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Perspectives in Fragment-based Substance Discovery: Something Relevant to Various Focuses on.
A PET scan showed multiple sites of hypermetabolism affecting the face and lymph nodes. Meglumine antimoniate was stopped and the patient experienced complete remission after chemotherapy. Conclusion Ulcerated nodules with acute progression on acral sites are characteristic of cutaneous CD8+ aggressive, epidermotropic, cytotoxic T-cell lymphoma. In our case, the positive result of PCR screening for Leishmania that was ultimately considered a false positive was a confounding factor in the diagnostic process. Regarding therapy, aggressive treatment strategies such as multiagent chemotherapy and hematopoietic stem-cell transplantation are needed due to the rapid progression of the lymphoma.Introduction People's motivations for nonmedical use of prescription drugs (NMUPD) are not well studied, particularly in longitudinal representative samples. However, understanding which motivations are most popular and how these change over time for specific groups is important to inform interventions for NMUPD. Methods The current study examined how young adults' motives for NMUPD changed over young adulthood, using a nationally representative sample of 12,223 young adults in 36 cohorts (1976-2012) as part of the Monitoring the Future study across three biennial waves (waves 1, 2, 3 modal ages 19/20, 21/22, and 23/24 years). We investigated these young adults' motivations for using stimulants, central nervous system depressants, and opioids when controlling for possible cohort effects. We included sex and college attendance as potential moderators. Results Participants commonly reported recreational and self-treatment motivations over time and across drug classes, reporting four to five popular motivations in each drug class. Generalized estimating equations repeated measure analyses revealed relatively stable NMUPD motivations across young adulthood. Participants reported some reductions in experimentation and boredom as motivations for NMUPD and increases in certain self-treatment motivations, depending on prescription drug class. Overall, men were more likely to endorse recreational motivations, whereas women were more likely to endorse self-treatment motivations, though this varied somewhat by prescription drug class. Young adults not enrolled in college courses were more likely to endorse using stimulants nonmedically for different reasons than their peers who were enrolled. Conclusions NMUPD prevention and treatment efforts tailored to the young adult population should include methods to reduce both self-treatment and recreational use and need to consider prescription drug class, sex, and college attendance.Medication for opioid use disorder (MOUD) is an important approach to address the opioid crisis, but rural areas have limited access to MOUD. In 2016, Nurse Practitioners (NPs) and Physician Assistants (PAs) became eligible to prescribe buprenorphine. Local and state stakeholders in Colorado, including clinicians, policymakers, law enforcement, and patient advocates, formed a collaborative to develop legislative policy and programs for the opioid epidemic. A pilot MOUD program was developed in 2017 to increase the number of NPs and PAs providing MOUD and to increase access to MOUD in 2 counties with high opioid overdose rates. A central coordinating site selected 3 clinical agencies through an open call for proposals, with review of applications by nursing faculty experts and a community advisory board. We then monitored the number of waivered providers and patients served in targeted counties. LXS-196 Providers at pilot program sites tracked costs, community-level barriers, facilitators of success via monthly reports. Sites were funded for 18 months. Seven MOUD providers were added in County 1, a 350% increase compared to the prior year, and there are now 8 MOUD providers in County 2 where there were previously none. County 1 increased MOUD services from 99 clients in 2017 to 582 in 2018 and 317 during the first half of 2019. County 2 provided MOUD services for 60 new clients in 2018 and 46 in the first half of 2019. Cognitive-behavioral therapy, family therapy, and other approaches were used to increase patient engagement and days without opioid use. Successes included community outreach, referral networks, and provider education to reduce stigma. link2 Barriers to sustainability included 1) reimbursement, 2) stigma, and 3) coordination with hospitals. Policy efforts, legislation, and academic-community collaboration led to an increase in MOUD providers and patients served in rural counties severely affected by the opioid crisis.Little is known about the rates and predictors of substance use treatment received in the Military Health System among Army soldiers diagnosed with a postdeployment substance use disorder (SUD). We used data from the Substance Use and Psychological Injury Combat study to determine the proportion of active duty (n = 338,708) and National Guard/Reserve (n = 178,801) enlisted soldiers returning from an Afghanistan/Iraq deployment in fiscal years 2008 to 2011 who had an SUD diagnosis in the first 150 days postdeployment. Among soldiers diagnosed with an SUD, we examined the rates and predictors of substance use treatment initiation and engagement according to the Healthcare Effectiveness Data and Information Set criteria. In the first 150 days postdeployment 3.3% of active duty soldiers and 1.0% of National Guard/Reserve soldiers were diagnosed with an SUD. Active duty soldiers were more likely to initiate and engage in substance use treatment than National Guard/Reserve soldiers, yet overall, engagement rates were low (25.0% and 15.7%, respectively). Soldiers were more