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Edinoff AN, Hathaway DB, Martinez Garza D, Rosen J, Suzuki J. The possible clinical utility of the alcohol biomarker phosphatidylethanol for managing suspected alcohol withdrawal in hospitalized patients: A case report. Am J Addict 2024; 33:351-353. [PMID: 38319035 PMCID: PMC11032224 DOI: 10.1111/ajad.13516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/16/2023] [Accepted: 12/31/2023] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The decision to initiate pharmacotherapy for alcohol withdrawal is typically based on examining self-reported use of alcohol and symptoms of withdrawal. Phosphatidylethanol (PEth) is a biomarker that could aim in clinical decision-making in withdrawal management. METHODS This report describes three cases highlighting the potential clinical utility of PEth in caring for individuals at risk for alcohol withdrawal. RESULTS Two of the cases received phenobarbital when their PEth showed that the risk of withdrawal was low and one case where PEth could have shown this was needed. The results were only available in a delayed fashion, however, could have been useful in informing clinical care. DISCUSSION AND CONCLUSION PEth can be a useful tool if available without delay. PEth can be used to quickly rule out alcohol withdrawal and avoid misdiagnoses and prolonged hospital stays. SCIENTIFIC SIGNIFICANCE This is a clinical case study available looking at PEth and withdrawal in hospitalized patients. It proposes that PEth can be used as a way to quickly rule out alcohol withdrawal to avoid misdiagnoses and the possibility of a prolonged hospital stay.
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Affiliation(s)
- Amber N. Edinoff
- McLean Hospital, Division of Alcohol, Drugs, and Addiction, Belmont, MA
- Harvard Medical School, Department of Psychiatry, Boston, MA
| | - David B. Hathaway
- Harvard Medical School, Department of Psychiatry, Boston, MA
- Brigham and Women’s Hospital, Department of Psychiatry, Boston, MA
| | - David Martinez Garza
- Harvard Medical School, Department of Psychiatry, Boston, MA
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA
| | - Jordan Rosen
- Harvard Medical School, Department of Psychiatry, Boston, MA
- Brigham and Women’s Hospital, Department of Psychiatry, Boston, MA
| | - Joji Suzuki
- Harvard Medical School, Department of Psychiatry, Boston, MA
- Brigham and Women’s Hospital, Department of Psychiatry, Boston, MA
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Hathaway DB, Bhat JA, Twark C, Rodriguez C, Suzuki J. Patients' experiences with continuation or discontinuation of buprenorphine before painful procedures: A brief report. Am J Addict 2023; 32:410-414. [PMID: 36850041 DOI: 10.1111/ajad.13396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/09/2023] [Accepted: 02/10/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Patients with opioid use disorder may be asked by their clinicians to discontinue maintenance buprenorphine treatment before surgical operations due to concerns that buprenorphine will interfere with acute pain management. However, discontinuation of buprenorphine may not be well tolerated or safe for all patients. We, therefore, administered a survey to better understand the experiences of patients on buprenorphine treatment who had previously undergone painful procedures and had their buprenorphine maintenance treatment either continued or discontinued before the procedure. METHODS After this study received institutional review board approval, patients were invited to participate if they were being prescribed sublingual buprenorphine for treatment of opioid use disorder and had also previously undergone a painful procedure requiring treatment with full agonist opioids. Patients who were eligible and agreed to participate (n = 32) then completed a survey of basic demographics; medical, psychiatric, and substance use histories; and their experience and satisfaction with the treatment of pain and substance use in the perioperative period, including whether buprenorphine was continued or discontinued before their procedure. RESULTS Compared with patients whose home dose of buprenorphine was continued (n = 15), patients whose buprenorphine was discontinued preoperatively (n = 17) reported less satisfaction with pain management and were more likely to be prescribed full agonist opioids upon discharge. DISCUSSION AND CONCLUSIONS Consistent with prior studies, these survey findings suggest that discontinuation of buprenorphine before painful surgeries may be associated with poorer clinical outcomes. SCIENTIFIC SIGNIFICANCE This survey study adds patients' perspective to a growing body of scientific literature suggesting that discontinuation of maintenance buprenorphine treatment before painful procedures may decrease patient satisfaction and increase clinical risk.
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Affiliation(s)
- David B Hathaway
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Jasra-Ali Bhat
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Claire Twark
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Claudia Rodriguez
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Joji Suzuki
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Weiner SG, Lo YC, Carroll AD, Zhou L, Ngo A, Hathaway DB, Rodriguez CP, Wakeman SE. The Incidence and Disparities in Use of Stigmatizing Language in Clinical Notes for Patients With Substance Use Disorder. J Addict Med 2023; 17:424-430. [PMID: 37579100 PMCID: PMC10387497 DOI: 10.1097/adm.0000000000001145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE The language used to describe people with substance use disorder impacts stigma and influences clinical decision making. This study evaluates the presence of stigmatizing language (SL) in clinical notes and detects patient- and provider-level differences. METHODS All free-text notes generated in a large health system for patients with substance-related diagnoses between December 2020 and November 2021 were included. A natural language processing algorithm using the National Institute on Drug Abuse's "Words Matter" list was developed to identify use of SL in context. RESULTS There were 546,309 notes for 30,391 patients, of which 100,792 (18.4%) contained SL. A total of 18,727 patients (61.6%) had at least one note with SL. The most common SLs used were "abuse" and "substance abuse." Nurses were least likely to use SL (4.1%) while physician assistants were most likely (46.9%). Male patients were more likely than female patients to have SL in their notes (adjusted odds ratio [aOR], 1.17; 95% confidence internal [CI], 1.11-1.23), younger patients aged 18 to 24 were less likely to have SL than patients 45 to 54 years (aOR, 0.55; 95% CI, 0.50-0.61), Asian patients were less likely to have SL than White patients (aOR, 0.45; 95% CI, 0.36-0.56), and Hispanic patients were less likely to have SL than non-Hispanic patients (aOR, 0.88; 95% CI, 0.80-0.98). CONCLUSIONS The majority of patients with substance-related diagnoses had at least one note containing SL. There were also several patient characteristic disparities associated with patients having SL in their notes. The work suggests that more clinician interventions about use of SL are needed.
