scholarly journals The “black-box” of Treatment. Clients’ Perspective on What Works in Medication-assisted Treatment for Opioid Use Disorder.

2021 ◽  
Author(s):  
Teresa C. Silva ◽  
Fredrik Andersson
Keyword(s):  
Sense Of Self ◽  
Treatment Plan ◽  
Black Box ◽  
Illegal Drug ◽  
Structural Factors ◽  
Opioid Use ◽  
Opioid Substitution Treatment ◽  
Convenience Sample ◽  
Treatment Stage ◽  
Pre Treatment

Abstract Background: A lack of conceptual modeling of how the components of medical-assisted treatment (MAT) for illegal opioid use work causes it to occasionally be labeled the “black-box” of treatment. This study had a two-fold objective: First, to analyze which factors related to MAT for opioid addiction contribute to the abstinence of illegal drug use and sustain recovery, from clients’ perspective; second, to understand which changes MAT produced in the individuals’ lives might significantly contribute to relapse prevention.Methods: We used qualitative methods of design, inquiry, and analysis from a convenience sample of 19 individuals in a Swedish treatment setting.Results: All the participants reported previous cycles of illegal drug abuse, treatment, abstinence, recovery, and relapse before starting the current MAT program. During the pre-treatment stage, specific events, internal processes, and social environments enhanced motivation toward abstinence and seeking treatment. During the treatment stage, participants perceived the quality of the human relationships established with primary social groups as important as medication and the individual plan of care in sustaining recovery. From the participants’ perspective, MAT was a turning point in their life course, allowing them a sense of self-fulfillment and the reconstruction of personal and social identity. However, they still struggled with the stigmatization produced by a society that values abstinence-oriented over medication-assisted treatments.Conclusion: MAT is not an isolated event in individuals’ lives but rather a process occurring within a specific social context. Structural factors and the sense of acceptance and belonging are essential to supporting the transformation. Treatment achievements and the risk for relapse most likely vary over time, so the objectives of the treatment plan must account for characteristics of the pre-treatment stage and the availability and capacity of individuals to restructure their social network, besides the opioid substitution treatment and institutional social care.

scholarly journals The “black box” of treatment: Patients’ perspective on what works in opioid maintenance treatment for opioid dependence

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Teresa C. Silva ◽  
Fredrik B. Andersson
Keyword(s):  
Opioid Dependence ◽  
Maintenance Treatment ◽  
Treatment Plan ◽  
Black Box ◽  
Opioid Maintenance Treatment ◽  
Convenience Sample ◽  
Problematic Use ◽  
Treatment Stage ◽  
Pre Treatment ◽  
Patients Perspective

Abstract Background A lack of conceptual modeling of how the components of opioid maintenance treatment (OMT) for opioid dependence (OD) work causes it to occasionally be labeled the “black-box” of treatment. This study had a two-fold objective: First, to analyze which factors related to OMT for OD contribute to the abstinence of problematic use of non-prescribed opioids and sustain recovery, from the patients’ perspective; second, to understand which changes OMT produced in the individuals’ lives might significantly contribute to relapse prevention. Methods We used qualitative methods of design, inquiry, and analysis from a convenience sample of 19 individuals in a Swedish treatment setting. Results All the participants reported previous cycles of problematic use of non-prescribed opioids and other non-prescribed psychoactive substances, treatment, abstinence, recovery, and relapse before starting the current OMT program. During the pre-treatment stage, specific events, internal processes, and social environments enhanced motivation toward abstinence and seeking treatment. During the treatment stage, participants perceived the quality of the human relationships established with primary social groups as important as medication and the individual plan of care in sustaining recovery. From the participants’ perspective, OMT was a turning point in their life course, allowing them a sense of self-fulfillment and the reconstruction of personal and social identity. However, they still struggled with the stigmatization produced by a society that values abstinence-oriented over medication-assisted treatments. Conclusion OMT is not an isolated event in individuals’ lives but rather a process occurring within a specific social context. Structural factors and the sense of acceptance and belonging are essential in supporting the transformation. Treatment achievements and the risk for relapse vary over time, so the objectives of the treatment plan must account for characteristics of the pre-treatment stage and the availability and capacity of individuals to restructure their social network, besides the opioid maintenance treatment and institutional social care.

scholarly journals Membrane condenser as emerging technology for water recovery and gas pre-treatment: current status and perspectives

