scholarly journals Use of Oral and Implantable Naltrexone in the Management of the Opioid-Impaired Physician

2003 ◽  
Vol 31 (2) ◽  
pp. 196-201 ◽  
Author(s):  
G. K. Hulse ◽  
G. O'Neil ◽  
M. Hatton ◽  
M. J. Paech
Keyword(s):  
Previous Treatment ◽  
Opioid Antagonist ◽  
Opioid Use ◽  
Medical Board ◽  
Prescription Drug Use ◽  
Increased Risk ◽  
Oral Naltrexone ◽  
Patients At Risk ◽  
Ongoing Monitoring

Doctors are at an increased risk for prescription drug use, particularly opioids and benzodiazpines. This use can interfere with work function and has major potential negative implications for patient safety. Oral naltrexone, an opioid antagonist, has been used as part of a management strategy for opioid-dependent physicians. While some patients stabilize on oral naltrexone, others relapse to opioid use. An alternative method of naltrexone maintenance involves the injection or surgical insertion of a sustained release preparation of naltrexone. This approach dramatically improves compliance, removing the onus from the previously opioid impaired physician to use daily oral naltrexone. This article describes the cases of four opioid-impaired doctors who received naltrexone (either oral or implant) as part of their management. The authors conclude that monitoring daily oral naltrexone use and detecting early opioid relapse is difficult, placing both the opioid impaired physician and their patients at risk. In contrast, by using implantable naltrexone, compliance is assured and opioid abstinence can virtually be guaranteed for five months. It is argued that naltrexone implants offer a level of protection not achieved with any previous treatment. It is recommended that management should involve early and close collaboration between the treating doctor and the Medical Board, with initial treatment, ongoing monitoring and follow-up being a Medical Board requirement for registration.

scholarly journals Factors associated with being lost to follow-up before completing tuberculosis treatment: analysis of surveillance data

2012 ◽  
Vol 141 (6) ◽  
pp. 1223-1231 ◽  
Author(s):  
E. R. C. MILLETT ◽  
D. NOEL ◽  
P. MANGTANI ◽  
I. ABUBAKAR ◽  
M. E. KRUIJSHAAR
Keyword(s):  
Surveillance Data ◽  
Sputum Smear ◽  
Tuberculosis Patients ◽  
Factors Associated ◽  
Increased Risk ◽  
Patients At Risk ◽  
Treatment Analysis ◽  
The Uk ◽  
Lost To Follow Up

SUMMARYCompletion of treatment is key to tuberculosis control. Using national surveillance data we assessed factors associated with tuberculosis patients being lost to follow-up before completing treatment (‘lost’). Patients reported in England, Wales and Northern Ireland between 2001 and 2007 who were lost 12 months after beginning treatment were compared to those who completed, or were still on treatment, using univariable and multivariable logistic regression. Of 41 120 patients, men [adjusted odds ratio (aOR) 1·29; 95% confidence interval (CI) 1·23–1·35], 15- to 44-year-olds (P<0·001), and patients with pulmonary sputum smear-positive disease (aOR 1·25, 95% CI 1·12–1·45) were at higher risk of being lost. Those recently arrived in the UK were also at increased risk, particularly those of the White ethnic group (aOR 6·39, 95% CI 4·46–9·14). Finally, lost patients had a higher risk of drug resistance (aOR 1·41, 95% CI 1·17–1·69). Patients at risk of being lost require enhanced case management and novel case retention methods are needed to prevent this group contributing towards onward transmission.

scholarly journals Increased risk of Graves´ophthalmopathy in patients with increasing TRAb after radioiodine treatment and the impact of CTLA4 on TRAb titres

Endocrine ◽  
2021 ◽  
Author(s):  
Bushra Shahida ◽  
Kleoniki Tsoumani ◽  
Tereza Planck ◽  
Vijayachitra Modhukur ◽  
Pernilla Asp ◽  
...  
Keyword(s):  
Previous Treatment ◽  
University Hospital ◽  
Risk Genes ◽  
Graves Ophthalmopathy ◽  
Increased Risk ◽  
Orbital Tissue ◽  
The Impact ◽  
The Relationship ◽  
Hospital Clinic

