Preparing for Treatment: Getting Started With Integrative Behavioral Treatment Strategies for Managing Opioid Use

2019 ◽  
Author(s):  
Jennifer L. Murphy
Keyword(s):  
Behavioral Treatment ◽  
Treatment Strategies ◽  
Opioid Use

Modernizing Perinatal Substance Use Management

2020 ◽  
pp. 152715442098194
Author(s):  
Brayden N. Kameg
Keyword(s):  
Substance Use ◽  
Pregnant Women ◽  
Registered Nurses ◽  
Treatment Strategies ◽  
Analytical Framework ◽  
Prevention Policy ◽  
Opioid Use ◽  
Health Crisis ◽  
State Regulations ◽  
Control And Prevention

The increase in prescription and illicit opioid use since 2000 has become an urgent public health crisis. While the opioid epidemic spans racial, regional, and socioeconomic divides, women have surfaced as one demographic affected by opioid use and related sequelae. Certain federal and state regulations, secondary to the Child Abuse Prevention and Treatment Act, strip pregnant women with opioid use disorders of the ability to engage autonomously with their health care clinician while simultaneously impeding their ability to achieve and sustain recovery. The purpose of this article is to explore current health policy that impacts pregnant women who use opioids. Recommendations to improve care, broadly, will be highlighted to include access to contraceptive services, universal screening for perinatal substance use, and access to appropriate treatment strategies. Policy modifications to facilitate these recommendations are discussed. The Centers for Disease Control and Prevention Policy Analytical Framework was utilized to derive recommendations. The recommendations are relevant to advanced practice registered nurses and midwives who have the potential to treat substance use in women, to women’s health and pediatric registered nurses, and to nursing administrators who are involved in decision-making in obstetric and pediatric settings.

scholarly journals Online Opioid Stewardship Training for Long-Term Care Staff

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 533-533
Author(s):  
Linda Edelman ◽  
Troy Andersen ◽  
Cherie Brunker ◽  
Nicholas Cox ◽  
Jorie Butler ◽  
...  
Keyword(s):  
Staff Training ◽  
Long Term Care ◽  
Treatment Strategies ◽  
Care Staff ◽  
Video Content ◽  
Opioid Use ◽  
Term Care ◽  
Increased Risk ◽  
Pain Management Strategy

Abstract Opioids are often the first-line chronic pain management strategy for long-term care (LTC) residents who are also at increased risk for opioid-related adverse events. Therefore, there is a need to train LTC providers and staff about appropriate opioid use and alternative treatment strategies. Our interdisciplinary team worked with LTC partners to identify staff educational needs around opioid stewardship. Based on this need’s assessment, we developed eight modules about opioid use and risks for older adults, including those with dementia, recommendations for de-prescribing including other pharmacological and non-pharmacological alternatives, SBIRT, and motivational interviewing to determine “what matters”. Each 20-minute module contains didactic and video content that is appropriate for group staff training or individuals and provides rural LTC facilities access to needed training in their home communities. Within the first month of launching online, the program received over 1100 hits and LTC partners are incorporating modules into clinical staff training schedules.

How Can Speech-Language Pathologists Think About Sensation During Swallowing Evaluation and Intervention?

2021 ◽  
pp. 1-11
Author(s):  
Aarthi Madhavan ◽  
Nicole M. Etter
Keyword(s):  
Behavioral Treatment ◽  
Sensory Information ◽  
Treatment Strategies ◽  
Clinical Importance ◽  
Functional Results ◽  
Future Research ◽  
Speech Language Pathologists ◽  
Swallowing Evaluation ◽  
Assessment And Treatment ◽  
Swallowing Assessment

Purpose Both the enjoyment of foods and safe swallowing revolve around incorporating multiple streams of sensory feedback to form a positive sensory experience; these include information about the taste, smell, texture, temperature, and even the sight of food. Traditional swallowing assessment and treatment paradigms have primarily focused on the motor aspects of swallowing. However, sensory information is vital for not only enjoying foods while eating but also coordinating safe and efficient swallow behaviors. The purpose of this clinical focus article is to discuss the clinical importance of sensation in swallowing evaluation and intervention. Conclusions During their clinical assessments of swallowing, speech-language pathologists are already documenting the functional results of oropharyngeal sensorimotor impairments (e.g., residue). A combination of sensory and motor aspects is already integrated within current behavioral treatment strategies for dysphagia. Focused attention to the salient sensory features of swallowing has the potential to improve swallowing evaluation and intervention efforts. A discussion of potential future research in improved measurement and documentation of altered sensation is provided.

