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Primary Care Patient and Clinician Perspectives on Safer Use Strategies for Opioids and/or Stimulants: A Mixed-Method Study
No full textIntroduction: Safer use strategies (SUS) are behaviors before, during, and after drug use to moderate use and/or mitigate unwanted consequences. As treatment of substance use disorders becomes more common in primary care, offering SUS in primary care merits exploration.
Method: We explored acceptability and use of SUS in primary care using a convergent parallel mixed-method design consisting of patient and clinician semi-structured interviews and surveys. Participants were recruited from primary care clinics involved in a multi-state practice research network. Patients with lifetime stimulant and/or opioid and any SUS use were eligible. All clinicians were eligible. Qualitative data were analyzed using a rapid assessment procedure. Quantitative data were analyzed descriptively.
Results: Participants included patients (n = 10) and clinicians (n = 12) from multiple disciplines. More than half of patients indicated that every SUS surveyed should be offered in primary care. Patients reported using multiple SUS to stay safer, reduce consequences, and limit use. Clinicians reported that offering SUS to primary care patients is acceptable and supported SUS use by sharing informational resources (e.g., safer injection practices) and tangible resources (e.g., naloxone, medication for opioid use disorder [MOUD]). Some strategies recommended by patients were not currently being systematically offered (e.g., fentanyl test strips). Several clinicians expressed willingness to discuss SUS with patients but wanted more training and resources to facilitate SUS discussions to support patient goals.
Conclusion: Offering SUS to primary care patients is acceptable to patients and clinicians. Clinicians supported some SUS use, though more SUS and harm reduction training and resources were desired. Providing SUS to patients who use stimulants and/or opioids could enhance patient-centered primary care, especially in clinics offering MOUD. More research is needed to optimize SUS support in primary care settings
Nebulized tranexamic acid for hemoptysis in critically and non-critically ill patients: A retrospective analysis
No full textIntroduction: Hemoptysis is a commonly encountered diagnosis caused by blood originating from the respiratory tract. Current pharmacological guideline recommendations for treatment do not exist. Tranexamic acid is a synthetic anti-fibrinolytic used in the management of various bleeding complications. Tranexamic acid has gained popularity for the treatment of hemoptysis with limited side effect knowledge. Our aim is to describe the clinical characteristics of patients receiving nebulized tranexamic acid for hemoptysis and compare clinical outcomes to those of patients receiving supportive care.
Materials and methods: This is a retrospective descriptive analysis performed in medical and ICU units at three tertiary hospitals. All patients were hospitalized with hemoptysis between January 1st, 2018 - December 31st, 2021. Demographic information, severity variables, and clinical outcomes were collected from medical records. For statistical analysis, we used t-test for continuous variables, chi-square or fishers' exact test for categorical variables, and propensity analysis to adjust for disease severity and underlying medical conditions.
Results: 488 patients were identified; 96 received tranexamic acid. There were slightly more smokers in the no TXA group (p = 0.04) but otherwise the two groups were similar in terms of demographic characteristics. The average length of hospital and ICU stay, need for mechanical ventilation or bronchoscopy, and mortality were significantly higher in the tranexamic acid group (p<0.01). The propensity analysis showed higher odds of death with nebulized tranexamic acid use, OR 2.51 (1.56-4.02).
Conclusions: There appears to be an indication bias for tranexamic acid based on disease severity without an obvious improvement in clinical outcomes. Our analysis suggests that nebulized tranexamic acid for hemoptysis may be potentially harmful, and further larger prospective research is warranted
Next-generation Onyx DES for elective intracranial atherosclerosis: A meta-analysis
No full textBackground:
Intracranial atherosclerotic disease (ICAD) is a growing cause of ischemic stroke globally, with a disproportionately high burden in Asian, Black, and Hispanic populations. Despite advances in medical therapy, ICAD remains associated with high rates of recurrent stroke, prompting interest in durable endovascular solutions. This study aims to systematically evaluate the current evidence on the safety and efficacy of elective intracranial stenting in adult patients with symptomatic ICAD using Onyx drug-eluting balloon-mounted stents (Onyx DES).
