Impact of Continuing Education on Clinicians' Self- Reported Knowledge of Tobacco Dependence and Tobacco Control Interventions

Purpose: To assess a tobacco cessation continuing education (CE) program for Indiana dental and medical providers. Methods: A 26-item immediate post-CE survey and a 19-item 3-month follow-up survey assessed changes in participants’ self-reported knowledge of tobacco dependence and tobacco control interventions. De-identified data were analyzed using descriptive statistics, Spearman correlation coefficients, and Mantel- Haenszel chi-square tests. Results: Participants totaled 252 across 6 programs statewide. Immediate post-CE course survey response was 98.4% (N=248): dental assistants (2%), dental hygienists (83%), dentists (8.5%), and other healthcare professionals (6.45%). Participants reported less knowledge before than immediately after CE (p< .0001) and 3 months after (p<.0001). Reported knowledge at 3 months was less than after CE (p< .002). Participants reported on their intention to apply program communication strategies (99%), implement brief tobacco interventions (85%), and refer patients to local cessation resources (95%), Indiana Quitline (96%). Follow-up survey response rate was 54% (N=136). Participants reported active engagement in tobacco interventions (48%, 78), applying CE communication strategies (85%, 109), and implementing brief interventions (71%, 90). Participants reported referring few patients to local or state quitline counselors. Conclusion:Tobacco dependence CE may enhance health care practitioners’ knowledge and willingness to integrate tobacco interventions in their healthcare settings but it does not ensure a change in clinical tobacco control intervention

Assessing the Depiction of Electronic Cigarettes in YouTube Videos

poster abstractObjective: Use of electronic cigarettes is an emerging phenomenon with unknown health implications. YouTube videos of e-cigarettes are abundant, easily accessible, and possess the potential to promote e-cigarette use through the increased visibility of user-generated content and novel marketing strategies. As there are no published studies examining the content of e-cigarette videos, this study aimed to assess the depiction of e-cigarettes in terms of content and viewing qualities. Methods: Two calibrated reviewers conducted 4 searches for e-cigarette English language YouTube videos between August 2, 2013 and November 26, 2013. Based on a Google Insights analysis, the sample was selected from the top 20 search results for the terms “electronic cigarette,” and “e-cig”. Two searches were performed for each term using the filters “Relevance” and “View Count”. The initial sample included a total of 80 short-length videos from which duplicates were removed, leaving a final sample of 63 unique videos. Data collected included: title; uploader alias; length; number of views, “likes”, “dislikes”, comments and actor demographics. Videos were rated independently by the two reviewers for content theme and connotation. Inter-rater reliability was good (k=.70). Reviewer ratings were compared; consensus was reached on any discrepancies. Data was coded and recorded into an electronic database for statistical analysis. Results: The sample of assessed videos (N=63), generated the following means: video length, 135 seconds; views, 199,311; “likes”, 21.5; “dislikes”, 98.2; and posted comments, 244. Of the actors shown, 49.2% were male, 61.9% were Caucasian, and 33.3%, the largest segment, were coded as young (i.e. < 40 years). The most commonly mentioned brand was Blu. Video content connotation was coded as follows: positive (76.1%); neutral (17.4%); and negative (6.3%). Videos were categorized into one of the following seven content themes: Advertisement (33%); Instructional/how-to (17.4%); news clip/story (19.0%); product review (12.7%); entertainment (11.1%); public health/educational (3.1%); and personal testimonial (3.1%). Conclusions: YouTube videos of electronic cigarettes primarily feature young, male, Caucasian actors and depict e-cigarettes in a positive manner. Most videos were non-traditional advertisements

Analyzing Medication Documentation in Electronic Health Records: Dental Students’ Self-Reported Behaviors and Charting Practices

The aim of this two-part study was to assess third- and fourth-year dental students’ perceptions, self-reported behaviors, and actual charting practices regarding medication documentation in axiUm, the electronic health record (EHR) system. In part one of the study, in fall 2015, all 125 third- and 85 fourth-year dental students at one U.S. dental school were invited to complete a ten-item anonymous survey on medication history-taking. In part two of the study, the EHRs of 519 recent dental school patients were randomly chosen via axiUm query based on age >21 years and the presence of at least one documented medication. Documentation completeness was assessed per EHR and each medication based on proper medication name, classification, dose/frequency, indication, potential oral effects, and correct medication spelling. Consistency was evaluated by identifying the presence/absence of a medical reason for each medication. The survey response rate was 90.6% (N=187). In total, 64.5% of responding students reported that taking a complete medication history is important and useful in enhancing pharmacology knowledge; 90.4% perceived it helped improve their understanding of patients’ medical conditions. The fourth-year students were more likely than the third-year students to value the latter (p=0.0236). Overall, 48.6% reported reviewing patient medications with clinic faculty 76-100% of the time. The respondents’ most frequently cited perceived barriers to medication documentation were patients’ not knowing their medications (68.5%) and, to a much lesser degree, axiUm limitations (14%). Proper medication name was most often recorded (93.6%), and potential oral effects were recorded the least (3.0%). Medication/medical condition consistency was 70.6%. In this study, most of the students perceived patient medication documentation as important; however, many did not appreciate the importance of all elements of a complete medication history, and complete medication documentation was low

