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Pain hygiene (PH) is a new concept that has not been well-defined. A qualitative content analysis was conducted to understand this newly developed concept. Based on the responses from 78 students, the perceptions of the meaning of the term "pain hygiene" and differences between the term "pain hygiene" and "sleep hygiene" through their participation in open-ended surveys was described. Using content analysis, four themes emerged to present students' meaning of the term "pain hygiene": prevention of worsening of pain; cleanliness or hygiene practices to manage pain; self-care to manage pain; and physical and psychological management of pain. Two themes emerged illustrating differences between PH and sleep hygiene: practices that contribute to a better quality of life and condition, and better sleep with no pain. As a newly developing concept, PH can be used to make changes in pain assessment, prevention, and pain management strategies for all people with pain, which can enrich their quality of life and bring change in pain care outcomes.

The gut microbiota among preterm infants is shaped by sex and feeding types. However, sex-specific weekly patterns of gut microbiome profiles among preterm infants during their neonatal intensive care unit (NICU) hospitalization remain unclear. This study aimed to investigate the effect of sex on the weekly development of preterm neonatal gut microbiota in the first 4 weeks of NICU hospitalization.This secondary data analysis included 28 preterm neonates with 261 stool samples collected from January 2014 to February 2015 in the Northeastern United States. The 16S rRNA V4 gene regions of the stool samples were sequenced and aligned against the SILVA 132 database by using Mothur 1.42.3. The sex-specific weekly diversity indexes and relative abundance of bacterial taxonomic composition were generated by Mothur and analyzed by R packages. Sex-specific weekly compositional patterns of the gut microbiome and predicted metabolic functions of gut microbiome profiles were compared, respectively.In each week of the NICU hospitalization, preterm females and males had significantly distinguished β-diversity indices and compositions of gut microbiota. Both females and males had significantly enrichedSex shaped the weekly patterns of preterm neonatal gut microbiome profiles during the first 4 weeks of the NICU hospitalization. Further clinical interventions should consider the distinct gut microbiota compositions and predicted functional profiles between female and male preterm neonates.

Background: Cancer pain prevalence remains high, and variance in self-efficacy for managing pain may explain why some patients experience greater pain severity. Aim: This study explored perceptions of self-efficacy in relation to cancer pain severity and treatment related characteristics. Method: A descriptive cross-sectional survey was administered to 50 cancer outpatients. Data analysis involved descriptive and correlational statistical analyses. Results: Self-efficacy to manage pain was significantly associated with time since diagnosis and ability to deal with frustration, and inversely associated with pain severity level. A large proportion of patients reported low satisfaction self-managing their pain. Most patients reported independently self-managing their cancer pain; however, satisfaction with pain management was low for a large proportion of patients. Time since cancer diagnosis and ability to deal with frustration due to cancer pain were positively associated with cancer pain self-efficacy, whereas pain self-efficacy had a significant inverse correlation with cancer pain severity. Conclusions: Enhancing self-efficacy to self-manage under-treated cancer pain is important with implications for improving pain outcomes and quality of life. Further investigation on unmet needs and preferences for cancer pain self-management support is warranted.

Objective To synthesize the impact of health literacy on pain self-management contexts, processes, and outcomes. Methods This systematic review employed a narrative synthesis. We used databases, including PubMed and PsycINFO, and handsearching of the reference lists to identify articles published before December 2020. Pain self-management variables were chosen based on the Individual and Family Self-Management Theory. Quality was assessed using the National Institute of Health quality assessment tool for observational and cross-sectional studies. Results Twenty studies that included 6173 participants were used. Most studies measured functional domains of the health literacy concept. Twelve studies reported small to large associations between health literacy and pain knowledge, medication regimen adherence, or pain. Thirteen studies considered health literacy clinical risks in tailoring education, while seven viewed it as personal assets developed via education. Conclusions Limited information on the contribution of health literacy to pain self-management context factors and processes exists. Current evidence was limited by a lack of temporality, theoretical basis, and a priori sample estimation. Practice Implications Using brief functional literacy scales in the clinical environment can be more practical. Identifying patients’ literacy levels helps clinicians personalize education, which then promotes patients’ knowledge of pain, medication regimen adherence, and pain control.

Aims This integrative review aims to describe the current evidence concerning the relationship between a broad range of psychological factors (depression, depressive symptoms, anxiety, stress, and type-D personality) and self-care in patients with heart failure. Methods and results Six electronic databases were searched and keywords were used to identify potential eligible studies published within the last 10 years. To be eligible, individuals with heart failure aged 18 years or older and who were included in any type of observational study that examined the association between psychological factors and self-care were considered. Twenty articles were included, and 16 of them reported that depression/depressive symptoms were associated with poorer self-care, after controlling for age, sex, education level, cardiac history, or comorbidities. Five studies found that self-care confidence/self-efficacy mediates the relationship between depression/depressive symptoms and self-care. The association between depression/depressive symptoms and self-care varied in assessment methods and statistical approaches. Seven studies showed an inverse association between anxiety and self-care. Four studies found a stronger association between self-care and depression compared with the relationship between self-care and other psychological factors. Stress and type-D personality were both associated with self-care in four studies. Conclusion Depression/depressive symptoms and anxiety were found to be inversely associated with self-care in patients with heart failure. Depression exhibited a stronger impact on self-care than other psychological factors. Limited studies assessed stress and type-D personality; the results should be considered with caution. Further studies are warranted on different psychological factors and their underlying mechanisms in individuals with heart failure.

