Decline in ACEI/ARB Prescribing as Heart Failure Core Metrics Improve During Computer-Based Clinical Decision Support.

Computer-based clinical decision-support systems are effective interventions to improve compliance with guidelines and quality measures. However, understanding of their long-term impact, including unintended consequences, is limited. The authors assessed the clinical impact of the sequential implementation of 2 such systems to improve the use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEIs/ARBs) in inpatients with heart failure.

Redefining retention: recovery from the patient's perspective.

This study examines the process of discharge and treatment reentry for six participants who entered treatment voluntarily but were administratively discharged from methadone treatment programs. The participants completed semistructured interviews at treatment entry and at four, eight and 12 months post-treatment entry. Grounded theory methodology was used to examine the phenomenon of treatment reentry from the perspective of the patients, who often viewed their recovery as an accumulation of positive changes.

The relationship of social support to treatment entry and engagement: the Community Assessment Inventory.

This study was conducted to determine the psychometric properties of a measure of social support, the Community Assessment Inventory (CAI), and to examine the role of social support in recovery. The CAI and the Addiction Severity Index (ASI) were administered to 196 opioid-dependent adults in (n = 135) or out of (n = 61) methadone treatment in Baltimore, Maryland, between 2004 and 2006. Baseline CAI scale scores indicated a generally high level of internal consistency (alpha scores).

Premature discharge from methadone treatment: patient perspectives.

Longer retention in drug abuse treatment is associated with better patient outcomes, and research indicates the first 12 months of methadone treatment are critical to patient success. Nevertheless, large-scale multisite longitudinal studies over the past three decades indicate that the majority of patients drop out during the first year of methadone treatment. Through an examination of 42 qualitative interviews with patients prematurely discharged from six methadone treatment programs in Baltimore, this study highlights factors patients describe as contributing to their reasons for being discharged within the first 12 months of the treatment.

Uses of diverted methadone and buprenorphine by opioid-addicted individuals in Baltimore, Maryland.

This study examined the uses of diverted methadone and buprenorphine among opiate-addicted individuals recruited from new admissions to methadone programs and from out-of-treatment individuals recruited from the streets. Self-report data regarding diversion were obtained from surveys and semi-structured qualitative interviews. Approximately 16% (n = 84) of the total sample (N = 515) reported using diverted (street) methadone two-three times per week for six months or more, and for an average of 7.

Incarceration and opioid withdrawal: the experiences of methadone patients and out-of-treatment heroin users.

Both heroin-addicted individuals and methadone maintenance patients are likely to face untreated opioid withdrawal while incarcerated. Limited research exists concerning the withdrawal experiences of addicted inmates and their impact on individuals' attitudes and plans concerning drug abuse treatment. In the present study, 53 opioid dependent adults (32 in methadone treatment and 21 out of treatment) were interviewed in an ethnographic investigation of withdrawal experiences during incarceration.

Gender Differences Among In- and Out-of-Treatment Opioid-Addicted Individuals.

Objective: Gender differences were explored among 355 in- and out-of-treatment opioid-addicted adults in Baltimore.

Methods: Addiction Severity Index and other variables were compared among: 1) in-treatment women vs. out-of-treatment women; 2) out-of-treatment: women vs.

Using expert rules to automate pressure ulcer alerts for the clinical nurse specialist.

Hospital acquired pressure ulcers are the focus of national attention. We report on a decision support system that notifies clinical nurse specialists of patients with pressure ulcers or risk for developing pressure ulcers. Auto-summed pressure ulcer risk and pressure ulcer occurrence data are embedded in nursing flowsheets, while the expert system technology runs in a separate application and sends a message back to the EMR environment; a system is successfully implemented across 60 inpatient units.

Why don't out-of-treatment individuals enter methadone treatment programmes?

Background: Despite the proven effectiveness of methadone treatment, the majority of heroin-dependent individuals are out-of-treatment.

Methods: Twenty-six opioid-dependent adults who met the criteria for methadone maintenance who were neither seeking methadone treatment at the time of study enrollment, nor had participated in such treatment during the past 12 months, were recruited from the streets of Baltimore, Maryland through targeted sampling. Ethnographic interviews were conducted to ascertain participants' attitudes toward methadone treatment and their reasons for not seeking treatment.

Attitudes toward buprenorphine and methadone among opioid-dependent individuals.

Attitudes and beliefs about drug abuse treatment have long been known to shape response to that treatment. Two major pharmacological alternatives are available for opioid dependence: methadone, which has been available for the past 40 years, and buprenorphine, a recently introduced medication. This mixed-methods study examined the attitudes of opioid-dependent individuals toward methadone and buprenorphine.

In-treatment vs. out-of-treatment opioid dependent adults: drug use and criminal history.

This study compared the characteristics of opioid-addicted adults seeking (n = 169) and not seeking (n = 74) methadone treatment in Baltimore, Maryland. Participants entering treatment were recruited from six methadone treatment programs, while out-of-treatment participants were recruited from the streets using targeted sampling methods. Measures included the Addiction Severity Index, a Supplemental Questionnaire, and urine drug test.

The impact of drug use on perceptions of credibility in indigenous outreach workers.

The authors conducted an investigation of perceptions of outreach worker credibility using the social network members (N = 20) of indigenous outreach workers in an HIV/AIDS prevention intervention. The network members included in the study received semistructured interviews following the program's completion. Outreach workers who were not actively using illicit drugs were more likely to be described as credible than were those who were using drugs.