scholarly journals Clinical leaders and providers’ perspectives on delivering medications for the treatment of opioid use disorder in Veteran Affairs’ facilities

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Eric J. Hawkins ◽  
Anissa N. Danner ◽  
Carol A. Malte ◽  
Brittany E. Blanchard ◽  
Emily C. Williams ◽  
...  
Keyword(s):  
Opioid Use Disorder ◽  
Opioid Use ◽  
Implementation Barriers ◽  
Mental Health Clinics ◽  
Time Points ◽  
Negative Beliefs ◽  
National Priority ◽  
Medical Facilities ◽  
Over Time

Abstract Background Improving access to medication treatment of opioid use disorder (MOUD) is a national priority, yet common modifiable barriers (e.g., limited provider knowledge, negative beliefs about MOUD) often challenge implementation of MOUD delivery. To address these barriers, the VA launched a multifaceted implementation intervention focused on planning and educational strategies to increase MOUD delivery in 18 medical facilities. The purpose of this investigation was to determine if a multifaceted intervention approach to increase MOUD delivery changed providers’ perceptions about MOUD over the first year of implementation. Methods Cross-disciplinary teams of clinic providers and leadership from primary care, pain, and mental health clinics at 18 VA medical facilities received invitations to complete an anonymous, electronic survey prior to intervention launch (baseline) and at 12- month follow-up. Responses were summarized using descriptive statistics, and changes over time were compared using regression models adjusted for gender and prescriber status, and clustered on facility. Responses to open-ended questions were thematically analyzed using a template analysis approach. Results Survey response rates at baseline and follow-up were 57.1% (56/98) and 50.4% (61/121), respectively. At both time points, most respondents agreed that MOUD delivery is important (94.7 vs. 86.9%), lifesaving (92.8 vs. 88.5%) and evidence-based (85.2 vs. 89.5%). Over one-third (37.5%) viewed MOUD delivery as time-consuming, and only 53.7% affirmed that clinic providers wanted to prescribe MOUD at baseline; similar responses were seen at follow-up (34.5 and 52.4%, respectively). Respondents rated their knowledge about OUD, comfort discussing opioid use with patients, job satisfaction, ability to help patients with OUD, and support from colleagues favorably at both time points. Respondents’ ratings of MOUD delivery filling a gap in care were high but declined significantly from baseline to follow-up (85.7 vs. 73.7%, p < 0.04). Open-ended responses identified implementation barriers including lack of support to diagnose and treat OUD and lack of time. Conclusions Although perceptions about MOUD generally were positive, targeted education and planning strategies did not improve providers’ and clinical leaders’ perceptions of MOUD over time. Strategies that improve leaders’ prioritization and support of MOUD and address time constraints related to delivering MOUD may increase access to MOUD in non-substance use treatment clinics.

scholarly journals Fluctuations in barriers to medication treatment for opioid use disorder prescribing over the course of a one-year external facilitation intervention

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Allison M. Gustavson ◽  
Marie E. Kenny ◽  
Jennifer P. Wisdom ◽  
Hope A. Salameh ◽  
Princess E. Ackland ◽  
...  
Keyword(s):  
Implementation Strategies ◽  
Opioid Use Disorder ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Medication Treatment ◽  
Conceptual Clarity ◽  
Parihs Framework ◽  
External Facilitation ◽  
Over Time