Poor ventilation in classrooms can increase the risk of infectious disease transmission, such as COVID-19, because it allows respiratory aerosol particles that may contain viruses to accumulate. Air purifiers can effectively reduce transmission rates in community spaces, including classrooms, because they increase the air change rate in the room and reduce particle concentrations. In this study, we investigate the effectiveness of Corsi-Rosenthal Boxes (C-R Box) in reducing particle concentrations in active, occupied classroom settings. A C-R Box is a do-it-yourself, cost-effective alternative to commercial air purifiers built from a box fan, four readily available filters, cardboard, and duct tape. We collected measurements of coarse (particles with diameters > 2.5μm) and fine (particles with diameters 0.5μm - 2.5 μm) particle number concentrations and PM2.5 (particles with diameter < 2.5μm) mass concentrations. Specifically, we compared measurements in occupied classrooms before and after we turned the C-R Boxes on. In our testing, C-R Boxes reduced fine particle number concentrations by 56-91% and PM2.5 mass concentrations by over 70% after we turn on the C-R Boxes. We also simulated velocity profiles in the classrooms with running C-R Boxes showing mixing throughout the classroom ensuring that all air can encounter the filter.

Purpose: This study evaluates feasibility and acceptability of a digital health coaching intervention for individuals who are within one year of completing primary cancer treatment of any modality, as well as its effect on health self-efficacy. Secondary endpoints evaluate trends in patient-reported outcomes (PRO), including financial toxicity, for which the Economic StraiN and Resilience in Cancer (ENRICh) tool is being validated. Additional endpoints explore associations between patient-reported symptoms, wearable, biomarker, and clinical data. This study seeks to fill a critical knowledge gap as to how health behavioral changes prompted by health coaching may modulate symptoms and physical/psychosocial well-being through the longitudinal tracking of patient reported, clinical, and bioinformatic data. Methods: This randomized, wait-list control trial is being conducted at geographically diverse National Cancer Institute-designated cancer centers. Per site enrollment is Summary Data: To date, 47 individuals have been enrolled at 3 study sites, Nebraska Medicine (36), Dana-Farber Cancer Institute (10), and The Ohio State University James Cancer Center (1). This includes 1 male and 46 female participants, with an average age of 63.62 (R 33-75), of whom 44 identify as White and 3 as Black or African American, and 47 identify as non-Hispanic. Among participants, 35 have a history of breast, 10 ovarian, 1 endometrial, and 1 gastric cancer. Two additional sites are planned to begin enrollment in 2023, one of which will primarily enroll participants identifying as Black and/or Hispanic. Conclusions: Enrollment is anticipated to complete by December 2023 with site-specific and composite results reported by December 2024. Novel outcomes related to the use of digital health coaching in the context of survivorship, as well as robust data assessing clinical, microbiome, dietary, patient-reported, and wearable data is expected to enhance existing evidence regarding outcomes in patients on both active surveillance and maintenance therapies for diverse tumor types. Citation Format: Kelly J. Brassil, Alexi Wright, Elizabeth Arthur, Austin Barr, Laura Flora, Barbara Halpenny, Mariah K. Jackson, Jessica Krok-Schoen, Robin Lally, Jennifer Loftis, Debra Lynch Kelly, Leorey Saligan, Rachael Schmidt, Grace L. Smith, Angela Starkweather, Anna Tavormina, Gisele Tlusty, Michael Vazquez, Marilyn Hammer. Trial in progress: Comprehensive outcomes for after cancer health (COACH), a randomized trial assessing health outcomes following primary cancer therapy [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 742.

