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Nagy A Mekhail,1 Shrif J Costandi,1 Sherif Armanyous,1 Ricardo Vallejo,2 Lawrence R Poree,3 Lora L Brown,4 Stanley Golovac,5 Timothy R Deer6 1Evidence-Based Pain Management Research, Cleveland Clinic, Cleveland, OH, USA; 2Millennium Pain Center, Bloomington, IL, USA; 3Pain Management Center, UCSF Health, San Francisco, CA, USA; 4TruWell Health, St. Petersburg, FL, USA; 5Florida Pain Institute, Merritt Island, FL, USA; 6Center for Pain Relief, Charleston, WV, USACorrespondence: Nagy A Mekhail Email mekhain@ccf.orgBackground and Purpose: Minimally invasive lumbar decompression (mild®) is an effective long-term therapy for patients with symptomatic lumbar spinal stenosis (LSS) resulting primarily from hypertrophic ligamentum flavum (HLF). Most subjects in clinical studies of the mild procedure have been older adults (age≥ 65). While the incidence of LSS increases with age, a substantial number of adults (age< 65) also suffer from neurogenic claudication secondary to HLF. In this report, outcomes of mild were compared between adults and older adults.Patients and Methods: All prospective studies of the mild procedure with a 1-year follow-up completed since the beginning of 2012 that allowed the inclusion of adult patients of all ages were reviewed. Outcomes of visual analog scale (VAS), Oswestry Disability Index (ODI), Pain Disability Index (PDI), Roland Morris Low Back Pain and Disability Questionnaire (RMQ), standing time and walking distance were compared for adults and older adults.Results: Four studies met the inclusion criteria, resulting in an analysis of 49 adults and 160 older adults. Patients in both age groups experienced significant mean improvements in all but one outcome measure at 6- and 12-month follow-up. Differences between the two age groups in all scores at 6 and 12 months were not statistically significant.Conclusion: Analysis of the four studies indicated that symptom improvements for adults and older adults were significant from baseline, and no statistically significant difference was observed between the two age groups. These results illustrate that mild can be an effective treatment for LSS due primarily to HLF, regardless of the adult patient age.Keywords: mild, neurogenic claudication, ligamentum flavum, LSS

Michael J Mello,1,2 Julie R Bromberg,1,2 Steven Rougas,1 Thomas H Chun,1 Linda L Brown,1 Christina S Parnagian,2 Janette Baird1,2 1Department of Emergency Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, USA; 2Injury Prevention Center, Rhode Island Hospital, Providence, RI, USA Introduction: Emergency medicine (EM) providers are in an opportunistic position to identify and intervene with patients at risk for alcohol misuse and related problems. However, alcohol screening, brief intervention, and referral to treatment (SBIRT) services are underutilized within the emergency department. Providing SBIRT training to trainees may help to increase ­utilization of these valuable services in the future. An SBIRT training program for EM faculty and ­trainees was developed and delivered to increase trainees’ skills and practice of SBIRT services. Methods: The SBIRT training program included unique tracks for medical students, physician assistant (PA) students, EM residents and faculty preceptors. Faculty and trainees completed ­performance measures at the end of each training session, 30 days post-training and 12 months later. Results: SBIRT training was provided to 238 trainees and 65 faculty members. At all follow-up time points, satisfaction of training and usefulness varied by trainee type with PA students rating constructs higher than both medical students and EM residents. At the 12-month follow-up survey, there was no significant difference in ratings of sharing the information (χ2 (2)=0.38, P=0.33) between these trainees, with the majority of all trainees (96% of PA students, 83% of residents and 68% of medical students) responding that they had applied what they learned in the training to their work. Conclusion: An SBIRT training curriculum for EM trainees was delivered successfully and utilized 12 months after implementation. Keywords: SBIRT, substance misuse, emergency medicine trainees