Abstract Background The Veterans Health Administration (VHA) is invested in expanding access to medication treatment for opioid use disorder (MOUD) to save lives. Access varies across VHA facilities and, thus, requires implementation strategies to promote system-wide adoption of MOUD. We conducted a 12-month study employing external facilitation that targeted MOUD treatment among low-adopting VHA facilities. In this study, we sought to evaluate the patterns of perceived barriers over 1 year of external implementation facilitation using the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework. Methods We randomly selected eight VHA facilities from the bottom quartile of the proportion of Veterans with an OUD diagnosis receiving MOUD (< 21%). The 1-year external implementation intervention included developmental evaluation to tailor the facilitation, an on-site visit, and monthly facilitation calls. Facilitators recorded detailed notes for each call on a structured template. Qualitative data was analyzed by coding and mapping barriers to the constructs in the i-PARIHS framework (Innovation, Recipients, Context). We identified emerging themes within each construct by month. Results Barriers related to the Innovation, such as provider perception of the need for MOUD in their setting, were minimal throughout the 12-month study. Barriers related to Recipients were predominant and fluctuated over time. Recipient barriers were common during the initial months when providers did not have the training and waivers necessary to prescribe MOUD. Once additional providers (Recipients) were trained and waivered to prescribe MOUD, Recipient barriers dropped and then resurfaced as the facilities worked to expand MOUD prescribing to other clinics. Context barriers, such as restrictions on which clinics could prescribe MOUD and fragmented communication across clinics regarding the management of patients receiving MOUD, emerged more prominently in the middle of the study. Conclusions VHA facilities participating in 12-month external facilitation interventions experienced fluctuations in barriers to MOUD prescribing with contextual barriers emerging after a facilitated reduction in recipient- level barriers. Adoption of MOUD prescribing in low-adopting VHA facilities requires continual reassessment, monitoring, and readjustment of implementation strategies over time to meet challenges. Although i-PARIHS was useful in categorizing most barriers, the lack of conceptual clarity was a concern for some constructs.

T3 Are Burns a Chronic Condition: Examining Physical and Mental Functioning up to 20 Years After Injury

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S2-S3
Author(s):  
Callie Abouzeid ◽  
Audrey E Wolfe ◽  
Gretchen J Carrougher ◽  
Nicole S Gibran ◽  
Radha K Holavanahalli ◽  
...  
Keyword(s):  
Mental Health ◽  
Hospital Stay ◽  
National Database ◽  
Time Points ◽  
Patient Reported ◽  
Burn Survivors ◽  
Population Demographic ◽  
The Impact ◽  
Over Time

Abstract Introduction Burn survivors often face many long-term physical and psychological symptoms associated with their injury. To date, however, few studies have examined the impact of burn injuries on quality of life beyond 2 years post-injury. The purpose of this study is to examine the physical and mental well-being of burn survivors up to 20 years after injury. Methods Data from the Burn Model System National Database (1997–2020) were analyzed. Patient-reported outcome measures were collected at discharge with a recall of preinjury status, and then at 5, 10, 15, and 20 years after injury. Outcomes examined were the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the Short Form-12. Trajectories were developed using linear mixed methods model with repeated measures of PCS and MCS scores over time and controlling for demographic and clinical variables. The model fitted score trajectory was generated with 95% confidence intervals to demonstrate score changes over time and associations with covariates. Results The study population included 420 adult burn survivors with a mean age of 42.4 years. The population was mainly male (66%) and white (76.4%) with a mean burn size of 21.5% and length of hospital stay of 31.3 days. Higher PCS scores were associated with follow-up time points closer to injury, shorter hospital stay, and younger age. Similarly, higher MCS scores were associated with earlier follow-up time points, shorter hospital stay, female gender, and non-perineal burns. MCS trajectories are demonstrated in the Figure. Conclusions Burn survivors’ physical and mental health worsened over time. Such a trend is different from previous reported results for mental health in the general population. Demographic and clinical predictors of recovery over time are identified.

Long-Term Reactions to the Loss of a Close Friend in an Extreme Terror Incident

2018 ◽  
Vol 82 (3) ◽  
pp. 351-369 ◽  
Author(s):  
Iren Johnsen ◽  
Kari Dyregrov ◽  
Stig Berge Matthiesen ◽  
Jon Christian Laberg
Keyword(s):  
Longitudinal Studies ◽  
Quantitative Data ◽  
Close Friend ◽  
Traumatic Death ◽  
Time Points ◽  
Grief Reactions ◽  
Over Time ◽  
Avoidant Behavior