BACKGROUND African American (AA) older adults with knee osteoarthritis experience more severe chronic pain and advanced physical disability. One of the most prominent stimuli that provokes knee pain is movement. Research suggests that, compared to Whites, AAs report significantly higher movement-evoked pain (MEP) in the knee. However, little is known about the biopsychosocial-behavioral mechanisms underlying MEP. OBJECTIVES The aim of the study was to present a study protocol to (a) characterize the biopsychosocial-behavioral mechanisms that predict MEP in AAs with knee osteoarthritis and (b) develop a targeted, mechanism-based self-management intervention to reduce MEP and maximize movement. METHODS An observational, mixed-methods cohort study will enroll 90 AA/Black adults (ages 55-90 years) to understand intraindividual and interindividual effects on MEP. Participants will complete assessments of MEP, function and gait, biopsychosocial-behavioral questionnaires, quantitative sensory testing, and 7-day ecological momentary assessments of pain and related symptoms. For the qualitative phase, focus groups will be conducted to co-construct a mechanism-based pain self-management intervention. RESULTS We will develop phenotypes of MEP based on biopsychosocial-behavioral predictors and correlate measures of MEP with function. Our central hypothesis is that higher levels of MEP will predict lower self-reported function and poorer performance on functional tasks and that multiple biopsychosocial and behavioral factors will be associated with MEP and function. Predictors may serve as risk or protective factors for MEP and physical function. In targeting the biopsychosocial-behavioral mechanisms of MEP, we anticipate that older AAs may request that intervention components include culturally tailored self-management education, movement/physical activity training, treatment decision-making skills, coaching, spirituality, and social/kinship support. CONCLUSION Osteoarthritis is now the single most common cause of disability, mobility limitations, and persistent pain in older adults-especially AA older adults. To our knowledge, this will be the first study to systematically phenotype MEP in an older racial minority population with knee osteoarthritis and will be relevant for reducing knee pain and improving function.

BACKGROUND The gut microbiome is an important determinant of health and disease in preterm infants. OBJECTIVES The objective of this article was to share our current protocol for other neonatal intensive care units to potentially expand their existing protocols, aiming to characterize the relationship between the intestinal microbiome and health outcomes in preterm infants. METHODS This prospective, longitudinal study planned to recruit 160 preterm infants born

Purpose Proinflammatory cytokines play a critical role in chronic inflammation and pain and contribute to behavioral symptoms (depressive symptoms, anxiety, fatigue, sleep disturbance) and comorbidities (diabetes, cardiac diseases, cancer). Evidence is lacking on the specific proinflammatory cytokines associated with these behavioral symptoms/comorbidities co-occurring with axial low back pain (aLBP). This review aimed to systematically analyze the following: (1) specific proinflammatory cytokines associated with aLBP in adults, (2) associations among proinflammatory cytokines and behavioral symptoms in aLBP, and (3) relationships among proinflammatory cytokines and comorbidities in aLBP, to develop a new clinical framework for future diagnostic and intervention targets for patients with aLBP. Methods Electronic databases, including PubMed/MEDLINE, ProQuest Nursing & Allied Health Source, and CINAHL Complete (EBSCO) were searched for the period January 2012 to February 2023. Eligible studies included cross-sectional, case-control, longitudinal, and cohort studies in which proinflammatory cytokines were reported in adults above 18 years with aLBP. Intervention studies and randomized controlled trails were excluded. The Joanna Briggs Institute (JBI) criteria were used for quality evaluation. Results Findings from 11 studies showed 3 proinflammatory cytokines associated with pain intensity in adult patients with aLBP: C-Reactive Protein (CRP), Tumor Necrosis Factor (TNF-α), and Interleukin (IL-6). Some studies assessed associations between proinflammatory cytokines and depressive symptoms; none explored the association of proinflammatory cytokines with fatigue, anxiety, sleep disturbance, or comorbidities (diabetes, cardiac diseases, and cancer) in aLBP. Conclusions Proinflammatory cytokines in aLBP can serve as composite biomarkers for pain, associated symptoms, and comorbidities and may serve as a target for future interventions. There is need for well-designed studies assessing associations among chronic inflammation, behavioral symptoms, and comorbidities.

BACKGROUND Chronic low back pain (CLBP) is a significant cause of disability, lost wages, and healthcare costs. Inflammatory mediators, such as interleukin-6 (IL-6), have been associated with LBP severity. Patients with CLBP commonly experience sleep disturbance, and poor sleep has been shown to increase pain severity and inflammation. In contrast, social support may benefit patients with CLBP by reducing pain intensity and inflammation. OBJECTIVES The purpose of this study was to examine the influence of social support on the relationships among sleep disturbance, inflammation, and pain severity in patients with CLBP. METHODS In a cross-sectional study, men and women with CLBP were enrolled from an outpatient pain clinic. Participants completed psychometric instruments for social support, sleep quality, and pain severity. Blood samples were obtained for measurement of the pro-inflammatory cytokine IL-6 by enzyme-linked immunoassay. RESULTS Linear regression revealed greater sleep disturbance predicted greater pain severity. In contrast, participants who reported higher social support had lower sleep disturbance and lower pain severity. Mediation analysis revealed sleep disturbance to mediate the relationship between social support and pain, such that sleep disturbance reduced the benefit of social support on pain severity. Furthermore, greater sleep disturbance and lower social support predicted increased IL-6. However, IL-6 did not mediate the relationship between social support and pain. DISCUSSION The findings suggest that increased social support is associated with lower sleep disturbance, lower inflammation, and lower pain severity in patients with CLBP. Assessing the extent of social support and fostering social support as part of a comprehensive pain management program may benefit patients with CLBP. Interventions to strengthen social support systems and cultivate support from family and/or informal social networks may reduce symptom burden and improve quality of life.

