Patients In Early Recovery Research Articles

Craving, distress tolerance, emotion dysregulation, and experiential avoidance among patients in early recovery from opioid use disorder in residential programs

ABSTRACT Objective Craving has been identified as a major factor in substance use relapse and studied in conjunction with distress tolerance. This research aimed to investigate the mediating roles of experiential avoidance and difficulties in emotion regulation in individuals recovering from opioid use disorder in the early stages. Methods The research involved 241 adult males in residential treatment centers. To be eligible for inclusion, participants must have a self-reported abstinence period of at least three months at the time of data collection. The structural model showed strong fit indices (GFI = 0.913, RMSEA = 0.075, SRMR = 0.047), with low distress tolerance determining high craving. Furthermore, only experiential avoidance and not emotion dysregulation mediated this path significantly. Conclusions The significant mediating effect of experiential avoidance rather than emotion dysregulation could be interpreted as the study participants would not see their distress as just unpleasant feelings. This implies that craving may be viewed as a private experience comprised of thoughts, feelings, memories, emotions, and bodily sensations. Thus, focusing on experiential avoidance might be more beneficial for individuals in the early stages of recovery from opioid use disorder in a residential program.

Patient Satisfaction Survey in Hospitals Providing SPA Care in Hungary

"Introduction: Balneotherapy and hydrotherapy treatments with a proven therapeutic effect are of great help to patients in early recovery. Objective: The aim of our study is to assess patient satisfaction in two health care institutions in Hungary. Methods: We conducted a questionnaire survey among the patients of two spas and other hospitals (H1: n=69 H2: n=59) in Hungary in 2019. The obtained results were evaluated with SPSS 25.0 software. Results: 74.22% of the respondents were female (n=95) and 25.78% were male (n=33), of whom 46.78% (n=60) were between 61 and 70 years of age. 71.88% (n=92) of the respondents were informed about the discounted treatments by their specialist and the majority were patients who return annually (n=106), who come again mainly (43.75%) for previous good experiences. They thought they would discover an 88.5% improvement in both the quality of care and treatments. Results of H1 and H2 hospital staff: help (H1: 6.61, H2: 6.05, p=0.001), pain relief (H1: 6.08, H2: 4.95, p=0.015) problem solving (H1: 6.16, H2: 5.46 p=0.009), information provision (H1: 5.82, H2: 5.05, p=0.050) were significantly higher in H1 hospital than in H2 hospital. In the overall picture of the institution, H2 achieved a higher result in terms of health improvement, despite the former lower evaluations, but there was no significance (H1: 5.86, H2: 6.00, p=0.584). Conclusions: Learning the use of treatments and patient satisfaction, constructive suggestions can be made to improve the quality of patient care. Keywords: patient satisfaction, spa, spa service, quality patient care "

Human Activities Detection for Patient Convalescence

A simple activity recognition method can allow a solitary human being to monitor all the surroundings with the purpose to guarantee safety and confidentiality while protective maintenance cost and efficiency with the rising level of accuracy. This monitoring system with real-time video surveillance can be deployed for patients and the elderly in a hospital or old age home and airport along with numerous human activities. For speedy analysis of action and accurate result while working with complex human behavior, we decided to use YOLOv4 (You Only Look Once) algorithm which is the latest and the fastest among them all. This technique uses bounding boxes to highlight the action. In this case, we have collected 4,674 number of dissimilar data from the hospital with different condition of ourselves. During this study, we divided the human action into three different patterns such as standing, sitting and walking. This model is able to detect and recognize numerous patients and other various human activities. This research accomplishes an average accuracy of 94.6667% while recognizing images and about 63.00% while recognizing activity from video clips. This study works with YOLOv4 while it performs better than TensorFlow and OpenPose platforms. The article proposed the outcome for patients in early recovery based on human activities investigation and analysis.

A Primary Care Response to COVID-19 for Patients with an Opioid Use Disorder.

A Primary Care Response to COVID-19 for Patients with an Opioid Use Disorder.

Methamphetamine Use: A New Wave in the Opioid Crisis?

The ongoing drug crisis in the United States continues to be headlined with numbers of deaths related to opioid overdose. Less known to the public and health care providers is the rise in methamphetamine use, often in conjunction with opioids or adulterated with fentanyl. An old practice with a new twist is the use of methamphetamine in conjunction with an opioid such as heroin. Although there are no Food and Drug Administration-approved medications to treat individuals with stimulant use disorders, a review of available studies suggests a few promising medications that may be helpful for patients in early recovery from methamphetamine. Some individuals are more likely to respond to medications such as long-acting naltrexone, bupropion, and mirtazapine, who have light-to-moderate use of methamphetamine. Naloxone kits should be considered for all patients who are actively using stimulants because of a high potential of adulterated methamphetamine.