scholarly journals 213. A Comparison of Medication Assisted Therapy Treatment Strategies for Opioid Use Disorder in Persons who Inject Drugs and are Hospitalized with Serious Infections

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S126-S126
Author(s):  
Laura Marks ◽  
Evan Schwarz ◽  
David Liss ◽  
Munigala Satish ◽  
David K Warren ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Hospital Readmissions ◽  
Treatment Strategies ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Readmission Rates ◽  
Persons Who Inject Drugs ◽  
Increased Risk ◽  
Hospital Patients ◽  
The Impact

Abstract Background Persons who inject drugs (PWID) with opioid use disorder (OUD) are at increased risk of invasive bacterial and fungal infections, which warrant prolonged, inpatient parenteral antimicrobial therapy. Such admissions are complicated by opioid cravings and withdrawal. Comparisons of medications for OUD during prolonged admissions for these patients have not been previously reported. The aim of this study was to evaluate the impact of different OUD treatment strategies in this population, and their impact on ED and hospital readmissions. Methods We retrospectively analyzed consecutive admissions for invasive bacterial or fungal infections in PWID, admitted between January 2016 and January 2019 at Barnes-Jewish Hospital. Patients in our cohort were required to receive an infectious diseases consult, and an anticipated antibiotic treatment duration of >2 weeks. We collected data on demographics, comorbidities, length of stay, microbiologic data, medications prescribed for OUD, mortality, and readmission rates. We compared 90-day readmission rates by OUD treatment strategies using Kaplan–Meier curves. Results In our cohort of 237 patients, treatment of OUD was buprenorphine (17.5%), methadone (25.3%), or none (56.2%). Among patients receiving OUD treatment, 30% had methadone tapers and/or methadone discontinued upon discharge. Patient demographics were similar for each OUD treatment strategy. Infection with HIV (2.8%), and hepatitis B (3%), and hepatitis C (67%) were similar between groups. Continuation of medications for OUD was associated with increased completion of parenteral antibiotics (odds ratio 2.11; 95% confidence interval 1.70–2.63). When comparing medications for OUD strategies, methadone had the lowest readmission rates, followed by buprenorphine, and no treatment (P = 0.0013) (figure). Discontinuation of methadone during the admission or upon discharge was associated with the highest readmission rates. Conclusion Continuation of OUD treatment without tapering, was associated with improved completion of parenteral antimicrobials in PWID with invasive bacterial or fungal infections lower readmission rates. Tapering OUD treatment during admission was associated with higher readmission rates. Disclosures All authors: No reported disclosures.

Reward Circuits and Apathy in Schizophrenia: Neuroimaging and Treatment Strategies

2017 ◽  
Vol 41 (S1) ◽  
pp. S58-S58
Author(s):  
A. Aleman
Keyword(s):  
Behavioral Treatment ◽  
Negative Symptoms ◽  
Meta Analysis ◽  
Critical Role ◽  
Unmet Need ◽  
Treatment Strategies ◽  
Reward Processing ◽  
Motivated Behavior ◽  
Novel Treatment Strategies ◽  
Quantitative Integration

