Isradipine augmentation of virtual reality cue exposure therapy for tobacco craving: a triple-blind randomized controlled trial.

Preclinical research with rodents suggests that the L-type calcium channel blocker isradipine can enhance long-term extinction of conditioned place preference for addictive substances when it is administered in conjunction with extinction training. Although isradipine alone, which is FDA-approved for hypertension, has not shown a direct effect on craving in human drug users, its potential to augment behavioral treatments designed to reduce craving remains unknown. We conducted a triple-blind, randomized placebo-controlled pilot clinical trial of isradipine combined with a novel virtual reality cue exposure therapy (VR-CET) approach with multimodal cues that targeted craving. After 24 hours of abstinence, 78 adults with an ongoing history of daily cigarette use received isradipine (n = 40) or placebo (n = 38) and reported craving levels after each of 10 trials of VR-CET. Consistent with pre-registered hypotheses, the isradipine group had significantly lower mean craving across cue exposure trials at the medication-free 24-hour follow-up (d = -0.42, p = 0.046). There were no serious adverse events; however, side effects such as headache and dizziness occurred more frequently in the isradipine group. The findings of the current study support follow-up clinical trials that specifically test the efficacy of isradipine-augmented VR-CET for reducing smoking relapse rates after an initial quit attempt. clinicaltrials.gov: NCT03083353.

Sexual Activity as Self-Injury: A Scoping Review.

Suicide and other self-injurious behaviors (SIB) are significant causes of morbidity and mortality as well as healthcare costs. Sexual risk behaviors are associated with many SIB, and sexual activities may act as SIB as well. In this scoping review, we consider ways in which sexual activity has been conceptualized as SIB - types of sexual activities as a form of self-injury - and cases in which sexual activities as SIB have been classified as direct or indirect self-injury. We include English-language publications that discuss any aspect of sexual activity as SIB. Database, citation list, and gray literature searches yielded 33 publications. Sexual activities as a form of self-injury included exposure to HIV/AIDS and other sexually transmitted infections, sadomasochistic behaviors undertaken for punishment rather than pleasure, selling sex, injury to the genitals, and sexual encounters with undesired partners or consisting of undesired acts. Twenty-three publications did not categorize sexual activities to self-injure as either direct or indirect self-injury, three publications categorized them as indirect self-injury, and seven publications as direct self-injury. Sexual activity is used to self-injure in a variety of ways and its conceptualization as indirect or direct self-injury remains unclear.

Adolescent Simulation in a Health Assessment Course for Advanced Practice Nursing Students.

ABSTRACT: Advanced practice registered nurse (APRN) students face challenges transitioning to practice. They benefit greatly from simulated learning experiences that build confidence and increase competence in the skills needed to perform in an APRN role. The purpose of this quality improvement project was to evaluate the effectiveness of a simulated adolescent well visit in an advanced health assessment course. Using a pretest/posttest design, qualitative and quantitative data were collected from participants. Results included high learner satisfaction, an increase in both self-reported competence and confidence, and an appreciation for the "safe space" of learning.

Applications of isradipine in human addiction studies: A systematic literature review.

Given the personal and public health burden of addictive disorders, innovative approaches to treatment are sorely needed. This systematic review examined the use of the pharmacological agent isradipine in the context of potential applications for addiction treatment. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided a comprehensive search of PubMed, Cochrane Library, and PsycINFO between the years 1985 to July 2022. Studies were included if isradipine was administered to adults with a current Diagnostic and Statistical Manual of Mental Disorders-5th edition diagnosis of a substance use disorder and/or to healthy volunteers alone and in conjunction with a substance (i.e, cocaine, methamphetamine, alcohol). A total of 16 studies with 252 participants were included in this review. Substantial variability was identified with study designs, isradipine dosages/dosing, and addictive substance of interest. Outcomes clustered in four categories: (a) cerebral blood flow (CBF), (b) hemodynamic effects, (c) subjective effects, and (d) cognitive effects. Isradipine was found to improve CBF in individuals with cocaine-induced hypoperfusion and in several studies was found to reduce parameters of blood pressure elevation after stimulant use. There were no significant findings on isradipine's effect on subjective reporting (i.e., craving, mood, drug affect) or cognition/attention. Given the limited number of studies identified in this review, there is insufficient data to draw clear conclusions. The direct effects of isradipine as a pharmacologic agent for addictive disorder treatment appear minimal, however, future work may benefit from examining the impact of isradipine as an augmentative agent within existing cue exposure paradigms for preventing cue-induced drug relapse. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