likely to engage in treatment if they received their index diagnosis in a specialty behavioral health setting. Efforts to improve substance use treatment in the Military Health System should include initiatives to more accurately identify soldiers with undiagnosed SUD. Suggestions to improve substance use treatment engagement in the Military Health System will be discussed.Objective To examine the hepatitis C virus (HCV) cascade of care at a community-based integrated harm reduction and treatment facility for people who inject drugs (PWID). Methods Queensland Injectors' Health Network is a community-based agency providing integrated harm reduction and treatment services, including HCV treatment. Program data were analyzed from program commencement (early 2015) up to December 2017. Results By December 2017, 476 participants with confirmed HCV infection had enrolled in treatment, of whom 72% had commenced treatment, 65% had completed treatment, and 44% had a confirmed sustained virologic response at 12-weeks post-treatment. Participants who commenced treatment tended to be older (ref 18-34 years; 35-49 years OR = 1.84, p = 0.037, 50+ years OR = 3.19, p = 0.002) and to feel safe and stable in their housing (OR = 2.36, p = 0.021). Participants who completed treatment were less likely to report legal issues (OR = 0.23, p = 0.009). Conclusions Integrated community-based services can successfully engage PWID throughout the HCV treatment journey. Additional social support, including linkage with housing and legal navigation services, may improve treatment uptake and completion. Point-of-care testing, including same-day scripting, could improve treatment uptake.Cognitive behavioral therapy (CBT) is one of the most common and effective treatments for substance use disorders (SUD); however, effective delivery of CBT depends on a wide variety of nuanced skills that require practice to master. We created a computer-based simulation training system to support the development of necessary skills for student trainees to be able to apply CBT effectively for clients with SUDs. CBT Introducing Cognitive Behavioral Therapy is an interactive, role-play simulation that provides opportunities for clinician trainees to hone their skills through repeated practice and real-time feedback before application in a clinical setting. This is the first study that tests whether such a simulation improves trainee skills for the treatment of clients with SUDs. link3 Graduate students (N = 65; social work, clinical psychology) completed standardized patient (SP) interviews, were randomized to the simulation training program or manual comparison condition (Project MATCH manual), and completed SP interviews three months post-baseline. Using general linear models, results indicated a significant time x group effect, with students assigned to the simulation training program showing greater improvement in "extensiveness" and "skillfulness" ratings across three skill categories general agenda setting (p = .03), explaining CBT concepts (p = .007), and understanding of CBT concepts (p = .001). However, manual comparison participants showed greater improvement than simulation trainees in "assessing primary drug use" (prange = .013-.024). No changes in extensiveness or skillfulness of motivational interviewing (MI) style were observed. This pilot test of CBT Introducing Cognitive Behavioral Therapy offers support for use of this novel technology as a potential approach to scale up CBT training for students, and perhaps clinicians, counseling people with SUDs.Opioid medication treatment access is a public health priority aimed to improve opioid use treatment outcomes. However, Medicaid does not cover all forms of MOUD, particularly methadone, in many states. We examined associations between medication for opioid use disorder (MOUD) plans and substance use treatment discharge reason (e.g., completed treatment, dropped out of treatment) as well as treatment retention (i.e., length of stay), and estimated whether these relationships were modified by state Medicaid methadone coverage. Data from the 2016 Treatment Episode Data Set for Discharges (TEDS-D) included 152,196 opioid-related treatment episodes from 47 states using relative risk regression with state clustering. Discharges involving MOUD had higher treatment retention for >180 days (aRR 1.60, 95% CI 1.29, 1.99) and >365 days (aRR 2.64, 95% CI 2.00, 3.49) but lower treatment completion (aRR 0.46, 95% CI 0.38, 0.57). There was no evidence that state Medicaid methadone coverage modified any of these relationships. Focusing on treatment completion alone may obscure health benefits associated with longer MOUD treatment retention.Non-medical use of both opioids and sedatives increases risk of overdose or accident. The purpose of the present study was to describe rates of co-use, to examine baseline characteristics and psychiatric conditions potentially associated with meeting criteria for co-occurring opioid use disorder and sedative use disorder, and to examine whether these relationships varied by gender. Participants were 330 individuals from the NESARC-III who met criteria for current opioid use disorder. Gender-stratified logistic regression analyses, accounting for the survey design, were used to identify psychiatric conditions associated with meeting criteria for co-occurring sedative use disorder. Results indicated that 16.4% of the sample also met criteria for sedative use disorder. Notably, 55.6% of the sample attained opioids through their own prescription. Of those with co-occurring sedative use disorder, 47.2% attained sedatives through their own prescription. Posttraumatic stress disorder (OR = 3.02, 95% CI = 1.40-6.51) and antisocial personality disorder (OR = 2.
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