The association between specific narrative elements and patient perspectives on acute pain treatment

BACKGROUND

Narratives are effective tools for communicating with patients about opioid prescribing for acute pain and improving patient satisfaction with pain management. It remains unclear, however, whether specific narrative elements may be particularly effective at influencing patient perspectives.

METHODS

This study was a secondary analysis of data collected for Life STORRIED, a multicenter RCT. Participants included 433 patients between 18 and 70 years-old presenting to the emergency department (ED) with renal colic or musculoskeletal back pain. Participants were instructed to view one or more narrative videos during their ED visit in which a patient storyteller discussed their experiences with opioids. We examined associations between exposure to individual narrative features and patients' 1) preference for opioids, 2) recall of opioid-related risks and 3) perspectives about the care they received.

RESULTS

Participants were more likely to watch videos featuring storytellers who shared their race or gender. We found that participants who watched videos that contained specific narrative elements, for example mention of prescribed opioids, were more likely to recall having received information about pain treatment options on the day after discharge (86.3% versus 72.9%, p = 0.02). Participants who watched a video that discussed family history of addiction reported more participation in their treatment decision than those who did not (7.6 versus 6.8 on a ten-point scale, p = 0.04).

CONCLUSIONS

Participants preferentially view narratives featuring storytellers who share their race or gender. Narrative elements were not meaningfully associated with patient-centered outcomes. These findings have implications for the design of narrative communication tools.

Novel Procedures for Preparing99mTc(III) Complexes with Tetradentate/Monodentate Coordination of Varying Lipophilicity and Adaptation to188Re Analogues

Improved methods are presented for the preparation of 99mTc and 188Re mixed-ligand complexes with tetradentate and monodentate ligands of the general formula [MIII(Lm)(Ln)] (M = Tc, Re; Lm = NS3 or NS3COOH; Ln = isocyanide or phosphine). To avoid the undesired formation of reduced-hydrolyzed species of both metals, the preparation of complexes is performed in a two-step procedure. At first the Tc(III)- or Re(III)-EDTA complex is formed which reacts in a second step with the tripodal ligand 2,2',2' '-nitrilotris(ethanethiol) (NS3) or its carboxyl derivative NS3COOH (a) and the monodentate phosphine ligands (triphenylphosphine L1, dimethylphenylphosphine L2) or isocyanides (tert-butyl isonitrile L3, methoxyisobutyl isonitrile L4, 4-isocyanomethylbenzoic acid-L-arginine L5, 4-isocyanomethylbenzoic acid-L-arginyl-L-arginine L6, 4-isocyanomethylbenzoic acid-neurotensin(8-13) L7) to the so-called '4+1' complex. Copper(I) isocyanide complexes are used for preparing the '4+1' complexes. That facilitates storage stability and allows kit formulations, and, moreover, enables the formation of 188Re complexes in acidic solution. Only micromolar amounts of the monodentate ligand are needed, and that results in high specific activity labeling of interesting molecules. The lipophilicity of complexes can be controlled by introducing a carboxyl group into the tetradentate ligand and/or derivatization of the monodentate ligands. Furthermore, the carboxyl group enables the conjugation of biomolecules. As an example, the neurotensin derivative CN-NT(8-13) was prepared and labeled with 99mTc according to the '4+1' approach, and its behavior in vivo was studied.

Elevated DNA double strand breaks and apoptosis in the CNS of scid mutant mice

Genetic approaches have provided evidence that DNA end-joining problems serve an essential role in neuronal survival during development of mammalian embryos. In the present study, we tested whether the DNA repair enzyme, DNA dependent protein kinase, plays an important role in the survival of cerebral cortical neurons in mice. DNA-PK is comprised of a DNA-binding subunit called Ku and a catalytic subunit called DNA-PKcs. In mice with the scid mutation, DNA-PKcs is truncated near the kinase domain, which causes loss of kinase activity. We compared the spatial and temporal aspects of neuronal cell death in scid versus isogenic wild-type embryos and found a significant increase in dying cells in scid mice, as assessed by nuclear changes, DNA fragmentation and caspase-3 activity. Additional biochemical and immunocytochemical studies indicated that of several DNA repair enzymes investigated, only PARP was increased in scid mice, possibly in response to elevated DNA strand breaks.

Clinical relevance of the primary findings of the MTA: success rates based on severity of ADHD and ODD symptoms at the end of treatment

OBJECTIVES

To develop a categorical outcome measure related to clinical decisions and to perform secondary analyses to supplement the primary analyses of the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA).