An Online Mindfulness-based Intervention for Certified Nursing Assistants in Long-term Care.

Purpose: Certified nursing assistants (CNAs) make up the largest segment of the long-term care (LTC) setting workforce, however, they are at high risk of job dissatisfaction and burnout. Evidence suggests that mindfulness-based interventions (MBIs) might be particularly relevant and useful for CNAs in reducing psychological distress, improving job satisfaction, and reducing burnout, but little research has investigated this possibility. A feasibility study of an online MBI for CNAs in LTC settings was therefore conducted. Methods: CNAs completed assessments at baseline and posttest. Paired t-tests assessed changes in mindfulness, psychological distress (i.e., depressive and anxiety symptoms, and stress), and professional quality of life. Results: Of the 19 CNAs who started the intervention, N = 13 (68%) completed it and provided postintervention data. Depressive symptoms were significantly decreased postintervention (F = 6.26, p = .036, d = .47). Conclusions: MBIs may have beneficial effects for CNAs in LTC settings. Further research with a larger CNA population will increase the power and relevance of these findings, ultimately contributing to the improvement of patient outcomes in LTC.

Evidence-Based Practice Knowledge Retention Among Nurse Practitioner Students.

ABSTRACT: The mastery of clinical scholarship and analytic methods for evidence-based practice (EBP) is a published essential for nurse practitioner (NP) education; however, retention of EBP-related knowledge during NP education remains unknown. We assessed EBP knowledge during a first-semester research course and again during the last semester using an item response model. We found that changes depended on the exam item, with performance dropping on a third of the items. Our findings suggest a need to integrate EBP concepts across curricula (e.g., feedback loops in courses other than the research course) to retain these essential skills.

Usage of L-type calcium channel blockers to suppress drug reward and memory driving addiction: Past, present, and future.

Over the past three decades, L-type Ca2+ channel (LTCC) blockers have been considered a potential therapeutic drug to alleviate the symptoms of drug addiction. This idea has been supported, in part, by 1) expression of LTCCs in the brain dopaminergic circuits that are thought to play critical roles in the development and expression of addictive behaviors and 2) common usage of LTCC blockers in treating hypertension, which may enable off-label use of these drugs with good brain penetration as therapeutics for brain disorders. Addiction can be viewed as a maladaptive form of learning where powerful memories of drug-associated stimuli and actions drive compulsive drug intake. Largely under this framework, we will focus on the dopaminergic system that is thought be critically involved in drug-associated learning and memory and provide a brief overview of the past and recent studies testing the therapeutic potential of LTCC blockers for addictive disorders in animal models and humans and offer a future perspective on the use of LTCC blockers in drug addiction and, possibly, addiction to other non-drug rewards (e.g., gambling, eating, shopping). Interested readers can refer to other related articles in this issue and a comprehensive review available elsewhere (Little, 2021) to gain further insights into the roles of LTCCs in drug addiction and withdrawal symptoms associated with dependence. This article is part of the Special Issue on 'L-type calcium channel mechanisms in neuropsychiatric disorders'.

A Pilot Study Assessing Sexual Behavior as Self-Injury in College Students.