Background Chronic low back pain is a prevalent condition, often involving an inflammatory process. Behavioral symptoms, including depressed mood, fatigue, and sleep disturbance, intensifies pain and reduces quality of life. Aims The objectives of this pilot study were to identify behavioral symptom clusters (depressive mood, fatigue, poor sleep) in individuals with chronic low back pain, and to determine whether there are differences in pain, quality of life and inflammation (plasma IL-6) based on cluster membership. Design and Settings A cross-sectional study was conducted in a pain clinic. Participants/ Subjects Participants between ages 21 to 70 years (N=69) were enrolled if they had chronic low back pain for at least six months. Methods Participants completed instruments measuring, pain, depressive mood, fatigue, sleep, and demographic form. Blood (10ml) was obtained. Latent class analysis was used to identify clusters. Results and Conclusions Findings revealed a two-class model, with Class 1 characterized by more depressive mood, fatigue, and sleep disturbance compared to Class 2. Class 1 participants reported worse quality of life than those in Class 2. Pain severity and pain interference were not significantly different between the classes. Levels of IL-6 were significantly greater in Class 1 participants compared to Class 2 with higher levels of IL-6 correlating with greater pain severity and sleep disturbances. Logistic regression revealed higher levels of IL-6 predicted Class 1 membership. Behavioral symptoms cluster exist in chronic low back pain patients and impact quality of life. Inflammation may contribute to relationship between behavioral symptoms and pain severity.

Background As genomic science moves beyond government-academic collaborations into routine healthcare operations, nursing’s holistic philosophy and evidence-based practice approach positions nurses as leaders to advance genomics and precision health care in routine patient care. Purpose To examine the status of and identify gaps for U.S. genomic nursing health care policy and precision health clinical practice implementation. Methods We conducted a scoping review and policy priorities analysis to clarify key genomic policy concepts and definitions, and to examine trends and utilization of health care quality benchmarking used in precision health. Findings Genomic nursing health care policy is an emerging area. Educating and training the nursing workforce to achieve full dissemination and integration of precision health into clinical practice remains an ongoing challenge. Use of health care quality measurement principles and federal benchmarking performance evaluation criteria for precision health implementation are not developed. Discussion Nine recommendations were formed with calls to action across nursing practice workforce and education, nursing research, and health care policy arenas. Conclusions To advance genomic nursing health care policy, it is imperative to develop genomic performance measurement tools for clinicians, purchasers, regulators and policymakers and to adequately prepare the nursing workforce.

This study explored the association of back pain and heart failure (HF) with health outcomes among community-dwelling older adults. Older adults who completed a follow-up in the 11th year (2007–2008) of the Health, Aging, and Body Composition (Health ABC) study were included. The mean age was 83.4 ± 2.78 years. Back pain and heart failure were reported by 55.40% (n = 657) and 8.09 % (n = 96) of the total subjects (N = 1186), respectively. Regression analysis indicated that older adults with back pain reported worse depressive symptoms, fatigue, and physical performance and function compared with those without back pain (p < 0.05), and HF presence increased fatigue levels and decreased physical function (p < 0.05) among older adults with back pain. The high incidence and negative impact of back pain highlight the need to develop strategies for pain management among older adults with and without HF.

Self-management of chronic disease and related symptoms provides a framework for understanding the contextual factors that influence self-management knowledge and skills that patients and families require to manage their condition on a day-to-day basis. The management of cancer pain is a significant issue for patients and families, and their experience can provide insight on cancer pain self-management support needs and preferences. A meta-synthesis of 20 qualitative research articles on self-management of cancer pain was conducted to gain a deeper understanding of the self-management support needs of patients with cancer pain. Noblit and Hare’s meta-ethnographic model was used. The meta-synthesis resulted in increased understanding of the needs and preferences for self-management support of cancer pain and the role of the health care practitioner. Practical implications are presented.

Fibromyalgia (FM) is a chronic noncommunicable disorder characterized by a constellation of symptoms that include fatigue, depression and chronic pain. FM affects 2%–8% of the U.S. population, 2% of the global population, with 61%–90% of FM diagnoses attributed to women. Key causal factors leading to the development and severity of FM-related symptoms have not yet been identified. The purpose of this article is to report relationships among identified metabolites and levels of fatigue, depression, pain severity, and pain interference in a sample of 20 women with FM. In this secondary analysis, we conducted global metabolomic analysis and examined the data for relationships of metabolite levels with self-reported symptoms of fatigue, depression, pain severity, and pain interference. Results revealed six metabolites (6-deoxy-hexose; pantothenic acid; ergothioneine; l-carnitine; n-acetylserotonin; butyrobetaine) and their associated metabolic pathways such as carnitine synthesis, lipid oxidation, tryptophan metabolism, beta-alanine metabolism and pantothenic and Coenzyme-A biosynthesis that were either positively or inversely related to pain severity, pain interference, or both. The preliminary data presented suggest that metabolites representing energy, amino acid, or lipid classification may be associated with pain symptom severity and interference in women with FM. Future work will confirm these findings in a large, comparative cohort, targeting metabolites and metabolite pathways to better understand the relationships of metabolites and symptomology.