This article presents results from one of the first longitudinal studies exploring the effects of losing a close friend to traumatic death, focusing on complicated grief over time and how this is affected by avoidant behavior and rumination about the loss. The sample consists of 88 persons (76% women and 24% men, mean age = 21) who lost a close friend in the Utøya killings in Norway on July 22, 2011.Quantitative data were collected at three time-points; 18, 28, and 40 months postloss. Main findings are that bereaved friends are heavily impacted by the loss and their grief reactions are affected negatively by avoidant behavior and rumination. This indicates that close bereaved friends are a group to be aware of and that there is a need for better strategies for identifying individuals in need for follow-up.

scholarly journals T55. DETECTING SEMANTIC DISTANCE ABNORMALITIES IN PSYCHOSIS: QUANTIFICATION OF WORD ASSOCIATIONS USING SEMANTIC SPACE MODELING

2020 ◽  
Vol 46 (Supplement_1) ◽  
pp. S252-S252
Author(s):  
Andrea Pintos ◽  
Charlton Cheung ◽  
Simon De Deyne ◽  
Christy L M Hui ◽  
Eric Y H Chen
Keyword(s):  
Word Association ◽  
Semantic Distance ◽  
Semantic Space ◽  
Psychotic Episode ◽  
Symptom Change ◽  
Time Points ◽  
Association Task ◽  
Cue Words ◽  
Over Time

Abstract Background Language Disorganisation is central to the conceptualization of psychosis. Disruptions in semantic processing have been observed both as a “state”, and a “trait” phenomena in psychotic disorders. Quantification of semantic abnormalities have been improved with recent advances in semantic modeling. The current study applied such computational methods on a word association task, using immediate response to cue words to explore semantic associations. We employed a longitudinal design to investigate semantic relationships during a psychotic episode compared with the same patients after remission six months later, in order to clarify the state-trait status of the semantic variables, and their relationships with clinical symptoms. We hypothesized that semantic distance would be significantly greater in patients than controls at baseline, and would decrease upon follow-up. Methods A continued word association task (WAT) was employed to elicit three associations per cue from a set of 200 cue-words. The set of cues were previously established as being representative of words in general speech, in terms of valence, concreteness and part-of-speech composition. The task was administered to 47 patients with schizophrenia spectrum disorders and 44 matched healthy control participants. Data was collected at two time points, at baseline when patients were actively psychotic and then at 6-months follow-up. In addition, extensive clinical and cognitive measures were collected at both time points. Patterns of word associations were explored using vector representations, derived from Word2Vec, that encompass semantic meaning. Semantic distance of each cue-response pairing is defined using the cosine angle of their vectors. Changes in semantic distance were further examined on their correlation with symptom change over time. Results There was a significant interaction between group and time point on semantic distance (F = 6.865, p = 0.009), where measures of the semantic distance of patients’ responses were significantly greater than healthy controls at both time-points (p &lt; 0.001).There is a significant time effect: the semantic distance reduced significantly over time (p &lt; 0.001). Within the patient group, a change in semantic distance was correlated with symptom change over time, specifically with general psychopathology (p =0.024), depressive (p = 0.046) and manic symptoms (p &lt; 0.01). Discussion Measures of semantic distance were significantly greater in patients both at baseline during a psychotic episode, and at follow-up upon clinical remission. There is a significant but not full normalization of semantic distance upon remission. Increase in semantic distance is therefore both a state and a trait marker in psychosis. We have employed a novel technique to quantify semantic distance of a word association task using Word2Vec to generate vector representations of responses in a high-dimensional semantic space. The findings illustrate the feasibility of applying Word2Vec to a word association task to detect subtle changes in language. Subsequent research possibilities using this approach includes exploration of the semantic content of responses, by grouping similar meaning responses into conceptual clusters, and its correlation with symptom change.