OBJECTIVE: The use of sexual activity to self-injure has been proposed in research literature but remains underexplored. The purpose of this pilot study was to determine the feasibility of identifying sexual activity as self-injury in a U.S. college-based sample and to provide a preliminary examination of sexual activity as self-injury to inform future study on this topic. METHOD: A cross-sectional descriptive pilot study was conducted to assess for recognition of and attitudes toward sexual behavior as self-injury and to identify participant-reported experiences of sexual activity to self-injure. RESULTS: A total of 50 participants completed the online survey. Thirteen (26%) participants reported they had heard of the concept of "sex as self-injury." Six (12%) participants reported ever having used sexual activity to cause physical or psychological harm to themselves. Participants reported intentions for engaging in sexual activity to self-injure, including causing physical pain, reliving past self-harm or trauma, showing vulnerability, proving self-worth, pleasing or wanting to feel needed by their partner, and suicidal ideation. CONCLUSION: Sexual activities have been used by some college students as a means of self-harm. Further research is needed to understand this phenomenon and clinicians should consider screening for this in patients who participate in dangerous sexual behaviors or self-injurious behaviors.

Outcomes of a Mindfulness-Based Healthy Lifestyle Intervention for Adolescents and Young Adults with Polycystic Ovary Syndrome.

STUDY OBJECTIVE: The purpose of this study was to examine the feasibility, acceptability, and preliminary efficacy of a mindfulness-based healthy lifestyle self-management intervention with adolescents and young adults diagnosed with polycystic ovary syndrome (PCOS). DESIGN: A pilot randomized controlled trial using a pre-post design was used. SETTING: Central Texas. PARTICIPANTS: Individuals aged 14-23 with a diagnosis of PCOS. INTERVENTIONS: The PCOS Kind Mind Program integrates a manualized mindfulness training program (Taming the Adolescent Mind) with health education in 4 key areas of self-management and health promotion: (1) medication adherence, (2) nutrition, (3) physical activity, and (4) sleep. MAIN OUTCOME MEASURES: Psychological distress, mindfulness, physical activity strategies, nutrition, and exercise self-efficacy. RESULTS: Linear regression models revealed that those in the PCOS Kind Mind condition reported significantly higher nutrition self-efficacy (ß = 6.50, 95% CI, 1.71-11.28, P = 0.013, d = 0.48), physical activity strategies (ß = 0.41, 95% CI, 0.04-0.79, P = 0.040, d = 0.67), and physical activity self-efficacy (ß = 0.48, 95% CI, 0.07-0.88, P = 0.028, d = 0.46). CONCLUSION: The PCOS Kind Mind Program improved self-efficacy in the key areas of nutrition and physical activity and increased physical activity strategies in adolescents and young people with PCOS. These findings are encouraging and suggest the need for larger-scale, randomized controlled trials with longer-term follow-up to more robustly evaluate the effects of the PCOS Kind Mind Program on the psychological and physiological health of adolescents and young people with PCOS.

A qualitative content analysis study using electronic medical records to understand youth suicide attempts.

PROBLEM: Suicide is the second leading cause of death for people aged 10-24 in the United States. The purpose of this study was to examine circumstances youth self-reported when presenting to hospitals due to a suicide attempt. METHODS: A qualitative content analysis of clinicians' notes identified major themes of patients' lived experiences and circumstances leading up to suicide attempt. FINDINGS: A total of 231 unique patient encounters were included in this study. Mean age of participants was 14.71 (SD = 2.04) the majority being female (75%) and Non-Hispanic White (48%). Four themes characterized contributing factors: (1) trauma, (2) relationship quality, (3) risky behaviors, and (4) personal emotions and symptoms. CONCLUSIONS: Findings suggest commonalities among these youths' circumstances and experiences which may have precipitated a suicide attempt. These data will aid nurses and other health-care providers in understanding the complex, and often traumatic, histories of youth who attempt suicide. Improved knowledge in this area has the potential to direct improved screening, treatment, and referral protocols as well as suggest areas to focus prevention efforts.

Response: "The Signal and the Noise"-a response to Clayton et al. (2021).

