Explore the vast range of titles available.

There are currently two indicators, Morphine Consumption Data and the Pain Management Index, that have been widely used to assess the efficacy of cancer pain treatment. Both are based on the World Health Organization guidelines for cancer pain and both have limitations in their ability to assess the quality of pain care for cancer patients. The published studies that have used these methods all report that cancer pain is generally undertreated in a wide range of clinical settings and care models.

People interpret abstract meanings from colors, which makes color a useful perceptual feature for visual communication. This process is complicated, however, because there is seldom a one-to-one correspondence between colors and meanings. One color can be associated with many different concepts (one-to-many mapping) and many colors can be associated with the same concept (many-to-one mapping). We propose that to interpret color-coding systems, people perform assignment inference to determine how colors map onto concepts. We studied assignment inference in the domain of recycling. Participants saw images of colored but unlabeled bins and were asked to indicate which bins they would use to discard different kinds of recyclables and trash. In Experiment 1, we tested two hypotheses for how people perform assignment inference. The local assignment hypothesis predicts that people simply match objects with their most strongly associated color. The global assignment hypothesis predicts that people also account for the association strengths between all other objects and colors within the scope of the color-coding system. Participants discarded objects in bins that optimized the color-object associations of the entire set, which is consistent with the global assignment hypothesis. This sometimes resulted in discarding objects in bins whose colors were weakly associated with the object, even when there was a stronger associated option available. In Experiment 2, we tested different methods for encoding color-coding systems and found that people were better at assignment inference when color sets simultaneously maximized the association strength between assigned color-object parings while minimizing associations between unassigned pairings. Our study provides an approach for designing intuitive color-coding systems that facilitate communication through visual media such as graphs, maps, signs, and artifacts.

This special issue is a tribute to our mentor, colleague and friend, Gavril W. Pasternak, MD, PhD. Homage to the breadth and depth of his work (~ 450 publications) over a 40 career in pharmacology and medicine cannot be captured fully in one special issue, but the 22 papers collected herein represent seven of the topics near and dear to Gav’s heart, and the colleagues, friends and mentees who held him near to theirs. The seven themes include: (1) sites and mechanisms of opioid actions in vivo; (2) development of novel analgesic agents; (3) opioid tolerance, withdrawal and addiction: mechanisms and treatment; (4) opioid receptor splice variants; (5) novel research tools and approaches; (6) receptor signaling and crosstalk in vitro; and (7) mentorship. This introduction to the issue summarizes contributions and includes formal and personal remembrances of Gav that illustrate his personality, warmth, and dedication to making a difference in patient care and people’s lives.

Hospital-based violence intervention programs (HVIPs) address intervention and prevention of community-based interpersonal violence. HVIPs employ Violence Prevention Professionals (VPPs) as first responders to the hospital bedside for patients who present with injuries resulting from community-based interpersonal violence, including firearm injury, stab wounds, and assault. Despite the growing presence of HVIPs in the U.S., the model lacks process and outcome measures to gauge program fidelity and effectiveness. This study utilized a research team of predominantly VPP researchers to conduct key informant interviews with 3 key groups of participants engaged with a regional HVIP, including clients (n = 7), VPPs (n = 9), and healthcare collaborators (n = 8). Analysis of interview data produced 6 overarching themes, including 3 process-based themes: (1) establish the relationship with the hospital site(s) and clients; (2) foundational client engagement; (3) The Work, and 3 outcome-based themes: (1) transition from relationship to partnership; (2) ongoing commitment; (3) The Change that span hospital- to community-based care. Further, the team identified 4 foundational programmatic goals of the HVIP: (1) inspire positive personal change, (2) reduce engagement in violence and other high-risk activity, 3) reduce risk of reinjury and justice system involvement, and (4) reignite young people as beacons of hope. The 6 process-and outcome-related themes and the 4 foundational programmatic goals produced a conceptual framework for the HVIP and a logic model that maps with the conceptual framework. These elements can guide evaluation of HVIP fidelity and effectiveness. Future work can explore the application of these measures at other sites to build the evidence base of the HVIP models in violence intervention and prevention of community-based interpersonal violence, as well as further define the role HVIPs play within the CVI ecosystem.

PurposeTo apply a Human Centered Design (HCD) approach to co-designing a comprehensive women’s health screening tool with community partners.DescriptionEvidenced-based health screenings for behaviors and risks are important tools in primary health care and disease prevention, especially for women. However, numerous barriers limit the effective implementation of comprehensive health screenings, and often lead to excluding important risks such as intimate partner violence (IPV). Utilizing a human centered design approach (HCD), Mountain Area Health Education Center (MAHEC, NC USA) developed a community co-designed 9-topic health screening for women. Key end-users were recruited to participate in the design process, including women who identified IPV as a health issue in their community, Spanish speaking women, domestic violence program organizers, and MAHEC staff.AssessmentA total of 21 participants collaborated during three design sessions on two specific goals: 1) creating a comprehensive women’s health screening tool from the existing tools that were in use in our clinics at the time, and 2) incorporating IPV screening. Through the HCD sessions, participants highlighted the impact of what they termed “Triple T: time, trust and talk” on the effectiveness of women’s health screening.ConclusionOur co-designed women’s health screening tool is a first step towards addressing screening barriers from both primary care provider’s and community women’s perspectives. Future research will explore the facilitators of and barriers to implementing the tools in different primary care settings. Future work should also more systematically examine whether and how screening processes may reinforce or contribute to women’s feelings of being stereotyped, and how screening processes can be designed to avoid stereotype threat, which has the potential to reduce the effectiveness of screenings intended to promote women’s health.

