bluuebunny/crossref_metadata_2025 huggingface dataset:
Nonphysician Practice of Cosmetic Dermatology: A Patient and Physician Perspective of Outcomes and Adverse Events
Authors: Rossi Anthony M. , Wilson Britney , Hibler Brian P. , Drake Lynn A.
Published: March 2019

BACKGROUND

Nonphysicians are expanding practice into specialty medicine. There are limited studies on patient and physician perspectives as well as safety outcomes regarding the nonphysician practice of cosmetic procedures.

OBJECTIVE

To identify the patient (consumer) and physician perspective on preferences, adverse events, and outcomes following cosmetic dermatology procedures performed by physicians and nonphysicians.

MATERIALS AND METHODS

Internet-based surveys were administered to consumers of cosmetic procedures and physician members of the American Society for Dermatologic Surgery. Descriptive statistics and graphical methods were used to assess responses. Comparisons between groups were based on contingency chi-square analyses and Fisher exact tests.

RESULTS

Two thousand one hundred sixteen commenced the patient survey with 401 having had a cosmetic procedure performed. Fifty adverse events were reported. A higher number of burns and discoloration occurred in the nonphysician–treated group and took place more often in a spa setting. Individuals seeing nonphysicians cited motivating factors such as level of licensure (type) of nonphysician, a referral from a friend, price, and the location of the practitioner. Improper technique by the nonphysician was cited most as a reason for the adverse event. Both groups agree that more regulation should be placed on who can perform cosmetic procedures. Recall bias associated with survey data.

CONCLUSION

Patients treated by nonphysicians experienced more burns and discoloration compared with physicians, and they are encountering these nonphysicians outside a traditional medical office, which are important from a patient safety and regulatory standpoint. Motivating factors for patients seeking cosmetic procedures may also factor into the choice of provider.

KEY POINTS

Both patients and physicians think more regulation should be in place on who can perform cosmetic procedures. More adverse events such as burns and discolorations occurred with patients seeing nonphysicians compared with those seeing physicians. In addition, for those seeing nonphysicians, a majority of these encounters took place in spa settings. Patient safety is of utmost concern when it comes to elective cosmetic medical procedures. More adverse events and encounters occurring outside traditional medical settings when nonphysicians performed these procedures call into question the required training and oversight needed for such procedures.
Pharmacodynamic Monitoring of mTOR Inhibitors
Authors: Millán Olga , Wieland Eberhard , Marquet Pierre , Brunet Mercè
Published: March 2019

Pharmacodynamic (PD) monitoring may complement routine pharmacokinetic monitoring of mTOR inhibitors (mTORis) in an attempt to better guide individualized sirolimus (SRL) or everolimus (EVR) treatment after organ transplantation. This review focuses on current knowledge about PD biomarkers for personalized mTORi therapies. Different strategies have already been used in the evaluation of the pharmacodynamics of SRL and EVR as a proxy for their effects on the immune response after transplantation. These include measuring p70S6K (70 kDa ribosomal protein S6 kinase) activity, p70S6K phosphorylation (P-p70S6K), or P-S6 protein expression. Compared with Western blot and ELISA, phosphoflow cytometry can detect phosphorylated proteins and differentiate activation-induced changes of signaling molecules inside the cell from unstimulated populations of identical cells in the same sample. Alternatively, in patients receiving a combined therapy, the other PD approach is to consider biomarkers such as NFAT residual expression for calcineurin inhibitors or to evaluate nonspecific effects of the drugs such as lymphocyte proliferation, interleukin synthesis, specific peripheral blood T regulatory subsets, or lymphocyte surface antigens, which have the advantage to reflect the overall immunosuppressive status achieved. Although limited, the available data on mTOR pathway biomarkers seem promising. Before clinical implementation, the analytical methodologies must be standardized and cross-validated, and the selected biomarkers will have to demonstrate their clinical utility for SRL or EVR dose individualization in multicenter clinical trials.
Dolutegravir Population Pharmacokinetics in a Real-Life Cohort of People Living With HIV Infection: A Covariate Analysis
Authors: Parant François , Miailhes Patrick , Brunel Florence , Gagnieu Marie-Claude
Published: March 2019

Background:

There are growing concerns about dolutegravir (DTG)-related neuropsychiatric adverse events and about differences in the characteristics of people living with HIV infection (PLWH) potentially associated with higher risks of said side effects. Several studies have shown that DTG was stopped more frequently among women, older PLWH, and PLWH who initiated abacavir (ABC) at the same time. This study aimed to clarify the factors affecting the pharmacokinetics (PKs) of DTG in a real-life cohort of PLWH using a population PK approach.

Methods:

The model-building strategy was based on a previously published model developed from premarketing trials (1-compartment model with first-order absorption and a lag time). Sparse therapeutic drug monitoring data were obtained from a real-life cohort of 279 PLWH, and population PK analysis was performed using Monolix software. A stepwise covariate model-building strategy was used to evaluate any relevant effects of age, body weight, gender, total bilirubin, smoking status, formulations of DTG, morning versus evening dosing, backbone therapy, and other comedications including CYP/UGT inducers/inhibitors.

