Impact of a jail-based treatment decision-making intervention on post-release initiation of medications for opioid use disorder.

INTRODUCTION: Opioid use disorder (OUD) is common among people in jail and is effectively treated with medications for OUD (MOUD). People with OUD may have an incomplete or inaccurate understanding of OUD and MOUD, and of how to access care. We evaluated an OUD treatment decision making (TDM) intervention to determine whether the intervention increased MOUD initiation post-release. METHODS: We conducted an observational retrospective cohort study of the TDM intervention on initiation of MOUD, individuals with records data indicating confirmed or suspected OUD incarcerated in four eligible jails were eligible to receive the intervention. Time-to-event analyses of the TDM intervention were conducted using Cox proportional hazard modeling with MOUD as the outcome. RESULTS: Cox proportional hazard modeling, with the intervention modeled as having a time-varying effect due to violation of the proportionality assumption, indicated that those receiving the TDM intervention (n = 568) were significantly more likely to initiate MOUD during the first month after release from jail (adjusted hazard ratio 6.27, 95 % C.I. 4.20-9.37), but not in subsequent months (AHR 1.33 95 % C.I. 0.94-1.89), adjusting for demographics, prior MOUD, or felony or gross misdemeanor arrest in the prior year compared to those not receiving the intervention (n = 3174). CONCLUSION: The TDM intervention was associated with a significantly higher relative hazard of starting MOUD, specifically during the first month after incarceration. However, a minority of all eligible people received any MOUD. Future research should examine ways to increase initiation on MOUD immediately after (or ideally during) incarceration.

The payment of research subjects: ethical concerns.

PURPOSE/OBJECTIVES: To present models for the payment of research subjects, pros and cons of each, and the application of ethical principles in the current environment. DATA SOURCES: Federal regulations and guidelines, current and historical research, and opinions expressed in the nursing, medical, bioethics, pharmacology, and clinical trial literature. DATA SYNTHESIS: Relevant regulations are sparse. A variety of payment models exist, but all are somewhat problematic. Balancing the principles of respect for people and justice in our current society will not be entirely possible. Practice decisions must be made for individual situations. Special care must be taken with patients because they are subject to therapeutic misconception. CONCLUSIONS: No model fits all situations, but research nurses can use their skills to evaluate particular applications. As a society, nurses must promote participation in research as a socially responsible activity and prevent unethical payment models from predominating. IMPLICATIONS FOR NURSING PRACTICE: Oncology research nurses may be involved with the consent process, the development of protocols, and staff education. A thorough understanding of an issue that may impair the consent process or impinge upon subjects' rights is critical to effective and ethical practice.

Atopic dermatitis: a case report and current clinical review of systemic and ocular manifestations.

PURPOSE: Atopic dermatitis is a relatively common hereditary dermatologic condition. Ocular sequellae are commonly seen in this disorder and may include involvement of both the anterior and posterior segments of the eye. Clinical symptoms and presentation may vary, as well as visual prognosis. METHOD: A 48-year-old black woman came to us with a sudden exacerbation of atopic disease with ocular complications-most notably, the classic "shield-like" anterior subcapsular cataract seen in patients with this disease. Extensive diagnostic and management considerations specific to this disorder are highlighted. RESULTS: A careful history and clinical examination will help direct appropriate diagnosis and management in this population. Although chronic in nature, acute exacerbations of the disease may require specific management. Proposed pathophysiologic mechanisms, including new aspects of treatment, are discussed. CONCLUSION: Ocular manifestations of atopic disease may be visually debilitating. Therefore, specific consideration relating to clinical course, effective diagnosis, and medical and surgical management of this disorder are discussed.

Light-induced amaurosis associated with carotid occlusive disease.

A 74-year-old man with the isolated complaint of uniocular transient visual loss after exposure to bright light was found to have severe ipsilateral, atherosclerotic carotid occlusive disease. Signs of ocular ischemia that were present included slightly reduced visual acuity, mild afferent pupillary defect, lowered intraocular pressure, increased photostress recovery time, and reduced opthalmodynamometry values on the affected side. After a subclavian to internal carotid artery bypass procedure, the patient's symptoms resolved completely and his ocular signs returned to normal. This patient's initial symptom, referred to as light-induced amaurosis (LIA), is an unfamiliar manifestation of the ocular ischemic syndrome. We discuss the condition and summarize the literature.

Preseptal cellulitis secondary to Proteus species: a case report and review.

BACKGROUND: Preseptal cellulitis is a serious ocular condition that--if left untreated--has the potential to cross the septal barrier, spread to the posterior orbit, and may result in fatal complications. Because it is difficult to determine the pathogen responsible for any cellulitis without aspirating a culture sample, treatment is usually instituted by an assumption of the most common causative organisms, Staphylococcus or Streptococcus. CASE REPORT: A 42-year-old black woman manifested signs and symptoms consistent with right preseptal cellulitis. Throughout treatment, visual acuity remained 20/20 for both eyes, extraocular muscles were unrestricted without pain, and anterior globe structures were clear. The patient was started on a regimen of 250-mg oral dicloxacillin four times a day. When no response was seen at 36 hours, the patient was changed to 500-mg oral ciprofloxacin every 12 hours. She responded to the 500-mg ciprofloxacin and recovered with no sequelae. An abscess, which had formed during the cellulitis, self expressed and this material was cultured. The cultures identified the responsible organism as Proteus species, an unexpected pathogen in a well-groomed patient. CONCLUSION: This case demonstrates the need to consider alternate pathogens when treating preseptal cellulitis, change medications accordingly, and consider alternate treatments as needed.