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Adele Brunetti ◽  
Francesca Macedonio ◽  
Giuseppe Barbieri ◽  
Enrico Drioli
Keyword(s):  
Current Status ◽  
Innovative Technology ◽  
Water Recovery ◽  
Treatment Unit ◽  
Treatment Stage ◽  
Treatment Technologies ◽  
Pre Treatment ◽  
And Control

Abstract The recent roadmap of SPIRE initiative includes the development of “new separation, extraction and pre-treatment technologies” as one of the “key actions” for boosting sustainability, enhancing the availability and quality of existing resources. Membrane condenser is an innovative technology that was recently investigated for the recovery of water vapor for waste gaseous streams, such as flue gas, biogas, cooling tower plumes, etc. Recently, it has been also proposed as pre-treatment unit for the reduction and control of contaminants in waste gaseous streams (SOx and NOx, VOCs, H2S, NH3, siloxanes, halides, particulates, organic pollutants). This perspective article reports recent progresses in the applications of the membrane condenser in the treatment of various gaseous streams for water recovery and contaminant control. After an overview of the operating principle, the membranes used, and the main results achieved, the work also proposes the role of this technology as pre-treatment stage to other separation technologies. The potentialities of the technology are also discussed aspiring to pave the way towards the development of an innovative technology where membrane condenser can cover a key role in redesigning the whole upgrading process.

scholarly journals Gender disparities in opioid treatment progress in methadone versus counseling

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Erick Guerrero ◽  
Hortensia Amaro ◽  
Yinfei Kong ◽  
Tenie Khachikian ◽  
Jeanne C. Marsh
Keyword(s):  
United States ◽  
Treatment Outcomes ◽  
Treatment Plan ◽  
Dropout Rate ◽  
The United States ◽  
Gender Disparities ◽  
Opioid Use ◽  
Lower Odds ◽  
Male Clients ◽  
Multi Level

Abstract Background In the United States, the high dropout rate (75%) in opioid use disorder (OUD) treatment among women and racial/ethnic minorities calls for understanding factors that contribute to making progress in treatment. Whereas counseling and medication for OUD (MOUD, e.g. methadone, buprenorphine, naltrexone) is considered the gold standard of care in substance use disorder (SUD) treatment, many individuals with OUD receive either counseling or methadone-only services. This study evaluates gender disparities in treatment plan progress in methadone- compared to counseling-based programs in one of the largest SUD treatment systems in the United States. Methods Multi-year and multi-level (treatment program and client-level) data were analyzed using the Integrated Substance Abuse Treatment to Eliminate Disparities (iSATed) dataset collected in Los Angeles County, California. The sample consisted of 4 waves: 2011 (66 SUD programs, 1035 clients), 2013 (77 SUD programs, 3686 clients), 2015 (75 SUD programs, 4626 clients), and 2017 (69 SUD programs, 4106 clients). We conducted two multi-level negative binomial regressions, one per each outcome (1) making progress towards completing treatment plan, and (2) completing treatment plan. We included outpatient clients discharged on each of the years of the study (over 95% of all clients) and accounted for demographics, wave, homelessness and prior treatment episodes, as well as clients clustered within programs. Results We detected gender differences in two treatment outcomes (progress and completion) considering two outpatient program service types (MOUD-methadone vs. counseling). Clients who received methadone vs. counseling had lower odds of completing their treatment plan (OR = 0.366; 95% CI = 0.163, 0.821). Female clients receiving methadone had lower odds of both making progress (OR = 0.668; 95% CI = 0.481, 0.929) and completing their treatment plan (OR = 0.666; 95% CI = 0.485, 0.916) compared to male clients and receiving counseling. Latina clients had lower odds of completing their treatment plan (OR = 0.617; 95% CI = 0.408, 0.934) compared with non-Latina clients. Conclusions Clients receiving methadone, the most common and highly effective MOUD in reducing opioid use, were less likely to make progress towards or complete their treatment plan than those receiving counseling. Women, and in particular those identified as Latinas, were least likely to benefit from methadone-based programs. These findings have implications for health policy and program design that consider the need for comprehensive and culturally responsive services in methadone-based programs to improve outpatient treatment outcomes among women.