Results:

For a typical 70-kg PLWH, the apparent clearance (CL/F) and apparent volume of distribution (V/F) were 0.748 L/h and 14.6 L, respectively. Of the demographic factors evaluated, body weight was a significant covariate for CL/F and for V/F. Smokers had a 17% higher CL/F relative to nonsmokers. Both strong enzyme inhibitors (eg, atazanavir) and inducers (eg, rifampicin) had marked effects on DTG exposure, with potential clinical implications. Ritonavir-boosted darunavir was found to moderately increase clearance of DTG by 23%. No significant effect of ABC-based backbone therapy was observed on the PK parameters of DTG.

Conclusions:

Our results did not support the hypothesis that ABC, by competing with the DTG metabolic pathway, may significantly increase DTG exposure leading to potential drug toxicity.
Amikacin Pharmacokinetics in Terminal Stage of Hematological Malignancy
Authors: Nakayama Hirokazu , Suzuki Masahiro , Usuki Kensuke , Kato Toshiaki
Published: March 2019

Background:

The influence of cancer cachexia on the pharmacokinetics of and kidney injury caused by amikacin remains unclear. This study investigated whether the pharmacokinetics of amikacin and the risk of kidney injury are altered with the progression of cancer cachexia.

Methods:

A retrospective analysis was conducted using therapeutic drug monitoring data obtained from 52 cancer patients who received amikacin intravenously for infection(s). The patients were classified into 2 groups based on the status of cachexia using a consensus definition: noncachexia group (n = 31) and cachexia group (n = 21). Differences in amikacin pharmacokinetics and occurrence of kidney injury were compared between the 2 groups. Amikacin pharmacokinetics was calculated based on a 1-compartment model using peak and trough concentrations measured clinically for therapeutic drug monitoring. In addition, intrapatient analysis was conducted based on patients who received amikacin treatments more than once during the study period to examine the alteration in amikacin pharmacokinetics with the progression of cancer cachexia.

Results:

Systemic clearance of amikacin [median (range)] was significantly (P< 0.05) lower in the cachexia group [37.3 (11.2–87.3) (mL/min)] than in the noncachexia group [52.0 (19.1–133.4) (mL/min)]. In contrast, volume of distribution was significantly (P< 0.05) increased in the cachexia group [0.47 (0.20–1.45) L/kg] compared with the noncachexia group [0.32 (0.21–1.00) L/kg]. There was no difference in the occurrence of kidney injuries between the 2 groups. In an intrapatient analysis of the longitudinal alteration of amikacin pharmacokinetics, an approximately 50% reduction in clearance and 30% increase in volume of distribution were observed as cancer cachexia progressed.

Conclusions:

The present study suggests that progression of cancer cachexia may reduce amikacin clearance and increase the volume of distribution, but cancer cachexia does not increase amikacin-induced kidney injury.
Examining the Relationship Between Vancomycin Area Under the Concentration Time Curve and Serum Trough Levels in Adults With Presumed or Documented Staphylococcal Infections
Authors: Clark Laura , Skrupky Lee P. , Servais Ryan , Brummitt Charles F. , Dilworth Thomas J.
Published: March 2019

Background:

Investigations of the relationship between vancomycin trough concentrations and area under the concentration time curve (AUC) are growing, but still limited. The authors sought to determine vancomycin exposure among hospitalized adults with presumed or confirmed invasive staphylococcal infections using 2-level pharmacokinetic monitoring to inform changes to an institutional vancomycin dosing protocol.

Methods:

This was a retrospective observational study performed in 2 acute care hospitals. Adults prescribed vancomycin (therapeutic trough 15–20 mg/L) for a presumed or documented invasive staphylococcal infection were evaluated. Two steady-state serum vancomycin levels were used to determine each patient's 24-hour AUC to minimum inhibitory concentration ratio (AUC/MIC) using a non-Bayesian, equation-based approach. Patient demographics and crude clinical outcomes were also collected.

Results:

Thirty-four patients were included in the study, with 2 patients having vancomycin levels drawn twice (36 sets of levels). Most patients were located in an intensive care unit (91.2%), and 85.3% of patients were prescribed vancomycin for bacteremia, pneumonia, or endocarditis. The mean ± SD vancomycin Cmin was 16.6 ± 6.1 mg/L, and the mean AUC/MIC was 588 ± 156 mg/L × hour. The rate of 24-hour vancomycin AUC/MIC target attainment was 91.2% (n = 31/34). Of the patients with a Cmin > 9 mg/L, 100% (n = 33) achieved AUC/MIC values >400 mg/L × hour and 93.9% were >500 mg/L × hour. There was a strong correlation between vancomycin Cmin and AUC24 hr (R2 = 0.731; P < 0.001).

Conclusions:

Targeting a vancomycin trough between 15 and 20 mg/L frequently resulted in an AUC/MIC greater than that thought to be necessary for efficacy optimization. Considering these findings alongside the practical challenges associated with wide-scale implementation of AUC monitoring, reducing the target trough as a means to prevent vancomycin overexposure warrants clinical consideration and further evaluation.
Pharmacodynamic Monitoring of Antiepileptic Drug Therapy
Authors: Brandt Christian
Published: March 2019

Epilepsy is characterized by seizures recurring at interindividually differing time intervals. It may be difficult to assess drug response if time intervals between seizures are long. Thus, the existence of surrogate parameters that could be used to reliably identify drug efficacy and tolerability at an early stage and also as prognostic factors would be desirable. Electroencephalography, magnetic resonance imaging, and genetic markers are the domains to be assessed in this respect. The availability of clinically useful pharmacodynamic parameters is, however, currently disappointing.
Strategies for Individualized Dosing of Clotting Factor Concentrates and Desmopressin in Hemophilia A and B
Authors: Preijers Tim , Schütte Lisette M. , Kruip Marieke J. H. A. , Cnossen Marjon H. , Leebeek Frank W. G. , van Hest Reinier M. , Mathôt Ron A. A.
Published: March 2019