Abstract Introduction Treatment of Graves´ disease (GD) with radioiodine increases the risk of developing Graves´ ophthalmopathy (GO), and the link between thyroid and orbital tissue may be the presence of TSH-receptors. Radioiodine increases the titers of TRAb and the aim was to investigate the relationship between GO and TRAb titers after treatment with radioiodine and to define the impact of risk genes. Methods GD patients without ophthalmopathy or previous treatment with radioiodine were prospectively included at treatment with radioiodine for hyperthyroidism. A follow-up was performed 1 year later for the registration of GO development. The study was performed at a University Hospital Clinic; a referral center of all patients treated with radioiodine in the south of Sweden. The main outcome measures were the development of TRAb, anti-TPO, and anti-TG after 3 months and GO after 12 months and relationship to the genetic background (HLA, CTLA-4, and CYR61). Results Three months of radioiodine TRAb titers increased in two thirds of patients (p < 0.0005) but not in the other third. Anti-TPO titers were associated with TRAb (R = 0.362, p < 0.0001) but not anti-TG. At follow-up 1 year later (n = 204) 32 patients developed GO with a proportion of 70% in the group increasing in TRAb titers and 30% in the group with unchanged or lower TRAb titers (p-value < 0.0005). Patients with GO had higher titers of TRAb than patients without GO. CTLA-4 (rs231775 SNP) was significantly (p < 0.005) associated with TRAb titers above the median three months after radioiodine. Conclusions The increase in TRAb titers after treatment with radioiodine is associated with GO and a genetic variation in CTLA-4 is associated with higher titers of TRAb.

scholarly journals Increased Risk of Graves´ophthalmopathy in Patients With Increasing TRAb After Radioiodine Treatment and the Impact of CTLA4 on TRAb Titres

2021 ◽  
Author(s):  
Bushra Shahida ◽  
Kleoniki Tsoumani ◽  
Tereza Planck ◽  
Vijayachitra Modhukur ◽  
Pernilla Asp ◽  
...  
Keyword(s):  
Previous Treatment ◽  
University Hospital ◽  
P Value ◽  
Graves Ophthalmopathy ◽  
Increased Risk ◽  
Orbital Tissue ◽  
One Year ◽  
The Impact ◽  
The Relationship

Abstract Introduction. Treatment of Graves´ disease (GD) with radioiodine increases the risk of developing Graves´ ophthalmopathy (GO) but the link between thyroid and orbital tissue remains undefined.The aim was to investigate the relationship between GO and TRAb after treatment with radioiodine and to define the impact of risk genes.Methods. GD patients without ophthalmopathy or previous treatment with radioiodine were prospectively included at treatment with radioiodine for hyperthyroidism. A follow-up was performed one year later for registration of GO development. The study was performed at a University Hospital Clinic; referral center of all patients treated with radioiodine in the south of Sweden. The main outcome measures were development of TRAb, anti-TPO, anti-TG after three months and GO after 12 months and relationship to the genetic background (HLA, CTLA-4, CYR61).Results. Three months of radioiodine TRAb increased in two thirds of patients (p<0.0005) but not in the other third. Anti-TPO was associated with TRAb (R=0.362, p <0.0001) but not anti-TG. At follow-up one year later (n=204) 32 patients developed GO with a proportion of 70% in the group increasing in TRAb and 30 % in the group with unchanged or lower TRAb (p-value <0.0005). Patients with GO had higher levels of TRAb than patients without GO. CTLA-4 (rs231775 SNP) was significantly (p<0.005) associated with TRAb levels above the median three months after radioiodine.Conclusions. The increase in TRAb after treatment with radioiodine is associated with GO and a genetic variation in CTLA-4 is associated with higher levels of TRAb.