Background:Nonpharmacologic stress reduction interventions provide an opportunity to modify chronic pain trajectories; however, the biological mechanisms underlying these interventions are poorly understood.Objectives:To examine clinical literature published in 2012–2018 with the goals of (1) identifying which biological mechanisms or biomarkers are currently being measured in nonpharmacologic stress reduction intervention studies for individuals with chronic pain and (2) evaluating the evidence to determine whether these stress reduction interventions lead to changes in (a) pain outcomes and/or (b) measured biomarkers.Data sources:Scientific articles in the electronic databases PubMed/Medline, Cumulative Index of Nursing and Allied Health Literature, PsychINFO, and SCOPUS following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.Study selection:Randomized controlled trials and quasi-experimental studies that recruited subjects with a chronic pain condition, examined a relationship between a nonpharmacologic stress reduction intervention and pain-related outcome(s), and included measurement of a biomarker.Results:The 13 articles that met inclusion criteria spanned four nonpharmacologic stress reduction categories: mindfulness-based stress reduction, physical exercise, manual therapies, and biofeedback. Methods for studying biomarkers included measuring biological samples, neurological function, and autonomic control. Although all studies investigated both biological measures and pain outcomes, only three demonstrated an association between the biomarker(s) and pain-related outcomes.Conclusions:The results of this review highlight the complex nature of stress–pain relationships and the lack of rigorous clinical research identifying specific stress-related biological factors that modulate pain outcomes. Stress reduction interventions remain a favorable method for symptom management in patients living with chronic pain, but consistency in study measures and design is needed for robust evaluation.

Objectives A number of factors, including heritability and the environment, contribute to risk of transition from acute low back pain to chronic low back pain (CLBP). The aim of this study was to (1) compare somatosensory function and pain ratings at low back pain (LBP) onset between the acute low back pain and CLBP conditions and (2) evaluate associations between BDNF and COMT polymorphisms and expression levels at LBP onset to acute and chronic pain burden and risk for transition to the chronic pain state. Methods In this longitudinal study, 220 participants were enrolled following recent onset of LBP and data were collected until the LBP resolved or until the end of the study at 6 months. Forty-two participants' pain resolved before 6 weeks from onset and 42 participants continued to have pain at 6 months. Patient-reported pain burden, somatosensory function (quantitative sensory testing), and blood samples were collected at each study visit. Results CLBP is associated with greater pain burden and somatosensory hypersensitivity at the time of LBP onset. COMT rs4680 genotype (GG) was associated with acute cold pain sensitivity and with the risk for transition to CLBP while COMT expression was independently associated with risk for transition. Discussion CLBP was characterized by higher reported pain burden and augmented hypersensitivity at LBP onset. COMT expression and genotype were associated with acute pain burden and likelihood of transition to CLBP.

Study Design: Scoping review. Objective: To examine potential underlying mechanisms of cognitive and physical impairment in patients with spinal cord injury and identify current research gaps. Methods: A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews to identify primary studies that explored mechanisms of cognitive and/or physical impairment after spinal cord injury. The databases searched were PubMed/MEDLINE, EMBASE (OVID), Cumulative Index to Nursing and Allied Health Literature (CINAHL; EBSCO), Web of Science, Scopus, and PsycInfo. These databases were searched from inception through December 20, 2021. Results: Accumulating research suggests that neuroinflammation and neurodegeneration after a traumatic event may be possible mechanisms for cognitive impairment among patients with SCI. In addition, lack of physical activity due to impaired mobility is associated with an increased risk of cognitive impairment. Conclusion: While the results establish a foundation for understanding how cognitive impairment, mental health, and physical function independently affect patients with SCI, further research is warranted to understand how these factors systemically impact the patient and discover refined targets for future rehabilitation therapies. Studies should also explore potential predisposing factors for the relationship between cognitive and physical impairment among patients with SCI.

Bias in health care negatively impacts disparities in care, treatment, and outcomes, especially among minority populations. A scoping review of the literature was performed to provide a deeper understanding of how bias influences musculoskeletal pain and potential effects of bias-targeted interventions on reducing pain disparities, as well as identify gaps and make suggestions for further research in this area. Publications from peer-reviewed journals were searched using the databases, Pubmed/Medline, PsycInfo, CINAHL, and Scopus, with 18 studies identified. The literature review revealed that clinician-based bias and discrimination worsen pain and disability by reducing access to treatment and increasing patient pain-related injustice, catastrophizing, depression, and perceived stress. In contrast, clinician education and perspective-taking, patient decision-tools, and community outreach interventions can help to reduce bias and disparities in musculoskeletal pain outcomes. Increasing the diversity of the health care workforce should also be a priority. Models of care focused on health equity may provide an ideal framework to reduce bias and provide sustainable improvement in musculoskeletal pain management.

