CPGs have been developed to support the safe and effective prescription of opioid medication for the management of chronic non-cancer pain. The extent of physician uptake and adherence to such guidelines is not yet well understood. The purpose of this review is to synthesize the published evidence about knowledge, attitudes, beliefs, and practices that HCPs hold regarding the prescription of opioids for chronic non-cancer pain. Methods An experienced information specialist will perform searches of CINAHL, Embase, MEDLINE, and PsycINFO bibliographic databases. The Cochrane library, PROSPERO, and the Joanna Briggs Institute will be searched for systematic reviews. Searches will be performed from inception to the present. Quantitative and qualitative study designs that report on HCP knowledge, attitudes, beliefs, or practices in North America will be eligible for inclusion. Studies reporting on interventions to improve HCP adherence to opioid prescribing CPGs will also be eligible for inclusion. Two trained graduate-level research assistants will independently screen articles for inclusion, perform data extraction, and perform risk of bias and quality assessment using recommended tools. Confidence in qualitative evidence will be evaluated using the Grades of Recommendation, Assessment, Development, and Evaluation-Confidence in the Evidence from Qualitative Reviews (GRADE-CERQual) approach. Confidence in quantitative evidence will be assessed using the GRADE approach. Discussion The ultimate goal of this work is to support interventions aiming to optimize opioid prescribing practices in order to prevent opioid-related morbidity and mortality without restricting a HCP’s ability to select the most appropriate treatment for an individual patient

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Towards the rapid assessment of pain expression: The Index of Facial Pain Expression (IFPE)

Pain is the most common reason for seeking healthcare and one in five Canadians suffer from chronic pain. Despite high prevalence and severe consequences, pain is often poorly recognized and inadequately managed. Training observers to recognize facial expressions of pain may improve observer detection and estimation of pain. Pain is accompanied by distinct and reliable changes in four facial muscles (i.e., brow, orbital, levator, eye closure) that can be characterized as a "pain expression." The facial expression of pain communicates quantitative information that is associated with self-report of pain. Observers do not fully utilize evidence for pain conveyed by the face and rely on salient indicators at the expense of subtle signs. This dissertation described the development, reliability, and validity of the Index of Facial Pain Expression (IFPE) - an abbreviated system for quantifying facial pain expression. This work consisted of three steps. First, we developed the IFPE which is an online environment designed to quantify pain through the use of an abbreviated Facial Action Coding System (FACS). This training environment included a manual, three online learning modules, and a final test containing 25 video-clips. Second, four comparable Sensitivity To Expressions of Pain (STEP) tests were designed to evaluate observer sensitivity and response bias to evidence of clinical pain. Participants (n=101) completed questionnaires, watched four STEP tests, and evaluated patient pain. Results indicated that observer characteristics were associated with evaluation of pain. Third, a controlled investigation was performed to evaluate the impact of training in the IFPE on observer sensitivity and response bias to clinical pain. Participants attended two laboratory testing sessions separated by an intervention period where they were assigned to complete the IFPE (n = 34) or a no contact control (n = 20). Participants completed questionnaires during the first testing session and watched parallel versions of the STEP test during laboratory sessions. Training in the IFPE resulted in reliable coding of facial muscle movements associated with pain, and improvement in sensitivity to evidence of clinical pain. Collectively, this work provides initial support for the IFPE as a tool to improve observer detection of facial pain expression

Maternal cortisol during pregnancy is related to infant cardiac vagal control

Author's accepted manuscript deposited according to Elsevier sharing policies http://www.elsevier.com/about/company-information/policies/policy-faq October 26, 2015Background: Prenatal exposure to maternal psychological distress and glucocorticoids result in neurobiological adaptations within the fetus that increase risk for developing exaggerated emotional, behavioral, and stress responses to novelty and challenges in childhood. The current study investigated the influence of maternal depressed mood and cortisol during pregnancy on infant cardiac vagal control (CVC) to standardized laboratory challenge tasks. Methods: The sample comprised 194 women and their infants. Maternal reports of depressed mood and salivary cortisol were assessed at 14 and 32 weeks gestational age. Linear regression was used to examine associations between maternal measures during early and late pregnancy, and infant CVC indexed via respiratory sinus arrhythmia (RSA) at rest and in response to laboratory tasks designed to elicit frustration when infants were 6 months of age. It was hypothesized that maternal depressed mood and cortisol would be associated with lower basal RSA and smaller decreases in RSA from baseline to challenge. Results: A significant decrease in infant RSA from baseline to frustration tasks indicated that laboratory tasks elicited a reliable decrease in RSA from baseline to frustration among infants which is characterized by reduction in vagal efferent activity on the heart in response to challenge. Higher maternal cortisol, but not depressed mood, was associated with lower basal RSA and greater decrease in RSA from baseline to frustration. Associations between maternal cortisol and infant basal RSA were observed for both early and late pregnancy whereas the associations between prenatal cortisol and decrease in RSA from baseline to frustration were observed for early, but not late, pregnancy. Conclusions: Maternal cortisol during pregnancy was associated with infant CVC at 6-months of age. Such influences may have enduring impacts on the child and important implications for the development of physical and mental health outcomes.YesThis research was supported in part by grants from Alberta Innovates Health Solutions, the Canadian Institutes of Health Research, the Alberta Centre for Child, Family and Community Research, and the Alberta Children's Hospital Research Institute. The sources of funding had no role in the study design, in the collection, analysis or interpretation of data; in writing the manuscript; or Financial Disclosure

Observer trait anxiety is associated with response bias to patient facial pain expression independent of pain catastrophizing