Scaphotrapeziotrapezoid Arthrodesis: A 10-Year Follow-up Study of Complications in 58 Wrists

Hand ◽  
2020 ◽  
pp. 155894472096497
Author(s):  
Miranda J. Rogers ◽  
Chao-Chin Lu ◽  
Andrew R. Stephens ◽  
Brittany N. Garcia ◽  
Wei Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Smoking History ◽  
Fixation Method ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Factors Associated ◽  
Increased Risk ◽  
Stt Arthrodesis

Background: Scaphotrapeziotrapezoid (STT) arthrodesis is a procedure used for specific degenerative arthritis and instability patterns of the wrist. This study evaluates nonunion rate and risk factors for reoperation after STT arthrodesis in the Veterans Affairs Department patient population. The purpose of our study was to assess the long-term nonunion rate following STT arthrodesis and to identify factors associated with reoperation. Methods: The national Veterans Health Administration Corporate Data Warehouse and Current Procedural Terminology codes identified STT arthrodesis procedures from 1995 to 2016. Frequencies of total wrist arthrodesis (TWA) and secondary operations were determined. Univariate analyses provided odds ratios for risk factors associated with complications. Results: Fifty-eight STT arthrodeses were performed in 54 patients with a mean follow-up of 120 months. Kirschner wires (K-wires) were the most common fixation method (69%). Six wrists (10%) required secondary procedures: 5 TWAs and 1 revision STT arthrodesis. Four patients underwent additional procedures for nonunion (7%). Twenty-four patients required K-wire removal, 8 (14%) of these in the operating room, which were not included in regression analysis. Every increase in 1 year of age resulted in a 15% decrease in likelihood of reoperation (95% confidence interval: 0.77-0.93; P < .0001). Opioid use within 90 days before surgery ( P = 1.00), positive smoking history ( P = 1.00), race ( P = .30), comorbidity count ( P = .25), and body mass index ( P = .19) were not associated with increased risk of reoperation. Conclusions: At a mean follow-up of 10 years, patients undergoing STT arthrodesis have a 10% risk of reoperation, and this risk decreases with older patient age. There was a symptomatic nonunion rate of 7%, similar to prior published rates. Patient demographics, comorbidity, smoking history, and opioid use did not appear to increase risk of reoperation.

Anthracycline-Induced Clinical Heart Failure in a Cohort of 607 Children: Long-Term Follow-Up Study

2001 ◽  
Vol 19 (1) ◽  
pp. 191-196 ◽  
Author(s):  
L. C.M. Kremer ◽  
E. C. van Dalen ◽  
M. Offringa ◽  
J. Ottenkamp ◽  
P. A. Voûte
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Cumulative Dose ◽  
Cumulative Incidence ◽  
Clinical Status ◽  
Young Patients ◽  
Increased Risk ◽  
Patients At Risk ◽  
Clinical Heart Failure

PURPOSE: To determine the early and late cumulative incidence of anthracycline-induced clinical heart failure (A-CHF) after anthracycline therapy in childhood and to identify associated risk factors. PATIENTS AND METHODS: The cumulative incidence of A-CHF and the risk factors of A-CHF were assessed in a cohort of 607 children who had been treated with anthracyclines between 1976 and 1996. For 96% of the cohort, we obtained the clinical status up to at least January 1997. The mean follow-up time was 6.3 years. RESULTS: The cumulative incidence of A-CHF was 2.8%, after a mean follow-up time of 6.3 years and a mean cumulative dose of anthracyclines of 301 mg/m2. A cumulative dose of anthracycline higher than 300 mg/m2 was associated with an increased risk of A-CHF (relative risk, 11.8; 95% confidence interval, 1.6 to 59.5) compared with a cumulative dose lower than 300 mg/m2. The estimated risk of A-CHF increased with time after the start of anthracycline chemotherapy to 2% after 2 years and 5% after 15 years. CONCLUSION: Up to 5% of patients will develop A-CHF 15 years after treatment, and patients treated with a cumulative dose of anthracyclines higher than 300 mg/m2 are at highest risk for A-CHF. This is thus a considerable and serious problem among these young patients. The findings reinforce the need for strategies for early detection of patients at risk for A-CHF and for the evaluation of other chemotherapeutic possibilities or cardioprotective agents in relation to the survival.