Methods:
A meta-analysis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five studies were initially identified, with one excluded due to overlapping cohorts, resulting in four final studies included for analysis. Meta-analysis was conducted utilizing random-effects models for pooled event rates (95% CIs) and weighted means.
Results:
Of 153 articles initially identified, four high-quality studies encompassing 314 patients met inclusion criteria. The mean (±SD) age was 64.6 (±12.4) years, with a predominance of males (70.7%) and common vascular comorbidities such as hypertension (85.7%) and diabetes (60.0%). Lesions were nearly equally distributed between the anterior and posterior circulations. Periprocedural complications were infrequent (1.0%), including one hemorrhagic stroke and one fatal aneurysm rupture. The 30-day complication rate remained low at 5%, involving strokes, deaths, and TIAs. However, follow-up at six months and beyond revealed rising rates of strokes, TIAs, and in-stent restenosis, reaching 9% at six months and persisting through one year.
Conclusion:
This descriptive meta-analysis suggests that Onyx DES may offer promising results in the treatment of symptomatic ICAD, with lower early complication rates reported. However, larger prospective studies are needed to confirm these observations and evaluate long-term efficacy and safety
A Model to guide force-based manipulation research and practice
Get PDFIntroduction: Manual therapies are forms of force-based manipulations (FBM) and involve the application of mechanical force to the outside of the body with therapeutic intent. The United States National Institutes of Health (NIH) U24 FBM Taxonomy and Terminology Committee (FBM-TTC) was formed to better understand why responses to FBM differ between individuals. One objective for this multi-disciplinary working group was to develop a framework outlining factors that should be considered, measured, and reported when developing and performing studies on FBM.
Methods: The workgroup collaborated to develop a model outlining elements to consider during FBM research and practice. Three different models were proposed by members of the group who voted on a preferred model using a rank-ordered process and refined the selected model based on consensus and published literature.
Results: A 3-dimensional (3D) matrix model was chosen that includes three elements: contextual factors influencing FBM outcomes, structure and function levels focusing on biological and physiological aspects, and force parameters. Each element expands into different components and sub-levels. The model is designed to be interactive, integrative, and dynamic.
Discussion: The model provides a framework to guide protocol development for FBM mechanistic research and clinical outcome studies. For example, researchers can design more robust studies systematically varying force parameters by considering other matrix components, while clinicians may develop more personalized treatment plans. The model supports the complexity of mechanistic responses to FBM by integrating the multitude of intrinsic and extrinsic factors that impact responses. Detailed discussion of each element is beyond the scope of this paper; however, content experts are encouraged to expand on this dynamic model.
Conclusions: An innovative 3D model was developed to guide FBM research. The framework integrates foundational elements and accommodates new insights, making it a valuable tool to advance FBM science and practice
PROTAC-Based Antivirals for Respiratory Viruses: A Novel Approach for Targeted Therapy and Vaccine Development
Get PDFThe global burden of respiratory viral infections is notable, which is attributed to their higher transmissibility compared to other viral diseases. Respiratory viruses are seen to have evolved resistance to available treatment options. Although vaccines and antiviral drugs control some respiratory viruses, this control is limited due to unexpected events, such as mutations and the development of antiviral resistance. The technology of proteolysis-targeting chimeras (PROTACs) has been emerging as a novel technology in viral therapeutics. These are small molecules that can selectively degrade target proteins via the ubiquitin-proteasome pathway. PROTACs as a therapy were initially developed against cancer, but they have recently shown promising results in their antiviral mechanisms by targeting viral and/or host proteins involved in the pathogenesis of viral infections. In this review, we elaborate on the antiviral potential of PROTACs as therapeutic agents and their potential as vaccine components against important respiratory viral pathogens, including influenza viruses, coronaviruses (SARS-CoV-2), and respiratory syncytial