The biological basis underlying cognitive dysfunction in women with early-stage breast cancer (BC) remains unclear, but could reflect gene expression changes that arise from the acquisition and long-term retention of soma-wide alterations in DNA methylation in response to chemotherapy. In this longitudinal study, we identified differences in peripheral methylation patterns present in women prior to treatment (T1) and 1 year after receiving chemotherapy (T4) and evaluated relationships among the differential methylation (DM) ratios with changes in cognitive function. A total of 58 paired (T1 and T4) blood specimens were evaluated. Methylation values were determined for DNA isolated from whole blood using a genome-wide array . Cognitive function was measured using the validated, computerized CNS Vital Signs platform. Relationships between methylation patterns and cognitive domain scores were compared using a stepwise linear regression analysis, with demographic variables as covariates. The symptom comparison analysis was restricted to 2,199 CpG positions showing significant methylation ratio changes between T1 and T4. The positions with DM were enriched for genes involved in the modulation of cytokine concentrations. Significant DM ratios were associated with memory domain (56 CpGs). Eight of the ten largest DM ratio changes associated with lack of memory improvement were localized to genes involved in either neural function (ECE2, PPFIBP2) or signalling processes (USP6NL, RIPOR2, KLF5, UBE2V1, DGKA, RPS6KA1). These results suggest that epigenetic changes acquired and retained for at least one year in non-tumour cells following chemotherapy may be associated with a lack of memory improvement following treatment in BC survivors.

Precision health refers to personalized healthcare based on a person’s unique genetic, genomic, or omic composition within the context of lifestyle, social, economic, cultural and environmental influences to help individuals achieve well-being and optimal health. Precision health utilizes big data sets that combine omics (i.e. genomic sequence, protein, metabolite, and microbiome information) with clinical information and health outcomes to optimize disease diagnosis, treatment and prevention specific to each patient. Successful implementation of precision health requires interprofessional collaboration, community outreach efforts, and coordination of care, a mission that nurses are well-positioned to lead. Despite the surge of interest and attention to precision health, most nurses are not well-versed in precision health or its implications for the nursing profession. Based on a critical analysis of literature and expert opinions, this paper provides an overview of precision health and the importance of engaging the nursing profession for its implementation. Other topics reviewed in this paper include big data and omics, information science, integration of family health history in precision health, and nursing omics research in symptom science. The paper concludes with recommendations for nurse leaders in research, education, clinical practice, nursing administration and policy settings for which to develop strategic plans to implement precision health. Keywords: Nurses, Genomics, Omics, Precision medicine, Precision health

Background Despite the emphasis on exercise to reduce pain and improve function among people with chronic low back pain (cLBP), little is known about the underlying mechanism of the impact of exercise on the neurophysiological and gene transcription alterations that characterize cLBP. Objectives To present a study protocol to examine the feasibility, acceptability, and initial efficacy of Problem-Solving Pain to Enhance Living Well (PROPEL) with the support of nurse consultations and wearable activity-tracking technology on self-management (SM) knowledge, skills, physical activity, and pain and to examine the differential neurophysiological and gene expression profiles in cLBP participants from pre- to post-PROPEL. Methods A pretest and posttest study is employed on 40 adults ages 18-60 years with cLBP who do not have serious complications and/or comorbidities that affect sensorimotor function. Participants will receive video modules focused on SM and biweekly phone consultations to facilitate symptom monitoring and problem-solving while increasing physical activity frequency and duration. Participants will be assessed for outcomes including SM skills, physical activity, and pain every 2 weeks for 12 weeks. We will examine the participants' differential neurophysiological and gene expression profiles at 12 weeks postintervention and correlate these outcomes with the total duration of physical activity. Results The study began in September 2018. Of the 99 subjects that were screened, 23 were enrolled and 8 completed data collection. Discussion Comparing the neurophysiological and gene expression profiles of people with cLBP exposed to PROPEL could inform the development of interventions that offer personalized physical activity dosage along with general SM support. Web-based programs such as PROPEL have the potential to enhance accessibility of evidence-based interventions that improve functionality and quality of life among people living with cLBP.

