scholarly journals Bringing Buprenorphine-Naloxone Detoxification to Community Treatment Providers: The NIDA Clinical Trials Network Field Experience

2004 ◽  
Vol 13 (s1) ◽  
pp. S42-S66 ◽  
Author(s):  
Leslie Amass ◽  
Walter Ling ◽  
Thomas E. Freese ◽  
Chris Reiber ◽  
Jeffrey J. Annon ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Field Experience ◽  
Community Treatment ◽  
Treatment Providers

scholarly journals Advancing the implementation and sustainment of medication assisted treatment for opioid use disorders in prisons and jails

2019 ◽  
Vol 7 (1) ◽  
Author(s):  
Warren J. Ferguson ◽  
Joan Johnston ◽  
Jennifer G. Clarke ◽  
Peter J. Koutoujian ◽  
Kathleen Maurer ◽  
...  
Keyword(s):  
Care Coordination ◽  
Institutional Design ◽  
Medical Condition ◽  
Training Group ◽  
Opioid Use Disorder ◽  
Community Treatment ◽  
Opioid Use ◽  
Treatment Protocols ◽  
Treatment Providers ◽  
Opioid Use Disorders

Abstract Background Opioid use disorder (OUD) is among the most prevalent medical condition experienced by incarcerated persons, yet medication assisted therapy (MAT) is uncommon. Four jail and prison systems partnered with researchers to document their adoption of MAT for incarcerated individuals with opioid use disorders (OUD) using their established treatment protocols. Employing the EPIS (Exploration, Planning, Implementation, and Sustainment) framework, programs report on systematic efforts to expand screening, treatment and provide linkage to community-based care upon release. Results All four systems were engaged with implementation of MAT at the outset of the study. Thus, findings focus more on uptake and penetration as part of implementation and sustainment of medication treatment. The prevalence of OUD during any given month ranged from 28 to 65% of the population in the participating facilities. All programs developed consistent approaches to screen individuals at intake and provided care coordination with community treatment providers at the time of release. The proportion of individuals with OUD who received MAT ranged considerably from 9 to 61%. Despite efforts at all four sites to increase utilization of MAT, only one site achieved sustained growth in the proportion of individuals treated over the course of the project. Government leadership, dedicated funding and collaboration with community treatment providers were deemed essential to adoption of MAT during implementation phases. Facilitators for MAT included increases in staffing and staff training; group education on medication assisted therapies; use of data to drive change processes; coordination with other elements of the criminal justice system to expand care; and ongoing contact with individuals post-release to encourage continued treatment. Barriers included lack of funding and space and institutional design; challenges in changing the cultural perception of all approved treatments; excluding or discontinuing treatment based on patient factors, movement or transfer of individuals; and inability to sustain care coordination at the time of release. Conclusions Adoption of evidence-based medication assisted therapies for OUD in prisons and jails can be accomplished but requires persistent effort to identify and overcome challenges and dedicated funding to sustain programs.

scholarly journals Developing effective interorganizational relationships between community corrections and community treatment providers

2016 ◽  
Vol 55 (7) ◽  
pp. 484-501 ◽  
Author(s):  
Laura B. Monico ◽  
Shannon Gwin Mitchell ◽  
Wayne Welsh ◽  
Nathan Link ◽  
Leah Hamilton ◽  
...  
Keyword(s):  
Interorganizational Relationships ◽  
Community Corrections ◽  
Community Treatment ◽  
Treatment Providers

Blinding in randomised clinical trials of psychological interventions: a retrospective study of published trial reports

2020 ◽  
pp. bmjebm-2020-111407
Author(s):  
Sophie Juul ◽  
Christian Gluud ◽  
Sebastian Simonsen ◽  
Frederik Weischer Frandsen ◽  
Irving Kirsch ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Retrospective Study ◽  
Null Hypothesis ◽  
Primary Outcome ◽  
Randomised Clinical Trials ◽  
Psychological Interventions ◽  
Potential Bias ◽  
Treatment Providers ◽  
Monitoring Committee ◽  
Bias Risk