virus. Advanced applications of PROTAC antiviral strategies, such as hemagglutinin and neuraminidase degraders for influenza and spike proteins of SARS-CoV-2, are detailed in this review. Additionally, the role of PROTACs in targeting cellular mechanisms within the host, thereby preventing viral pathogenesis and eliciting an antiviral effect, is discussed. The potential of PROTACs as vaccines, utilizing proteasome-based virus attenuation to achieve a robust protective immune response, while ensuring safety and enhancing efficient production, is also presented. With the promises exhibited by PROTACs, this technology faces significant challenges, including the emergence of novel viral strains, tissue-specific expression of E3 ligases, and pharmacokinetic constraints. With advanced computational design in molecular platforms, PROTAC-based antiviral development offers an alternative, transformative path in tackling respiratory viruses
A digital workflow for full-arch implant fixed prosthesis: Clinical application of a 3D-printed polychromatic flangeless trial denture, anatomic bone reduction guide, and intraoral scanning for definitive prosthesis fabrication
Get PDFThis clinical report presents a comprehensive digital workflow for rehabilitating a patient with maxillary terminal dentition using a full-arch, implant-supported fixed dental prosthesis (FP-1). It highlights the integration of a 3D-printed polychromatic flangeless trial denture and a customized anatomic bone reduction template, enabling prosthetically driven implant planning and optimal bone architecture modification. The workflow incorporated fully guided implant surgery using sequential templates and immediate loading with a closed-mouth pickup system. Intraoral scanning protocols were employed for definitive prosthesis fabrication. This approach addressed high esthetic risks while achieving surgical precision, efficient treatment execution, and favorable clinical outcomes
Bridging the Gaps: Family Perspectives on Accessing Services for Individuals with Autism Spectrum Disorder
Get PDFThis project explored the challenges families face in navigating services for individuals with Autism Spectrum Disorder (ASD) by analyzing qualitative data from structured interviews with caregivers and professionals. As a student volunteer research assistant at HANDS in Autism, the intern supported data coding and curriculum development for the ECHO project—an initiative designed to foster collaborative learning through educational modules, micro-credentials, and digital badges. Despite limitations in sample size, preliminary findings identified recurring themes in preferred support sources and unmet service needs. The experience enhanced the intern’s understanding of research design, data management, and cross-functional teamwork in the context of developmental and behavioral health. This foundational work guides future studies aimed at developing targeted tools and resources to support better families navigating complex autism service systems
Serum Periostin is Able to Stratify Type 2-Dominant Ulcerative Colitis
Get PDFBackground: Ulcerative colitis (UC) is a heterogeneous disease composed of different endotypes. It is important to develop useful biomarkers for endotyping UC; however, available biomarkers are insufficient. We have already established that periostin is a surrogate biomarker of type 2 inflammation. In this study, we examined the usefulness of periostin as a biomarker of UC and the role of periostin in its pathogenesis.
Methods: We examined periostin expression in the colons of UC patients. We next investigated serum periostin in UC patients and its correlation with eosinophilic infiltration in their colons. We then examined whether serum periostin could predict the efficacy of oral prednisolone. Finally, we investigated the role of periostin in UC pathogenesis by creating its genetic deficiency using dextran sulfate sodium (DSS)-treated mice.
Results: Periostin expression and serum periostin were significantly high in UC patients compared to healthy controls; however, both were diverse, showing heterogeneity of the underlying mechanism of UC. Both serum periostin and tissue periostin expression, but not blood eosinophils, were significantly associated with eosinophil infiltration. Type 2-dominant UC patients as defined by serum periostin showed significantly higher clinical remission rates for the treatment with oral prednisolone. Genetic deficiency in periostin improved colonic inflammation in a DSS-treated mouse model.
Conclusions: Periostin can be a useful biomarker to stratify type 2-dominant UC patients, thereby predicting the efficacy of oral prednisolone. Moreover, periostin plays an important role in the setting of type 2-dominant UC