Social support and self-efficacy for abstinence: is peer identification an issue?

This study investigated levels of abstinence social support and abstinence self-efficacy in relation to characteristics among recovering substance abusers (57 men, 43 women) residing in Oxford Houses. Significant relationships between treatment and sociodemographic variables were observed on measures of abstinence social support and abstinence self-efficacy. Residence time in an Oxford House and 12-step participation were related to increased levels of abstinence social support and abstinence self-efficacy. However, residents who reported that their veteran status or prior incarceration experiences were issues they perceived as making identification with other recovering peers difficult reported lower levels of abstinence social support. In addition, residents who reported having at least one identification issue (57%) and residents who reported being a parent (73%) also reported lower levels of abstinence self-efficacy. Results of this study have important treatment implications for our understanding of social support and self-efficacy within ongoing recovery.     

Chemically Dependent Physicians and Informed Consent Disclosure

Developments in law, professional guidelines, and public attitudes support informed consent disclosure by physicians who have been treated for chemical dependency. This view is built on the apparent materiality of the risk of relapse to informed treatment decisions by patients. Several considerations undercut this position. The probability is remote that a patient will be injured by a recovering physician who suffers an undetected relapse while being properly monitored. Monitoring by impaired physicians programs provides a more sensitive and specific mechanism for detecting relapsed physicians. Moreover, compromise of the privacy and employment rights of recovering physicians by consent disclosure is not justified if programs provide rigorous monitoring that protects the welfare of patients. Finally, required consent disclosure will reduce referrals of chemically dependent physicians to impaired physicians programs, thereby increasing the danger to patients. Limiting demands for required consent disclosure necessitates effective operation of impaired physicians programs.     

Bulimia in opiate-addicted women: developmental cousin and relapse factor

There has been a growing awareness that eating disorders and substance abuse may coexist in the same individual. While several studies have documented the prevalence of these problems, few have addressed their relationship in the recovering patient. In the present study, the charts and hospital course of all female patients admitted to an inpatient treatment program for opiate dependency were reviewed. Approximately 20% of the patients had bulimic pathology that predated the drug abuse and re-emerged during detoxification. A theoretical model is presented which examines the possible developmental interplay between the two disorders and the role that renewed food problems may serve as a prodrome for relapse. The difficulty in addressing these issues during both the assessment and treatment phases of recovery is also discussed.     

Unintended consequences for patients of future personalized pharmacoprinting

Manufacturing pharmaceuticals by the use of 3D printing is a promising way to achieve more personalized drug treatment. To effectively use this technology, patients need to continuously measure their health, and new decisions have to be taken, for example, regarding the number of daily drugs including how many active pharmaceutical substances these should contain along with decisions around size, shape and color. Positive as well as negative effects of pharmacoprinted medicine on patients are likely to occur. Negative consequences with influence on patient autonomy and role might include: patients not being capable or interested in conducting self-monitoring, loosing overview of the medical treatment, reducing the ability to perform self-regulation, loosing trust in the pharmacoprinted medicine, and not being interested in taking on a new role in medical decision making. These issues are discussed in the paper in order to prevent upcoming challenges in the area of pharmacoprinting.     

Assessing Comorbid Substance Use in Detained Psychiatric Patients: Issues and Instruments for Evaluating Treatment Outcome

This review assesses the issues involved in the selection and treatment of patients comorbid for mental illness and substance misuse being treated in secure psychiatric facilities. It includes those individuals who have a history of offending and whose placement is the result of severe behavioral disturbance. The relevant issues in the assessment and treatment of these patients are reviewed and a battery of tests is suggested on the basis of their usefulness with this population in terms of their brevity, ease of administration, and for their value in planning treatment, providing motivational feedback, and monitoring change. The paucity of assessment tools developed specifically for this patient population is highlighted.     

Aripiprazole for the treatment of bipolar disorder: a review of current evidence

INTRODUCTION: several medications are available for the treatment of different phases of bipolar disorder, yet many of the drugs that are currently approved carry a substantial burden of side effects or do not lead all treated patients to remission. AREAS COVERED: this paper comprises a review and commentary regarding the use of oral and intramuscular aripiprazole in the acute and maintenance phases of bipolar disorder. Basic principles in dosing, switching, management of side effects and co-administration of aripiprazole with other medications are provided. This paper presents practical strategies to translate the data from clinical research into clinical practice. EXPERT OPINION: aripiprazole has proven to be an effective medication for the acute treatment of manic and mixed episodes, as well as for the prophylactic-maintenance phase of bipolar disorder in patients recovering from a manic/mixed episode. Choosing the appropriate dosing and tapering strategy, addressing the side effects, controlling withdrawal symptoms from previous medications and using adjunctive medications when necessary are key to successful treatment with aripiprazole.     

