According to the Centers for Disease Control and Prevention, a deadly consequence of the opioid crisis is the increased incidence of blood-borne infections, including those related to bacteria/fungi causing endocarditis, a life-threatening infection of the heart's inner lining that disproportionally affects patients with all forms of opioid use disorder (OUD). Its significant morbidity and mortality burdens the healthcare system through prolonged, high-complexity episodes of acute hospitalization. This study compared bacteremia/sepsis/endocarditis rates between patients prescribed an FDA-authorized prescription digital therapeutic (PDT) and controls.

Opioid Use Disorder (OUD) affects roughly 2.7 million Americans. Prescription digital therapeutics (PDTs) have been associated with reduced health care resource utilization (HCRU). This machine learning analysis assessed HCRU and cost by PDT engagement level, compared to controls.

Background: Mindfulness is our innate capacity to pay full, conscious, and compassionate attention to something in the moment. It is also a skill that can be strengthened by mental practice. More recently, mindfulness-based interventions (MBIs) are identified within clinical practice guidelines as an intervention in the treatment of certain symptoms for children with cancer. However, there is little guidance available on the practice of using MBIs in the pediatric oncology population. The aim of this paper is to provide an overview of mindfulness, highlights symptoms where mindfulness practices may be of benefit, identifies trauma-sensitive considerations, and provides examples of MBIs that may be considered in the context of pediatric oncology. Methods: Collaboration of expert opinion, which included The Mindfulness Project Team, has enabled this collective informative paper. Results: Mindfulness has been recommended to help with the symptom of fatigue in children with cancer. Emotional symptoms such as anxiety, sadness, and anger may also benefit from the use of MBIs. Ideal MBIs for this population may include mindful movement, mindfulness of the senses, mindfulness of breath, mindfulness of emotions, and the body scan. These approaches can easily be adapted according to the age of the child. Many approaches have been administered with minimal training, with very few requiring a facilitator. However, hospitals have started to incorporate mindfulness experts within their care provision. Conclusion: Future research should continue to investigate the use of MBI programs for children with cancer.

Abstract Introduction The loss of income from injury, additional health care expenses, and inability to return work can lead to unsatisfactory outcomes. Community level disadvantage (e.g., low high school completion, low home ownership, low income) are more common among minority groups. We hypothesized community level disadvantage would negatively impact the ability to return to work after burn injury. This could serve to identify patients who need focused social, vocational, and financial support during rehabilitation. Methods Data from adult participants in a large multicenter database from 1998-2021 were linked by zip-code to three multi-domain community level-indices: i) Distressed Communities Index, ii) Social Vulnerabilities Index (SVI), iii) Social Deprivation Index (SDI). Cohort characteristics, the distribution of each index within cohort, and days to return to work were described. Fit and strength of association between the indices and return to work was assessed with multi-level logistic regression models. A non-responder analysis examining demographic and clinical differences between was performed using Chi-square tests and Wilcoxon rank sum tests to understand potential bias in the findings. Results A total of 1960 participants provided both zip code and employment data 6 months after injury. 75% of participants were male. Mean age was 39. Race/Ethnicity Data: 81.4% identified as White, 11% Black, and 7% as “other” race; 84% of the participants as non-Hispanic or Latino. Median burn size was 20% TBSA (IQR 0.1-95.0), and length of hospitalization was 30 days (IQR 0-379). Of the community indices tested, both DCI and SVI were associated with return to work with DCI having the strongest association with return to work after injury, irrespective of indices. However, when DCI and SVI were included in the model to represent community disadvantage, the impact of race on return to work was less. Participants who did not provide employment information were younger, sustained larger burn sizes, and had longer LOS compared to those who did. Conclusions DCI and SVI are associated with return to work after burn injury and can be used to focus limited social, vocational, and financial services. Minoritized participants were less likely to return to work but they live in communities with greater disadvantage (e.g. fewer employment opportunities), which highlights the public health impacts of structural racism.

The rising incidence of opioid use disorder (OUD) in the U.S. places a substantial burden on the healthcare system. This study examined changes in all-cause healthcare resource utilization (HCRU) among patients prescribed an FDA-authorized prescription digital therapeutic (PDT) for OUD.