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Affiliation(s)
- Scott G. Weiner
- Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Ying-Chih Lo
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Aleta D. Carroll
- Mass General Brigham, Enterprise Analytics, Boston, Massachusetts
| | - Li Zhou
- Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ashley Ngo
- Mass General Brigham, Enterprise Analytics, Boston, Massachusetts
| | - David B. Hathaway
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Claudia P. Rodriguez
- Harvard Medical School, Boston, Massachusetts
- Department of Psychiatry, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Sarah E. Wakeman
- Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Mass General Brigham, Office of the Chief Medical Officer, Boston, Massachusetts
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Hathaway DB, de Oliveira E Oliveira FHA, Mirhom M, Moreira-Almeida A, Fung WLA, Peteet JR. Teaching Spiritual and Religious Competencies to Psychiatry Residents: A Scoping and Systematic Review. Acad Med 2022; 97:300-310. [PMID: 34010864 DOI: 10.1097/acm.0000000000004167] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
PURPOSE For many persons worldwide, mental health is inseparably linked with spirituality and religion (S&R), yet psychiatrists have repeatedly expressed doubts regarding their preparedness to address patients' spirituality or religion appropriately. In recent decades, medical educators have developed and implemented curricula for teaching S&R-related competencies to psychiatry residents. The authors reviewed the literature to understand the scope and effectiveness of these educational initiatives. METHOD The authors searched 8 databases to identify studies for a scoping review and a systematic review. The scoping review explored educational approaches (topics, methods) used in psychiatry residency programs to teach S&R-related competencies. The systematic review examined changes in psychiatry trainees' competencies and/or in patient outcomes following exposure to these educational interventions. RESULTS Twelve studies met criteria for inclusion in the scoping review. All reported providing residents with both (1) a general overview of the intersections between mental health and S&R and (2) training in relevant interviewing and assessment skills. Seven of these studies-representing an estimated 218 postgraduate psychiatry trainees and at least 84 patients-were included in the systematic review. Residents generally rated themselves as being more competent in addressing patients' S&R-related concerns following the trainings. One randomized controlled trial found that patients with severe mental illness who were treated by residents trained in S&R-related competencies attended more appointments than control patients. CONCLUSIONS S&R-related educational interventions appeared generally well tolerated and appreciated by psychiatry trainees and their patients; however, some topics (e.g., Alcoholics Anonymous) received infrequent emphasis, and some experiential teaching methodologies (e.g., attending chaplaincy rounds) were less frequently used for psychiatry residents than for medical students. The positive association between teaching S&R-related competencies to psychiatry residents and patient appointment attendance merits further study. Future trainings should supplement classroom learning with experiential approaches and incorporate objective measures of resident competence.
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Affiliation(s)
- David B Hathaway
- D.B. Hathaway is attending physician, Department of Psychiatry, Brigham and Women's Hospital, and an instructor of psychiatry, Harvard Medical School, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-7271-0018
| | - Fabrício H A de Oliveira E Oliveira
- F.H.A. de Oliveira e Oliveira is psychiatrist and a PhD student, Center for Research in Spirituality and Health (NUPES), Universidade Federal de Juiz de Fora School of Medicine, Minas Gerais, Brazil; ORCID: https://orcid.org/0000-0001-5304-2835
| | - Mena Mirhom
- M. Mirhom is co-director and a post-doctoral clinical fellow, Public Psychiatry Fellowship, Columbia University Department of Psychiatry, New York, New York; ORCID: https://orcid.org/0000-0003-0408-4056
| | - Alexander Moreira-Almeida
- A. Moreira-Almeida is associate professor of psychiatry and director, Center for Research in Spirituality and Health (NUPES), Universidade Federal de Juiz de Fora School of Medicine, Minas Gerais, Brazil; ORCID: https://orcid.org/0000-0002-9135-2532
| | - Wai Lun Alan Fung
- W.L.A. Fung is research professor, Tyndale University, faculty member, University of Toronto Faculty of Medicine, medical director, Mount Sinai Hospital Wellness Centre, and attending physician, Department of Psychiatry, Mount Sinai Hospital and North York General Hospital, Toronto, Ontario, Canada; ORCID: https://orcid.org/0000-0001-7260-9163
| | - John R Peteet
- J.R. Peteet is associate professor of psychiatry, Harvard Medical School, site director, Fellowship in Psychosocial Oncology and Palliative Care, Dana-Faber Cancer Institute, and attending physician, Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts; ORCID: https://orcid.org/0000-0001-5362-1765
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