Dyeing Adsorption Isotherm and Equilibrium Modeling Characteristics of Enzymatic and Caustic Pre-Treated Lyocell Fibers

2011 ◽  
Vol 332-334 ◽  
pp. 568-571
Author(s):  
Yi Jun Pan ◽  
Chien Teng Hsieh ◽  
Chien Kuo Yen
Keyword(s):  
Treatment Condition ◽  
Enzymatic Treatment ◽  
Equilibrium Modeling ◽  
Sorption Ability ◽  
Treatment Stage ◽  
Lyocell Fibers ◽  
Lyocell Fiber ◽  
Consequent Effect ◽  
Pre Treatment ◽  
Dyes Adsorption

The purpose of this study is to achieve a better understanding of the influences of enzymatic and caustic pretreatments on the dying adsorption behavior of Lyocell yarns. The substantivity behavior, dyeing adsorption isotherms and their correlation between the equilibrium modeling and equilibrium isotherm parameters of the pre-treated Lyocell fibers have been studied. Although the conditions of each treatment were the same, changing the processing sequences caused substantially different modifications on the Lyocell fiber fine structure with consequent effect on dyeing behaviors. In general, pretreatment by caustic soda and/or enzyme can improve their dyeability of Lyocell fibers. The results of dyes adsorption show that for the same enzymatic treatment condition if the enzymatic treatment stage is applied before the caustic pre-treatment, the dyeability and sorption ability of small molecule dye on pre-treated Lyocell can be improved over that which can be obtained for caustic pre-treated yarn.

Treatments for Substance Use Disorders

2020 ◽  
pp. 267-324
Author(s):  
Arash Ansari ◽  
David N. Osser
Keyword(s):  
Substance Use ◽  
Substance Use Disorders ◽  
Clinical Characteristics ◽  
Black Box ◽  
Brand Names ◽  
Opioid Use ◽  
Childbearing Age ◽  
Black Box Warnings ◽  
Amphetamine Use ◽  
Opioid Use Disorders

The chapter on treatments for substance use disorders discusses and reviews the use of medication-assisted treatments with (a) methadone, buprenorphine/naloxone, and naltrexone for opioid use disorders; (b) disulfiram, acamprosate, naltrexone, and several off-label medications for alcohol use disorders; and (c) nicotine replacement therapies, bupropion, and varenicline for tobacco use disorders. The chapter reviews the mechanisms of action, clinical characteristics, potential medication interactions, and adverse effects of these medications, followed by an in-depth discussion of their clinical use in these disorders. The chapter also briefly reviews several non-Food and Drug Administration (FDA)-approved medicines studied for cocaine, cannabis, and amphetamine use disorders. It also briefly discusses complementary and alternative pharmacotherapies, such as the use of cannabinoids. It also discusses the use of these medicines in women of childbearing age, notably for pregnancy and breastfeeding considerations. Finally, the chapter includes a table of approved substance use disorder medicines that includes each medicine’s generic and brand names, usual adult doses, pertinent clinical comments, black box warnings, and FDA indications.

A survey of pain assessment and management practices among critical care nurses

1994 ◽  
Vol 3 (2) ◽  
pp. 123-128 ◽  
Author(s):  
MC Gujol
Keyword(s):  
Critical Care ◽  
Pain Assessment ◽  
Management Practices ◽  
Critical Care Nurses ◽  
Opioid Use ◽  
Convenience Sample ◽  
Policy Makers ◽  
Survey Results ◽  
Medication Decisions ◽  
The Relationship

BACKGROUND: Postoperative pain is one of the major obstacles in the prevention of complications during patient recovery. Pain and its management have gained great interest among researchers, clinicians and policy-makers. PURPOSES: To explore the relationship between two variables in pain assessment (length of time after surgery and ventilator status) and medication decisions made by critical care nurses, and to identify nurses' concerns about opioid use. METHODS: A convenience sample of 71 critical care nurses participated in the survey. RESULTS: Certain patient conditions such as length of time after surgery and ventilator status affected nurses' assessment and management of pain. Nurses' knowledge about pain assessment and management may affect patient care and outcomes.