Hemophilia A and hemophilia B are hereditary bleeding disorders, caused by a deficiency of clotting factor VIII or clotting factor IX, respectively. To treat and prevent bleedings, patients can administer clotting factor concentrates (hemophilia A and B) or desmopressin (hemophilia A). Both clotting factor concentrates and desmopressin are currently dosed according to the patients' body weight. However, clotting factor concentrates exhibit considerable pharmacokinetic (PK) variability. Therefore, several alternative dosing strategies to individualize dosing of clotting factor concentrates and desmopressin in hemophilia A and B have been proposed. In this study, a review of the existing literature on the individualization of dosing based on PK guidance was performed. In total, 79 articles were included. The methods to individualize dosing were divided into 3 categories: (1) methods using clinical parameters, (2) empirical individual PK-guided methods, and (3) maximum a posteriori (MAP) Bayesian estimation methods. The clinical parameter mainly used to individualize dosing is bleeding phenotype. Dosing based on bleeding phenotype may decrease clotting factor consumption. However, with this method, it is not possible to individualize on-demand dosing during bleeding events or in the perioperative setting. Empirical individual PK-guided methods can be used both for prevention and treatment of bleedings. These methods include dose individualization using a nomogram and individualized in vivo recovery. In the perioperative setting, adjustment of the rate of continuous infusion can be applied to obtain a specific target level. The final category, MAP Bayesian estimation methods, relies on the availability of a population PK model. In total, 22 population PK models describing clotting factor concentrate or desmopressin dosing are currently available in literature. MAP Bayesian estimates can be used to calculate the individualized doses required to achieve or maintain a target level in every setting. The application of PK-guided and pharmacodynamic-guided dosing of clotting factor concentrates and desmopressin seems promising, although further investigation is warranted. Prospective studies analyzing its potential benefit are on the way.
Tolerability of Erythrocyte Ribavirin Triphosphate Concentrations Depends on the ITPA Genotype
Authors: Tanaka Yoichi , Inoue Akiko , Mizunuma Tomohiko , Matsumura Haruka , Yokomori Hiroaki , Komiyama Takako , Otori Katsuya
Published: March 2019

Background:

Ribavirin (RBV) is an antiviral drug that is part of the current standard therapy for chronic hepatitis C (CHC). It is enzymatically converted to ribavirin triphosphate (RTP) that inhibits the activity of viral RNA polymerase, thereby preventing viral replication. However, one of its adverse effects includes hemolytic anemia that limits its application. The variant of ITPA (inosine triphosphatase), which dephosphorylates inosine triphosphate to inosine monophosphate, is a protective factor for RBV-induced anemia. RTP is an important metabolite required for ribavirin action. This study evaluated the time-dependent association of RTP concentrations in erythrocytes, RBV-induced toxicity, and virological response to RBV treatment for hepatitis C.

Methods:

A total of 28 Japanese patients with CHC were treated with RBV/peg-interferon/simeprevir or RBV/sofosbuvir and were genotyped for ITPA variants (rs1127354 and rs7270101). We measured RTP concentrations in erythrocytes in a total of 76 samples collected at 4, 8, and 12 weeks from the initiation of treatment.

Results:

The ITPA rs1127354 variant was found in 7 patients. This was associated with significantly higher RTP concentrations in erythrocytes than in the wild-type patients (P < 0.001). Moreover, a significant correlation was observed between RTP concentrations and decline in hemoglobin (Hb) levels from baseline values in ITPA wild type and rs1127354 variant 12 weeks after treatment initiation (P < 0.01; r = −0.618 and −0.967, respectively). Multiple regression analysis revealed that ITPA genotype and erythrocyte RTP concentrations were major factors associated with reduced Hb levels in RBV therapy for CHC. However, we did not find any association between erythrocyte concentrations and virological response.

Conclusions:

The increased tolerability to RTP concentrations in erythrocytes in the ITPA variant rs1127354 plays a role in preventing RBV-induced severe anemia in this ITPA variant.
Comparison of Immunoassays for Measuring Serum Levels of Golimumab and Antibodies Against Golimumab in Ulcerative Colitis: A Retrospective Observational Study
Authors: Berger Anne-Emmanuelle , Duru Gerard , de Vries Annick , Marini Joseph C. , Aoucheta Djamila , Cornillie Freddy , Nancey Stephane , Detrez Iris , Gils Ann , Roblin Xavier , Paul Stephane
Published: March 2019

Background:

Golimumab is a monoclonal anti–tumor necrosis factor alpha antibody, which is used in ulcerative colitis with an exposure–response relationship. The goal of this study was to compare results obtained with different immunoassays (golimumab and antigolimumab antibodies trough levels).