Neuroprotective effects of creatine treatment on the differentiation of E14 rat cortical stem cells and expression of GABA-ergic neurons.

Along with the promotion of muscle growth and recovery, it has been observed that the supplement, creatine, also contains neuroprotective properties that aid in the developmental process of neuronal cells by increasing developmental competency in early differentiation. In clinical research, addiction treatments are beginning to introduce dietary supplements such as Creatine for patients in early recovery to improve recovery abstinence. Research has shown that supplemental Creatine induces higher cerebral phosphocreatine levels which could help with improved neuron connectivity. In order to examine the neuroprotective effects of Creatine, E14 rat cortical stem cells were differentiated and treated with different dosages of alcohol and creatine. Alcohol was used as a negative control in order to compare the differentiation and expression of GABAergic neurons associated with alcohol exposure and neuronal protection from Creative. We anticipate that Creatine acts as a neuroprotective agent in GABAergic neurons treated with alcohol

NEUROPROTECTIVE EFFECTS OF CREATINE TREATMENT ON THE DIFFERENTIATION OF E14 RAT CORTISOL STEM CELLS AND EXPRESSION OF GABA-ERGIC NEURONS

Along with the promotion of muscle growth and recovery, it has been observed that the supplement, Creatine, also contains neuroprotective properties that aid in the developmental process of neuronal cells by increasing developmental competency in early differentiation. In clinical research, addiction treatments are beginning to introduce dietary supplements such as Creatine for patients in early recovery to improve recovery abstinence. Research has shown that supplemental Creatine induces higher cerebral phosphocreatine levels which could help with improved neuron connectivity. In order to examine the neuroprotective effects of Creatine, E14 rat cortical stem cells were differentiated and treated with different dosages of alcohol and creatine. Alcohol was used as a negative control in order to compare the differentiation and expression of GABAergic neurons associated with alcohol exposure and neuronal protection from Creative. We anticipate that Creatine acts as a neuroprotective agent in GABAergic neurons treated with alcohol.

Impact of retained blood requiring reintervention on outcomes after cardiac surgery

ObjectivesEvacuation of shed blood from around the heart and lungs is a critical requirement for patients in early recovery after cardiac surgery. Incomplete evacuation of shed blood can result in retained blood, which may require subsequent reinterventions to facilitate recovery. The purpose of this study was to determine the incidence of retained blood requiring reintervention and examine the impact on outcomes. MethodsWe performed a cross-sectional, observational study of all adult patients undergoing cardiac surgery between 2006 and 2013. Subjects who required an intervention to remove blood, blood clot, or bloodily fluid were attributed to the retained blood group. These patients were compared with those not presenting with any of the defined criteria for retained blood. Multivariate regression was performed to account for confounders. ResultsOf 6909 adult patients who underwent cardiac surgery, 1316 (19%) presented with a retained blood-related condition. Retained blood was associated with increased in-hospital mortality (odds ratio [OR], 4.041; 95% confidence interval [CI], 2.589-6.351, P < .001) and a length of stay more than 13 days in the hospital (OR, 3.853; 95% CI, 2.882-5.206; P < .001) and 5 days in the intensive care unit (OR, 4.602; 95% CI, 3.449-6.183; P < .001). The OR for a time of ventilation greater than 23 hours was 3.596 (95% CI, 2.690-4.851; P < .001) and for incidence of renal replacement therapy was 4.449 (95% CI, 3.188-6.226; P < .001). ConclusionsPostoperative retained blood is a common outcome and associated with higher in-hospital mortality, longer intensive care unit and hospital stay, and higher incidence of renal replacement therapy. Further research is needed to validate these results and explore interventions to reduce these complications.

Evidence of anhedonia and differential reward processing in prefrontal cortex among post-withdrawal patients with prescription opiate dependence.