scholarly journals Long-Acting Injectable naltrexone for the Management of patients with Opioid Dependence

2011 ◽  
Vol 5 ◽  
pp. SART.S5452 ◽  
Author(s):  
Kimberly L. Kjome ◽  
F. Gerard Moeller
Keyword(s):  
Treatment Adherence ◽  
Opioid Dependence ◽  
Opioid Antagonist ◽  
Published Data ◽  
Remission Maintenance ◽  
Increased Risk ◽  
Oral Naltrexone ◽  
Poor Treatment ◽  
Naltrexone Treatment ◽  
Long Acting

Opioid dependence is a condition with serious clinical ramifications. Treatment has focused on detoxification, agonist therapy with methadone or buprenorphine, or remission maintenance with the opioid antagonist, naltrexone. Treatment with oral naltrexone has been limited by poor treatment adherence and relapse. Studies with long-acting formulations have shown increased treatment adherence. Extended-release injectable naltrexone has been used for the treatment of alcohol dependence, and has recently received an indication for treatment of opioid dependence from the US Food and Drug Administration. Dosing occurs once monthly and existing data with long-acting naltrexone supports efficacy of treatment for opioid dependence; however published data is sparse. Treatment with long-acting naltrexone should be monitored for hepatotoxicity, and patients should be made aware of increased risk of overdose with administration of opioids during and immediately after discontinuation of long-acting naltrexone.

scholarly journals NALTREXONE ASSOCIATED SEIZURE: A CASE REPORT

2021 ◽  
pp. 1-2
Author(s):  
Rajdip Barman ◽  
Pradipta Majumder ◽  
Varun Sharma
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Alcohol Use Disorder ◽  
Opioid Use Disorder ◽  
Opioid Antagonist ◽  
Opioid Use ◽  
Oral Naltrexone ◽  
Rare Side Effect ◽  
Gastrointestinal Side Effects ◽  
Long Acting

Naltrexone is an opioid antagonist prescribed to treat opioid use disorder and as an anti-craving medication for alcohol use disorder. Gastrointestinal side effects are considered the most common, and liver damage is a serious and rare side effect of naltrexone. In this case report, we describe a 40-year-old patient who developed a seizure after initiating treatment with naltrexone. Although the mechanism is not clear as naltrexone is not a well-known pro-convulsant medication, a few hypotheses for association with seizure have been postulated based on the studies on opioid agonists and similar opioid antagonist naloxone. Based on this case report, we strongly recommend that clinicians should thoroughly assess the risk factors for seizures in patients before using naltrexone and start long-acting injectable naltrexone only after an adequate trial of oral naltrexone to minimize the risk of seizure.

scholarly journals The LACE Score as a Tool to Identify Radical Cystectomy Patients at Increased Risk of 90-Day Readmission and Mortality

2018 ◽  
Vol 12 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Jennifer L. Saluk ◽  
Robert H. Blackwell ◽  
William S. Gange ◽  
Matthew A. C. Zapf ◽  
Anai N. Kothari ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
High Risk ◽  
Radical Cystectomy ◽  
Multivariable Analysis ◽  
Emergency Department Visits ◽  
High Risk Patients ◽  
Increased Risk ◽  
Patients At Risk ◽  
Risk Patients