Methods:

This study was based on samples from 78 ulcerative colitis patients on golimumab treatment. Golimumab was quantified by either an anti-IgG detection antibody (Theradiag, Marne la Vallée, France) or an antibody directed against golimumab (Sanquin, Amsterdam, The Netherlands, KU Leuven, Leuven, Belgium, and Janssen R&D, San Diego, CA). Bridging drug-sensitive enzyme-linked immunosorbent assays (Theradiag, Janssen R&D, and KU Leuven), a bridging drug-tolerant enzyme-linked immunosorbent assay (Janssen R&D), and a radioimmunoassay (Sanquin) were used to quantify antidrug antibody.

Results:

Median serum golimumab levels were 4.5, 3.5, 4.9, and 2.4 mcg/mL with Theradiag, Sanquin, KU Leuven, and Janssen R&D assay, respectively (P < 0.05). Correlation coefficients between assays ranged from 0.9 to 0.97. When using the KU Leuven and Janssen R&D assays, 86% of samples were in the same quartile of distribution of values, and for Sanquin and Janssen R&D assays, this overlap was 80%. The concordance observed for the other pairs was 83% (Sanquin/KU Leuven R&D), 71% (Theradiag/KU Leuven), and 68% (Theradiag/Janssen R&D and Theradiag/Sanquin). The specificity of assays for golimumab was demonstrated. Antidrug antibodies were detected in 28.2% of the samples with the Janssen R&D drug-tolerant assay and in the same 2 patients by the 3 other assays.

Conclusions:

Performances of these immunoassays were similar in terms of quality, but differences in the quantitative results point to the importance of using the same assay consistently to monitor a patient's treatment.
Longitudinal Effects of Medical Comorbidities on Functional Outcome and Life Satisfaction After Traumatic Brain Injury: An Individual Growth Curve Analysis of NIDILRR Traumatic Brain Injury Model System Data
Authors: Malec James F. , Ketchum Jessica M. , Hammond Flora M. , Corrigan John D. , Dams-O'Connor Kristen , Hart Tessa , Novack Thomas , Dahdah Marie , Whiteneck Gale G. , Bogner Jennifer
Published: March 2019

Objective:

To explore associations of specific physical and neuropsychiatric medical conditions to motor and cognitive functioning and life satisfaction over the first 10 years following traumatic brain injury (TBI).

Setting:

Telephone follow-up through 6 TBI Model System centers.

Participants:

In total, 404 individuals or proxies with TBI enrolled in the TBI Model System longitudinal study participating in 10-year follow-up.

Design:

Individual growth curve analysis.

Main Measures:

FIM Motor and Cognitive subscales, Satisfaction With Life Scales, and Medical and Mental Health Comorbidities Interview.

Results:

Hypertension, diabetes, cancers, rheumatoid arthritis, and anxiety negatively affected the trajectory of motor functioning over time. Diabetes, cancers, chronic bronchitis, anxiety, and depression negatively impacted cognitive functioning. Numerous neuropsychiatric conditions (sleep disorder, alcoholism, drug addiction, anxiety, panic attacks, posttraumatic stress disorder, depression, and bipolar disorder), as well as hypertension, liver disease, and cancers, diminished life satisfaction. Other medical conditions had a negative effect on functioning and satisfaction at specific follow-up periods.

Conclusion:

Natural recovery after TBI may include delayed onset of functional decline or early recovery, followed by progressive deterioration, and is negatively affected by medical comorbidities. Results contribute to the growing evidence that TBI is most appropriately treated as a chronic medical condition complicated by a variety of comorbid conditions.
An Evidence-Based Care Model for Workers With Concussion
Authors: Thompson Aaron , Chechulin Yuriy , Bain Donna , Bayley Mark
Published: March 2019

Objective:

To evaluate the impact of an evidence-based assessment program for people with workers' compensation claims for concussion on healthcare utilization and duration of lost time from work.

Setting:

An assessment program for people with a work-related concussion was introduced to provide physician assessment focused on education and appropriate triage.

Participants:

A total of 3865 people with accepted workers' compensation claims for concussion with dates of injury between January 1, 2014, and February 28, 2017.

Design:

A quasiexperimental pre-/poststudy of healthcare utilization (measured by healthcare costs) and duration of time off work (measured by loss of earnings benefits) in a cohort of people with workers' compensation claims for concussion in the period prior to and following introduction of a new assessment program. Administrative data were retrospectively analyzed to compare outcomes in patients from the preassessment program implementation period to those in the postimplementation period.

Results:

The assessment program resulted in reduced healthcare utilization reflected by a 14.4% (95% confidence interval, −28.7% to −0.8%) decrease in healthcare costs. The greatest decrease in healthcare costs was for assessment services (−27.9%) followed by diagnostic services (−25.7%). There was no significant difference in time off work as measured by loss-of-earnings benefits.

Conclusion:

A care model for people with a work-related concussion involving an evidence-based assessment by a single physician focused on patient education resulted in significantly decreased healthcare utilization without increasing duration of time off work.
Neuropsychiatric Outcomes in UK Military Veterans With Mild Traumatic Brain Injury and Vestibular Dysfunction
Authors: Denby Emma , Murphy Dominic , Busuttil Walter , Sakel Mohamed , Wilkinson David
Published: March 2019

Objective:

To estimate the frequency of vestibular dysfunction following blunt, blast, and combined blunt and blast mild traumatic brain injury (mTBI) and thereon assess the long-term impact of vestibular dysfunction on neurobehavioral function and disability independently of comorbid psychiatric symptoms.

Setting:

Combat Stress residential and Veterans' Outreach drop-in centers for psychological support.