The Use of Simulation in Pre-doctoral Medical Emergencies Training

poster abstractObjective: This purpose of this study was to determine the level and method of teaching medical emergencies management in U.S. pre-doctoral programs, particularly the extent to which patient simulation techniques are employed for instruction and /or assessment. Methods: In the fall of 2013, a 22- item survey instrument was developed, piloted with a small cohort of oral and maxillofacial surgery faculty, and modified based on feedback. Survey items assessed curriculum content and teaching methods used for medical emergencies training, and program demographics. A link to the survey was sent to the institutional email of the Academic Dean and Oral and Maxillofacial Surgery Department Chair at each U.S. dental school. The internet-based survey platform Qualtrics was used to record responses and track non-responders. Two follow-up reminders were sent via email to non-responders. Response data were de-identified and statistical analyses were conducted. Results: Completed surveys were returned by respondents from 40 schools (62.5% response rate). Of responding schools, 95% (38) offered medical emergencies training; teaching methods included lecture, seminar, and small group learning. Median instruction time was 12 hours. Of responding schools, 12 reported providing management of medical emergencies instruction via high fidelity patient simulation (HFPS), 16 used role playing, 5 employed computer-based programs, and 6 utilized standardized patients. While 6 schools reported employing HFPS for 3-5 yrs., no school reported using it for > 5 yrs.; however, 4 schools reported utilizing role-playing for > 5 yrs. While class size was not significantly associated with use of HFPS, cost was significantly associated with non-use of HFPS (p=0.0274). Conclusions: Although the vast majority of pre-doctoral dental programs educate students in the management of medical emergencies, few programs utilize simulation as an instructional method

Gender Differences: Smokers With and Without Substance Abuse History

poster abstractPrevious research suggests that individuals with chemical dependence history experience more intense nicotine addiction, and during smoking cessation may be more likely to demonstrate increased negative affect and unfavorable scores on psychometric assessments. It is unknown how men and women may differ in their susceptibilities to such undesirable outcomes. From 1992-2004, The Indiana University Nicotine Dependence Program (IUNDP) treated over 1200 patients using a Mayo Clinic-based protocol which assesses the behavioral, social, and physiological aspects of nicotine dependence. The IUNDP was instituted at Fairbanks Hospital’s addictions center to address tobacco use among the patients and staff. Charts of individuals who completed nicotine dependence treatment (1992-2011) were selected from IU School of Dentistry and Fairbanks Hospital for retrospective analysis. Chart selection criteria consisted of the availability of complete pre-and post quit measures for a minimum of four total appointments and two post-quit appointments. Reviewed were 107 charts from patients without a history of chemical dependence (ND) and 123 from those with a chemical dependence history (CD), including 120 men and 110 women. Student researchers used a standardized protocol to capture 16 tobacco use and demographic variables and 12 post-quit measures. Comparisons between CD and ND groups were made using Pearson chi-square tests for binary data, Wilcoxon rank sum tests for all other data, and Wilcoxon signed rank tests for changes between time periods. Despite similarities among CD and ND smokers, males and females appear to face distinct challenges. Results suggest CD males are significantly more negative in mood, and are more likely to have increased withdrawal symptoms at the end of treatment. Males were also more likely to experience adverse events with NRT. Both CD males and females experienced more increased appetite than their ND counterparts. Females scored higher on addiction-related sensorimotor manipulation and may have increased propensity for psychological dependence

Retail promotions and perceptions of R.J. Reynolds' novel dissolvable tobacco in a US test market