Anhedonia is an important but understudied element of a neuroadaptive model underlying vulnerability to relapse in opioid dependence. Previous research using fMRI has shown reduced activation to pleasant stimuli in rostral prefrontal cortex among heroin-dependent patients in early recovery. This study evaluated the presence of anhedonia among recently withdrawn prescription opiate dependent patients (PODP) in residential treatment compared to control subjects. Anhedonia was assessed using self-report, affect-modulated startle response (AMSR), and a cue reactivity task during which participant's rostral prefrontal cortex (RPFC) and ventrolateral prefrontal cortex (VLPFC) was monitored with functional near infrared spectroscopy (fNIRS). The cue reactivity task included three distinct categories of natural reward stimuli: highly palatable food, positive social situations, and intimate (non-erotic) interactions. PODP reported greater anhedonia on self-report (Snaith-Hamilton Pleasure Scale), and showed reduced hedonic response to positive stimuli in the AMSR task relative to controls. PODP also exhibited reduced neural activation in bilateral RPFC and left VLPFC in response to food images and reduced left VLPFC in response to images depicting positive social situations relative to controls. No differences were found for emotionally intimate stimuli. When patients were divided into groups based on the Snaith-Hamilton criteria for the presence or absence of anhedonia, patients endorsing anhedonia showed reduced neural responses to images depicting positive social stimuli and food relative to patients who did not endorse anhedonia. Activations were in areas of RPFC that support the retrieval of episodic memories. The results suggest the presence of anhedonia in a subsample of PODP.

Daily Telephone Monitoring Compared with Retrospective Recall of Alcohol Use among Patients in Early Recovery

Most studies comparing frequent self-monitoring protocols and retrospective assessments of alcohol use find good correspondence, but have excluded participants with significant comorbidity and/or social instability, and some have included abstainers. We evaluated the correspondence between measures of alcohol use based on daily interactive voice response (IVR) telephone monitoring and a 28-day modification of the Form-90 (Form-28). Participants were 25 outpatients with alcohol use disorder and significant PTSD symptomatology . Overall correlations between the IVR and Form-28 on days drinking and total standard drink units (SDUs) were strong for the entire sample and the subsample of drinkers (n = 7). Day-to-day correspondence between IVR and Form-28 was modest, but much stronger for the most recent week assessed than for the prior 3 weeks. Finally, the drinkers reported significantly greater total SDUs and heavy drinking days on the Form-28 than via IVR. The results indicate a need for further refinement of IVR methodology for treatment seeking populations as well as caution when retrospectively assessing drinking over time periods longer than a week among these individuals.

Emergence from minimally conscious state

Guidelines for defining the minimally conscious state (MCS) specify behaviors that characterize emergence, including "reliable and consistent" functional communication (accurate yes/no responding). Guidelines were developed by consensus because of lack of empirical data. To evaluate the utility of the operational threshold for emergence from posttraumatic MCS, by determining yes/no accuracy to questions of varied difficulty, including simple orientation questions, using all items from the Yes/No Subscale of the Mississippi Aphasia Screening Test. Prospective observational study of a cohort of responsive patients recovering from traumatic brain injury in an acute inpatient brain injury rehabilitation program. Of the 629 observations from 144 participants, name recognition was the easiest yes/no question, with nonconfused individuals responding with 100% accuracy, whereas only 75% to 78% of confused participants on initial evaluation answered this question correctly. Generalized Estimating Equations analysis revealed that confused participants were more likely to respond inaccurately to all yes/no questions. Nonconfused participants had a reduction in odds of inaccuracy ranging from 45.6% to 99.7% (p = 0.001 to 0.02) depending on the type of yes/no question. Accuracy for simple orientation yes/no questions remains challenging for responsive patients in early recovery from traumatic brain injury. Although name recognition questions are relatively easier than other types of yes/no questions, including situational orientation questions, confused patients still may answer these incorrectly. Results suggest the operational threshold for yes/no response accuracy as a diagnostic criterion for emergence from the minimally conscious state should be revisited, with particular consideration of the type of yes/no questions and the requisite accuracy threshold for responses.

Serial yes/no reliability after traumatic brain injury: implications regarding the operational criteria for emergence from the minimally conscious state

Background:Published guidelines for defining the “minimally conscious state” (MCS) included behaviours that characterise emergence, specifically “reliable and consistent” functional interactive communication (accurate yes/no responding) and functional use of objects. Guidelines...

Telephone self-monitoring among alcohol use disorder patients in early recovery: a randomized study of feasibility and measurement reactivity

Frequent symptom self-monitoring protocols have become popular tools in the addiction field. Interactive Voice Response (IVR) is a telephone monitoring system that has been shown to be feasible for collecting frequent self-reports from a variety of research populations. Little is known, however, about the feasibility of using IVR monitoring in clinical samples, and few controlled trials exist assessing the impact of any type of frequent self-report monitoring on the behaviors monitored. This pilot study with patients in early recovery from an alcohol use disorder ( n = 98) evaluated compliance with two IVR monitoring protocols, subjective experiences with monitoring, and change in symptoms associated with monitoring (i.e., measurement reactivity). Participants were randomly assigned to call an IVR system daily for 28 days, once per week for 4 weeks, or only to complete 28-day follow-up assessment including retrospective drinking reports. Monitoring calls assessed alcohol craving, substance use, emotional well-being, and PTSD symptoms. Most monitoring participants completed calls on at least 75% of scheduled days (72.2% and 59.2% for daily and weekly, respectively). Including reconstructed data from follow-up of missed calls yielded 77.8% and 74.1% of maximum data points, respectively. Most monitoring participants indicated the protocol was manageable and reported positive or no effects of monitoring on urges to use alcohol, actual drinking, and PTSD symptoms. Analyses of measurement reactivity based on assessment one month after randomization found no significant group differences on drinking, craving for alcohol, or PTSD-related symptoms. Results suggest that IVR technology is feasible and appropriate for telephone symptom monitoring in similar clinical samples.

