Journal Article Annotations
2021, 1st Quarter
Annotations by Aum Pathare, MD
Nearly half of outpatients at the study site who had been diagnosed with schizophrenia, bipolar disorder, or major depressive disorder reported risky sexual behaviour (RSB), which could be one or more of four issues—unprotected sex, multiple (2 or more) sexual partners, alcohol or drug driven sexual intercourse, or exchanging money for sex. This population was predominantly orthodox, seen at the University of Gondar Comprehensive Specialized Hospital in Ethiopia, and between 18-34 years of age. The risk in men was three-fold that of women, with a slightly higher risk being conferred by illiteracy, psychiatric hospitalization, and lack of social supports. Patients with self-stigmatization were also at increased risk, and bipolar disorder contributed to more risk than major depressive disorder.
Strength and weaknesses:
This study examined stigma and its role in risky sexual behavior, which is an often-ignored aspect in such endeavours. The investigators selected patients with an understanding of their insight, which increased the reliability of information collected. General limitations relate to social desirability and recall biases, and challenges in survey construction. Drug/alcohol use was not clearly identified or quantified in the survey, and it was restricted to outpatients who may have better judgement and ability to participate in the study. The definition of RSB could (one out of four questions answered affirmatively) could fail to identify other risks.
Type of study:
Despite being admitted with endocarditis or osteomyelitis in the setting of opioid use disorder (OUD), fewer than 20 % of patients were initiated on medications for OUD treatment such as methadone and Suboxone. Even among patients who were treated with medications, 30-day readmission rates were not lowered nor was there a decreased risk of discharge against medical advice. Patients receiving OUD treatment had about 30 % longer treatment with IV antibiotics than average, but this success must be interpreted in the light that the overall duration of treatment remained about two weeks short of goal.
Strength and weaknesses:
This study examines missed opportunities for treatment of OUD in patients admitted with severe infections related to substance use. One of the major limitations of this study is the lack of clarity whether the patients given buprenorphine or methadone were being transitioned to maintenance treatment versus being managed for symptoms of withdrawal. Only first hospitalizations were noted, and the possibility of clustering within hospitals remained. Patient’s treatment decisions and other medical reasons for foregoing treatment could not be accounted for in this model.
Medications remain underutilized for treatment of opioid use disorders, even in the context of serious illnesses that occur as a consequence of IV drug use. Physician discomfort, lack of access to expert care, and patient resistance have been factors preventing adequate usage of these agents in the past. The adverse outcomes include increased number of discharges against medical advice and increased 30-day readmission rates. C-L psychiatrists are crucial partner in increasing patient engagement through focusing on early and adequate MAT and helping hospital systems retain patients longer for IV antibiotic treatment. While the total number of days with IV antibiotic treatment remains suboptimal, interventions for OUD may still result in a better timeline for transition to oral agents.
Type of study (EBM guide):