Participants:

One hundred sixty-two help-seeking UK military veterans.

Main Measures:

Self-reported frequency and severity of mTBI (using the Ohio State TBI Identification Method), Vertigo Symptom Scale, PTSD Checklist for DSM-5, Kessler Psychological Distress Scale (K10), Neurobehavioral Symptom Inventory, Headache Impact Test (HIT6), Memory Complaints Inventory, World Health Organization Disability Assessment Schedule II short version (WHODAS 2.0).

Results:

Seventy-two percent of the sample reported 1 or more mTBIs over their lifetime. Chi-square analyses indicated that vestibular disturbance, which affected 69% of participants, was equally prevalent following blunt (59%) or blast (47%) injury and most prevalent following blunt and blast combined (83%). Mediation analysis indicated that when posttraumatic stress disorder, depression, and anxiety were taken into account, vestibular dysfunction in participants with mTBI was directly and independently associated with increased postconcussive symptoms and functional disability.

Conclusion:

Vestibular dysfunction is common after combined blunt and blast mTBI and singularly predictive of poor long-term mental health. From a treatment perspective, vestibular rehabilitation may provide relief from postconcussive symptoms other than dizziness and imbalance.
Therapeutic Challenges and Prognosis of Descemet's Membrane Endothelial Keratoplasty in Herpes Simplex Eye Disease
Authors: Abdelmassih Youssef , Dubrulle Pierre , Sitbon Charles , el-Khoury Sylvain , Guindolet Damien , Doan Serge , Labetoulle Marc , Cochereau Isabelle , Gabison Eric E.
Published: March 2019

Purpose:

To describe the functional outcome, postoperative complications, and complication management of Descemet's membrane endothelial keratoplasty (DMEK) in corneal decompensation secondary to Herpes simplex eye disease (HED).

Methods:

This retrospective interventional case series included 17 eyes that received DMEK for endothelial decompensation secondary to HED. Complete ophthalmological examination, including corrected-distance visual acuity (CDVA), anterior segment slit-lamp, and optical coherence tomography assessment, were performed preoperatively and postoperatively at regular follow-up intervals. Visual outcome and complication rates were compared with those of 72 consecutive eyes that received DMEK for Fuchs endothelial corneal dystrophy (FECD) and pseudophakic bullous keratopathy (PBK) during the same period.

Results:

Mean follow-up time was 11.1 ± 5.9 months (range 6–27). CDVA improved from 1.16 ± 0.46 logMAR to 0.62 ± 0.44 logMAR (P = 0.001). Corneal pachymetry significantly decreased from 695 ± 53 μm at day 1 to 569 ± 88 μm at 2 months (P < 0.001). Postoperative complications occurred in 12 eyes, including primary graft failure (12%), endotheliitis (29%), corneal ulcers (35%), and cystoid macular edema (18%). Most complications occurred shortly after surgery, with a median delay of 2.5 months. In comparison, the complication rates for DMEK in FECD and PBK were significantly lower (no graft failure, P = 0.005; no endotheliitis, P < 0.001; no corneal ulcers, P < 0.001 and 3% cystoid macular edema, P = 0.046).

Conclusions:

DMEK surgery significantly improved CDVA in patients with endothelial decompensation due to HED. The rate of postoperative complications was higher than for FECD and PBK. Close follow-up is mandatory and the rate of postoperative inflammatory events suggests that patients should be kept on high doses of oral valacyclovir.
A Comparison Between the Involuntary and Voluntary Treatment of Patients With Alcohol Use Disorder in a Residential Rehabilitation Treatment Program
Authors: Boit Hellen , Palmer Glen A. , Olson Stephen A.
Published: March 2019

Objective:

The purpose of the study was to determine if there was a significant difference between veterans who received treatment voluntarily versus involuntarily in regard to length of sobriety.

Method:

A sample of 120 veterans being treated for alcohol use disorder in a residential rehabilitation treatment program was used for this study. Veterans who were admitted under recommendation by court order (n = 60) were matched with veterans who were admitted without recommendation of court order (n = 60). Success of the program was determined by the number of days of sobriety postdischarge.

Results:

The study revealed that there was no significant difference between types of motivation for residential treatment (i.e., voluntary vs. involuntary treatment) and length of sobriety for veterans with alcohol use disorder posttreatment.

Conclusions:

Findings revealed that there was no significant relationship when comparing types of motivation for treatment in a residential treatment program for veterans in regard to length of sobriety posttreatment. Therefore, a veteran’s motivation for treatment may not necessarily be an accurate indicator of treatment outcomes (i.e., length of sobriety posttreatment) for residential treatment settings.
An Old Treatment for an Even Older Problem
Authors: Legg Timothy J.
Published: March 2019

The fact that addictive disorders have a significant negative impact on the health of the global population is well documented in contemporary health literature. What is less well documented is the uncomfortable realization that the tools in our armament to help individuals who struggle with addictive disorders are limited. Many individuals will spend their lives “cycling” through the addiction treatment continuum only to again be met with relapse. Third-party reimbursement for addiction treatment has focused on time-limited treatments and “brief” therapies with an additional emphasis on support group attendance (aka “free” services) with minimal focus on the fact that brief therapies have poor evidence for efficacy. In this article, we explore an alternative to brief therapies by reaching back to the earliest and most comprehensive treatment we have for behavioral change—psychoanalysis. This article engages in a literature review to determine whether sufficient evidence exists for the use of psychoanalysis as a treatment for addictive disorders. Implications for advanced practice psychiatric nurses are discussed.
A Causal Model of Binge Drinking Among University Students in Northern Thailand
Authors: Tonkuriman Asawinee , Sethabouppha Hunsa , Thungjaroenkul Petsunee , Kittirattanapaiboon Phunnapa
Published: March 2019