Treatment of Sleep Disturbance in Alcohol Recovery

Sleep disturbance is common among patients in recovery from alcoholism and can precipitate relapse. Though sleep complaints are commonly managed with medication, little is known about their management among recovering alcoholic patients. We performed a postal survey of a self-weighted, random systematic sampleof 503 members of the American Society of Addiction Medicine (ASAM) to examine addiction medicine physicians' medical management of sleep disturbance among patients in early recovery from alcoholism. After 3 mailings, 311 (62%) responded. Of responents, 64% have offered pharmacological treatment to an insomniac, alcoholic patient in the first 3 months after detoxification, but only 22% offered medication to more than half of such patients. Trazodone was the preferred therapy, chosen first by 38% of respondents, followed by other sedating antidepressants (12%), and antihistamines (12%). The mean duration of therapy for trazodone and other sedating antidepressants exceeded one month. Experts in addiction medicine appear reluctant to prescribe medication to sleep-disturbed patients in early recovery from alcoholism. When they do prescribe, trazodone, other sedating antidepressants and antihistamines are favored, despite limited evidence for or against this indication. Although the treatment of disordered sleep among alcoholic patients in early recovery may have merit to prevent relapse, controlled studies of these sleep agents are needed.

Psychosocial experiences of cardiac patients in early recovery: a community-based study.

To report on the nature, incidence and severity of problems commonly experienced by cardiac patients in the early months of recovery, and to test the hypotheses that there exist differences in the incidences of these problems depending on age and sex. 1124 emergency cardiac patients discharged from hospital with acute myocardial infarction, unstable angina, stable angina pectoris, chronic ischaemic heart disease or heart failure were surveyed 4 months after discharge. They were asked to indicate how often during the previous 2 weeks they had experienced each of a range of feelings and problems common to cardiac patients. A large proportion of patients reported experiencing problems in the areas of emotional reactions (70%), physical condition (79%), convalescence (67%) and relating to family and friends (63%). Severe problems were experienced especially in the physical and convalescence areas (43% and 44%, respectively). A greater proportion of patients diagnosed with heart failure experienced problems than those with other diagnoses, and these problems were more severe. Amongst myocardial infarction patients, a greater proportion of females than males reported severe problems in the emotional and physical areas, and patients 65 years and over were more likely than younger patients to report experiencing severe problems with physical condition. Many cardiac patients are experiencing psychosocial problems 4 months after hospital discharge, especially with physical activities and convalescence. A knowledge of the incidence and nature of these problems may help nurses to assist patients to validate their experiences.

Problems of cardiac patients in early recovery

Most studies of the problems and information needs of patients describe these only for the period of hospitalization. In this study, however, the authors focused on the first 6 months after discharge. Eighty-two cardiac patients, admitted to a university hospital with a myocardial infarction (MI) or for coronary artery bypass surgery (CABS), were interviewed 6 months after discharge. Questions required them to describe problems they experienced in early recovery and what information they needed. All but one of the 82 patients stated they had experienced problems during the first 6 months after discharge. Most problems described concerned: emotional reactions (59%), their change in physical condition (59%), deleterious effects of treatment (56%) and convalescence (54%). Topics on which most patients needed additional or different information were: deleterious effects of the treatment (26%), physical condition (24%), risk factors (24%), convalescence (24%) and knowledge of the disease (24%).

Cognitive impairments in early sobriety: Nursing interventions

In the United States, more than 100,000 people are treated in inpatient treatment centers for alcoholism and other forms of mind-altering drug addictions. One of the most important elements of this treatment is education about the disease process, recovery, and the effects of the drugs on the body, mind, and spirit. Unfortunately, many alcoholics experience cognitive impairment that may impede their learning in the early weeks of recovery. After briefly describing how cognitive impairment may manifest itself in many alcoholic patients in early recovery, and listing some of the possible causes of this impairment, the authors provide several nursing interventions designed to enhance the learning process in early alcoholic recovery.