Effect of Slime and Impurity Removal as a Pre-Treatment Stage Using a Low-Grade Zinc-Oxide Sample

2019 ◽  
Vol 60 (5) ◽  
pp. 463-472
Author(s):  
Aisan Ramadi ◽  
Mohammad Noaparast ◽  
Seyed Ziaedin Shafaie ◽  
Armin Salsani
Keyword(s):  
Zinc Oxide ◽  
Low Grade ◽  
Impurity Removal ◽  
Treatment Stage ◽  
Pre Treatment ◽  
Oxide Sample

scholarly journals FDG-PET Improves Management of Patients with Colorectal Liver Metastases Allocated for Local Treatment: A Consecutive Prospective Study

2007 ◽  
Vol 96 (3) ◽  
pp. 209-213 ◽  
Author(s):  
M. Sørensen ◽  
F. V. Mortensen ◽  
M. Høyer ◽  
H. Vilstrup ◽  
S. Keiding ◽  
...  
Keyword(s):  
Liver Metastases ◽  
Fdg Pet ◽  
Colorectal Liver Metastases ◽  
Imaging Modality ◽  
Treatment Plan ◽  
Local Treatment ◽  
Liver Lesions ◽  
Term Survival ◽  
Pre Treatment

Background and Aim: Colorectal cancer is a common cancer in the Nordic countries and 50% of the patients develop liver metastases. Liver resection may result in long term survival. Proper staging is therefore essential and CT is the standard imaging modality. We examined whether additional FDG-PET improves therapeutic management of patients with colorectal liver metastases. Patients and Methods: Fifty-four consecutive patients were enrolled. Each patient had a treatment plan made based on our standard evaluation. The patients then had a PET scan and the treatment plan was re-evaluated, taking these results into account. Results: In 76% of the cases, PET did not change the treatment plan due to complete concordance with CT. In another 19% of the cases, the plan was altered due to finding of more liver lesions by PET than by CT (four patients), fewer or no liver lesions (three patients), and extrahepatic lesions not visible on CT (three patients). In 5% of the cases, non-concordance between PET and CT did not change the therapeutic plan. Conclusion: Pre-treatment FDG-PET, used supplementary to CT, improved the treatment plan in one fifth of the patients with colorectal liver metastases.

scholarly journals Barriers and facilitators to recruitment and enrollment of HIV-infected individuals with opioid use disorder in a clinical trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kim A. Hoffman ◽  
Robin Baker ◽  
Lynn E. Kunkel ◽  
Elizabeth Needham Waddell ◽  
Paula J. Lum ◽  
...  
Keyword(s):  
Eligible Patient ◽  
Barriers And Facilitators ◽  
Recruitment Strategies ◽  
Structural Factors ◽  
Opioid Use ◽  
Hiv Viral Load ◽  
Treatment As Usual ◽  
Study Recruitment ◽  
Study Protocols ◽  
Peer Outreach

Abstract Background The CTN-0067 CHOICES trial tests implementation of extended-release naltrexone (XR-NTX) versus treatment-as-usual (TAU) for opioid use disorders (OUD) in HIV clinics to improve HIV viral suppression. The study team investigated recruitment strategies to elucidate the barriers and facilitators to recruitment and enrollment in the study. Main text Methods: Semi-structured, in-depth, digitally recorded interviews were completed with study recruitment-related staff and medical providers (n = 26) from six participating HIV clinics in the fall of 2018. Interviews probed 1) factors that might prevent prospective participants from engaging in study recruitment and enrollment procedures and 2) strategies used by study staff that encourage eligible patient participation. Interviews were transcribed and thematically analyzed using a content analysis approach. Results: All respondents reported that barriers to recruitment and enrollment included challenging patient social and structural factors (e.g., homelessness or living environments with high substance use, criminal justice involvement), difficulty locating patients with unsuppressed HIV viral load and OUD within the HIV clinic, time-consuming study enrollment processes, and stigma around HIV and OUD which inhibited treatment seeking. Some respondents observed that distrust of research and researchers impeded recruitment activities in the community. A specific medication-related barrier was patient fear of opioid abstinence required prior to XR-NTX induction. Facilitators of recruitment included use of trusted peer outreach/recruitment workers in the community, hospitalizations that offered windows of opportunities for screening and XR-NTX induction, providing participant transportation, and partnerships with harm reduction organizations for referrals. Conclusions Though study personnel encountered barriers to recruitment in the CHOICES study, persons with untreated HIV and OUD can be enrolled in multisite clinical trials by using enhanced recruitment strategies that extend outside of the HIV clinic. Employing peer outreach workers and collaborating with syringe service programs may be especially helpful in facilitating recruitment and merit inclusion in similar study protocols.

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