The purpose of this response is to clarify points about the steps we took in a systematic review of the literature and to reaffirm our findings.

Self-management for youth and young adults with special health needs: protocol for a scoping review of health care transition planning literature.

OBJECTIVE: The purpose of this scoping review is to explore the extent to which self-management of youth and young adults with special health care needs is reported in the health care transition literature. INTRODUCTION: It is essential for youth and young adults with special health care needs to learn the self-management skills, to the extent possible, that are essential in maintaining the stability of their chronic condition to seamlessly transfer to adult care and live independently. Acquisition of self-management competencies for chronic care management is an essential component of health care transition preparation. INCLUSION CRITERIA: The inclusion criteria will be based upon age and condition designation. The age range of participants will include youth and young adults, aged nine to 35 years, who have special health care needs. Inclusion criteria consists of both non-categorical and diagnostic specific terminology for youth and young adults with a childhood acquired chronic condition. Non-categorical terms used include "long-term chronic condition," "special health care needs," "medical complex condition," "complex care needs," "developmental disability," "intellectual disability," "mental health condition," "emotional disabilities," "physical disabilities," "chronic illness," and "chronic condition." METHODS: The following databases will be accessed for this health care transition scoping review: CINAHL, Cochrane CENTRAL, Embase, Ovid MEDLINE, PsycINFO, and Web of Science. Relevant gray literature will be accessed as well. The Covidence software platform will be used to review citations and full-text articles. Two reviewers will independently review abstracts and full texts of studies, and extract data using the data extraction tool. Any conflicts will be resolved with a third reviewer. Review findings will be presented in tabular format and narrative synthesis based upon the scoping review objective.

Review: Puberty blockers for transgender and gender diverse youth-a critical review of the literature.

BACKGROUND: Increasingly, early adolescents who are transgender or gender diverse (TGD) are seeking gender-affirming healthcare services. Pediatric healthcare providers supported by professional guidelines are treating many of these children with gonadotropin-releasing hormone agonists (GnRHa), which reversibly block pubertal development, giving the child and their family more time in which to explore the possibility of medical transition. METHODS: We conducted a critical review of the literature to answer a series of questions about criteria for using puberty-blocking medications, the specific drugs used, the risks and adverse consequences and/or the positive outcomes associated with their use. We searched four databases: LGBT Life, PsycINFO, PubMed, and Web of Science. From an initial sample of 211 articles, we systematically reviewed 9 research studies that met inclusion/exclusion criteria. RESULTS: Studies reviewed had samples ranging from 1 to 192 (N = 543). The majority (71%) of participants in these studies required a diagnosis of gender dysphoria to qualify for puberty suppression and were administered medication during Tanner stages 2 through 4. Positive outcomes were decreased suicidality in adulthood, improved affect and psychological functioning, and improved social life. Adverse factors associated with use were changes in body composition, slow growth, decreased height velocity, decreased bone turnover, cost of drugs, and lack of insurance coverage. One study met all quality criteria and was judged 'excellent', five studies met the majority of quality criteria resulting in 'good' ratings, whereas three studies were judged fair and had serious risks of bias. CONCLUSION: Given the potentially life-saving benefits of these medications for TGD youth, it is critical that rigorous longitudinal and mixed methods research be conducted that includes stakeholders and members of the gender diverse community with representative samples.

Lessons learned from eight teams: The value of pilot and feasibility studies in self-management science.

