Support Models for Addiction Related Treatment (SMART) for pregnant women: Study protocol of a cluster randomized trial of two treatment models for opioid use disorder in prenatal clinics

Introduction The prevalence of opioid use disorder (OUD) in pregnancy increased nearly five-fold over the past decade. Despite this, obstetric providers are less likely to treat pregnant women with medication for OUD than non-obstetric providers (75% vs 91%). A major reason is many obstetricians feel unprepared to prescribe medication for opioid use disorder (MOUD). Education and support may increase prescribing and overall comfort in delivering care for pregnant women with OUD, but optimal models of education and support are yet to be determined. Methods and analysis We describe the rationale and conduct of a matched-pair cluster randomized clinical trial to compare the effectiveness of two models of support for reproductive health clinicians to provide care for pregnant and postpartum women with OUD. The primary outcomes of this trial are patient treatment engagement and retention in OUD treatment. This study compares two support models: 1) a collaborative care approach, based upon the Massachusetts Office-Based-Opioid Treatment Model, that provides practice-level training and support to providers and patients through the use of care managers, versus 2) a telesupport approach based on the Project Extension for Community Healthcare Outcomes, a remote education model that provides mentorship, guided practice, and participation in a learning community, via video conferencing. Discussion This clustered randomized clinical trial aims to test the effectiveness of two approaches to support practitioners who care for pregnant women with an OUD. The results of this trial will help determine the best model to improve the capacity of obstetrical providers to deliver treatment for OUD in prenatal clinics. Trial registration Clinicaltrials.gov trial registration number: NCT0424039.

Experiences of advanced psychiatric nurses regarding the need for prescriptive authority in KwaZulu-Natal

Background: Nurse prescribing has become a global and transformational practice to ensure the achieving of optimal health outcomes, including advanced psychiatric nurses. Despite the transformational practice globally, South Africa seems to lag behind because nurses do not have permission to prescribe medication.Aim: To describe the experiences of advanced psychiatric nurses regarding the need to prescribe medication treatment in KwaZulu-Natal.Setting: The study took place in three mental healthcare institutions in KwaZulu-Natal in inpatient units.Method: The qualitative, descriptive design was used to collect the experiences of advanced psychiatric nurses in KwaZulu-Natal regarding the need for prescriptive authority. Six focus group interviews were conducted to gather information. The seven steps of Colaizzi’s method were used to analyze the data.Results: The study found two primary themes and two sub-themes. The findings highlighted the necessity for advanced psychiatric nurse role recognition and prescribing. Insufficient use of skilled psychiatric nurses caused delays in addressing mental health patients in emergencies.Conclusion: The two themes, prescribing role of advanced psychiatric nurses and role recognition, revealed that granting advanced psychiatric nurses’ autonomy to prescribe remained a challenge. Advanced psychiatric nurses are expected to provide high-quality care, but they are limited in their abilities. Because advanced psychiatric nurses are not used to prescribe in KwaZulu-Natal, they rely on psychiatrists to manage psychotic patients.Contribution: The evaluation of policies and procedures that guide advanced psychiatric nurses in prescribing psychotropic medications.

Responsibility with a Safety Net: Exploring the Medical Student to Junior Doctor Transition During COVID-19

Introduction The Foundation Interim Year-one (FiY1) Programme was part of a UK strategy to increase the medical workforce in response to the COVID-19 pandemic. However, the strategy was introduced urgently without evidence. We sought to explore the transition experience of medical student to FiY1 to foundation doctor, with a view to inform future undergraduate education. Methods In this hermeneutic phenomenology study, semi-structured individual interviews were completed with nine foundation doctors who had experience of an FiY1 placement. A template analysis approach was taken, and themes reported. Results Participants reported that FiY1 tended to offer a positive experience of transition as a stepping stone to becoming a foundation doctor. Having a degree of clinical responsibility including the right to prescribe medication with supervision was highly valued, as was feeling a core member of the healthcare team. Participants perceived that FiY1 made them more prepared for the foundation transition, and more resilient to the challenges they faced during their first foundation job. Discussion The FiY1 fostered many opportunities for junior doctors to bridge the transition to foundation doctor. Aspects of the FiY1 programme, such as early licencing and increased team membership, should be considered for final-year students in the future.