Introduction: Radical cystectomy for bladder cancer is associated with high rates of readmission. We investigated the LACE score, a validated prediction tool for readmission and mortality, in the radical cystectomy population. Materials &amp; Methods: Patients who underwent radical cystectomy for bladder cancer were identified by ICD-9 codes from the Healthcare Cost and Utilization Project State Inpatient Database for California years 2007-2010. The LACE score was calculated as previously described, with components of L: length of stay, A: acuity of admission, C: comorbidity, and E: number of emergency department visits within 6 months preceding surgery. Results: Of 3,470 radical cystectomy patients, 638 (18.4%) experienced 90-day readmission, and 160 (4.6%) 90-day mortality. At a previously validated “high-risk” LACE score ≥ 10, patients experienced an increased risk of 90-day readmission (22.8 vs. 17.7%, p = 0.002) and mortality (9.1 vs. 3.5%, p < 0.001). On adjusted multivariable analysis, “high risk” patients by LACE score had increased 90-day odds of readmission (adjusted OR = 1.24, 95% CI: 0.99-1.54, p = 0.050) and mortality (adjusted OR = 2.09, 95% CI: 1.47-2.99, p < 0.001). Conclusion: The LACE score reasonably identifies patients at risk for 90-day mortality following radical cystectomy, but only poorly predicts readmission. Providers may use the LACE score to target high-risk patients for closer follow-up or intervention.

scholarly journals Urinary Markers of Tubular Injury in HIV-Infected Patients

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Temesgen Fiseha ◽  
Angesom Gebreweld
Keyword(s):  
Renal Disease ◽  
Patient Outcomes ◽  
Renal Involvement ◽  
Tubular Injury ◽  
Accurate Identification ◽  
Urinary Markers ◽  
Increased Risk ◽  
Patients At Risk ◽  
Improve Patient

Renal disease is a common complication of HIV-infected patients, associated with increased risk of cardiovascular events, progression to AIDS, AIDS-defining illness, and mortality. Early and accurate identification of renal disease is therefore crucial to improve patient outcomes. The use of serum creatinine, along with proteinuria, to detect renal involvement is essentially to screen for markers of glomerular disease and may not be effective in detecting earlier stages of renal injury. Therefore, more sensitive and specific markers are needed in order to early identify HIV-infected patients at risk of renal disease. This review article summarizes some new and important urinary markers of tubular injury in HIV-infected patients and their clinical usefulness in the renal safety follow-up of TDF-treated patients.

Opioid tapering after surgery: a qualitative study of patients’ experiences

2020 ◽  
Vol 20 (3) ◽  
pp. 555-563
Author(s):  
Peter Uhrbrand ◽  
Anne Phillipsen ◽  
Pia Dreyer ◽  
Lone Nikolajsen
Keyword(s):  
Qualitative Study ◽  
Health Care Professionals ◽  
Patient Involvement ◽  
Withdrawal Symptoms ◽  
Opioid Use ◽  
Daily Consumption ◽  
Opioid Dependency ◽  
Patients At Risk ◽  
Opioid Tapering

AbstractBackground and aimsPatients usually receive a prescription for morphine or another opioid at discharge after surgery. Several studies have shown that many patients do not step down but develop persistent opioid use following surgery. The purpose of this study was to gain insight of patients’ experiences with opioid tapering after surgery and to propose recommendations for clinicians to assist patients in opioid tapering.MethodsUsing a qualitative study design, 15 adult patients who took opioids before surgery and still had a daily consumption of opioids 6 months following spine surgery were interviewed.ResultsAnalyses of the transcripts identified three major themes and eight subthemes. The major themes were as follows: (1) The patients’ experienced that their whole life revolved around pain and opioids and felt stigmatized and suspected of being drug addicts by their social circle and health care professionals (2) Barriers for opioid tapering were increased pain, opioid dependency and fear of withdrawal symptoms (3) Motivational factors for opioid tapering were fear of dependency, the prospect of a better health, patient involvement in opioid tapering and a trusting relationship between patient and clinician.ConclusionsThe results of this study highlight that opioid tapering is challenging and may be influenced by many different factors. Some patients find opioid tapering particularly difficult and therefore need additional assistance in order to taper off successfully.ImplicationsFor opioid tapering to succeed, it is highly important to establish a trustful relationship with the patients, to take each patient’s personal circumstances into account and to address fears of increased pain and withdrawal symptoms. Clinicians should also focus on patient involvement in opioid tapering and consider to offer a follow-up after discharge to patients at risk for prolonged opioid use.

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