To characterize the needs and preferences for pain self-management support (SMS) among patients with cancer during the transition of cancer care from the hospital to the home setting.38 participants with cancer pain at a research-intensive cancer center in New England.A descriptive, cross-sectional survey study was conducted to investigate relationships among preferred and received support, extent and management of transitional change, and pain outcomes. Pain intensity and interference were measured using the Brief Pain Inventory-Short Form, transitional change was measured using the Measurement of Transitions in Cancer Scale, and SMS was measured using dichotomous questions.About half of participants reported concordance between preferred and received cancer pain SMS in the hospital and at home. The extent of transitional change in cancer care was found to be a significant predictor of average pain intensity in the hospital and pain interference at home. Satisfaction with cancer pain SMS was a significant predictor of pain intensity at home.The extent of change during care transitions should be considered when fulfilling patient needs and preferences for cancer pain SMS to optimize outcomes.

The emergency department often serves as a port of entry to palliative care services for patients with complex symptoms and/or care coordination, individuals with chronic disease(s), and people at the end of life. This chapter outlines the role of the palliative advanced practice registered nurse (APRN) in the emergency department and highlights strategies for the successful integration of palliative care in the emergency department setting and common barriers to its implementation. Various models that may be used are described along with approaches to operationalize the provision of palliative care to patients in the emergency department. Methods to identify patients at greatest need for palliative care and guide the evaluation of palliative care services are discussed. Guidance for death notification by telephone or using other technologies is offered.

Concussion or mild traumatic brain injury (mTBI) is a common phenomenon in the United States, with up to 3.6 million sport-related mTBIs diagnosed annually. Return to learn protocols have been developed to facilitate the reintegration of students into school after mTBI, however, the implementation of return to learn protocols varies significantly across geographic regions and school districts. An integrative review of the literature was performed using Whittemore and Knalf's methodology. A search of published literature was conducted using the PRISMA checklist. Database searches were conducted from March 2,019 to October 2,021 using the terms “mild traumatic brain injury” and “return to learn.” Twenty-eight publications were included. Three themes were derived from this review: lack of policy, poor staff education on concussion symptoms and stakeholder communication breakdown. The development of communication patterns and use of a return to learn protocol could facilitate a gradual return to full academic workload after concussion.

Background The 2016 U.S. Centers for Disease Control Opioid Prescribing Guideline (CDC Guideline) is currently being revised amid concern that it may be harmful to people with chronic pain on long-term opioid therapy (CP-LTOT). However, a methodology to faithfully implement the CDC guideline, measure prescriber adherence, and systematically test its effect on patient and public health outcomes is lacking. We developed and tested a CDC Guideline implementation strategy (termed TOWER), focusing on an outpatient HIV-focused primary care setting. Methods TOWER was developed in a stakeholder-engaged, multi-step iterative process within an Information, Motivation and Behavioral Skills (IMB) framework of behavior change. TOWER consists of: 1) a patient-facing opioid management app (OM-App); 2) a progress note template (OM-Note) to guide the office visit; and 3) a primary care provider (PCP) training. TOWER was evaluated in a 9-month, randomized-controlled trial of HIV-PCPs (N = 11) and their patients with HIV and CP-LTOT (N = 40). The primary outcome was CDC Guideline adherence based on electronic health record (EHR) documentation and measured by the validated Safer Opioid Prescribing Evaluation Tool (SOPET). Qualitative data including one-on-one PCP interviews were collected. We also piloted patient-reported outcome measures (PROMs) reflective of domains identified as important by stakeholders (pain intensity and function; mood; substance use; medication use and adherence; relationship with provider; stigma and discrimination). Results PCPs randomized to TOWER were 48% more CDC Guideline adherent (p Conclusions CDC-guideline adherence can be promoted and measured, and is not associated with worsening of outcomes for people with HIV receiving LTOT for CP. Future work would be needed to document scalability of these results and to determine whether CDC-guideline adherence results in a positive effect on public health. Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT03669939. Registration date: 9/13/2018

OBJECTIVES: To investigate if somatosensory profiles can differentiate pain and psychophysiological symptoms among young adults with irritable bowel syndrome (IBS). MATERIALS AND METHODS: We performed a cluster analysis of data collected from a randomized clinical trial (RCT) of 80 IBS patients and 21 age-matched healthy controls (HCs) to stratify pain and symptoms among young adults with IBS by their peripheral sensory profiles. Data of quantitative sensory testing (QST) and IBS related pain and symptoms were collected at baseline and 6- and 12-week follow-ups. RESULTS: Using the K-means method, IBS subjects were classified into two clusters, the “IBS normal threshold” (IBS-NT) and the “IBS increased threshold” (IBS-IT). The IBS-NT cluster had a similar pain threshold as the HCs, and the IBS-IT had an increased threshold of somatic pain perception (lower cold pain threshold, higher heat pain threshold, and higher pressure pain threshold, all p < 0.001) than HCs. Compared with the IBS-NT, the IBS-IT cluster reported higher levels of IBS related pain intensity, anxiety, fatigue, and sleep disturbance over the three visits (all p < 0.05). DISCUSSION: Young adults with IBS fell into two clusters, one with similar sensory threshold as HCs and another with increased pain threshold who reported higher pain intensity and more severe symptoms. Somatic sensory profiles should be integrated into further personalized self-management intervention among patients with IBS.

