Data Collection

Mobile Telemedicine for Buprenorphine Treatment in Rural Populations With Opioid Use Disorder

Bethie Seay — Fri, 03 Sep 2021 05:00:00 +0000

Date Added:

September 3, 2021

Type:

Clinical Research Results

DOI (1):

10.1001/jamanetworkopen.2021.18487

A report and description of the use of telemedicine and mobile services to help people in rural areas with substance abuse challenges.

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Importance
The demand for medications for opioid use disorder (MOUD) in rural US counties far outweighs their availability. Novel approaches to extend treatment capacity include telemedicine (TM) and mobile treatment on demand; however, their combined use has not been reported or evaluated.

Objective
To evaluate the use of a TM mobile treatment unit (TM-MTU) to improve access to MOUD for individuals living in an underserved rural area.

Design, Setting, and Participants
This quality improvement study evaluated data collected from adult outpatients with a diagnosis of OUD enrolled in the TM-MTU initiative from February 2019 (program inception) to June 2020. Program staff traveled to rural areas in a modified recreational vehicle equipped with medical, videoconferencing, and data collection devices. Patients were virtually connected with physicians based more than 70 miles (112 km) away. Data analysis was performed from June to October 2020.

Intervention
Patients received buprenorphine prescriptions after initial teleconsultation and follow-up visits from a study physician specialized in addiction psychiatry and medicine.

Main Outcomes and Measures
The primary outcome was 3-month treatment retention, and the secondary outcome was opioid-positive urine screens. Exploratory outcomes included use of other drugs and patients’ travel distance to treatment.

Results
A total of 118 patients were enrolled in treatment, of whom 94 were seen for follow-up treatment predominantly (at least 2 of 3 visits [>50%]) on the TM-MTU; only those 94 patients’ data are considered in all analyses. The mean (SD) age of patients was 36.53 (9.78) years, 59 (62.77%) were men, 71 (75.53%) identified as White, and 90 (95.74%) were of non-Hispanic ethnicity. Fifty-five patients (58.51%) were retained in treatment by 3 months (90 days) after baseline. Opioid use was reduced by 32.84% at 3 months, compared with baseline, and was negatively associated with treatment duration (F = 12.69; P = .001). In addition, compared with the nearest brick-and-mortar treatment location, TM-MTU treatment was a mean of 6.52 miles (range, 0.10-58.70 miles) (10.43 km; range, 0.16-93.92 km) and a mean of 10 minutes (range, 1-49 minutes) closer for patients.

Conclusions and Relevance
These data demonstrate the feasibility of combining TM with mobile treatment, with outcomes (retention and opioid use) similar to those obtained from office-based TM MOUD programs. By implementing a traveling virtual platform, this clinical paradigm not only helps fill the void of rural MOUD practitioners but also facilitates access to underserved populations who are less likely to reach traditional medical settings, with critical relevance in the context of the COVID-19 pandemic.

Author/s:

Weintraub, E., Seneviratne, C., Anane, J.

Mobile phone text messaging and app-based interventions for smoking cessation

Devin Evans — Mon, 08 Mar 2021 06:00:00 +0000

Date Added:

March 8, 2021

Journal/Publication:

Cochrane Database System Review

Publication Date:

October 22, 2019

Issue:

Volume:

URL:

Mobile phone text messaging and app-based interventions for smoking cessation

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1002/14651858.CD006611.pub5

Keywords

PMID (1):

31638271

MeSH

Text messaging strategies can increase smoking cessation rates by 50-60%. James W. Mold, MD, MPH

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Background: Mobile phone-based smoking cessation support (mCessation) offers the opportunity to provide behavioural support to those who cannot or do not want face-to-face support. In addition, mCessation can be automated and therefore provided affordably even in resource-poor settings. This is an update of a Cochrane Review first published in 2006, and previously updated in 2009 and 2012.

Objectives: To determine whether mobile phone-based smoking cessation interventions increase smoking cessation rates in people who smoke.

Search methods: For this update, we searched the Cochrane Tobacco Addiction Group's Specialised Register, along with clinicaltrials.gov and the ICTRP. The date of the most recent searches was 29 October 2018.

Selection criteria: Participants were smokers of any age. Eligible interventions were those testing any type of predominantly mobile phone-based programme (such as text messages (or smartphone app) for smoking cessation. We included randomised controlled trials with smoking cessation outcomes reported at at least six-month follow-up.

Data collection and analysis: We used standard methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We performed both study eligibility checks and data extraction in duplicate. We performed meta-analyses of the most stringent measures of abstinence at six months' follow-up or longer, using a Mantel-Haenszel random-effects method, pooling studies with similar interventions and similar comparators to calculate risk ratios (RR) and their corresponding 95% confidence intervals (CI). We conducted analyses including all randomised (with dropouts counted as still smoking) and complete cases only.