Nonverbal communication, such as facial expression, is an important component of the communication of pain to an observer. One factor that influences pain perception by an observer is characteristics specific to the observer themselves (ie, ‘top-down’ characteristics). The authors of this article aimed to assess how anxiety in the observer affects their ability to rate a sufferer’s pain, controlling for pain catastrophizing

Observer trait anxiety is associated with response bias to patient facial pain expression independent of pain catastrophizing

Nonverbal communication, such as facial expression, is an important component of the communication of pain to an observer. One factor that influences pain perception by an observer is characteristics specific to the observer themselves (ie, ‘top-down’ characteristics). The authors of this article aimed to assess how anxiety in the observer affects their ability to rate a sufferer’s pain, controlling for pain catastrophizing.BACKGROUND: Top-down characteristics of an observer influence the detection and estimation of a sufferer’s pain. A comprehensive understanding of these characteristics is important because they influence observer helping behaviours and the sufferer’s experience of pain.OBJECTIVES: To examine the hypothesis that individuals who score high in trait anxiety would perceive more intense pain in others, as indicated by a larger negative response bias, and that this association would persist after adjusting for pain catastrophizing.METHODS: Healthy young adult participants (n=99; 50 male) watched videos containing excerpts of facial expressions taken from patients with shoulder pain and were asked to rate how much pain the patient was experiencing using an 11-point numerical rating scale. Sensitivity and response bias were calculated using signal detection methods.RESULTS: Trait anxiety was a predictor of response bias after statistically adjusting for pain catastrophizing and observer sex. More anxious individuals had a proclivity toward imputing greater pain to a sufferer.CONCLUSIONS: Individuals scoring higher on trait anxiety were more likely to impute pain to a sufferer. Anxious caregivers may be better able to respond with appropriate intervention once pain behaviour is detected, or they may exacerbate symptoms by engaging in excessive palliative care and solicitous behaviour.Peer Reviewe

Short-term autonomic nervous system and experiential responses during a labyrinth walk

The labyrinth is a simple geometric form with one path leading to the center and out. It is often used in religious and health-related institutions for quiet walking and meditation. It is considered a convenient tool for decreasing psychological and physical stress. This study sought to better understand and characterize the short-term physiological responses of the autonomic nervous system associated with walking a projected light labyrinth by measuring respiratory sinus arrhythmia (RSA) and salivary alpha amylase (sAA) in 25 young adults and youth. Our objective was to examine the physiology of labyrinth walking as a potential clinical tool for use by individuals who are experiencing psychological stress. Three hypotheses were put forward: 1) walking the labyrinth would result in physiological arousal as indicated by a decrease in RSA and an increase in sAA; 2) physiological relaxation would be indicated by an increase in RSA after the labyrinth walk; and 3) participants would self-report calmness and relaxation following the labyrinth. Consistent with hypotheses, participants experienced immediate physiological arousal while walking the labyrinth, and heightened physiological and self-reported relaxation during and after the labyrinth walk

Full-term deliveries without antecedent labor reveal sex differences in umbilical cord glucocorticoid concentrations.

Author's accepted manuscript deposited according to Elsevier sharing policies: http://www.elsevier.com/about/company-information/policies/policy-faq (December 1st, 2016)Background: Previous studies have shown that pregnant women have higher salivary cortisol levels when the fetus is female. These findings suggest a basis for the sex differences observed in many offspring outcomes after exposure to in utero stress, but it is not known if fetal adrenal glucocorticoid synthesis differs by sex. Methods: Arterial and venous umbilical cord blood samples were collected immediately after scheduled cesarean delivery (n = 52, 25 female). Cortisol and corticosterone concentrations were quantified by liquid chromatography coupled to tandem mass spectrometry. Results: Sex differences were observed for fetal arterial and venous cortisol and venous corticosterone, with higher levels present when the fetus was female. However, sex differences were not observed for fetal synthesis of cortisol, suggesting that the fetus does not control the differences observed in cord blood glucocorticoids. Conclusions: The presence of sex differences in umbilical cord glucocorticoid concentrations in the absence of sex differences in glucocorticoid synthesis by the fetal adrenal gland suggests that these differences have a maternal or placental origin. Thus, the in utero glucocorticoids in circulation are sex-specific and may have developmental importance for sex differences in psychiatric and neurodevelopment disorders that display sex biases.Ye

An experimental study revisiting the link between media attention and breast cancer concern: Exploring the role of cognitive fusion

Research examining the link between media attention and breast cancer concern has been frequently conducted with middle/old-age women, even though young women (<40 years old) have been overrepresented media stories about breast cancer. Accordingly, little is known about young women’s emotional reactions to breast cancer media messages and the psychological factors modulating such reactions. This study examined the impact of breast cancer media messages and cognitive fusion on negative affect, fear of breast cancer (FBC), and perceived susceptibility to breast cancer. 207 young women were randomly assigned to watch a low- or highthreat video about breast cancer. A MANCOVA revealed that participants who viewed the high-threat video reported greater negative affect and perceived susceptibility, but not FBC; however, participants in both conditions showed moderate/high FBC. Correlational analyses and a MANOVA showed that participants reporting higher cognitive fusion reported higher negative affect across conditions, as well as higher FBC in the high-threat condition. Taken together, these results suggest that young women may show habituation to alarmist media messages, but may nonetheless construe breast cancer as a significant threat. Moreover, young women showing medium/high cognitive fusion seem more likely to show heightened concern upon exposure to alarmist media messages about breast cancer.Sin financiación1.739 JCR (2020) Q3, 130/176 Public, Environvental & Occupational Health0.610 SJR (2020) Q2, 1107/2447 Medicine (miscellaneous)No data IDR 2020UE