METHOD

End-of-treatment status was summarized by averaging the parent and teacher ratings of attention-deficit/hyperactivity disorder and oppositional defiant disorder symptoms on the Swanson, Nolan, and Pelham, version IV (SNAP-IV) scale, and low symptom-severity ("Just a Little") on this continuous measure was set as a clinical cutoff to form a categorical outcome measure reflecting successful treatment. Three orthogonal comparisons of the treatment groups (combined treatment [Comb], medication management [MedMgt], behavioral treatment [Beh], and community comparison [CC]) evaluated hypotheses about the MTA medication algorithm ("Comb + MedMgt versus Beh + CC"), multimodality superiority ("Comb versus MedMgt"), and psychosocial substitution ("Beh versus CC").

RESULTS

The summary of SNAP-IV ratings across sources and domains increased the precision of measurement by 30%. The secondary analyses of group differences in success rates (Comb = 68%; MedMgt = 56%; Beh = 34%; CC = 25%) confirmed the large effect of the MTA medication algorithm and a smaller effect of multimodality superiority, which was now statistically significant (p < .05). The psychosocial substitution effect remained negligible and nonsignificant.

CONCLUSION

These secondary analyses confirm the primary findings and clarify clinical decisions about the choice between multimodal and unimodal treatment with medication.

Psychosocial treatment strategies in the MTA study: rationale, methods, and critical issues in design and implementation

The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first multisite, cooperative agreement treatment study of children, and the largest psychiatric/psychological treatment trial ever conducted by the National Institute of Mental Health. It examines the effectiveness of Medication vs. Psychosocial treatment vs. their combination for treatment of ADHD and compares these experimental arms to each other and to routine community care. In a parallel group design, 579 (male and female) ADHD children, aged 7-9 years, 11 months, were randomly assigned to one of the four experimental arms, and then received 14 months of prescribed treatment (or community care) with periodic reassessments. After delineating the theoretical and empirical rationales for Psychosocial treatment of ADHD, we describe the MTA's Psychosocial Treatment strategy applied to all children in two of the four experimental arms (Psychosocial treatment alone; Combined treatment). Psychosocial treatment consisted of three major components: a Parent Training component, a two-part School Intervention component, and a child treatment component anchored in an intensive Summer Treatment Program. Components were selected based on evidence of treatment efficacy and because they address comprehensive symptom targets, settings, comorbidities, and functional domains. We delineate key conceptual and logistical issues faced by clinical researchers in design and implementation of Psychosocial research with examples of how these issues were addressed in the MTA study.

National Institute of Mental Health Collaborative Multimodal Treatment Study of Children with ADHD (the MTA). Design challenges and choices

The Collaborative Multimodal Treatment Study of Children with Attention Deficit Hyperactivity Disorder (ADHD), the MTA, is the first child multisite cooperative agreement treatment study of children conducted by the National Institute of Mental Health, Rockville, Md. It examines the long-term effectiveness of medication vs behavioral treatment vs both for treatment of ADHD and compares state-of-the-art treatment with routine community care. In a parallel-groups design, 576 children (age, 7-9 years) with ADHD (96 at each site) are thoroughly assessed and randomized to 4 conditions: (1) medication alone, (2) psychosocial treatment alone, (3) the combination of both, (4) or community comparison. The first 3 groups are treated for 14 months and all are reassessed periodically for 24 months. Designers met the following challenges: framing clinically relevant primary questions; defining the target population; choice, intensity, and integration and combination of treatments for fair comparisons; combining scientific controls and standardization with clinical flexibility; and implementing a controlled clinical trial in a nonclinical setting (school) controlled by others. Innovative solutions included extensive decision algorithms and manualized adaptations of treatments to specific needs.

What we know about using research findings: implications for improving special education practice

This article discusses the alternative roles and responsibilities that researchers might assume to bridge the gap between special education research and classroom practice. Literature is reviewed that addresses why some research-based practices fail, and the factors likely to lead to sustained use of research-based practices. The roles of researchers as collaborators, facilitators and coaches, interpreters of the culture and dynamics of the school, and critics are described in an attempt to promote researchers as leaders in efforts to improve practices in the field of special education.

Quantification of reactive oxygen species generated by alveolar macrophages using lucigenin-enhanced chemiluminescence--methodical aspects

Alveolar macrophages lavaged from bovine lungs using Ca2(+)- and Mg2(+)-deprived saline containing EGTA for calcium chelation were cultivated in RPMI-1640 medium. The generation of reactive oxygen species (ROS) was assessed by determination of lucigenin-enhanced chemiluminescence (LUC-CL) using a LB 9505 C Biolumat. Monitoring of LUC-CL depends on various methodical parameters: besides medium constituents, the method of cell harvesting and the time-schedule of the protocol appear to be essential parameters that influence ROS-generation. In addition, the cell number (cell density) as well as the ratio of cell number to particle mass influence the amount of ROS-generation. Following exposure of cells to micronized quartz, we observed a dose-related increase in the generation of ROS.