Approximately 50% of patients with schizophrenia shows deficits in motivation and initiation of goal-directed behavior, which are suggestive of reward system dysfunction. We conducted a meta-analysis of neuroimaging studies reporting on the neural correlates of reward processing and negative symptoms in schizophrenia. A significant mean weighted correlation was observerd, revealing deficits in activation of reward neurocircuitry. A more specific findings is comprised activation of the ventral striatum, involved in anticipation of reward, and structures that play a critical role in the ability to represent the value of outcomes and plans. In a study of VTA connectivity in the resting state in a large group of patients with schizophrenia, we found reduced connectivity with lateral prefrontal, temporal and parietal regions to be associated with higher degrees of apathy. Apathy belongs to the most debilitating symptoms of schizophrenia and represents a significant unmet need in its treatment. Quantitative integration of published findings suggests that treatment with noninvasive magnetic brain stimulation can improve negative symptoms. Previous PET-studies have shown that such stimulation may target circuits with dopaminergic innervation. A behavioral treatment approach that may also target reward-related circuits will also be discussed briefly. It can be concluded that recent results regarding reward and motivated behavior in schizophrenia have clinical implications and may help develop novel treatment strategies.Disclosure of interestAA received speaker fees from Lundbeck.

scholarly journals Efficacy of Intraperitoneal Dexamethasone Infusion in Reduction of Shoulder Pain and Nausea/Vomiting After Gynecological Laparoscopy

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Behnaz Nouri ◽  
Maliheh Arab ◽  
Somaye Lotfpour
Keyword(s):  
Shoulder Pain ◽  
Intervention Group ◽  
Treatment Strategies ◽  
Postoperative Nausea And Vomiting ◽  
Study Groups ◽  
Opioid Use ◽  
Double Blind ◽  
Mean Values ◽  
Gynecological Laparoscopy ◽  
Surgery Duration

Background: The reduction of shoulder pain and postoperative nausea and vomiting (PONV), causing great discomfort for patients after gynecological laparoscopy, requires preventive or treatment strategies. Objectives: The present study aimed to determine the efficacy of intraperitoneal (IP) dexamethasone in the reduction of shoulder pain and PONV after gynecological laparoscopy. Methods: In this double-blind, randomized clinical trial, 130 consecutive patients undergoing gynecological laparoscopy were randomly assigned to two groups of 65 patients within May 2015 to May 2016. One group received 16 mg IP dexamethasone before the end of the surgery, and the other group received the placebo (i.e., the IP infusion of distilled water). Patients' age and body mass index (BMI), and surgery duration were recorded in this study. The severity of shoulder pain was evaluated by the visual analog scale (VAS) at recovery and 2, 6, 12, and 24 h after the surgery. Moreover, the need for opioid use and PONV were recorded within the first 24 h after the surgery. The study outcomes were compared between the two study groups and among the different intervals using SPSS software (version 21). Results: The groups had similar demographics (i.e., age and BMI) and mean surgery duration (P > 0.05). The mean values of VAS scores of the intervention group were lower than those of the placebo group at five intervals (P = 0.001). The frequency of opioid use was significantly lower in the dexamethasone group (P = 0.010). In addition, 20% and 60% of the patients in the dexamethasone and placebo groups had PONV, respectively (P < 0.001). Conclusions: The IP dexamethasone is effective in the reduction of shoulder pain and nausea/vomiting after gynecological laparoscopy and can significantly reduce opioid requirement within the first 24 h after surgery; however, IP dexamethasone does not increase surgery duration. Therefore, it is recommended to use this technique during gynecological laparoscopy.

scholarly journals Opioid Crisis: A Qualitative Analysis of Financial Influences and Addiction

2021 ◽  
Vol 4 (1) ◽  
pp. 16
Author(s):  
Nicole Naccarato ◽  
Noah Wacker ◽  
Lissa Gagnon
Keyword(s):  
Lived Experiences ◽  
Treatment Strategies ◽  
Population Data ◽  
Diverse Population ◽  
Opioid Use ◽  
Northern Ontario ◽  
Effective Prevention ◽  
Health Crisis ◽  
Public Health Crisis ◽  
Treatment Centre

The province of Ontario is currently engaged in a public health crisis centered around the use of opioids. As the number of opioid-related harms continues to grow, reports have identified a need for further investigation and understanding of opioid use.  The purpose of this qualitative study was to examine the differences in motives for opioid use amongst a diverse population. Data collection occurred by interviewing 14 participants at an Addictions Treatment Centre in Northern Ontario. Theoretical thematic analysis and an interpretive framework were used to analyze participants’ lived experiences with opioid use.  Analysis of the results revealed the theme of financial influence in addiction and recovery.  These insights are helpful in strengthening effective prevention and treatment strategies.  

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