BackgroundIrritable bowel syndrome (IBS) is a chronic pain condition that needs life-long self-management. However, the effect of self-management among young adults with IBS is limited.ObjectivesThis study aimed to examine the effect of a nurse-led self-management program on IBS related pain and symptoms, and quality of life (QOL) among young adults with IBS.Theoretical frameworkThe Individual and Family Self-Management Theory (IFSMT).DesignA randomized controlled trial with data collected at baseline, 6- and 12-week follow up.Settings and participantsEighty young adults with IBS recruited from two campuses of a public university and two gastrointestinal clinics were randomly assigned into a Self- Management Online education and learning Modules group (SMOM, n = 41) or a Nurse-Led SMOM group (NL + SMOM, n = 39). Twenty-one healthy controls (HCs) were also recruited from these two campuses.MethodsAll the IBS participants received the SMOM after baseline data collection. Participants in the NL + SMOM received additional three nurse-led one-to-one consultations at baseline, 6- and 12-week follow up. Self-reported pain, symptoms, IBS-related QOL, self- efficacy for managing chronic disease, and coping were measured at baseline, and 6- and 12- week follow up among the IBS participants. The HCs completed data collection of pain and symptoms at baseline and 12-week follow up. The intervention effects across study time points and the comparisons between the two interventional groups were analyzed using linear mixed models. A longitudinal mediation analysis was also conducted to explore the mediation effects of self-management mechanisms of the interventions.ResultsBoth the SMOM and NL + SMOM groups showed significant interventional effects on decreasing pain intensity and pain interference and increasing IBS-QOL among young adults with IBS at the 12-week follow up (all p < 0.05). The NL + SMOM also had significant effect on reducing anxiety and greater improvement in IBS-QOL compared with the SMOM at the 12- week follow up (both p < 0.05). Increased self-efficacy mediated the intervention effect of the NL + SMOM on reducing pain interference and improving IBS-QOL, while the effect of the SMOM was mediated through decreased an inefficient coping strategy-catastrophizing.ConclusionsGuided by the IFSMT, this study showed that both the pain self-management online education and nurse-led interventions were effective for alleviating pain and improving QOL among young adults with IBS by targeting the self-management process. The nurse-led program had a better outcome than the online education alone in improving IBS-QOL. Registration number: NCT03332537What is already known about the topicIrritable bowel syndrome (IBS) is a chronic condition warranting lifelong self- management.Unrelieved abdominal pain is associated with increased healthcare expenditures and decreased quality of life (QOL) in young adults with IBS.Self-management interventions have moderate effect on attenuating IBS related pain and symptoms.What this paper addsBoth the IBS Self-Management Online education and learning Modules (SMOM) and Nurse-Led SMOM (NL + SMOM) developed in this study were efficient in reducing pain intensity and pain interference and ameliorating IBS-QOL among young adults with IBS.The NL + SMOM had a greater interventional effect on improving IBS-QOL compared with the SMOM alone.The NL + SMOM had an indirect effect on pain and QOL by increasing self-efficacy, while the indirect effect of SMOM on pain and QOL was derived by decreasing inefficient coping (e.g., catastrophizing).

Psychosocial and sensory factors, including anxiety, depression, and pressure pain threshold have been used to cluster chronic symptoms in irritable bowel syndrome (IBS). This study examined the contribution of psychosocial sensory factors on pain interference and quality of life (QOL) in this population.We performed a cross-sectional analysis of baseline data from a randomized controlled trial.Two gastrointestinal clinics, general communities, and two large campuses of a public university in the Northeastern United States.Eighty young adults with IBS aged 21 ± 2.57 years (76.25% female).Demographic and psychosocial factors including anxiety, depression, fatigue, cognition or general concerns, sleep disturbance, self-efficacy, coping, and food intake were measured as independent variables. Quantitative sensory testing was conducted to measure mechanical, thermal, and pressure pain thresholds. Self-reported pain measured by the brief pain inventory (BPI) and IBS-QOL were assessed as the outcome variables. Regression analysis and mediation analysis were conducted to determine the associated factors of IBS pain and QOL.Age, sex, and psychosocial factors including coping, self-efficacy, alcohol intake, mechanical pain sensitivity, and cold pain threshold were significantly associated with pain interference (all p0.05). Coping, and self-efficacy were significantly associated with IBS-QOL (all p0.05). In the mediation analysis, coping catastrophizing and self-efficacy were indirectly associated with IBS-QOL mediated by fatigue.Psychosocial factors including coping and self-efficacy, and quantitative sensory testing factors significantly correlate with self-reported pain and QOL among young adults with IBS. This preliminary research calls for further interventional studies that target personalized psychosocial and quantitative sensory factors to improve pain management and quality of life in IBS patients.