Binge drinking, an extreme drinking pattern and the most common form of hazardous alcohol consumption among university students, has remained a public health concern with physical, psychological, academic, and social problems. Tracking multiple factors is needed to find ways to deal with such hazardous drinking patterns and their adverse consequences. In Thailand, the particular factors leading to binge drinking patterns among university students are still not recognized. Four hundred thirteen university students in Northern Thailand self-administered a Web-based survey about the causal factors. The survey was based on a hypothesized model from the Social Ecological Model and from empirical studies. There were four factors that were hypothesized to directly increase binge drinking behavior: attitudes toward drinking, peer influence, physical environments of drinking, and alcohol advertisements. However, there were another four factors that were hypothesized to directly decrease binge drinking behavior: drinking refusal self-efficacy, university alcohol regulations, alcohol public policies, and knowledge. Through testing of the hypothesized model by Structural Equation Modeling, the causal model of binge drinking among Thai university students revealed “binge drinking refusal self-efficacy” (β = −.22,p< .001) and “peer influence” (β = −.14,p< .05) as significant negative factors and “physical environments” (β = .18,p< .001) as a positive predictor regarding binge drinking. The study shows how healthcare providers may be able to lessen binge drinking by designing effective prevention programs centering on an intrapersonal factor (binge drinking refusal self-efficacy), an interpersonal factor (peer influence), and a community factor (physical environments).
Personal Factors as Correlates and Predictors of Relapse in Nurses With Impaired Practice
Authors: Mumba Mercy N. , Baxley Susan M. , Cipher Daisha J. , Snow Diane E.
Published: March 2019

Relapse is the unauthorized use of any mind-altering substance, prescribed or not, after an individual has entered treatment for substance use (Darbro, 2011). Among nurses with impaired practice, the 5-year relapse rate is estimated at about 40% (Zhong, Kenward, Sheets, Doherty, & Gross, 2009), and the risk of relapse is highest in the first year of recovery (Clark & Farnsworth, 2006). Many factors influence susceptibility to relapse among nurses including presence of psychiatric comorbidities (Schellekens, de Jong, Buitelaar, & Verkes, 2015), history of criminal background (Zhong et al., 2009), spirituality and religiosity (Allen & Lo, 2010), and receiving prelicensure education in the United States (Waneka, Spetz, & Keane, 2011). The purpose of this study was to examine the correlates and predictors of relapse among nurses and to establish at what point they are most susceptible to relapse. This study was a retrospective secondary data analysis of nurses in Texas with impaired practice. The total number of participants was 1,553. The time it takes participants to enroll in a peer assistance program is negatively associated with length in program (p < .001). Conversely, there is a strong, positive, significant relationship between the number of days abstinent and the length in program (p < .001). More men compared with women (p = .037) were likely to be employed while participating in the program. Finally, participants who were referred for substance use disorders alone had 55% less risk of relapse. Those who used alcohol as their primary drug of choice had 1.7 times higher risk of relapse.
Effectiveness of Providing Education About Alcohol Use Disorders and Compassion Fatigue for Emergency Department Nurses
Authors: Williamson Dawn
Published: March 2019

Background:

Emergency departments (EDs) treat over 20,000 patients daily with alcohol use disorders (AUDs). However, nurses receive limited education about AUDs. Studies have shown that ED nurses have negative attitudes about patients with AUDs. Negativity can contribute to the symptoms of compassion fatigue (CF) and to dissatisfaction with work.

Purpose:

The aim of this study was to design, implement, and evaluate education about AUDs and CF for ED nurses.

Design:

This study used a quasi-experimental pretest–posttest within-subjects design.

Sample:

A convenience sample of 44 nurses was recruited at a large urban ED.

Methods:

Nurses completed demographics, Professional Quality of Life: Compassion Satisfaction and Fatigue (ProQOL), and Short Alcohol and Alcohol Problems Perceptions Questionnaire. Then, the nurses participated in 5 hours of an online educational program and a 1-hour live class about AUDs and CF. The surveys were readministered.

Results:

The difference in pretest and posttest Short Alcohol and Alcohol Problems Perceptions Questionnaire subscales of role security (expected value = 8.5, p < .006) and therapeutic commitment (expected value = 7.50, p = .018) was statistically significant. For ProQOL constructs, no statistical significance was found. The ProQOL subscales were compared with norms and were statistically significantly different.