Validity and Reliability of the Computer-Administered Routine Opioid Outcome Monitoring (ROOM) Tool

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3645-3654
Author(s):  
Louisa Picco ◽  
Melissa Middleton ◽  
Raimondo Bruno ◽  
Michala Kowalski ◽  
Suzanne Nielsen
Keyword(s):  
Alcohol Use ◽  
Pearson Correlation ◽  
Correlation Coefficients ◽  
Opioid Use Disorder ◽  
Opioid Use ◽  
Chronic Noncancer Pain ◽  
Retest Reliability ◽  
Outcome Monitoring ◽  
Test Retest Reliability ◽  
Over Time

Abstract Objective The Routine Opioid Outcome Monitoring (ROOM) tool measures outcomes with opioids using an established framework which includes domains such as pain, mood, opioid use disorder, alcohol use, and constipation. This study aims to validate and establish the test-retest reliability of the computer-administered ROOM tool. Design and Setting Cross-sectional analysis of an online sample. Subjects Participants comprised those with chronic noncancer pain who regularly used prescription opioids. Methods Participants self-completed the online ROOM tool along with other validated measures (validation questionnaire), and those who were agreeable also completed the online test-retest questionnaire approximately two weeks later. Subcomponents of the ROOM tool (i.e., pain, mood, alcohol use, opioid use disorder, and constipation) were validated against longer measures of the same construct using Pearson correlation coefficients. Intraclass correlation coefficients were used to assess the stability of the ROOM tool over time. Results A total of 324 participants completed the validation questionnaire, of whom 260 also completed the test-retest questionnaire. The opioid use disorder domain showed good sensitivity (73.6) and specificity (75.8) against the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, any opioid use disorder. All ROOM components showed moderate correlation (r = 0.55–0.73) with their longer counterparts. Test-retest reliability was fair (0.58–0.75), indicating that responses were relatively stable over time. Reliability did vary, however, based on the components being measured and how certain tools were scored. Conclusion The computer-administered ROOM tool is a valid approach for brief monitoring of outcomes with prescribed opioids in primary care settings and appears to be acceptable to people who are using prescribed opioids for chronic pain.

scholarly journals Changes of trace element status during aging: results of the EPIC-Potsdam cohort study

2019 ◽  
Vol 59 (7) ◽  
pp. 3045-3058 ◽  
Author(s):  
Julia Baudry ◽  
Johannes F. Kopp ◽  
Heiner Boeing ◽  
Anna P. Kipp ◽  
Tanja Schwerdtle ◽  
...  
Keyword(s):  
Reference Ranges ◽  
Linear Regression Models ◽  
Serum Samples ◽  
Time Points ◽  
Supplement Use ◽  
Healthy Elderly ◽  
Age Related ◽  
Longitudinal Variability ◽  
Over Time

Abstract Purpose We aimed to evaluate age-dependent changes of six trace elements (TE) [manganese (Mn), iron (Fe), zinc (Zn), copper (Cu), iodine (I), and selenium (Se)] over a 20-year period. Methods TE concentrations were determined using repeated serum samples taken at baseline and after 20 years of follow-up from 219 healthy participants of the EPIC-Potsdam study, using inductively coupled plasma tandem mass spectrometry. For each TE, absolute and relative differences were calculated between the two time points, as well as the proportion of individuals within normal reference ranges. Interdependence between age-related TE differences was investigated using principal component analysis (PCA). Relationships between selected factors (lifestyle, sociodemographic, anthropometric factors, and hypertension) and corresponding TE longitudinal variability were examined using multivariable linear regression models. Results Median age of our study sample was 58.32 years (4.42) at baseline and 40% were females. Median Mn, Zn, Se concentrations and Se to Cu ratio significantly decreased during aging while median Fe, Cu, I concentrations and Cu to Zn ratio significantly increased. A substantial percentage of the participants, at both time points, had Zn concentrations below the reference range. The first PCA-extracted factor reflected the correlated decline in both Mn and Zn over time while the second factor reflected the observed (on average) increase in both Cu and I over time. Overall, none of the investigated factors were strong determinants of TE longitudinal variability, except possibly dietary supplement use, and alcohol use for Fe. Conclusions In conclusion, in this population-based study of healthy elderly, decrease in Mn, Zn, and Se concentrations and increase in Fe, Cu, and I concentrations were observed over 20 years of follow-up. Further research is required to investigate dietary determinants and markers of TE status as well as the relationships between TE profiles and the risk of age-related diseases.

