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Expanded access to buprenorphine induction, including via emergency departments, increases the likelihood of treatment engagement for patients with opioid use disorder (OUD). However, longer-term retention among these patients remains a challenge. In this study, we aimed to identify barriers to engaging and retaining patients with OUD in care and additional services that might improve retention.

We surveyed counselors at an urban safety net addictions treatment clinic.

Twenty-five of 27 (93%) eligible counselors responded. Counselors described patients who were homeless, had no prior treatment history, or lacked health insurance as hardest to retain in treatment. Housing assistance, residential treatment placement, regular access to a phone, and mental health services were thought to be most beneficial for improving retention. Respondents most often reported that screening for services should happen at intake, and almost all respondents agreed that "retention of patients receiving treatment for OUD would improve with a dedicated case manager and/or more coordinated case management services."

Engagement in OUD treatment would be improved with interventions to mitigate the significant social and psychiatric comorbidities of addiction. Community- and emergency department-initiated buprenorphine is a promising intervention whose full promise cannot be realized without interventions to improve treatment retention.

Engagement in OUD treatment would be improved with interventions to mitigate the significant social and psychiatric comorbidities of addiction. Community- and emergency department-initiated buprenorphine is a promising intervention whose full promise cannot be realized without interventions to improve treatment retention.

To describe the outcomes of buprenorphine/naloxone low dose induction with overlap of full opioid agonists among hospitalized patients with opioid use disorder (OUD) as an alternative to standard induction strategies.

Retrospective cohort study of patients with OUD who were admitted to the hospital over a 1-year period and initiated ono buprenorphine using initial doses of 0.5 mg and gradually increased while the patient remained on full agonists. Descriptive variables included basic demographics, reason for switching to buprenorphine, baseline opioid and morphine equivalent dose. The primary outcome was a successful transition defined by the patient leaving the hospital with a buprenorphine prescription. Bivariate analysis identified factors associated with unsuccessful medication transitions. Secondary outcomes included reported withdrawal symptoms and 30 day follow up to an outpatient buprenorphine program.

Sixty two patients underwent low dose with overlap induction during the study period. Fourteensociated with lower likelihood of success. Future work could focus on treatment of withdrawal symptoms and system-level changes ensuring patient-centered medication decisions.

Pain is a common but understudied symptom among patients with heart failure (HF) transported by emergency medical services (EMS). The aims were to determine explanatory factors of a primary complaint of pain and pain severity, and characterize pain among patients with HF transported by EMS.

Data from electronic health records of patients with HF transported by EMS within a midwestern United States county from 2009 to 2017 were analyzed. Descriptive statistics, χ2, analysis of variance, and logistic and multiple linear regression analyses were used.

The sample (N = 4663) was predominantly women (58.1%) with self-reported race as Black (57.7%). The mean age was 64.2 ± 14.3 years. Pain was the primary complaint in 22.2% of the sample, with an average pain score of 6.8 ± 3.1 out of 10. The most common pain complaint was chest pain (68.1%). Factors associated with a primary pain complaint were younger age (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.96-0.97), history of myocardial infarction (OR, 1.96; 95% CI, 1.55-2.49), and absence of shortness of breath (OR, 0.67; 95% CI, 0.58-0.77). Factors associated with higher pain severity were younger age (b = -0.05, SE = 0.013), being a woman (b = 1.17, SE = 0.357), and White race (b = -1.11, SE = 0.349).

Clinical and demographic factors need consideration in understanding pain in HF during EMS transport. Additional research is needed to examine these factors to improve pain management and reduce transports due to pain.

Clinical and demographic factors need consideration in understanding pain in HF during EMS transport. Additional research is needed to examine these factors to improve pain management and reduce transports due to pain.

Dietary salt restriction is recommended by many guidelines for patients with heart failure (HF). Quality of life (QoL) is an important end point of this intervention. However, the literature is still limited regarding the effect of dietary salt restriction on QoL in patients with HF.

We performed a systematic review and meta-analysis of randomized controlled trials to evaluate the effect of dietary sodium restriction on QoL in patients with HF.

We searched PubMed (MEDLINE), the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and Cumulative Index to Nursing and Allied Health from the establishment of each database to December 20, 2020. We included randomized controlled trials with sodium restriction as an intervention. The primary outcome was QoL, and the secondary outcomes were mortality, readmission, and fatigue. We obtained the full text of potentially relevant trials, extracted data from the included trials, assessed their risk of bias, and performed a meta-analysis.

We included 10 trials (1011 participants with HF) with 7 days to 83 months of follow-up. Dietary sodium restriction did not improve QoL over the long term (>30 days) (P = .61). The pooled effects showed that this intervention might increase mortality risk (P < .00001). It did not reduce the readmission rate within the short term (≤30 days) (P = .78) but increased the readmission rate over the long term (P = .0003).