Multidrug-resistant (MDR) tuberculosis is costly, difficult to treat, and poses a global threat to tuberculosis control. The high burden of disease and treatment for patients, poor cure rates, and high mortality bring distress to patients, families, and caregivers. Despite guidance to improve treatment outcomes, little attention has been paid to palliative care of patients and families, such as for physical, psychosocial, social, and spiritual difficulties. An international expert symposium was convened to articulate an appropriate palliative care response for people with MDR tuberculosis. Several policies should be updated to ensure that palliative and end-of-life care is in place alongside treatment should cure be achieved, and to the end of life if not. Many services have been developed that exemplify integrated palliative care (ie, provided from within existing tuberculosis care). We recommend that existing expertise within palliative care can be used, which will improve management of problems such as dyspnoea, cachexia, and haemoptysis for patients across care settings, including at home, and enhance performance of control programmes.

Chronic neuropathic pain is a serious problem resulting from injury to the central or peripheral nervous system; it affects more than 2 million Americans. Despite advances in our understanding of the pathophysiology and molecular biology of neuropathic pain, its clinical management remains disappointing and controversial. Antidepressants and anticonvulsants have been demonstrated to provide analgesia but are effective in less than half of patients half the time. 1 Opioid treatment of neuropathic pain is often discouraged, because of concern about ineffectiveness, the potential for the development of tolerance, the risk of addiction, and limiting side effects. 2 In this issue of the Journal, . . .

The purpose of this study was to examine, using a US electronic medical records (EMR) database, the clinical characteristics and real-world treatment sequences in men with advanced prostate cancer who initiated treatment with abiraterone acetate or enzalutamide. This retrospective, observational study evaluated adult male patients with a diagnosis of prostate cancer (International Classification of Diseases, Ninth Revision, Clinical Modification code 185) in the EMR database between July 1, 2011, and March 31, 2014, who had initiated first-line treatment with abiraterone acetate or enzalutamide between September 1, 2012, and March 31, 2014. The first record for a patient initiating abiraterone acetate or enzalutamide was the index date. Patients had 6 months of pre-index medical record history and a variable length follow-up period, extending from the index date to the end of medical record data availability or date of the end of the study (March 31, 2014). The sequence of first- and second-line therapies for advanced prostate cancer therapy was reported. A total of 809 patients met study inclusion and exclusion criteria. This study found that the majority of patients who initiated treatment with either abiraterone acetate or enzalutamide between September 1, 2012, and March 31, 2014, received a single line of therapy (72%); abiraterone acetate was the most common first-line treatment (74% of first-line patients). A subset of patients treated first-line with either abiraterone acetate or enzalutamide were transitioned to an oral second-line agent (17% of first-line abiraterone acetate–treated patients transitioned to second-line enzalutamide, and 16% of first-line enzalutamide-treated patients transitioned to second-line abiraterone acetate). Chemotherapy with docetaxel was also a commonly observed second-line treatment selection, occurring in 8% of first-line abiraterone acetate–treated patients and in 7% of first-line enzalutamide-treated patients. This EMR study is among the first to present evidence of US physician practice prescribing patterns regarding initiation of oral antineoplastic agents and use of subsequent therapies in patients with advanced prostate cancer.

East Toronto Health Partners (ETHP) is a network of organizations that serve residents of East Toronto, Ontario, Canada. ETHP is a newly formed integrated model of care in which hospital, primary care, community providers and patients/families work together to improve population health. We describe and evaluate the evolution of this emerging integrated care system as it responded to a global health crisis. This paper begins by describing ETHP's pandemic response mapping out over two years of data. To evaluate the response, semi-structured interviews were conducted with 30 decision makers, clinicians, staff, and volunteers who were part of the response. The interviews were thematically analyzed, and emergent themes mapped onto the nine pillars of integrated care. The ETHP pandemic response evolved rapidly. Early siloed responses gave way to collaborative efforts and equity emerged as a central priority. New alliances formed, resources were shared, leaders emerged, and community members stepped forward to contribute. Interviewees identified positives as well as many opportunities for improvement post-pandemic. The pandemic was a catalyst for change in East Toronto that accelerated existing initiatives to achieve integrated care. The East Toronto experience may serve as a useful guide for other emerging integrated care systems.

While religious communities often stress the universal nature of their beliefs, it remains true that people choose to worship alongside those they identify with most easily. Multiethnic churches are rare in the United States, but as American attitudes toward diversity change, so too does the appeal of a church that offers diversity. Joining such a community, however, is uncomfortable — worshippers must literally cross the barriers of ethnic difference by entering the religious space of the ethnically “other”. Using the story of one multiethnic congregation in Southern California, this book examines what it means to confront the challenges in forming a religious community across ethnic divisions and attracting a more varied membership.