Impact of Continuing Education in Reducing Perceived Challenges to Treating Patients Co-Prescribed Opioids and Benzodiazepines Among Midwest Clinicians

Goal The goal of this Capstone project was to provide meaningful Continuing Education (CE) to clinicians in the Midwest to reduce perceived challenges to safely treating patients co-prescribed opioid analgesics and benzodiazepines Objectives Using continuing education, increase clinician knowledge of effective alternative non-opioid and non-benzodiazepine therapies for chronic conditions while increasing clinician comfort in tapering patients off opioid analgesics and benzodiazepines Methods A one-hour CE presentation was prepared with the assistance of the Nebraska Department of Health and Human Services (NeDHHS) and broadcast to clinicians in the Midwest through a live webinar in coordination with the Great Plains Quality Innovation Network (GPQIN) and the Nebraska Medical Association (NMA). Clinicians registering for the webinar included physicians, mid-level providers such as physician assistants and nurse practitioners, pharmacists, and nurses. In the process of registering for the webinar, clinicians were required to answer five questions to assess their perceived knowledge of effective alternative non-opioid and non-benzodiazepine therapies and their comfort with tapering patients off opioid analgesics and benzodiazepines. After the webinar, providers were required to complete a post-assessment survey of identical questions to obtain their CE credit. These questions were arranged on a 5-point Likert scale describing their level of agreement with the statements posed. Post-webinar responses were compared to the pre-webinar responses to examine the effect of the CE presentation on provider knowledge and comfort in treating patients prescribed both opioids and benzodiazepines. The Wilcoxon signed-rank test was used to compare the pre- and post-webinar responses to determine if the CE presentation was associated with a difference in self-reported knowledge and comfort in guideline recommended practices. Project Impact This study demonstrated that continuing education was associated with a statistically significant increase in self-reported clinician knowledge of effective alternative non-opioid and non-benzodiazepine therapies for chronic conditions while also increasing self-reported clinician comfort in tapering patients off opioid analgesics and benzodiazepines. State health departments should promote the use of CE in reducing perceived challenges to safely treating patients co-prescribed opioid analgesics and benzodiazepines in their efforts to decrease the incidence of opioid-related overdose deaths

Gene expression changes in normal haematopoietic cells.

The complexity of the healthy haematopoietic system is immense, and as such, one must understand the biology driving normal haematopoietic expression profiles when designing experiments and interpreting expression data that involve normal cells. This article seeks to present an organised approach to the use and interpretation of gene profiling in normal haematopoiesis and broadly illustrates the challenges of selecting appropriate controls for high-throughput expression studies

Exploring demographic and lifestyle associations with patient experience following telephone triage by a primary care doctor or nurse:secondary analyses from a cluster randomised controlled trial

The ESTEEM trial was a cluster randomised controlled trial that compared two telephone triage management systems (general practitioner (GP) or a nurse supported by computer decision support software) with usual care, in response to a request for same-day consultation in general practice

Pharmacogenetics of antipsychotic adverse effects: Case studies and a literature review for clinicians

There is a growing body of literature supporting the contribution of genetic variability to the mechanisms responsible for the adverse effects of antipsychotic medications particularly movement disorders and weight gain. Despite the current gap between research studies and the practical tools available to the clinician to identify such risks, it is hoped that in the foreseeable future, pharmacogenetics will become a critical aid to guide the development of personalized therapeutic regimes with fewer adverse effects. We provide a summary of two cases that are examples of using cytochrome P450 pharmacogenetics in an attempt to guide treatment in the context of recent literature concerning the role of pharmacogenetics in the manifestation of adverse effects of antipsychotic therapies. These examples and the review of recent literature on pharmacogenetics of antipsychotic adverse effects illustrate the potential for applying the principles of predictive, preventive, and personalized medicine to the therapy of psychotic disorders

Live Logic Programming

Abstract-Logic programming languages are today used to build applications accessing large database systems. This raises the possibility of building live development environments for them. Of particular interest is how specific language features such as level of abstraction, transactions, etc. affect the design of such an environment. In this paper, we explore this question for a specific logic language, Datalog, contrast traditional and live approaches for its tooling and discuss issues that arise

Tumor Necrosis Factor Polymorphism Affects Transplantation Outcome in Patients with Myelodysplastic Syndrome but Not in Those with Chronic Myelogenous Leukemia, Independent of the Presence of HLA-DR15