[Ultrastructure of the liver and endocrine system in aging rats: effect of piracetam]

Lipogenic pigmentation is described in thyroid follicular, parathyroid, and pineal cells, as well as in adrenocortical macrophages. Piracetam activated pituitary prolactin cells and increased paracrystals in thyroid follicular cells; smooth endoplasmic reticulum was increased and glycogen content decreased in numerous hepatocytes randomly distributed over the lobule.

Detection and separation of mitoxantrone and its metabolites in plasma and urine by high-performance liquid chromatography

A high-performance liquid chromatographic method using ion-pair chromatography on reversed-phase C18 material was developed. After sample clean-up on XAD columns, mitoxantrone at concentrations below 1 ng/ml in serum and 0.2 ng/ml in urine were measurable with a coefficient of variation of less than 9.3% at a wavelength of 658 nm. Four metabolites were separated in urine. The two major metabolites co-chromatographed with the synthesized mono- and dicarboxylic acid derivatives of mitoxantrone. The method allowed the measurement of mitoxantrone and its metabolites in serum up to more than one week and in urine up to four weeks after administration of the drug.

Consistency and variation among instruments purporting to measure the Type A behavior pattern

A variety of instruments have been developed to measure the Type A behavior pattern (TABP), although concern has often been expressed that no single measure captures the complete range of attributes encompassed by the notion of the TABP. This paper presents data using a broad range of these instruments applied to a large sample of men at risk of coronary heart disease (CHD). The data indicate considerable variation in strengths of association between measures of the TABP, and recommend three conclusions. Firstly, the TABP is a complex phenomenon and not a unitary one. Secondly, self-report measures of the TABP assess only parts of the overall behavior pattern, and this varies from one instrument to another. Thirdly, the Structured Interview (SI), insofar as it relates modestly and consistently to other instruments, remains the first measure of choice for the TABP. The need to develop new measures, however, seems strongly indicated.

The pharmacokinetics and metabolism of mitoxantrone in man

An HPLC method using paired-ion chromatography on RP C-18 material was developed. After sample clean up on XAD columns, mitoxantrone (Novantrone; dihydroxyanthracenedione) in concentrations below 1 ng/ml in serum and 0.2 ng/ml in urine were measurable with a coefficient of variation less than 9.3% at a wavelength of 658 nm. Four metabolites were separated in urine. The major metabolite cochromatographed with the synthesized dicarboxylic acid of mitoxantrone. Within 48 hours 4.4% of the administered dose was excreted in urine as mitoxantrone, 0.5% as metabolite 1 and 0.3% as metabolite 2. The pharmacokinetic parameters are adequately described by a three-compartment model with a terminal half-life of 214.8 hours, and a volume of distribution (ss) of 3792 litres. The total body clearance was 358 ml/min and the renal clearance was 26.2 ml/min.

[Chromatographic investigation of the substrate properties of 8-bromo-ATP in the nucleoside diphosphate kinase reaction (author's transl)]

8-bromo-ATP is a substrate of nucleoside diphosphate kinase. Its reactivity is similar to that of ATP, and the reaction appears to be unaffected by the different conformations of these two substrates. The nucleoside diphosphate kinase reaction with 8-bromo-ATP cannot be monitored photometrically (optical test) using an NADH/NAD+-dependent enzyme system, because the product 8-bromo-ADP is not a substrate for pyruvate kinase. Measurements of the nucleoside diphosphate kinase reaction with 8-bromo-ATP therefore, were carried out by chromatographic analysis of the nucleoside-triphosphate/diphosphate ratio.

Return to work after a myocardial infarction: evaluation of planned rehabilitation and of a predictive rating scale

This paper reports the first recorded controlled trial of cardiac rehabilitation after myocardial infarction in men of working age, viewed as a team intervention effort to facilitate the patient's return to normal work. Our results show that this intervention is helpful in returning to jobs which they can handle successfully men who would otherwise be at risk of remaining unemployed. A previously developed rating scale for predicting return to work after myocardial infarction was used and reevaluated. Employment and occupational level at admission to hospital, work history, availability of the previous job, educational level, family and social stability, age at which regular cigarette smoking commenced, and level of anxiety and depression on a personality scale proved highly predictive.