Designing and conducting effective intervention research is an important domain of nursing science. Nurse scientists have long recognized people with chronic conditions need effective self-management strategies across the lifespan, so they have led the way in establishing theoretical and practical grounds for the science of self-management. Guidance from pilot and feasibility research for self-management interventions is scarce. Documented exemplars of successes and failures in pilot and feasibility study designs are scant in the literature. The purpose of this paper is to illustrate methodological approaches using pilot and feasibility examples. To maximize collective lessons learned in self-management science study design, features of our pilot and feasibility research strategies that yielded both desirable and undesirable outcomes are described, analyzed, and paired with alternative solutions. A National Institute of Nursing Research P30 grant center, awarded grants to 8 pilot investigators to pilot self-management interventions. A wide variety of chronic conditions were addressed, including heart failure, chronic kidney disease, multiple sclerosis, diabetes, and HIV. The investigators provided their experiences of study implementation. Common themes across the studies were identified. There were four lessons learned from these studies: 1) maximize resources and develop enough evidence for subsequent studies; 2) embed patient-centered feasibility within implementation testing with new patient populations; 3) develop a flexible participant recruitment plan to allow for adjustments when unexpected barriers arise; and 4) define study-specific data collection procedures to demonstrate feasibility. Researchers conducting preliminary small-scale self-management intervention research must balance resources to develop and implement interventions to meet pilot and feasibility objectives.

Isradipine enhancement of virtual reality cue exposure for smoking cessation: Rationale and study protocol for a double-blind randomized controlled trial.

Cigarette smoking remains a leading cause of preventable death in the United States, contributing to over 480,000 deaths each year. Although significant strides have been made in the development of effective smoking cessation treatments, most established interventions are associated with high relapse rates. One avenue for increasing the effectiveness of smoking cessation interventions is to design focused, efficient, and rigorous experiments testing engagement of well-defined mechanistic targets. Toward this aim, the current protocol will apply a pharmacologic augmentation strategy informed by basic research in animal models of addiction. Our goal is to evaluate the enhancing effect of isradipine, an FDA-approved calcium channel blocker, on the extinction of craving-a key mechanism of drug relapse after periods of abstinence. To activate craving robustly in human participants, we will use multimodal smoking cues including novel 360° video environments developed for this project and delivered through consumer virtual reality headsets. Adult smokers will take either isradipine or placebo and complete the cue exposure protocol in a double-blind randomized control trial. In order to test the hypothesis that isradipine will enhance retention of craving extinction, participants will repeat cue exposure 24 h later without the administration of isradipine or placebo. The study will be implemented in a primary care setting where adult smokers receive healthcare, and smoking behavior will be tracked throughout the trial with ecological momentary assessment.

Relationship Between Contact Lens Sensor Output Parameters and Visual Field Progression in Open-angle Glaucoma: Assessment of a Practical Tool to Guide Clinical Risk-assessment.

PURPOSE: In recent years, new technologies have emerged to better analyze and interpret intraocular pressure (IOP) fluctuations. Among them is the progression report (PR), an algorithm based on continuous contact lens sensor (CLS) readings to estimate the likelihood of fast visual field (VF) glaucomatous progression. The objective of this study is to validate the PR. METHODS: In this retrospective study, 30 open-angle glaucoma patients were enrolled. Twenty-four hours IOP-related variations were recorded using a CLS. Recordings were used to generate PR. The likelihood of fast VF progression (<-1 dB/y mean deviation) was estimated by 2 masked assessors based on clinical parameters. At least 3 VF were performed over the 2 years following the initial assessment, to determine actual progression. RESULTS: Mean age was 65.9±10.45 years, with a mean baseline mean deviation of -5.4±5.1. After a mean follow-up of 29.5±12.9 months, 26.7% of eyes were assessed as fast progressors (-2.9±1.9 dBs/y). The average risk-score attributed by the PR was 42% [41% (slow) vs. 44% (fast); P=0.035]. Correlations between the 2 assessors were good (r=0.59), and identical to that between PR and the averaged assessors' gradings. Correlations between mean deviation progression rates and PR, Assessor 1 and Assessor 2's gradings were, r=0.57, 0.31, and 0.43, respectively. CONCLUSIONS: PR provided comparable predictions of the risk of fast VF progression as did physician estimates based on all available clinical data. With their relationship to the eye's biomechanical properties and the ocular tissues' response to pressure variations, CLS recordings may offer new information that complements conventional examinations.

Assessing mental health stigma: Nurse practitioners' attitudes regarding managing patients with mental health disorders.