Both the presence of HLA-DR15 and tumor necrosis factor (TNF)-α levels have been reported to affect outcome after hematopoietic cell transplantation (HCT). Patients with a myelodysplastic syndrome (MDS) show a high prevalence of HLA-DR15 and express high levels of TNF-α in the bone marrow. The present analysis involving 7950 patients showed an HLA-DR15 frequency of 31% in patients with MDS, compared with only 23% in patients with chronic myelogenous leukemia (CML). HLA-DR15 was more prevalent in Caucasian patients than in non-Caucasian patients (P = .01). The numbers of patients in the non-Caucasian subgroups were too small to allow further analysis. Among Caucasian patients with MDS and CML, the presence of HLA-DR15 did not significantly affect the occurrence of graft-versus-host disease, relapse, nonrelapse mortality (NRM), or survival. However, there was a significant correlation between DR15 and TNF polymorphisms at position -308 among patients with MDS, and the TNF-308 AG genotype conferred an increased risk of NRM compared with the GG genotype (hazard ratio [HR], 1.49; P = .02), even after adjusting for DR15. Conversely, the TNF-863 AA genotype was correlated with decreased overall mortality and NRM compared with the CC genotype (HR, 0.36, P = .04 vs HR, 0.13, P = .04), even after adjusting for DR15. There was no significant association between TNF-308 or -863 polymorphisms and transplantation outcome in CML patients. These results suggest that TNF polymorphisms, but not DR15, affect transplantation outcome in a disease-dependent manner

Toward a task model of concurrent software maintenance

This paper describes a first step toward developing a methodology for the maintenance of concurrent software that incorporates best practices in design and verification. Specifically, we describe our plan for using the think-aloud method to study the strategies, goals, and intentions of contemporary practitioners engaged in the maintenance of concurrent software. The method will yield a task model that details the specific tasks practitioners undertake while so engaged. Initially, we will conduct the study with graduate students in a formal-methods course at Michigan State University. Copyright 2007 ACM

Sensory protein kinase signalling in ' Schistosoma mansoni ' Cercariae : host location and invasion

Schistosoma mansoni cercariae display specific behavioural responses to abiotic/biotic stimuli enabling them to locate and infect the definitive human host. Here we report the effect of such stimulants on signalling pathways of cercariae in relation to host finding and invasion. Cercariae exposed to various light/temperature regimes displayed modulated protein kinase C (PKC), extracellular signal-regulated kinase (ERK) and p38 mitogen-activated protein kinase (p38 MAPK) activities, with distinct responses at 37°C and intense light/dark, when compared to 24°C under normal light. Kinase activities were localized to regions including the oral sensory papillae, acetabular ducts, tegument, acetabular glands, and nervous system. Furthermore, linoleic acid (LA) modulated PKC and ERK activities concurrent with the temporal release of acetabular gland components. Attenuation of PKC, ERK and p38 MAPK activities significantly reduced gland component release, particularly in response to LA, demonstrating the importance of these signalling pathways to host penetration mechanisms

Gene Expression Patterns in Myelodyplasia Underline the Role of Apoptosis and Differentiation in Disease Initiation and Progression

The myelodysplastic syndromes (MDS) are clonal stem cell disorders, characterized by ineffective and dysplastic hematopoiesis. The genetic and epigenetic pathways that determine disease stage and progression are largely unknown. In the current study we used gene expression microarray methodology to examine the gene expression differences between normal hematopoietic cells and hematopoietic cells from patients with MDS at different disease stages, using both unselected and CD34+ selected cells. Significant differences between normal and MDS hematopoietic cells were observed for several genes and pathways. Several genes promoting or opposing apoptosis were dysregulated in MDS cases, most notably MCL1 and EPOR. Progression from RA to RAEB(T) was associated with increased expression of several histone genes. In addition, the RAR-RXR pathway, critical for maintaining a balance between self-renewal and differentiation of hematopoietic stem cells, was found to be deregulated in hematopoietic cells from patients with advanced MDS compared to patients with refractory anemia. These findings provide new insights into the understanding of the pathophysiology and progression of MDS, and may guide to new targets for therapy. Taken together with previous published data, the present results also underscore the considerable complexity of the regulation of gene expression in MDS