Main results: This review includes 26 studies (33,849 participants). Overall, we judged 13 studies to be at low risk of bias, three at high risk, and the remainder at unclear risk. Settings and recruitment procedures varied across studies, but most studies were conducted in high-income countries. There was moderate-certainty evidence, limited by inconsistency, that automated text messaging interventions were more effective than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; I2 = 71%; 13 studies, 14,133 participants). There was also moderate-certainty evidence, limited by imprecision, that text messaging added to other smoking cessation interventions was more effective than the other smoking cessation interventions alone (RR 1.59, 95% CI 1.09 to 2.33; I2 = 0%, 4 studies, 997 participants). Two studies comparing text messaging with other smoking cessation interventions, and three studies comparing high- and low-intensity messaging, did not show significant differences between groups (RR 0.92 95% CI 0.61 to 1.40; I2 = 27%; 2 studies, 2238 participants; and RR 1.00, 95% CI 0.95 to 1.06; I2 = 0%, 3 studies, 12,985 participants, respectively) but confidence intervals were wide in the former comparison. Five studies compared a smoking cessation smartphone app with lower-intensity smoking cessation support (either a lower-intensity app or non-app minimal support). We pooled the evidence and deemed it to be of very low certainty due to inconsistency and serious imprecision. It provided no evidence that smartphone apps improved the likelihood of smoking cessation (RR 1.00, 95% CI 0.66 to 1.52; I2 = 59%; 5 studies, 3079 participants). Other smartphone apps tested differed from the apps included in the analysis, as two used contingency management and one combined text messaging with an app, and so we did not pool them. Using complete case data as opposed to using data from all participants randomised did not substantially alter the findings.

Authors' conclusions: There is moderate-certainty evidence that automated text message-based smoking cessation interventions result in greater quit rates than minimal smoking cessation support. There is moderate-certainty evidence of the benefit of text messaging interventions in addition to other smoking cessation support in comparison with that smoking cessation support alone. The evidence comparing smartphone apps with less intensive support was of very low certainty, and more randomised controlled trials are needed to test these interventions.

Author/s:

Whittaker, Robyn, McRobbie, Hayden, Bullen, Chris, Rodgers, Anthony, Gu, Yulong, Dobson, Rosie

Compounded Bioidentical Hormone Therapy The National Academies Weigh In

Devin Evans — Mon, 21 Dec 2020 06:00:00 +0000

Date Added:

December 21, 2020

Journal/Publication:

Journal of the American Medical Association Internal Medicine

Publication Date:

December 14, 2020

URL:

Compounded Bioidentical Hormone Therapy The National Academies Weigh In

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2020.7232

Keywords

menopause

hormone therapy

Menopausal women

PMID (1):

33315055

MeSH

menopause

Data Collection

Endocrinologists

A concise summary of the findings of the National Academy of Medicine regarding the safety and effectiveness of compounded bio-identical hormones for management of menopausal women. James W. Mold, MD, MPH

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After 21 months of data collection and analysis, the NASEM committee’s overarching conclusion was, “Given the paucity of data on the safety and effectiveness of cBHT…there is insufficient evidence to support the overall clinical utility of cBHT as treatment for menopause.”1(p9) Specific concerns included inadequate labeling requirements of cBHT preparations, paucity of reliable pharmacokinetic and bioavailability data, technical challenges with difficult-to-compound steroid hormones (particularly pellet therapies), and insufficient high-quality evidence to establish whether cBHT preparations are safe and effective. The committee further concluded that most marketing claims about safety and effectiveness are not supported by evidence from welldesigned, properly controlled studies. Incomplete adverse event reporting contributes to safety concerns. The committee acknowledged that in the absence of safety and effectiveness data for cBHT, patient preference should not be the sole driver for use.

Author/s:

Stuenkel, Cynthia A., Manson, JoAnn E.

Management of Kidney Stones in 2020

John Bayhi — Mon, 23 Mar 2020 22:42:52 +0000

Date Added:

March 23, 2020

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

March 19, 2020

URL:

Management of Kidney Stones in 2020

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2020.0662

Keywords

kidney stones

symptomatic kidney stones

asymptomatic kidney stones

PMID (1):

32191284

MeSH

A concise update on management of kidney stones in adults. James W. Mold, MD, MPH

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Kidney stones are common, painful, and frequently recur. Although precise estimates of the incidence of symptomatic kidney stones for the entire US are unavailable, a Minnesota population-based study reported that between 1984 and 2012, the incidence of symptomatic kidney stones that required treatment increased from 51 to 217 per 100 000 person-years in women and from 145 to 299 per 100 000 person-years in men.

Author/s:

Rule, AD, Lieske, JC, Pais, VM Jr

Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices

Brian Desmarais — Tue, 14 Jan 2020 15:17:31 +0000

Date Added:

January 14, 2020

Journal/Publication:

Morbidity and Mortality Weekly Report

Publisher:

U.S. Department of Health and Human Services

Publication Date:

August 16, 2019

URL:

Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

http://dx.doi.org/10.15585/mmwr.mm6832a3

MeSH

Centers for Disease Control and Prevention, U.S.

Data Collection

vaccination

Papillomaviridae

clinical decision-making

public health

Papillomavirus Infections

Middle Aged

child

United States

HPV vaccination appears to be both safe and effective in adults 27-45 years of age. While the public health impact of routine HPV vaccination of adults would be small, some high-risk individuals could benefit significantly. James W. Mold, MD, MPH

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Summary

What is already known about this topic?

Vaccination against human papillomavirus (HPV) is routinely recommended at age 11 or 12 years. Catch-up recommendations apply to persons not vaccinated at age 11 or 12 years.

What is added by this report?

After reviewing new evidence, CDC updated HPV vaccination recommendations for U.S. adults.

What are the implications for public health practice?

Routine recommendations for HPV vaccination of adolescents have not changed. Catch-up HPV vaccination is now recommended for all persons through age 26 years. For adults aged 27 through 45 years, public health benefit of HPV vaccination in this age range is minimal; shared clinical decision-making is recommended because some persons who are not adequately vaccinated might benefit.

Author/s:

Meites, E., Szilagyi, P., Chesson, H.W., Unger, E.R., Romero, J.R., Markowitz, L.E.