<p>Abstract</p> <p>Background</p> <p>With declining cigarette sales, tobacco manufacturers have been developing and marketing new smokeless products, such as R. J. Reynolds' dissolvable tobacco, Camel Sticks, Strips and Orbs. This study assessed the availability, price and point-of-purchase promotional strategies for Camel Dissolvables, and investigated consumer awareness, interest and perception of these products in the Indiana test market.</p> <p>Methods</p> <p>An exploratory retail audit of point-of-purchase promotions was conducted in a random sample of retailers from 6 store categories (n = 81) in the test market area. Data included: store type, location, product placement, forms/flavors carried, price, types and locations of advertisements and promotions, and ad messages. An Awareness-Attitude-Usage (AAU) survey was used to gauge consumer awareness and knowledge of tobacco products including Camel Dissolvables. Respondents were shown promotional materials from a package onsert and perceptions and interest in the Camel Dissolvables were assessed. An Intended Target Survey (ITS) compared subjects' perceptions of ad targets for several non-tobacco products, as well as Camel Snus, Camel No. 9 and Camel Dissolvables. Respondents were asked to identify each ad's intended target category, perceived targetedness, and purchase intent.</p> <p>Results</p> <p>The products were carried by 46% of stores, most frequently gas stations (100%) and convenience stores (75%). They were shelved near smokeless tobacco (70%), cigarettes (25%) or candy (5%). Prices ranged from $3.59 -$4.19 per package; most stores carried at least 1 promotional item. Ad messages included: "Dissolvable Tobacco" (60%). "Free Trial" (24%), "Special Price" (24%), "What's Your Style?" (22%). At 14% of stores, free trial packs of Camel Dissolvables were offered with another Camel purchase. Awareness was reported by 42% of respondents (n = 243), and trial by 3%. Consumer interest was very low, but younger respondents (< 40 years) were more familiar with Camel Dissolvables (60% vs. 45% for those > 40 years, p < .01). Males, as well as current and former smokers had higher rates of interest and trial; only 1% of never smokers reported trial. In the ITS, only for the 3 tobacco product ads, was perceived targetedness for smokers significantly higher than for non-smokers. Smokers and nonsmokers perceived that the ads targeted smokers.</p> <p>Conclusions</p> <p>Current retail promotional strategies for Camel Sticks, Strips & Orbs appear to be targeting a select audience, primarily current smokers. Overall, consumer awareness, interest and trial were low.</p

GABA and Glutamate Levels in Occlusal Splint-Wearing Males with Possible Bruxism

Objective The inhibitory neurotransmitter γ-aminobutyric acid (GABA) plays an important role in the pathophysiology of anxiety behavioural disorders such as panic disorder and post-traumatic stress disorder and is also implicated in the manifestation of tooth-grinding and clenching behaviours generally known as bruxism. In order to test whether the stress-related behaviours of tooth-grinding and clenching share similar underlying mechanisms involving GABA and other metabolites as do anxiety-related behavioural disorders, we performed a Magnetic Resonance Spectroscopy (MRS) study for accurate, in vivo metabolite quantification in anxiety-related brain regions. Design MRS was performed in the right hippocampus and right thalamus involved in the hypothalamic−pituitary−adrenal axis system, together with a motor planning region (dorsal anterior cingulate cortex/pre-supplementary motor area) and right dorsolateral prefrontal cortex (DLPFC). Eight occlusal splint-wearing men (OCS) with possible tooth-grinding and clenching behaviours and nine male controls (CON) with no such behaviour were studied. Results Repeated-measures ANOVA showed significant Group × Region interaction for GABA+ (p = 0.001) and glutamate (Glu) (p = 0.031). Between-group post hoc ANOVA showed significantly lower levels of GABA+ (p = 0.003) and higher levels of Glu (p = 0.002) in DLPFC of OCS subjects. These GABA+ and Glu group differences remained significant (GABA+, p = 0.049; Glu, p = 0.039) after the inclusion of anxiety as a covariate. Additionally, GABA and Glu levels in the DLPFC of all subjects were negatively related (Pearson's r = −0.75, p = 0.003). Conclusions These findings indicate that the oral behaviours of tooth-grinding and clenching, generally known as bruxism, may be associated with disturbances in brain GABAergic and glutamatergic systems

Puffing Topography and Interpersonal Bonding Behavior Observed Among Recovering Drug Addicts Versus General Smokers