Our study did not show that interventions to restrict dietary sodium had a positive effect on patients with HF in terms of QoL, mortality, or readmission.

Our study did not show that interventions to restrict dietary sodium had a positive effect on patients with HF in terms of QoL, mortality, or readmission.

Virtual education has been described before and during the COVID-19 pandemic. Studies evaluating virtual OSCEs (vOSCE) with postgraduate learners is lacking. This study (1) evaluated the experiences of all participants in a vOSCE; and (2) assessed the validity and reliability of selected vOSCE stations for skills in Physical Medicine and Rehabilitation (PMR).

Convergent mixed-methods design was used. Participants included three PMR residency programs holding a joint vOSCE. Analysis included descriptive statistics and thematic analysis. Performance of virtual to previous in-person OSCE was compared using independent t-tests.

Survey response rate was 85%. No participants had previous experience with vOSCE. Participants found the vOSCE to be acceptable (79.4%), believable (84.4%), and valuable for learning (93.9%). No significant differences between in-person and vOSCE scores was found for 3/4 stations, and improved score in 1/4. Four themes were identified (1) vOSCEs are better for communication stations; (2) significant organization is required to run a vOSCE; (3) adaptations are required compared to in-person OSCEs; and (4) vOSCEs provide improved accessibility and useful practice for virtual clinical encounters.

Utility of vOSCEs as a component of a program of assessment should be carefully considered and may provide valuable learning opportunities going forward.

Utility of vOSCEs as a component of a program of assessment should be carefully considered and may provide valuable learning opportunities going forward.

Investigate improvement in ability realization and additional long-term outcomes, during and after inpatient rehabilitation for Guillain-Barré syndrome.

This is a retrospective, longitudinal cohort study, in which outcomes were examined using validated scales, for 47 inpatients with Guillain-Barré syndrome.

Scores improved from 65 on the American Spinal Injury Association Motor Score (AMS) and 50 on the Spinal Cord Independence Measure (SCIM III), at admission to inpatient rehabilitation, to 81 and 80 at discharge, and to 92 and 95 at the end of 7.5 years, on average, at the follow-up (P = 0.001). The mean SCIM III/AMS ratio, which reflects the ability realization, increased during rehabilitation from 50/65 to 80/81 (P = 0.001), and tended to increase further at follow-up to 95/92 (P = 0.228). At follow-up, pain did not correlate, and fatigue showed a weak correlation with the AMS, SCIM III, and the Adult Subjective Assessment of Participation (r = -0.363, p = 0.012; r = -0.362, p = 0.012; r = -0.392, p = 0.006).

Ability realization improved during inpatient rehabilitation for Guillain-Barré syndrome, and remained high after discharge, suggesting a likely contribution of rehabilitation to the functional outcome, beyond the contribution of neurological recovery. Despite residual fatigue and pain, there was only minor or no effect on daily function or participation.

Ability realization improved during inpatient rehabilitation for Guillain-Barré syndrome, and remained high after discharge, suggesting a likely contribution of rehabilitation to the functional outcome, beyond the contribution of neurological recovery. Despite residual fatigue and pain, there was only minor or no effect on daily function or participation.

Patients with back pain comprise a large proportion of the outpatient practice among physiatrists. Diagnostic tools are limited to clinical history, physical examinations and imaging. Non-surgical treatments are largely empirical, encompassing medications, physical therapy, manual treatments and interventional spinal procedures. A body of literature is emerging confirming elevated levels of biomarkers including inflammatory cytokines in patients with back pain and/or radiculopathy, largely because the protein assay sensitivity has increased. These biomarkers may serve as tool to assist diagnosis and assess outcomes.The presence of inflammatory mediators in the intervertebral disc tissues and blood helped confirming the inflammatory underpinnings of back pain related to intervertebral disc degeneration. Literature reviewed here suggests that biomarkers could assist clinical diagnosis and monitor physiological outcomes during and following treatments for spine related pain. Biomarkers must be measured in a laarkers may serve as tool to assist diagnosis and assess outcomes.The presence of inflammatory mediators in the intervertebral disc tissues and blood helped confirming the inflammatory underpinnings of back pain related to intervertebral disc degeneration. Literature reviewed here suggests that biomarkers could assist clinical diagnosis and monitor physiological outcomes during and following treatments for spine related pain. Biomarkers must be measured in a large and diverse asymptomatic population, in the context of age and comorbidities to prevent false positive tests. These levels can then be rationally compared to those in patients with back disorders including discogenic back pain, radiculopathy and spinal stenosis. While studies reviewed here used "candidate marker" approaches, future non-biased approaches in clearly defined patient populations could uncover novel biomarkers in clinical management of patients.