ObjectivesTo study the extent of blinding in randomised clinical trials of psychological interventions and the interpretative considerations if randomised clinical trials are not blinded.DesignRetrospective study of trial reports published in six high impact factor journals within the field of psychiatry in 2017 and 2018.SettingTrial reports published in World Psychiatry, JAMA Psychiatry, Lancet Psychiatry, American Journal of Psychiatry, British Journal of Psychiatry, or Psychotherapy and Psychosomatics.Main outcome measuresBlinding status of participants, treatment providers, outcome assessors, data managers, the data safety and monitoring committee, statisticians and conclusion makers, if trialists rejected the null hypothesis on the primary outcome measure, and if trialists discussed the potential bias risk from lack of blinding in the published trial report.Results63 randomised clinical trials of psychological interventions were identified. None (0%; 95% CI 0% to 5.75%) of the trials reported blinding of all possible key persons. 37 (58.7%; 95% CI 46.42% to 70.04%) trials reported blinding of outcome assessors. Two (3.2%; 95% CI 0.87% to 10.86%) trials reported blinding of participants. Two (3.2%; 95% CI 0.87% to 10.86%) trials reported blinding of data managers. Three (4.8%; 95% CI 1.63% to 13.09%) trials reported blinding of statisticians. None of the trials reported blinding of treatment providers, the data safety and monitoring committee, and conclusion makers. 45 (71.4%; 95% CI 59.30% to 81.10%) trials rejected the null hypothesis on the primary outcome(s). 13 (20.7%; 95% CI 12.48% to 32.17%) trials discussed the potential bias risk from lack of blinding in the published trial report.ConclusionsBlinding of key persons involved in randomised clinical trials of psychological interventions is rarely sufficiently documented. The possible interpretative limitations are only rarely considered. There is a need of randomised clinical trials of psychological interventions with documented blinding attempts of all possible key persons.

scholarly journals The NIDA clinical trials network: evolving, expanding, and addressing the opioid epidemic

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Betty Tai ◽  
Ronald Dobbins ◽  
Quandra Blackeney ◽  
David Liu ◽  
Landhing Moran
Keyword(s):  
Clinical Trials ◽  
Substance Use ◽  
Drug Abuse ◽  
Task Force ◽  
Research Priorities ◽  
Workforce Training ◽  
Opioid Epidemic ◽  
Opioid Use ◽  
Treatment Providers ◽  
Abuse Treatment

AbstractOver the past two decades, the National Drug Abuse Treatment Clinical Trials Network (CTN), a program of the National Institute on Drug Abuse (NIDA), has expanded from the initial six Nodes to 16 Nodes, as a nationwide consortium of research scientists and treatment providers working together to improve care for substance use in the nation’s communities. Encompassing both specialty care programs and general medical settings, the Network has become a unique resource for expertise on clinically focused research, bridging the gap between research and treatment delivery. Over 22 years, the CTN has completed 101 studies, resulting in 650 publications. In response to the opioid epidemic, a CTN task force generated a comprehensive list of research priorities in the areas of prevention, treatment, knowledge dissemination, and workforce training, to form the basis of the Network’s opioid portfolio. The Network’s opioid portfolio currently includes five main categories of studies: (1) large multi-site studies; (2) studies aimed at closing the treatment gap; (3) expansion of ongoing studies to improve service delivery and implementation; (4) studies to explore the use of substance use data in electronic health record systems; (5) training and dissemination projects to expand the research/health care provider workforce. With funding from the Helping to End Addiction Long-Term InitiativeSM (HEAL), the CTN established five new Nodes, which, along with the pre-existing Nodes, are distributed in every region of the nation and engage researchers and clinicians in areas that have been among the hardest hit by the opioid epidemic. Through this expanded network and its commitment to developing personalized, evidence-based treatments, the CTN is poised to address and provide solutions for the ongoing epidemic of opioid use and addiction.

scholarly journals The Place of Adoption in the NIDA Clinical Trials Network

2008 ◽  
Vol 38 (4) ◽  
pp. 1083-1104 ◽  
Author(s):  
Martha A. Jessup ◽  
Joseph Guydish ◽  
Sarah Turcotte Manser ◽  
Barbara Tajima
Keyword(s):  
Clinical Trials ◽  
Drug Abuse ◽  
Observational Research ◽  
Drug Abuse Treatment ◽  
Evidence Based ◽  
Treatment Interventions ◽  
Treatment Providers ◽  
Research Findings ◽  
Post Trial ◽  
Abuse Treatment

The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) was established in 1999 to determine effectiveness of drug abuse treatment interventions among diverse client populations and settings. To address dissemination of research findings, the CTN also has as its mission the transfer of research findings to treatment providers. In a qualitative study of adoption of evidence-based practice in the context of two CTN clinical trials, we interviewed 29 participants from seven organizational levels of the multisite study organization about post-trial adoption, their role in the clinical trial, and interactions between the research initiative and clinic staff and setting. Analysis of interview data revealed a range of opinion among participants on the place of adoption within the CTN. Innovation within the CTN to support adoption and further observational research on dynamics of adoption within the CTN can increase dissemination of evidence-based drug abuse treatment interventions in the future.