Interpersonal Trauma Among Women and Men Receiving Buprenorphine in Outpatient Treatment for Opioid Use Disorder

2021 ◽  
pp. 107780122110327
Author(s):  
Caitlin E. Martin ◽  
Anna Beth Parlier-Ahmad ◽  
Lori Beck ◽  
Nicholas D. Thomson
Keyword(s):  
Substance Use ◽  
Interpersonal Trauma ◽  
Opioid Use Disorder ◽  
Sex And Gender ◽  
Opioid Use ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
And Gender ◽  
Public Health Strategies

People with opioid use disorder (OUD) are vulnerable to negative health outcomes related to substance use and psychosocial issues, such as interpersonal trauma (IPT). Participants receiving buprenorphine completed a cross-sectional survey (July–September 2019). OUD outcomes were prospectively abstracted over a 28-week timeframe. More than a third reported recent IPT (40% women, 36% men). Sexual violence was more common among women than men ( p = .02). For women only, IPT was associated with substance use during follow-up (β = 20.72, 95% CI: 4.24, 37.21). It is important for public health strategies in the opioid crisis to address IPT using sex- and gender-informed approaches.

Captagon use in a patient with iatrogenic opioid use disorder

2021 ◽  
Vol 10 ◽  
Author(s):  
Mohammed Hamdan ◽  
Samer El Hayek ◽  
Maya Bizri
Keyword(s):  
Middle Eastern ◽  
Opioid Use Disorder ◽  
Opioid Withdrawal ◽  
Psychotic Symptoms ◽  
Patient Counseling ◽  
Opioid Use ◽  
Case Presentation ◽  
Recreational Use ◽  
Reducing Properties

Background: Captagon or Fenethylline is a synthetic theophylline derivative of amphetamine that is widely available for recreational use in the Middle East. It has pain-reducing properties and is known to induce restlessness, irritability, and psychotic symptoms. Case presentation: A middle-aged man with iatrogenic opioid use disorder was admitted for acute cholecystitis. A week following cholecystectomy, the patient used Captagon while hospitalized to manage opioid withdrawal pain. He experienced waxing and waning episodes of irritability, aggressiveness, disorganized behaviors, delusions, and hallucinations, all concurrent with his Captagon intake. These episodes were managed similarly to intoxication with other stimulant types. Conclusion: Careful patient counseling and close follow-up are essential when opioids are prescribed. Captagon’s pain-reducing properties make it an attractive and dangerous option for Middle Eastern patients suffering from opioid withdrawal. Captagon intoxication is currently managed similarly to other stimulant types, but more studies are needed to develop management guidelines specific to this substance.

Persistent Cytotoxic T Lymphocyte Expansions after Allogeneic Hematopoietic Stem Cell Transplantation: Kinetics, Clinical Impact and Absence of STAT3 Mutations

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3153-3153
Author(s):  
Julia Muñoz-Ballester ◽  
Tzu Hua Chen-Liang ◽  
Ana María Hurtado ◽  
Pastora Iniesta ◽  
María Dolores García-Malo ◽  
...  
Keyword(s):  
T Lymphocyte ◽  
Cytotoxic T Lymphocyte ◽  
Linear Representation ◽  
Time Points ◽  
Linear Plot ◽  
Line Slope ◽  
Stat3 Mutations ◽  
Over Time