Conclusion:

Nurses’ attitudes about patients with AUDs improved after completing the curriculum. Studied nurses had higher levels of professional satisfaction at baseline.
Comparing the Differences in Health of Body, Mental, and Spirit Among Category 3 and 4 Controlled Drug Users, Nursing Students, and Psychology Students
Authors: Sun Fan-Ko , Su Chen-Ying , Wei Chi-Fang , Lan Chu-Mei , Chiang Chun-Ying
Published: March 2019

Drug abuse adversely affects the health of populations in many counties and contributes immensely to social issues. Schedule III and IV controlled drug abuse is popular in young adults. Medical education is one of the most stressful academic fields for students. The aim of this study was to compare the health differences in body, mind, and spirit among Schedule III and IV controlled drugs users, nursing students, and psychology students. This study uses a cross-sectional comparative study on a convenience sample. Four hundred eleven participants were recruited from three different samples that include Schedule III and IV controlled drug users (n = 211), nursing students (n = 100), and psychology students (n = 100), all from either a drug abuse prevention center or two universities in Southern Taiwan. Relying on the Health of Body, Mind and Spirit Scale, a linear regression model was used to identify the health differences among drug users, nursing students, and psychology students. The results show that drug users scored higher on the physical subscale (ß = −.249, p < .001), the mental subscale (ß = −.120, p < .05), the spiritual subscale (ß = −.154, p < .01), and the Health of Body, Mind and Spirit Scale (ß = −.210, p < .001) than psychology students. The nursing students scored higher on the mental subscale (ß = .146, p < .01) than drug users did. These results could help health staff and instructors understand the differences and improve the physical, mental, and spiritual health among Schedule III and IV controlled drug users, nursing students, and psychology students. Furthermore, future study could further investigate the factors that may affect physical, mental, and spiritual health.
Predictors for Digital Game Addiction Among Turkish Adolescents
Authors: Irmak Aylin Yalçin , Erdoğan Semra
Published: March 2019

Background:

Digital game addiction among adolescents is a growing problem. The purpose of this study is to describe the predictors for this addiction in a group of Turkish adolescents using a conceptual framework.

Methods:

A descriptive correlational study was conducted on 865 students (aged 11–16 years) and their parents. Self-reported digital game behaviors were measured using the Game Addiction Scale. The risk factors for gaming addiction were examined using multiple regression analysis.

Results:

Adolescents spent 10.78 ± 13.42 hours per week playing digital games, and the rate of digital game addiction was calculated at 4.32% and 28.8% in monothetic and polythetic formats, respectively. Family environment and school performance directly affected female adolescents’ digital gaming behaviors, whereas male adolescents’ digital gaming behaviors were directly affected by computer self-efficacy, psychosocial problems, diminished impulse control, and levels of in-game violence.

Conclusions:

The interaction model of client health behavior can be used to describe adolescents’ digital game use. Nurses can assess adolescents’ gaming behaviors and use the effective predictors from the male and female models to develop intervention programs.
Shining a Light
Authors: Wood Tara , Bordelon Curry , Fogger Susanne
Published: March 2019

Background and Purpose:

The epidemic use of opioids is negatively influencing the health of the American people. Pregnant women and their unborn babies have not escaped the ravages of substance use. A dramatic increase in maternal opioid use has led to an increasing number of infants experiencing withdrawal symptoms known as neonatal abstinence syndrome (NAS). The purpose of this article is to highlight best practice for the management of infants with opioid withdrawal.

Review of Protocols and Treatments:

Review of available protocols and treatments revealed wide variation in the treatment of NAS and little use of standardized guidelines or protocols, despite current recommendations of the American Academy of Pediatrics. There is supporting evidence showing that the use of standardized protocols reduces the length of treatment and enhances outcomes in the neonatal population.

Evidence-Based Recommendations:

Evidence-based strategies to address gaps in practice include developing strong protocols to identify infants at risk and implementing standardized plans when treating NAS. Consistent assessment, initial treatment with nonpharmacologic measures, and conservative use of pharmacologic agents are important elements to an NAS treatment protocol.

Conclusions and Implications:

In evaluating the current literature for best practice in the management of the newborn with opioid withdrawal, it is clear that evidence-based standardized protocols need to be in place for the best treatment of the mother–infant dyad, caring for both the infants with NAS as well as the mothers with opioid use disorder.
International Control Efforts to Curb the Global Production and Trafficking of Fentanyl and Other Synthetic Opioids
Authors: Fornili Katherine Smith
Published: March 2019

The purpose of this Policy Watch column is to provide a brief overview of the global problems associated with the illicit production and trafficking of synthetic opioids as well as international efforts and policy approaches designed to curb them. An in-depth evaluation of drug control efforts of many different nations is important for a comprehensive analysis. However, because of the vast amount of information available, this column is limited to cooperative global control efforts, not efforts specific to any one nation. A great deal of information about production methods, clandestine laboratories, international trafficking methods, and online sales over the dark Web has been omitted. It is important to understand key issues regarding the illicit cultivation and distribution of plant-based opioids derived from natural compounds found in opium poppies (heroin, opium, morphine, codeine) or other drugs (cocaine, methamphetamines, etc.), but the scope of this column is limited to discussion about synthetic opioids including fentanyl, fentanyl analogues, and fentanyl precursor chemicals. Issues about human rights and ethical considerations for nurses and other addictions professionals are also discussed.
Shared Care During Breast and Colorectal Cancer Treatment: Is It Associated With Patient-Reported Care Quality?
Authors: Doose Michelle , McGee-Avila Jennifer , Stroup Antoinette M. , Ferrante Jeanne , Xu Baichen , Herman Natalia L. , Demissie Kitaw , Tsui Jennifer
Published: March 2019

