• Changes in nursing education in Hong Kong - Progressive or regressive?

      Chair, Sek Ying; Chan, Carmen Wing Han; Yu, Doris Sau Fung; Taylor-Piliae, Ruth E.; Univ Arizona, Coll Nursing (CHURCHILL LIVINGSTONE, 2018-05)
    • Clinical learning experiences of nursing students using an innovative clinical partnership model: A non-randomized controlled trial

      Chan, Aileen W.K.; Tang, Fiona W.K.; Choi, Kai Chow; Liu, Ting; Taylor-Piliae, Ruth E.; Univ Arizona, Coll Nursing (CHURCHILL LIVINGSTONE, 2018-09)
      Background: Clinical practicum is a major learning component for pre-registration nursing students. Various clinical practicum models have been used to facilitate students' clinical learning experiences, employing both university-based and hospital-based clinical teachers. Considering the strengths and limitations of these clinical practicum models, along with nursing workforce shortages, we developed and tested an innovative clinical partnership model (CPM) in Hong Kong. Objective: To evaluate an innovative CPM among nursing students actual and preferred clinical learning environment, compared with a conventional facilitation model (CFM). Design: A non-randomized controlled trial examining students' clinical experiences, comparing the CPM (supervised by hospital clinical teacher) with the CFM (supervised by university clinical teacher). Setting One university in Hong Kong. Participants: Pre-registration nursing students (N = 331), including bachelor of nursing (n = 246 year three-BN) and masters-entry nursing (n = 85 year one-MNSP). Methods: Students were assigned to either the CPM (n = 48 BN plus n = 85 MNSP students) or the CFM (n = 198 BN students) for their clinical practice experiences in an acute medical-surgical ward. Clinical teachers supervised between 6 and 8 students at a time, during these clinical practicums (duration = 4-6 weeks). At the end of the clinical practicum, students were invited to complete the Clinical Learning Environment Inventory (CLEI). Analysis of covariance was used to compare groups; adjusted for age, gender and prior work experience. Results: A total of 259 students (mean age = 22 years, 76% female, 81% prior work experience) completed the CLEI (78% response rate). Students had higher scores on preferred versus actual experiences, in all domains of the CLEI. CPM student experiences indicated a higher preferred task orientation (p = 0.004), while CFM student experiences indicated a higher actual (p < 0.001) and preferred individualization (p = 0.005). No significant differences were noted in the other domains. Conclusions: The CPM draws on the strengths of existing clinical learning models and provides complementary methods to facilitate clinical learning for pre-registration nursing students. Additional studies examining this CPM with longer duration of clinical practicum are recommended.
    • Development and Characterization of An Injury-free Model of Functional Pain in Rats by Exposure to Red Light

      Khanna, Rajesh; Patwardhan, Amol; Yang, Xiaofang; Li, Wennan; Cai, Song; Ji, Yingshi; Chew, Lindsey A; Dorame, Angie; Bellampalli, Shreya S; Schmoll, Ryan W; et al. (CHURCHILL LIVINGSTONE, 2019-11-01)
      We report the development and characterization of a novel, injury-free rat model in which nociceptive sensitization after red light is observed in multiple body areas reminiscent of widespread pain in functional pain syndromes. Rats were exposed to red light-emitting diodes (RLED) (LEDs, 660 nm) at an intensity of 50 Lux for 8 hours daily for 5 days resulting in time- and dose-dependent thermal hyperalgesia and mechanical allodynia in both male and female rats. Females showed an earlier onset of mechanical allodynia than males. The pronociceptive effects of RLED were mediated through the visual system. RLED-induced thermal hyperalgesia and mechanical allodynia were reversed with medications commonly used for widespread pain, including gabapentin, tricyclic antidepressants, serotonin/norepinephrine reuptake inhibitors, and nonsteroidal anti-inflammatory drugs. Acetaminophen failed to reverse the RLED induced hypersensitivity. The hyperalgesic effects of RLED were blocked when bicuculline, a gamma-aminobutyric acid-A receptor antagonist, was administered into the rostra! ventromedial medulla, suggesting a role for increased descending facilitation in the pain pathway. Key experiments were subjected to a replication study with randomization, investigator blinding, inclusion of all data, and high levels of statistical rigor. RLED-induced thermal hyperalgesia and mechanical allodynia without injury offers a novel injury-free rodent model useful for the study of functional pain syndromes with widespread pain. RLED exposure also emphasizes the different biological effects of different colors of light exposure. Perspective: This study demonstrates the effect of light exposure on nociceptive thresholds. These biological effects of red LED add evidence to the emerging understanding of the biological effects of light of different colors in animals and humans. Understanding the underlying biology of red light-induced widespread pain may offer insights into functional pain states. (C) 2019 by the American Pain Society
    • A Kappa Opioid Receptor Agonist Blocks Bone Cancer Pain Without Altering Bone Loss, Tumor Size, or Cancer Cell Proliferation in a Mouse Model of Cancer-Induced Bone Pain