Abstract Thymic-independent peripheral expansion of CD8+ cells derived from the graft in the initial stage of post-HSCT immune recovery is a well-known physiological event. Nevertheless, the description of symptomatic LGL leukemias and aggressive malignant cases in this setting may generate uncertainty, mostly in those cases in which the cytotoxic T lymphocyte expansion CTLe persists beyond the early transplantation period. We aimed to assess the nature of CTLe in adults during the post-alloHSCT period in a series of 154 patients with a long term surveillance. We studied the longitudinal kinetics of those expansions, their relation to clinical events, and their phenotypic and molecular features, including recently reported CTL leukemia-STAT3 mutations. In our study, trying to adhere to the WHO annotation of T-LGL, we considered two definitions for a CTL expansion: an absolute increase (≥ 2000 x109/L), and a relative expansion (a CD8/CD4 ratio ≥ 1.5), persisting more than six months in both cases. Persistent relative CTLe cases are frequent (49%) and related with timoglobulin prophylaxis (p≤0.001), acute graft versus host disease (GVHD, p=0.02), reduced intensity conditioning (p=0.04) and fungal and viral infections in the early post-HSCT. No differences in the number of serious infectious events from day 180 was found. Absolute CTLe are scarce (9%), related with chronic GVHD and absence of relapses. TCR rearrangement was reported as clonal and oligoclonal in the majority of patients with CTLe. We studied in a cross sectional manner with an extended immunophenotypic panel 17 patients: 5 patients with an absolute CTLe and 12 cases with a relative CTLe. A similar cytotoxic T αβ-effector phenotype was observed in all cases, with slight differences in the expression of CD25, CD16 and 1a. One patient with a relative CTLe expressed CD56 intensely: his ratio normalized at day 730 and no immune-related events were recorded. DNA stored during the post-alloHSCT setting was available from 68/75 relative CTLe patients (14/14 absolute CTLe cases). All of them went through molecular TCR rearrangement and STAT3 exon 21 mutations determination. In the relative CTLe cohort, TCR rearrangement was described as clonal, oligoclonal or polyclonal in 77%, 16% and 7%, respectively. Regarding absolute CTLe patients, TCR rearrangement was described as clonal in all the patients (n=14) of this subset. To increase the sensibility of the Sanger PCR, it was performed on DNA from CD3+ sorted cells in 54 out of 68 cases. No STAT3 mutation could be found in the CD3+ sorted fraction of relative or absolute defined CTLe. Not using an absolute threshold would establish a diagnosis of a persistent CTL expansion in 49% of our cohort of allo-transplanted patients. Additional diagnostic tools, as an effector phenotype, the presence of a NK marker or a monoclonal TCR rearrangement would not reduce significantly that percentage: CD57 was invariably expressed in CTLe cases, and 80% of our patients with expansions showed a TCR monoclonal pattern. STAT3 mutations resulting in persistent proliferation of CTL clones are a frequent event in large granular lymphocytic leukemia, and those clones have also been described in autoimmunity-driven disorders as acquired aplastic anemia and hypocellular myelodysplastic syndromes. We establish in this study the absence of exon 21 STAT3 mutations in the persistent CTL expansions found in a large series of patients with a long-term post-alloHSCT surveillance. The absence of STAT3 mutations and the CD8/CD4 declining longitudinal kinetics in the late period, supports its benign nature, expressed clinically by the null detrimental impact of these expansions on post-transplant outcome and/or serious infectious events. Figure 1. Relative and absolute CTLe kinetics. A) Linear representation over time of the CD8/CD4 ratio in the 75 patients with relative CTLe. B) Trend linear plot of 25 patients with a relative CTLe and a follow up of, at least, 1440 days from transplantation. Each line depicts a patientxs longitudinally measured CD8/CD4 ratio. Patients are grouped by similar pattern of ratio behaviour through follow up. The line "slope" depicts the magnitude of the change between time points. C) Linear representation over time of the CD3/CD8 count in PB in the 14 patients with an absolute CTLe. D) Trend linear plot illustrating the CD8/CD4 ratio behaviour of the 14 patients with an absolute CTLe. Figure 1. Relative and absolute CTLe kinetics. A) Linear representation over time of the CD8/CD4 ratio in the 75 patients with relative CTLe. B) Trend linear plot of 25 patients with a relative CTLe and a follow up of, at least, 1440 days from transplantation. Each line depicts a patientxs longitudinally measured CD8/CD4 ratio. Patients are grouped by similar pattern of ratio behaviour through follow up. The line "slope" depicts the magnitude of the change between time points. C) Linear representation over time of the CD3/CD8 count in PB in the 14 patients with an absolute CTLe. D) Trend linear plot illustrating the CD8/CD4 ratio behaviour of the 14 patients with an absolute CTLe. Disclosures No relevant conflicts of interest to declare.

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