scholarly journals Ten years of implementation: Assertive Community Treatment and Integrated Dual Disorder Treatment in a statewide system

2019 ◽  
Vol 3 (2) ◽  
Author(s):  
Jennifer Ellen Harrison ◽  
Holli Taylor
Keyword(s):  
Assertive Community Treatment ◽  
Research Policy ◽  
Systems Of Care ◽  
Lessons Learned ◽  
Community Treatment ◽  
Treatment Providers ◽  
Dual Disorder ◽  
Disorder Treatment ◽  
Integrated Dual Disorder Treatment ◽  
Dual Disorder Treatment

The prevalence and seriousness of co-occurring mental health and substance use disorders are significant public health issues facing our communities. Individuals with co-occurring disorders have worse outcomes in important areas, including physical health, employment, incarceration, and housing, and are often more difficult to engage in effective treatment. Equally important, however, are the multiple examples of impressive recovery journeys for individuals with even the most severe co-occurring illnesses, often in collaboration with treatment providers who support that recovery. Implementation and sustainability of evidence-based practices, which are associated with improved outcomes in areas of hospitalization, incarceration, employment, and treatment engagement, is an individual recovery and policy imperative. Yet, the implementation of these complex practices involving multiple practitioners from different disciplines can be challenging for systems of care. Training, systemic changes, and fidelity monitoring can be components to enhance implementation. In one state, the implementation, support, and fidelity measurement of two multi-disciplinary practices for the treatment of co-disorders, Integrated Dual Disorder Treatment (IDDT) and Assertive Community Treatment (ACT), is studied. Iterative steps to implementation over a ten-year period are examined. Lessons learned for research, policy, and training of teams to assist people in achieving recovery are reviewed.

scholarly journals What have we learnt from 40 years of research on Intensive Case Management?

2008 ◽  
Vol 17 (2) ◽  
pp. 106-109 ◽  
Author(s):  
Max Marshall
Keyword(s):  
Clinical Trials ◽  
Case Management ◽  
Assertive Community Treatment ◽  
Complex Interventions ◽  
Community Treatment ◽  
Successful Outcome ◽  
Control Group ◽  
Intensive Case Management ◽  
Treatment Model ◽  
Process Of Care

AbstractThe aims of the Editorial are to summarise what we know for certain from clinical trials of Intensive Case Management, and to highlight lessons for clinicians and researchers. I will upon two systematic reviews of trials of Intensive Case Management versus standard care or low intensity case management. Both incorporated a meta-regression which examined the effect of fidelity to the Assertive Community Treatment model on outcome. The effectiveness of Intensive Case Management was limited to improving patient satisfaction and reducing attrition. Intensive Case Management teams organised according to the Assertive Community Treatment model offered the additional benefit of reducing days in hospital, but only when the team's clients had been high users of hospital care over the previous 12 months. Four important lessons can be drawn: a) Changes to the process of care tend to affect process variables, not outcome variables. b) Complex interventions must be defined meticulously in clear terminology. c) Researchers must demonstrate that complex interventions have been properly implemented in clinical trials. d) It is important to remember that in a clinical trial a successful outcome is determined as much by the control group as by the intervention.

Localization of Gallium-67 in Peritoneal Cells by Electron Microscopic Autoradiography

1973 ◽  
Vol 31 ◽  
pp. 404-405
Author(s):  
D. C. Swartzendruber ◽  
Norma L. Idoyaga-Vargas
Keyword(s):  
Clinical Trials ◽  
Soft Tissue ◽  
Tumor Tissue ◽  
Soft Tissue Tumors ◽  
Clinical Usefulness ◽  
Electron Microscopic ◽  
Normal Cells ◽  
Electron Microscopic Autoradiography ◽  
Peritoneal Cells ◽  
Gallium 67

The radionuclide gallium-67 (67Ga) localizes preferentially but not specifically in many human and experimental soft-tissue tumors. Because of this localization, 67Ga is used in clinical trials to detect humar. cancers by external scintiscanning methods. However, the fact that 67Ga does not localize specifically in tumors requires for its eventual clinical usefulness a fuller understanding of the mechanisms that control its deposition in both malignant and normal cells. We have previously reported that 67Ga localizes in lysosomal-like bodies, notably, although not exclusively, in macrophages of the spocytaneous AKR thymoma. Further studies on the uptake of 67Ga by macrophages are needed to determine whether there are factors related to malignancy that might alter the localization of 67Ga in these cells and thus provide clues to discovering the mechanism of 67Ga localization in tumor tissue.

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