The opioid epidemic continues to grow, and the health care system continues to struggle with an insufficient number of counselors to help patients in recovery. reSET-O® is an FDA-authorized prescription digital therapeutic (PDT) for opioid use disorder (OUD) providing cognitive behavioral therapy with contingency management. This analysis examined the real-world, 12-month impact of the PDT on indicators of relapse and retention among patients with OUD.

Despite the implementation of the Indian Child Welfare Act over the last 40 years, American Indian/Alaska Native (AIAN) children continue to be removed from their homes at an alarming rate and are overrepresented across the United States’ foster care system. To ensure the future of tribal communities, it is imperative that AIAN children grow up connected to their culture and their identity. One method to ensure stability is to increase efforts to recruit and retain competent, committed tribal relatives as caretakers, and when not possible, AIAN resource parents who are ready and able to care for them. This study utilized PRISMA methodology to conduct a systematic review to identify characteristics and competencies of successful resource parents who care for AIAN children and youth. Four major characteristics (strong cultural identity, resilient and adaptive to change, willingness to access tribal resources, and willingness to access kin/family as resources) and five major competencies (history, laws and policy; health and wellness from the AIAN perspective, AIAN family, kinship and community structure, and AIAN learning style, pedagogy and methods) were identified. Implications for policy and practice are discussed.

To study the health-related quality of life (HRQoL) of persons with opioid use disorder (OUD) initiating medication treatment. We conducted a secondary analysis of data collected from a clinical trial funded by the National Drug Abuse Treatment Clinical Trials Network, where participants (N=570) in residential treatment were randomized to initiating extended-release naltrexone (XR-NTX) or buprenorphine-naloxone (BUP-NX) for the prevention of opioid relapse. A generalized structural equation latent-class model was used to identify associations and describe HRQoL trajectories over the 24-week trial and subsequent 28- and 36-week follow-ups for all participants regardless of success initiating treatment. Two latent classes were identified and defined: HRQoL “pharmacotherapy responsive” (82.3%), and HRQoL “baseline sensitive” (17.7%). The pharmacotherapy responsive class was characterized by HRQoL that tended to increase over time and a significant positive association between HRQoL and whether BUP-NX or XR-NTX was received in the past 30 days. The baseline sensitive class was characterized by lower average receipt of pharmacotherapy, initial increase in HRQoL with gradual decrease over time, and no significant HRQoL response to pharmacotherapy. HRQoL changes over time among patients in this class were sensitive to age, race, marital status, and motivation at baseline. Compared to the pharmacotherapy responsive class, the baseline sensitive class included higher proportions of participants who were female, white, married, less educated, and less motivated at baseline. The pharmacotherapy responsive class participants had, on average, less severe medical, drug, legal, and psychiatric problems at baseline. The majority of persons with OUD enrolled in this trial experienced improvements in HRQoL that were associated with pharmacotherapy, while a smaller sub-group with lower average receipt of pharmacotherapy had HRQoL changes that were associated with baseline characteristics but not pharmacotherapy. Our analysis provides insights for improved person-centered care for OUD patients receiving pharmacotherapy who are not adherent to treatment.

Psychological interventions have shown benefit in reducing symptoms in children and adolescents with cancer. More recently, mindfulness-based interventions (MBIs) have been shown to be a promising approach to symptom intervention in adolescents with chronic illnesses. In this systematic review, we aimed to describe MBIs or focused-breathing interventions that have been used to treat symptoms in children receiving cancer therapy. A systematic review was conducted using MEDLINE/PubMed, EMBASE, CINAHL, and PsycINFO from inception to September 2019. We identified relevant articles in which MBIs or focused-breathing interventions were the primary interventions delivered to improve symptoms in children or adolescents with cancer. Six studies met the inclusion criteria. MBIs included controlled breathing and belly breathing. Intervention effects were found to be beneficial with regard to symptoms that included procedural pain, distress, and quality of life. The interventions were generally well accepted and beneficial. All studies suffered limitations because of methodological flaws, including the lack of randomization, and small sample sizes. Despite the small numbers of studies and participants, MBIs delivered to children with cancer may have beneficial effects on certain symptoms. Implications for future research include interventions tailored to the specific symptom burden. Studies must aim to increase sample sizes as well as to include individuals at high risk for severe symptoms.