阴道超声介入在人工流产术中的临床应用

目的探讨应用阴道超声介入下人工流产术的可行性。方法 2009年1月至2010年12月期间,因意外妊娠来我站要求终止妊娠的300例受术者,将其随机分为两组,对照组150例,观察组150例,分别观察两组患者的手术时间、术后出血时间、术后恢复月经时间。结果观察组与对照组相比,手术时间、术后出血时间及术后恢复月经时间明显缩短(P<0.05)。结论阴道超声介入下人工流产术,能有效防止漏吸、吸宫不全,手术时间、术后出血时间及术后恢复月经时间明显缩短,值得临床推广应用。     

脑卒中失语症的预后及其影响因素的分析

目的通过对脑血管病失语症患者半年随访,了解其语言能力恢复过程及相关影响因素。方法收集2011年1月至2012年7月在垂杨柳医院神经内科住院存在失语症的脑卒中患者34例,对其发病后1月、2月、4月、6月的失语恢复情况进行随访观察,采用西部失语症成套检查(WAB)进行语言评价,计算出失语商(aphasia quotient,AQ),根据AQ值的变化,判断失语恢复的程度,分析患者文化程度、年龄及发病时的失语严重程度与语言能力恢复程度的相关性。结果患者在2个月内恢复最明显,2～6个月仍存在恢复,但改善的幅度减慢。自发语、听理解、复述、命名1个月时已有显著恢复,阅读到2月时开始恢复,书写成绩在6个月观察期间无明显恢复。性别在失语恢复程度上的无差异,6个月时复述能力恢复脑出血患者优于脑梗死患者,发病时严重程度越重,恢复越差,而年龄、文化程度与言语能力的改善幅度无关。结论脑卒中失语患者在发病6个月内各单项言语功能恢复程度不同,发病时失语严重程度越重,语言恢复越差,年龄、文化程度与言语恢复无相关性。     

伽玛刀治疗患者住院期间健康教育需求调查分析

目的 了解伽玛刀治疗患者住院期间健康教育需求情况,以便采取更合理的教育方式满足患者需求.方法 采用自行设计的问卷对260例行伽玛刀治疗的患者进行健康教育需求调查.结果 治疗前相关信息的需求程度最集中,达86.0%,其后依次是治疗结束相关信息(72.0%)、疾病相关信息(68.0%)及出院前相关信息(63.0%).在疾病...     

Contextual barriers to successful reentry of recovering drug offenders

Recidivism among recovering ex-offenders is usually conceptualized as an outcome of the interplay between personal traits and treatment interventions. This focus on the individual, to the exclusion of the sociolegal context in which recovery and reintegration take place, has limited extant policy initiatives. Recidivism data from 440 drug-abusing felons who had successfully completed long-term residential treatment were examined. All else being equal, recovering offenders who began their reentry during times of high unemployment, low risk of incarceration for new offenses, or both, were found to be more likely to recidivate during their first year in the community. These findings highlight the promise of blending effective drug abuse treatment with credible sanctions against drug offenses as well as the need for job training, placement, and advocacy services.     

Treatment options for sleep disturbances during alcohol recovery

Sleep disturbances are extremely common in the early stages of recovery from alcohol dependence and may persist for several months despite continued abstinence. Studies indicate that sleep disturbances independently increase the risk for relapse to alcohol, suggesting that targeting these problems during recovery may support continued abstinence. However, there is limited information in the addiction literature about available and effective treatments for sleep disturbances in recovering alcoholic patients. The primary goals of this article are to describe the phenomenology of sleep disturbances during recovery from alcohol dependence, to outline the evidence linking sleep problems with alcohol relapse, and to describe available pharmacological and nonpharmacological treatment options, including the evidence regarding their efficacy in recovering alcoholic patients. Recommendations for future research are provided along with special considerations for treating insomnia in this population, including avoiding cross-dependent sedatives, such as benzodiazepines and benzodiazepine receptor agonists (BzRAs).     

Medical Care Utilization as a Function of Recovery Status Following Chemical Addiction Treatment

A sample of 3,572 chemical dependency inpatients aged 25 to 82 years were the subjects of a study to evaluate whether observed reductions in health care costs are associated with successful recovery from alcoholism and other drug dependence, a function of regression to the mean, or ancillary health care during alcoholism/drug abuse treatment. The total number of hospital days were calculated for the year prior to treatment, and one and two years post-treatment. Utilization rates are not significantly different between recovering and relapsed patients prior to treatment; however, the differences between the two groups for the first and second year post-treatment are significant. The recovery patients showed a continued low utilization rate while the relapsed group had considerably higher utilization in both years. Recovery status is an essential factor to consider when determining valid cost-offsets for medical care utilization after alcoholism/drug abuse treatment.     

The role of recovering physicians in 19th century addiction medicine: an organizational case study

An elaborate network of inebriate homes, inebriate asylums, nationally franchised private addiction treatment institutes, and proprietary home cures for addiction arose on the American landscape between 1850 and 1900. The pinnacle of the movement to professionalize America's first addiction treatment field was the founding of the American Association for the Cure of Inebriety in 1870 and its publication of the first issue of the Journal of Inebriety in 1876. One of the most contentious issues among the various branches of this new professional field was the question of the use of "reformed men" as physicians, managers and attendants within treatment institutions. This article describes the employment of recovering physicians within one 19th century addiction treatment franchise--the Keeley Institutes--and documents the nature of the professional debate stirred by what was then a controversial practice.     