poster abstractSmokers can inherently manipulate nicotine doses on a puff-by-puff basis. The character of smoking behavior may be determined by using complex forms of smoking topography in laboratory settings or by unobtrusively observing the time spent smoking a single cigarette, the number of puffs taken, interpuff intervals and smokers’ behaviors. The purpose of this study was to observe and compare smoking topography and interpersonal bonding behaviors of recovering drug addicts to that of general smokers in a natural setting (introduction). Following a variable chemical substance detox/treatment period, Fairbanks addiction treatment patients spend 3-12 weeks in follow-up treatment in two groups: Partial Hospitalized Patients (PHP) and Intensive Outpatients (IOP). PHP and IOP form tight interpersonal bonds and friendships with each other. Patients are periodically released and they meet and smoke together at an approved outdoor smoking area. From a distance, PHP and IOP (20 men and 20 women) cigarette puffing behaviors were unobtrusively observed and recorded. Two calibrated investigators, using a stop watch monitored the exact time of lighting and the extinguishing of each cigarette. For each subject, the number of puffs taken was recorded and the interpuff interval was calculated. The same protocol was followed for a population of general smokers observed on the campus of IUPUI (methods). The mean interpuff intervals were IUPUI men: 25.2 seconds (SD 11.93); IUPUI women: 30.9 seconds (SD 16.0); Fairbanks men: 16.2 seconds (SD 6.21); and Fairbanks women: 21.1 seconds (SD 6.51). There was a statistically significant difference in interpuff intervals between the general smokers and the recovering addicts (p<0.001) and this effect was not dependent upon gender. Behavioral observations between general smokers versus recovering addicts will be presented (results). Smokers who were recovering from chemical drug addiction smoked more intensely than the general smoking population and their smoking behaviors were often quite different (conclusions)

Snus use and rejection in the USA

OBJECTIVE: To determine whether snus might become a strategy for reducing the harm associated with cigarette smoking in the USA as appears to be the case in Sweden, we examined receptivity to snus use in two cities with the greatest exposure to the major brands. METHODS: A dual frame, telephone survey and a brief mail survey were conducted in 2011 and 2012 in Indianapolis, Indiana and Dallas/Fort Worth Texas. Over 5000 adults completed surveys. Trial, ever use, current use and reasons for using or quitting snus after trial were measured. RESULTS: Among male smokers, 29.9% had ever tried snus (CI 22.7 to 38.1) and 4.2% were current users (CI 1.6 to 10.7). Among female smokers, 8.5% ever tried snus (CI 4.4 to 15.7) and current use was unknown. Current use was virtually absent among former smokers and never smokers. A major predictor of any level of snus use was current use of conventional smokeless tobacco. Those who tried and gave up snus cited curiosity (41.3%) and the fact that it was available at low or no cost (30%) as reasons for trial; reasons for not continuing included preferring another form of tobacco (75.1%) and disliking the mouth feel (34.6%). Almost all current snus users indicated that they were trying to cut down on cigarettes, but few (3.9%) were using it to quit smoking entirely. CONCLUSIONS: The low rate of adoption of snus suggests that neither the hopes nor the fears surrounding this new product are likely to be realised in the USA with the current marketing patterns

Cetuximab continuation after first progression in metastatic colorectal cancer (CAPRI-GOIM): A randomized phase II trial of FOLFOX plus cetuximab versus FOLFOX

Background: Cetuximab plus chemotherapy is a first-line treatment option in metastatic KRAS and NRAS wild-type colorectal cancer (CRC) patients. No data are currently available on continuing anti-epidermal growth factor receptor (EGFR) therapy beyond progression. Patients and methods: We did this open-label, 1:1 randomized phase II trial at 25 hospitals in Italy to evaluate the efficacy of cetuximab plus 5-fluorouracil, folinic acid and oxaliplatin (FOLFOX) as second-line treatment of KRAS exon 2 wild-type metastatic CRC patients treated in first line with 5-fluorouracil, folinic acid and irinotecan (FOLFIRI) plus cetuximab. Patients received FOLFOX plus cetuximab (arm A) or FOLFOX (arm B). Primary end point was progressionfree survival (PFS). Tumour tissues were assessed by next-generation sequencing (NGS). This report is the final analysis. Results: Between 1 February 2010 and 28 September 2014, 153 patients were randomized (74 in arm A and 79 in arm B). Median PFS was 6.4 [95% confidence interval (CI) 4.7-8.0] versus 4.5 months (95% CI 3.3-5.7); [hazard ratio (HR), 0.81; 95% CI 0.58-1.12; P = 0.19], respectively. NGS was performed in 117/153 (76.5%) cases; 66/117 patients (34 in arm A and 32 in arm B) had KRAS, NRAS, BRAF and PIK3CA wild-type tumours. For these patients, PFS was longer in the FOLFOX plus cetuximab arm [median 6.9 (95% CI 5.5-8.2) versus 5.3 months (95% CI 3.7-6.9); HR, 0.56 (95% CI 0.33-0.94); P = 0.025]. There was a trend in better overall survival: median 23.7 [(95% CI 19.4-28.0) versus 19.8 months (95% CI 14.9-24.7); HR, 0.57 (95% CI 0.32-1.02); P = 0.056]. Conclusions: Continuing cetuximab treatment in combination with chemotherapy is of potential therapeutic efficacy in molecularly selected patients and should be validated in randomized phase III trials