      Edwards, Katie A.; Havelin, Joshua J.; McIntosh, Mary I.; Ciccone, Haley A.; Pangilinan, Kathlene; Imbert, Ian; Largent-Milnes, Tally M.; King, Tamara; Vanderah, Todd W.; Streicher, John M.; et al. (CHURCHILL LIVINGSTONE, 2018-06)
      Breast cancer metastasizes to bone, diminishing quality of life of patients because of pain, fracture, and limited mobility. Cancer-induced bone pain (CIBP) is characterized as moderate to severe ongoing pain, primarily managed by mu opioid agonists such as fentanyl. However, opioids are limited by escalating doses and serious side effects. One alternative may be kappa opioid receptor (KOR) agonists. There are few studies examining KOR efficacy on CIBP, whereas KOR agonists are efficacious in peripheral and inflammatory pain. We thus examined the effects of the KOR agonist U50,488 given twice daily across 7 days to block CIBP, tumor-induced bone loss, and tumor burden. U50,488 dose-dependently blocked tumor-induced spontaneous flinching and impaired limb use, without changing tactile hypersensitivity, and was fully reversed by the KOR antagonist nor-binaltorphimine. U50,488 treatment was higher in efficacy and duration of action at later time points. U50,488 blocked this pain without altering tumor-induced bone loss or tumor growth. Follow-up studies in human cancer cell lines confirmed that KOR agonists do not affect cancer cell proliferation. These studies suggest that KOR agonists could be a new target for cancer pain management that does not induce cancer cell proliferation or alter bone loss. Perspective: This study demonstrates the efficacy of KOR agonists in the treatment of bone cancer-induced pain in mice, without changing tumor size or proliferation in cancer cell lines. This suggests that KOR agonists could be used to manage cancer pain without the drawbacks of mu opioid ago-nists and without worsening disease progression. (C) 2018 by the American Pain Society
    • POWERPIINC (PreOperative Window of Endocrine TheRapy Provides Information to Increase Compliance) trial: Changes in tumor proliferation index and quality of life with 7 days of preoperative tamoxifen

      Cohen, Adam L.; Factor, Rachel E.; Mooney, Kathi; Salama, Mohamed E.; Wade, Mark; Serpico, Victoria; Ostrander, Emily; Nelson, Edward; Porretta, Jane; Matsen, Cindy; et al. (CHURCHILL LIVINGSTONE, 2017-02)
      Objectives: A decrease in Ki67 during neoadjuvant therapy predicts response to tamoxifen. Previous trials have shown a decreased Ki67 in breast tumors with as little as two or more weeks of preoperative tamoxifen. Shortening the preoperative treatment time in window of opportunity clinical trials makes these trials more attractive to women. POWERPIINC examined the effect of 7 days of preoperative tamoxifen on breast tumor proliferation and patient symptoms. Methods: Women with untreated stage I/II, ER-positive, invasive breast cancer with no contraindications to tamoxifen were enrolled. Women received 20 mg of tamoxifen for 7 days up to the day of surgery. Proliferation was assessed by Ki67 immunohistochemistry before and after 7 days of tamoxifen. Symptoms and QOL were assessed by the FACT-ES and MENQOL. Adherence was measured by pill counts. Results: 52 women were enrolled, and 44 were evaluable for Ki67. The median age was 58.5 years, and the median tumor diameter was 1.2 cm. Most women (73%) were post-menopausal. Most tumors were PR positive (88%) and HER2-negative (92%). The Ki67 decreased by a geometric mean of 40% (95% CI 29%-63%), and 73% (95% CI 57%-85%) of women had tumors with decreased proliferation (p = 0.0001 by paired t-test). Adherence to taking tamoxifen during the preoperative period was 100%. Women reported minimal bother from psychosocial or physical symptoms at baseline or on the day of surgery. Conclusion: Seven days of tamoxifen showed a similar relative decrease in Ki67 as that reported for longer courses, was acceptable to women, and could be considered for window of opportunity studies.
    • Tai Chi in Chinese adults with metabolic syndrome: A pilot randomized controlled trial

      Leung, Leona Yuen-Ling; Chan, Aileen Wai-Kiu; Sit, Janet Wing-Hung; Liu, Ting; Taylor-Piliae, Ruth E; Univ Arizona, Coll Nursing (CHURCHILL LIVINGSTONE, 2019-10-01)
      Objective: To determine the feasibility, acceptability and effects of a 12-week Tai Chi exercise program on cardiometabolic risk factors and quality of life in community-dwelling Chinese adults with metabolic syndrome. Design: A single blind, pilot randomized controlled trial. Setting/location: A general outpatient clinic of a community-based hospital in Hong Kong. Subjects: Ethnic Chinese, 18 years and older, who had at least three of the five criteria of metabolic syndrome defined by the National Cholesterol Education- Adult Treatment Panel III. Intervention: The Tai Chi group attended a 1-h Tai Chi class, twice a week for 12 weeks, plus 30-minutes home practice three-times per week. The control group maintained their usual daily activities. Outcome measures: Primary outcomes were feasibility and acceptability of the Tai Chi intervention. Secondary outcome measures were cardiometabolic risk factors, quality of life, stress and Tai Chi exercise self-efficacy. Results: Study retention rate was 65% (n = 35). Overall satisfaction of completers with the Tai Chi intervention was 4.5 +/- 0.63 (possible range = 1-5). When compared to controls, the Tai Chi group had significantly lower systolic blood pressure (p = 0.037) at 12-weeks. Significant within group changes for the Tai Chi group included lower diastolic blood pressure (p = 0.015), higher fasting blood glucose (p = 0.009), higher waist circumference (females only, p = 0.007), and better perceived mental health (p = 0.046); while controls had significantly higher fasting blood glucose (p = 0.031), and higher waist circumference (females only, p = 0.003). Conclusion: The study intervention was feasible and acceptable for Chinese adults with metabolic syndrome. While not powered to find statistically significant differences, positive and negative changes were observed in some cardiometabolic risk factors and quality of life. Further investigation with a larger sample size and longer study period is needed to explore potential environmental factors that may have influenced the study results.