Aripiprazole for the treatment of bipolar disorder: a review of current evidence

Introduction: Several medications are available for the treatment of different phases of bipolar disorder, yet many of the drugs that are currently approved carry a substantial burden of side effects or do not lead all treated patients to remission.

Areas covered: This paper comprises a review and commentary regarding the use of oral and intramuscular aripiprazole in the acute and maintenance phases of bipolar disorder. Basic principles in dosing, switching, management of side effects and co-administration of aripiprazole with other medications are provided. This paper presents practical strategies to translate the data from clinical research into clinical practice.

Expert opinion: Aripiprazole has proven to be an effective medication for the acute treatment of manic and mixed episodes, as well as for the prophylactic–maintenance phase of bipolar disorder in patients recovering from a manic/mixed episode. Choosing the appropriate dosing and tapering strategy, addressing the side effects, controlling withdrawal symptoms from previous medications and using adjunctive medications when necessary are key to successful treatment with aripiprazole.     

Coagulopathy,Venous Thromboembolism,and Anticoagulation in Patients with COVID-19

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic, and patients with the infection are referred to as having COVID-19. Although COVID-19 is commonly considered a respiratory disease, there is clearly a thrombotic potential that was not expected. The pathophysiology of the disease and subsequent coagulopathy produce an inflammatory, hypercoagulable, and hypofibrinolytic state. Several observational studies have demonstrated surprisingly high rates of venous thromboembolism (VTE) in both general ward and intensive care patients with COVID-19. Many of these observational studies demonstrate high rates of VTE despite patients being on standard, or even higher intensity, pharmacologic VTE prophylaxis. Fibrinolytic therapy has also been used in patients with acute respiratory distress syndrome. Unfortunately, high quality randomized controlled trials are lacking. A literature search was performed to provide the most up-to-date information on the pathophysiology, coagulopathy, risk of VTE, and prevention and treatment of VTE in patients with COVID-19. These topics are reviewed in detail, along with practical issues of anticoagulant selection and duration. Although many international organizations have produced guidelines or consensus statements, they do not all cover the same issues regarding anticoagulant therapy for patients with COVID-19, and they do not all agree. These statements and the most recent literature are combined into a list of clinical considerations that clinicians can use for the prevention and treatment of VTE in patients with COVID-19.     

Simultaneous equations in ordered discrete responses with regressor-dependent thresholds

Summary The parameters of ordered discrete response (ODR) models are identified only up to a positive scale. In this paper, we examine the identification issue for simultaneous equations with ODR, where the well-known identification problem in simultaneous equations of recovering structural-form parameters from reduced-form parameters is compounded with the ODR identification problem. We allow the thresholds in ODR to be regressor dependent as well as constant; the former is particularly challenging because threshold parameters get mixed with regression parameters, adding one more dimension to the identification problem. We also explore a cross-equation restriction on threshold differences, under which the structural form parameters are fully identified as if the dependent variables are continuously distributed. An empirical example with farm–household joint labour supply is provided to illustrate the identification issues, to show how our proposals work and to apply tests devised for the threshold constancy and cross-equation restrictions.     

Targeted nano-delivery strategies for facilitating thrombolysis treatment in ischemic stroke

Ischemic stroke is one of the major causes of severe disability and death worldwide. It is mainly caused by a sudden reduction in cerebral blood flow due to obstruction of the supplying vessel by thrombi and subsequent initiation of a complex cascade of pathophysiological changes, which ultimately lead to brain ischemia and even irreversible infarction. Thus, timely and effective thrombolysis therapy remains a mainstay for acute ischemic stroke treatment. Tissue plasminogen activator (tPA), the only thrombolytic agent approved globally, provides substantial benefits by exerting a fibrinolysis effect, recovering the blood supply in occluded vessels and, thereby, salvaging the ischemic tissue. However, the clinical application of tPA was limited because of a few unsolved issues, such as a narrow therapeutic window, hemorrhagic complications, and limited thrombolytic efficacy, especially, for large thrombi. With the prosperous development of nanotechnology, a series of targeted delivery strategies and nanocomposites have been extensively investigated for delivering thrombolytic agents to facilitate thrombolysis treatment. Excitingly, numerous novel attempts have been reported to be effective in extending the half-life, targeting the thrombus site, and improving the thrombolytic efficacy in preclinical models. This article begins with a brief introduction to ischemic stroke, then describes the current state of thrombolysis treatment and, finally, introduces the application of various nanotechnology-based strategies for targeted delivery of thrombolytic agents. Representative studies are reviewed according to diverse strategies and nano-formulations, with the aim of providing integrated and up-to-date information and to improve the development of thrombolysis treatment for stroke patients.