BACKGROUND: A contributing factor in the provision of suboptimal mental health care is the presence of stigmatizing attitudes among health care providers. Although numerous studies have investigated stigmatizing attitudes among physicians, nurses in psychiatric settings, and various populations of students, mental health stigma among nurse practitioners (NPs) has not yet been addressed. PURPOSE: The purpose of this study was to assess NPs' attitudes and beliefs regarding working with individuals with a mental health disorder. METHODS: A cross-sectional descriptive design was used. Nurse practitioners attending a national practice conference completed a survey for demographic and practice information and a standardized measure for assessing stigmatizing attitudes regarding three mental health conditions: (a) anxiety/depression, (b) attention deficit hyperactivity disorder, and (c) substance use disorders (SUDs). RESULTS: A total of 141 NPs participated in this study. The most favorable attitudes were reported for working with individuals with anxiety/depression, and the least favorable attitudes were reported for working with those with an SUD. IMPLICATIONS FOR PRACTICE: Stigmatizing attitudes are present among practicing NPs. Effective bias-reducing interventions are indicated to improve the patient-centered care NPs provide to individuals with mental health disorders.

A Theoretically Grounded Exploration of Individual and Family Self-Management of Polycystic Ovary Syndrome in Adolescents.

Polycystic ovary syndrome (PCOS) is highly prevalent and increasingly diagnosed during adolescence. This study explored the context and processes of self-management among adolescents, and parents of adolescents, who have PCOS. Adolescents with PCOS (n = 7) and their parents (n = 8) participated in a series of focus groups. Deductive thematic analysis was guided by the Individual and Family Self-Management Theory (IFSMT), and the patterns that were identified aligned with the contexts and processes described therein. A secondary inductive approach was employed as a novel contextual pattern emerged: psychological health and well-being. Study findings suggest that adolescents and their families have a desire to engage in optimal self-management, and particularly effective strategies may consider a holistic, family intervention approach that addresses psychological health and well-being in addition to behavior change. Study findings are the first to reflect the unique needs of adolescents with PCOS and their families.

Transition to Self-Management among Adolescents with Polycystic Ovary Syndrome: Parent and Adolescent Perspectives.

PURPOSE: Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among females. The foundation of PCOS self-management is engaging in healthy lifestyle habits, however, there is limited literature regarding adolescents' transition to PCOS self-management. The purpose of this study, therefore, is to explore parental and adolescent views of the transition to PCOS self-management. DESIGN AND METHODS: A qualitative descriptive approach was used through focus groups (N = 4) with adolescents diagnosed with PCOS and their parents. RESULTS: A total of seven adolescents and eight parents participated in two focus groups each. The primary theme from the parent groups was Concerns for Transition to Self-Care with the subthemes of facilitation versus direction and recognition of personal habits. The primary theme identified from the adolescent groups was Taking Control with subthemes of managing symptoms, cognitive dissonance, support, and balance. CONCLUSIONS: Study findings provide insight into the experiences of adolescents with PCOS and their parents as they navigate both a family-level transition in health habits and anticipate the adolescent transition to self-management as an emerging adult. PRACTICE IMPLICATIONS: Nurses and other health care providers can help facilitate transition to self-management among adolescents with PCOS by encouraging increased independence in health behavior decisions while they are still living at home. Middle and older adolescents who begin to take ownership of their physical activity, nutritional choices, and sleep hygiene will have a firm foundation on which to build as they transition into life beyond high school.

Testing the Feasibility of a Mindfulness-Based Intervention With Underserved Adolescents at Risk for Depression.

This study tested the feasibility, acceptability, and preliminary effects of a mindfulness-based intervention with at-risk adolescents from a predominantly Hispanic/Latino community. Seven adolescents (57% female, 85% Hispanic/Latino) completed the mindfulness-based intervention, demonstrating feasibility, and reported acceptability as well as sustained improvements in depressive symptoms, perceived stress, and self-esteem.