To evaluate the cost-effectiveness of a prescription digital therapeutic (PDT) for opioid use disorder (OUD). The incremental cost-effectiveness ratio (ICER) of PDT+ treatment-as-usual (TAU) vs. TAU was calculated as the difference in direct costs (PDT cost + TAU + health care resource utilization (HCRU)-related cost vs. TAU + HCRU) incurred over 12 weeks between the two treatment strategies, divided by the difference in buprenorphine treatment retention rate at 12 weeks. PDT cost was assumed to be $1,500. TAU cost was derived from the sum of its individual components over 12 weeks (Office visits (6*$33) + urinalyses (36*$70), + buprenorphine 3*$123: $3,086 total). HCRU costs were obtained from an analysis of claims data that showed lower costs over 12 weeks in adherent vs. non-adherent patients ($3,887 vs. $11,219, respectively). HCRU costs were weighted to account for the retention difference observed in the PDT’s pivotal clinical trial (PDT+TAU 80%; TAU 64%) by ascribing adherent costs to retained patients, and non-adherent costs to non-retained patients using the following formula: HCRUtreatment = HCRUCostAdherent × Retentiontreatment + HCRUCostNonadherent × (1 – Retentiontreatment). A Monte Carlo simulation was performed with 1,000 iterations. Probabilistic sensitivity analysis was performed to estimate the probability that PDT+TAU would be considered cost-effective at various willingness-to-pay thresholds. The ICER for PDT+TAU was $18.70 per 1 percentage-point increase in retention. The probability that reSET-O would be considered cost-effective was greater than 92% for third party payers with willingness-to-pay thresholds of $6,000 or more for a one percentage-point increase in the buprenorphine treatment retention rate. The addition of this PDT to treatment-as-usual may be cost-effective for increasing OUD treatment retention rates. Better retention has elsewhere been associated with improved clinical and humanistic patient outcomes.

In a US randomized clinical trial testing the effectiveness of preventing opioid relapse among individuals initiating extended-release naltrexone (XR-NTX) compared to buprenorphine-naloxone (BUP-NX) in an inpatient detoxification setting, the additional time required to detoxify from opioids prior to initiating XR-NTX resulted in fewer persons initiating XR-NTX, leading to a higher opioid relapse rate, and higher detoxification costs compared to BUP-NX. The objective of this study was to use trial data to estimate whether an efficient model of inpatient opioid detoxification would improve the economic value of XR-NTX compared to BUP-NX. We identified efficient models of inpatient detoxification for trial participants assigned to XR-NTX using 1) latent class analysis to identify detoxification pharmacotherapy use patterns, 2) a multivariable generalized structural equation model to explore determinants of XR-NTX initiation and detoxification duration, while controlling for endogeneity, and 3) data from the trial on detoxification daily cost by site. We then estimated trial cost-effectiveness outcomes from the healthcare sector perspective assuming alternative detoxification models for trial participants. Five latent pharmacotherapy classes were identified and included in the multivariable model. Site effects were the largest determinants of both XRT-NTX initiation and detoxification duration. The predicted probabilities of successful initiation per detoxification-day ranged from 0.13–0.15 at the four sites with significant effects, and the predicted durations ranged from 5.5 to 6.9 days. The predicted cost/detoxification-day varied from $115–$348, largely due to different staffing models. We estimated that the most efficient site model would result in non-significant cost and effectiveness differences between initiating XR-NTX or BUP-NX. Adopting an efficient model of XR-NTX initiation could result in XR-NTX and BUP-NX having similar economic value from the healthcare sector perspective for the average patient requiring residential detoxification before initiating XR-NTX. The feasibility of implementing more efficient detoxification models needs to be explored.