Towards the Development of a Substance Abuse Index (SEI) through Informatics

Substance abuse or drug dependence is a prevalent phenomenon, and is on the rise in United States. Important contributing factors for the prevalence are the addictive nature of certain medicinal/prescriptive drugs, individual dispositions (biological, physiological, and psychological), and other external influences (e.g., pharmaceutical advertising campaigns). However, currently there is no comprehensive computational or machine learning framework that allows systematic studies of substance abuse and its factors with majority of the works using subjective surveys questionnaires and focusing on classification techniques. Lacking standardized methods and/or measures to prescribe medication and to study substance abuse makes it difficult to advance through collective research efforts. Thus, in this paper, we propose to test the feasibility of developing a, objective substance effect index, SEI, that can measure the tendency of an individual towards substance abuse. To that end, we combine the benefits of Electronics Medical Records (EMR) with machine learning technology by defining SEI as a function of EMR data and using logistics regression to obtain a closed form expression for SEI. We conduct various evaluations to validate the proposed model, and the results show that further work towards the development of SEI will not only provide researchers with standard computational measure for substance abuse, but may also allow them to study certain attribute interactions to gain further insights into substance abuse tendencies.

Development of a Minimum Data Set for Drug Module of Computerized Physician Order Entry System

Introduction: One way to reduce medication errors in the cardiovascular settings is to electronically prescribe medication through the computerized physician order entry system (CPOE). Improper design and non-compliance with users' needs are obstacles to implementing this system. Therefore, it is necessary to consider the standard minimum data set (MDS) of this system in order to meet the basic needs of its users. The aim of this study was to introduce MDS in the cardiovascular CPOE drug system to standardize data items as well as to facilitate data sharing and integration with other systems.Material and Methods: This study was a survey study conducted in 1399 in Iran. The study population was all cardiologists in Iran. The data collection tool was a researcher-made questionnaire consisting of 33 questions. Data were analyzed in SPSS-24 using descriptive statistics.Results: A total of 31 cardiologists participated in this study. The participants identified 19 of the 25 drug data items as essential for drug MDS. Five data items (Medication name, Medication dosage, Medication frequency, Medication start date and Patient medication history) were considered essential by more than 90% of the participants.Conclusion: The results of this study identified drug MDS for the cardiovascular CPOE system. The results of this study can be a model for CPOE system designers to develop new systems or upgrade existing systems.

Artificial Intelligence, Robots and Bioethical Challenges

"The arrival of digital research, where the object of research is transformed into numerical data, makes it possible to study the world and medicine, using new epistemological paradigms. What matters now is only the correlation between two quantities of data, with no concern for any consistent theory that explains such correlation. Today these correlations are used to predict with acceptable accuracy. What seems to be the outcome of this new revolution is the dominance of information, a conceptual labyrinth whose most common definition is based on an equally problematic category-data. The technological evolution of information and of the world seen as a series of data takes its concrete form in artificial intelligence (AI) and in robots. We are now able to construct machines that can make autonomous decisions and coexist with human beings. And in the context of healthcare it is possible to develop diagnostic approach, prescribe medication (see IBM Watson Program) or offer radiosurgery systems like Cyberknife. Contemporary society presents extremely delicate challenges where the most important variable is not intelligence but rather the little time available in which to make a decision. Here, cognitive mechanisms can have important applications. A series of anthropological and bioethical reflections can help to understand the challenges in the healthcare field: “Is it clear how this logic of hyper-individualization, governed by the use of artificial intelligence, will undermine the humanistic need for solidarity in this in deeds and mindset, in favor of private relationships between individuals and organizations?” (E. Sadin). "

Situational analysis and reflections on the introduction of advanced practice nurses in Brazilian primary healthcare

Background The shortage of doctors and their unequal distribution serve as challenges to advancing primary healthcare (PHC) and achieving effective universal healthcare coverage in Brazil. In an effort to use nurses’ potential more efficiently, the country is investigating the introduction of the advanced practice nurse (APN) into PHC. This paper presents a situational analysis of the practices of Brazilian nurses based on the following components: regulation, practice, and education. Methods This is a national multi-method study with triangulated data from a documentary study, a scoping review, and an exploratory study. The regulation component involved the analysis of official normative documents on the regulation of nursing education and nurses’ scope of practice. The practice component aimed to identify the practices performed by nurses in Brazilian PHC based on primary studies. The education component intended to identify the practices taught in nursing training based on a survey and interviews with directors of undergraduate nursing programs. Results Federal legislation in Brazil authorizes nursing graduates to perform a set of advanced practices as part of the PHC nurse's daily routine. They can request and interpret complementary tests and prescribe medication. However, in the local context, municipalities define the scope of this assistance based on technical norms or nursing protocols. Furthermore, this study indicates that undergraduate nursing programs do not fully prepare students to adequately execute these tasks. Conclusions In the context of Brazilian PHC, advanced practices have already been implemented and respond to main healthcare demands. Therefore, it is unnecessary to introduce the APN as a new professional category. Upon detecting deficiencies in the training process, the current education model should undergo reforms that seek to incorporate the skills compatible with the regulated advanced practices and in-service training for practicing nurses. Regarding the introduction of APN along international lines, this article presents recommendations that may support the operationalization of a Brazilian APN model.