There is growing evidence that shared care, where the oncologist, primary care physician, and/or other specialty physicians jointly participate in care, can improve the quality of patients' cancer care. This cross-sectional study of breast and colorectal cancer patients (N = 534) recruited from the New Jersey State Cancer Registry examined patient and health system factors associated with receipt of shared care during cancer treatment into the early survivorship phase. We also assessed whether shared care was associated with quality indicators of cancer care: receipt of comprehensive care, follow-up care instructions, and written treatment summaries. Less than two-thirds of participants reported shared care during their cancer treatment. The odds of reporting shared care were 2.5 (95% CI: 1.46–4.17) times higher for colorectal than breast cancer patients and 52% (95% CI: 0.24–0.95) lower for uninsured compared with privately insured, after adjusting for other sociodemographic, clinical/tumor, and health system factors. No significant relationships were observed between shared care and quality indicators of cancer care. Given a substantial proportion of patients did not receive shared care, there may be missed opportunities for integrating primary care and nononcology specialists in cancer care, who can play critical roles in care coordination and managing comorbidities during cancer treatment.
Bispectral Index Values Are Accurate Diagnostic Indices Correlated With Glasgow Coma Scale Scores
Authors: Li Shuojie , Fei Zhimin , Zhang Jue , Shu Guowei , Wang Jingyu , Cai Peihao , Gong Li , Kong Lingjun , Xu Leyi , Qiu Feng , Chen Li , Yuan Jie , Zhou Dejun
Published: March 2019

Objective: The Glasgow Coma Scale (GCS) is widely used in neurosurgery to evaluate the depth of coma in patients with brain injury. The bispectral index (BIS) was developed primarily to monitor the depth of unconsciousness. Recent evidence suggests that BIS may also help in the assessment of brain injury. This study explores the correlation between GCS scores and BIS values in patients with brain injury. Methods: Fifty patients were divided into 2 groups—moderate (GCS 9–12) and severe (GCS 3–8)—in this prospective, double-blind, observational study. Bispectral index data were recorded when electromyography was less than 40 and signal quality index was greater than 75 for 5 minutes. Linear regression was used to examine the correlation between BIS and GCS, and receiver operating characteristic curves were plotted. Cutoff points were identified to show the feasibility and accuracy of BIS for assessing brain injury. Results: The mean BIS value of the moderate group was 65.62 ± 12.84, and that of the severe group was 46.27 ± 17.35. Bispectral index values were significantly correlated with GCS (R
2 = 0.729, P < .01). The regression line and 95% confidence interval were determined; the regression equation was BIS = 5.46*GCS + 12.72. The receiver operating characteristic curve showed high diagnostic accuracy when GCS is less than 9; the area under the curve was 0.8164, and the cutoff point (BIS value) corresponding to the maximum sensitivity (0.91) and specificity (0.63) was 60.2. Conclusion: BIS values and GCS scores were significantly correlated in patients with brain injury. As a continuous and objective measurement, BIS is a viable evaluation and monitoring tool for brain injury.
Readmissions after left ventricular assist device implantation: Considerations for nurse practitioners
Authors: Kaiser Jennifer A.
Published: March 2019

Background and purpose:

Left ventricular assist device (LVAD) therapy is becoming a widespread treatment for advanced heart failure. Implantation of an LVAD introduces complications that contribute to high rates of rehospitalization. This study examines the presenting signs and symptoms in LVAD patients at the time of readmission and explores the prevalence of psychosocial factors that are significantly associated with readmissions in this patient population.

Methods:

This is a retrospective review of 226 patients who had an LVAD implanted at a single transplant center. Data were extracted from individual electronic health record review and analyzed for readmissions within 6 months of discharge from the index hospitalization.

Conclusions:

Post-LVAD readmission rates are high and occur more frequently in destination therapy (DT) patients. Anxiety and depression are significant predictors of readmission. These factors negatively affect post-LVAD quality of life, particularly in DT patients.

Implications for practice:

By understanding the etiologies and factors related to readmission after an LVAD, nurse practitioners can identify and address these issues before they result in rehospitalization to improve post-LVAD quality of life. With these considerations, ongoing nonemergent discussions of goals of care and quality of life are imperative because more patients will be offered the choice of an LVAD as a potentially life-long treatment.
Diagnostic readiness tests: Preparing nurse practitioner students for national certification examinations
Authors: Coppa Denise , Barcelos Winchester Suzy
Published: March 2019

Background and purpose:

Nurse practitioner (NP) faculties are challenged to offer programs that balance didactic knowledge with the clinical experiences required to prepare graduates for the complexities of health care. Students have the stress of extrapolating the information they obtain during these programs and applying it to postgraduation certification examinations. Innovative educational tools are necessary to ease the uncertainty that NP students experience to graduate and pass certification examinations. Tools include academic–clinical partnerships (ACPs) to enhance clinical opportunities and resources to integrate diagnostic readiness tests (DRTs) into curricula.

Methods:

This was a quasi-experimental one group, pretest/posttest design using a convenience sample of NP students randomly assigned to clinical in ACP or non-ACP clinical placements. They completed the DRTs twice during their final program semesters.

Conclusions:

The overall DRT group scores for the NP students significantly improved over time. The Wilcoxon signed ranks test showed that the posttest scores were significantly higher than the pretest scores. The Mann–Whitney U test revealed no differences between the ACP and non-ACP students. Students performed the best on assessment, diagnosis, management, and pharmacology domains. This demonstrates support for the integration of DRTs into NP programs.

Implications for practice:

Integrating DRTs into NP programs can facilitate transition to the NP role.