Background: Age, total burn surface area (TBSA), and inhalation injury are proven predictors of mortality and morbidity following burn injury. Most previous studies have also found that African Americans and females with burns also fare worse. We sought to determine whether these disparities were reduced when burn victims were analyzed separately by categories of insurance coverage. Methods: We evaluated records in the National Burn Registry (NBR) from 2002 to 2011. Multivariate logistic regression was performed to determine factors associated with inpatient mortality, including age, TBSA, inhalation injury, race, and sex, and allowing for clustering by hospital. Separate models were constructed for each category of insurance. 95% confidence intervals (CI) not including 1 for any odds ratio were considered evidence of statistical significance (designated by * in the table below). Results: NBR included records from 172,640 patients (55.8% Caucasian, 18.1% African American, 14.2% Hispanic, 6.4% other minority groups, 5.4% unknown). Age, TBSA, and inhalation were strong predictors of mortality as expected. Non-African American males were the largest group for all insurance categories, and had the lowest mortality. Controlling for these factors, and compared with non-African American males, African American males had consistently increased odds of mortality regardless of insurance coverage. African American females had increased odds of mortality if they had Private, Medicare, or Medicaid insurance, and Non-African American females had increased odds of mortality if they had Private or Medicaid insurance. [GRAPHICS] The association of Hispanic ethnicity with mortality was inconsistent or insignificant, and other minority groups had too few members to evaluate. Most patients were missing comorbidity data, and no other socioeconomic or hospital data were available in NBR. Conclusions: African American males with burn injury are at increased risk of mortality regardless of insurance coverage, and most females are at increased risk regardless of race. Analyzing the reasons for these disparities will require databases containing more complete comorbidity, socioeconomic, and/or hospital data. (C) 2018 Elsevier Inc. All rights reserved.

A recent eight-site randomized effectiveness trial compared buprenorphine-naloxone (BUP-NX) to extended-release naltrexone (XR-NTX) to prevent opioid-use relapse. Participants were recruited from inpatient-detoxification or short-term residential treatment programs. Current treatment protocols require persons initiating XR-NTX, but not BUP-NX, to be fully detoxified from opioids. This detoxification requirement resulted in fewer persons initiating XR-NTX, higher detoxification costs, and a higher relapse rate. However, among those who successfully initiated pharmacotherapy, relapse rates were not significantly different between XR-NTX and BUP-NX. We used trial data to identify factors associated with an efficient model of residential/inpatient opioid detoxification; i.e., factors that simultaneously increase the likelihood of XR-NTX initiation, and minimize detoxification duration. Given the many potential combinations of supportive medications that can be used in the detoxification process, latent class analysis (Stata 15.1) was used to categorize participants randomized to XR-NTX. A multivariable generalized structural equation model was then estimated to explore determinants of XR-NTX initiation and detoxification duration, while controlling for the simultaneous influence that many factors have on both measures. Five latent pharmacotherapy classes were identified. Neither pharmacotherapy class, nor detoxification duration was a significant determinant of XR-NTX initiation. Site effects were the largest determinants of both initiation and duration, and both factors varied by site, as did efficiency. Across the four sites associated with a significantly higher likelihood of initiation, predicted probabilities of success/day spent in detoxification ranged from 0.12–0.16. The predicted cost/day of detoxification varied from $115–$348, largely due to different staffing models. The most efficient site relied on physician assistants or nurse practitioners, and counselors; had a predicted probability of success/day=0.16; and had a predicted cost/day=$115. Identifying and adopting efficient site models of XR-NTX initiation could improve its relative economic value, thereby increasing its attractiveness to payers for patients who prefer this treatment.

The aims of this study were to: 1) determine which of 16 substance abuse content areas nursing faculty fellows considered important for their professional growth; 2) determine content areas in which faculty fellows planned to obtain knowledge and skill development during the coming year; and 3) to identify content areas faculty fellows thought undergraduate and/or graduate students should be taught. Questionnaires were mailed to the 43 nursing faculty fellows who were recipients of substance abuse federal training during the 1989-1994 academic years. The response rate was 81%. One and a half years later, 66% responded to the same items on a follow-up survey. The results showed that faculty ratings of knowledge and skill development needs for themselves and their students in nursing were stable over time. Findings can be used to guide faculty and curriculum development in alcohol and other substance abuse.