Tobacco use, knowledge of harms, and cessation support among patients with non-tobacco related cancers.

e24029 Background: Continued cigarette smoking among patients with cancer leads to numerous adverse health outcomes, even among patients with non-tobacco-related cancers such as breast, colon, and prostate cancer. Continued smoking is associated with poorer response to cancer treatment, increased risk for treatment-related toxicities, and shorter overall survival. While some patients with a smoking-related cancer make efforts to quit smoking at the time of diagnosis, patients with other forms of cancer might not understand the negative effects of continued smoking. In this study, we assessed patient knowledge of the harms of continued smoking, previous cessation attempts, and cessation support. Methods: We surveyed 102 adults with breast, colon, and prostate cancer at three locations: an NCI-designated cancer center, an urban safety-net medical center, and a rural cancer center. Patients were asked about current smoking behaviors, beliefs about the harms of continued smoking, quit attempts and resources used, and cessation support. We also surveyed seven oncologists to assess beliefs about harms of continued smoking, cessation support provided to patients, training and confidence in cessation counseling, and barriers to providing cessation support. Results: Most patients (82%) agreed or strongly agreed that continued smoking may shorten life expectancy, and 70% agreed or strongly agreed that continued smoking increased the risk of getting a different type of cancer. Only 41% of patients agreed or strongly agreed that continued smoking may cause more side effects from cancer treatment, and only 40% agreed or strongly agreed that ongoing smoking may affect treatment response. The majority of patients (86%) had tried to quit smoking for good, with an average 4.1 quit attempts per patient. Patients reported that physicians advised them to quit the majority of the time (92%), prescribed medication 33% of the time, and followed up on cessation attempts 43% of the time. Overall, oncologists had higher knowledge of the harms of continued smoking on treatment outcomes and survival. Those in practice for 20 years or more had higher confidence in cessation counseling than those in practice less than 4 years. Oncologists described lack of time and lack of confidence in cessation counseling as barriers to providing more cessation support. Conclusions: Among 102 patients with breast, colon, and prostate cancer who currently smoke, there was incomplete knowledge of the harms of continued smoking. Oncologists believe that tobacco cessation is important and frequently advise patients to quit, however they less frequently prescribe medication or follow up on cessation efforts. Interventions are needed to educate patients with cancer about the harms of continued smoking and to provide further cessation support.

Monitoring Patients to Prevent Myocardial Infarction using Internet of Things Technology

Introduction: The Iranian Ministry of Health has announced that when a heart attack occurs, 50% of patients die within the first hours after a heart attack. The purpose of this article is to provide a system for 24-hour patient monitoring, prevention of heart attack and reduction of mortality. Methods: In this original research study, by reviewing the valid articles of 2020, two sensor samples with the least error, fast and user-friendly were selected, then presented by new system methods including two-phase: warning transmission and normal mode. Received information from both of the phases is stored in the patient's digital file. Based on this information, personalized decisions can be made for each patient. Results: According to the Iranian Ministry of Health and Medical Education, more than 40% of deaths in the country are related to the heart diseases, 19% of them are related to the heart attack, while 50% of deaths due to myocardial infraction happen in the first hours. Our proposed 24-hour monitoring system, using the most up-to-date and accurate measurement tools, reduces the risk by continuously measuring the patient's vital signs. Conclusion: In our proposed system, the time and numerical interval of each measurement by the sensors are determined by the respective doctor, then the information is stored in each person's digital medical record. This system helps prescribe medication and make more accurate decisions based on the patient's specific circumstances. It is recommended that the drug delivery phase be performed within the arrival time of the medical team to minimize the risk.