Jenna's Project: Preventing Overdose and Improving Recovery Outcomes for Women Leaving Incarcerated Settings During Pregnancy and Postpartum Periods.

Objectives: For people with opioid use disorder (OUD), transitioning from pregnancy to postpartum and from incarceration to the community is a time of increased risk for opioid overdose. This prospective project evaluated the extent of Jenna's Project's success in preventing overdoses and improving recovery outcomes by coordinating postrelease care in incarcerated OUD perinatal patients.

Methods: Participants (N = 132) were pregnant or postpartum (1 year postdelivery) with OUD during incarceration and self-referred for postrelease services.

Comprehensive Treatment for Pregnant and Parenting Women with Substance Use Disorders and Their Children: The UNC Horizons Story.

Objectives: To describe how the UNC Horizons program, a comprehensive women-centered program for pregnant and parenting women with substance use disorders, and its patient population have changed over time and summarize basic neonatal outcomes for infants born to women in treatment at Horizons.

Methods: Yearly Annual Reports from fiscal years of 1994 to 2017 were abstracted. Patient characteristics and infant outcomes compared to normative North Carolina data were examined.

Advanced Practice Provider-Led Medication for Opioid Use Disorder Programs for Pregnant and Parenting Women.

This article describes 2 innovative models of advanced practice provider-led medication for opioid use disorder treatment programs offering comprehensive, interprofessional care for pregnant patients and provides implications for broader adaptation of practice. Increasing the number of midwives and nurse practitioners waivered to prescribe buprenorphine and able to connect pregnant patients with opioid use disorder to appropriate community-based resources, treatment, and self-help programs could address alarming substance use trends including overdose deaths and other sequelae associated with the opioid epidemic.

Sex and female empowerment (SAFE): A randomized trial comparing sexual health interventions for women in treatment for opioid use disorder.

Background: Unintended pregnancies are prevalent among women with opioid use disorder (OUD). The Sex and Female Empowerment (SAFE) project developed a social-cognitive, theory-driven intervention to increase acceptance of and adherence to contraceptive practices among women receiving medication for OUD (MOUD). This study evaluated the feasibility and acceptability of two SAFE interventions (Face-to-face and Computer-adapted) compared to usual care as well as their efficacy to improve contraception utilization.

Improving access to care through Advanced Practice Registered Nurses: Focus on perinatal patients with Opioid Use Disorder.

Perinatal substance use disorders, and all of the associated sequelae, continue to be a national health crisis that is further impacted by shifts in access to obstetrical care, particularly in rural areas. Opioid Use Disorder (OUD) specifically presents as a medical condition for which evidence-based guidelines support the use of medication treatment for opioid use disorder (MOUD) in the form of Methadone or Buprenorphine for both non-pregnant and pregnant women. However, the overall rates of access for those treatment modalities remain sparse.

Bundled Payments for Care Improvement: Health System Experience With Lower Extremity Joint Replacement at Higher and Lower Volume Hospitals.

Background: The Bundled Payments for Care Improvement (BPCI) initiative was introduced in 2013 to reduce Medicare healthcare costs while preserving or enhancing quality. We examined data from a metropolitan healthcare system comprised of 1 higher volume hospital and 4 lower volume hospitals that voluntarily elected to participate in the BPCI Major Joint Replacement of the Lower Extremity Model 2, beginning July 1, 2015. Stratifying the data by hospital volume, we determined how costs changed during the 16-month period when all 5 hospitals participated compared to the 1-year period preceding BPCI participation, where savings were achieved, and how the hospitals were rewarded.

Models of care for opioid dependent pregnant women.

As the opioid crisis continues to exist in the United States, opioid use in pregnancy is becoming a more common occurrence. Left untreated, it may result in an increased risk for adverse outcomes for both the mother and her unborn child. Unfortunately, women with opioid use disorders often face numerous barriers when trying to access prenatal care services including limited availability or treatment options, stigma, legal consequences, co-morbid psychiatric disorders, and trauma exposure.

Psychometric assessment of the Neonatal Abstinence Scoring System and the MOTHER NAS Scale.

Background And Objectives: The present study examined the psychometric characteristics of the Neonatal Abstinence Scoring System (NASS; "Finnegan Scale") and the MOTHER NAS Scale (MNS).

Methods: Secondary analysis of data from 131 neonates from the Maternal Opioid Treatment: Human Experimental Research (MOTHER) study, a randomized trial in opioid-dependent pregnant women administered buprenorphine or methadone.

Results: Both the NASS and MNS demonstrated poor psychometric properties, with internal consistency (Cronbach's αs) failing to exceed .

Neonatal Abstinence Syndrome: Presentation and Treatment Considerations.

This clinical case conference discusses the treatment of a pregnant woman with opioid use disorder in a comprehensive care program that includes buprenorphine pharmacotherapy. The presentation summarizes common experiences that pregnant women who receive buprenorphine pharmacotherapy face, and also what their prenatally opioid-exposed children confront in the immediate postpartum period. It describes the elements of a successful comprehensive care model and corollary neonatal abstinence syndrome treatment regimen.

Measurement of neonatal abstinence syndrome: Evaluation of short forms.

Objectives: 1) How well do the short forms previously developed from the Maternal Opioid Treatment: Human Experimental Research (MOTHER) neonatal abstinence syndrome (NAS) scale (MNS) discriminate between neonates untreated and treated for NAS? (2) Can a short form be developed that is superior to other short forms in discriminating between the two groups?

Design/participants: This secondary analysis study used data from 131 delivered neonates in the MOTHER study, a randomized controlled trial comparing neonatal and maternal outcomes in opioid-dependent pregnant women administered buprenorphine or methadone.

Setting: Comprehensive care was provided at seven university hospitals.

Outcome Measures: A 19-item instrument measuring neonatal abstinence signs.

Vulvar skin atrophy induced by topical glucocorticoids.

Steroid-induced skin atrophy is the most frequent and perhaps most important cutaneous side effect of topical glucocorticoid therapy. To date, it has not been described in vulvar skin. A patient presented with significant vulvar skin atrophy following prolonged steroid application to treat vulvar dermatitis.

Genitofemoral and perineal neuralgia after transobturator midurethral sling.

Background: Midurethral slings successfully treat stress urinary incontinence through a minimally invasive vaginal approach. Postoperative pain related to sling placement can occur and poses both diagnostic and treatment dilemmas.

Case: Four years after transobturator midurethral sling placement, the patient presented with complaints of left labial pain and dyspareunia since surgery.

Use of the impedance threshold device improves survival rate and neurological outcome in a swine model of asphyxial cardiac arrest*.

Objective: To assess whether intermittent impedance of inspiratory gas exchange improves hemodynamic parameters, 48-hr survival, and neurologic outcome in a swine model of asphyxial cardiac arrest treated with active compression-decompression cardiopulmonary resuscitation.

Design: Prospective, randomized, double-blind study.

Setting: Laboratory investigation.

Erythema and burning pain in the vulva: a possible phenotype of erythromelalgia.

We report a case of burning vulvar pain accompanied by erythema responding to an oral combination of a benzodiazepine and a beta blocker. The positive response to two medication classes used in the treatment of erythromelalgia supports the possibility of a localized manifestation of this disorder in the genital region.