Journal of Addition Medicine

https://pubmed.ncbi.nlm.nih.gov/38227854/

John Barrett  1 , Rebecca Schapiro, Emily Casey, Judy Chertok

Introduction: Buprenorphine extended-release subcutaneous injection (BUP-XR) is a medication used to treat opioid use disorder. It is a long-acting formulation of buprenorphine, which is a partial opioid agonist. Buprenorphine extended-release subcutaneous injection is injected into the subcutaneous space forming a depot that can last up to a month. The most common adverse effects of BUP-XR are injection site pain, erythema, and induration.

Case report: A man in his late 30s presented to the emergency department 48 hours after BUP-XR injection with abdominal pain. He was found to have superficial venous thrombosis of an abdominal wall vessel extending near the deep venous system. He was subsequently started on apixaban for 30 days and cefadroxil for 7 days to reduce the risk of extension and infection. He fully recovered and has since restarted BUP-XR without further complications.

Conclusions: Venous thrombosis is a rare but potentially life-threatening complication of BUP-XR. It is important for emergency and outpatient clinicians to be aware of adverse reactions associated with this medication. The patient was successfully treated with a 30-day course of apixaban and able to resume taking BUP-XR without further complications. Clinicians may want to consider supplementing BUP-XR with sublingual film after injection-related complications due to possible lower serum levels.

Journal of Advanced Practice Oncology

https://doi.org/10.6004/jadpro.2022.13.4.3

JIBRAN MAJEED, DNP, ACNP-BC, CCRN, BARBARA S. TURNER, PhD, RN, FAAN, DEIRDRE KELLY, ACNP-BC, CHESTER POON, JULIE A. THOMPSON, PhD, JOHN BARRETT, DNP, FNP-BC, AGACNP-BC, and GERALD A. SOFF, MD

Background: Cancer patients with venous thromboembolic (VTE) dis- ease are complex, and many factors must be considered when initiating anticoagulation management. Clinical decision support systems can aid in decision-making by utilizing guidelines at the point of care.
Objectives: The purpose of our project was to develop, implement, and evaluate an electronic clinical decision tool (CDT) utilizing evidence-based guidelines to aid in decision-making for adult oncologic patients who present with new VTE to symptom care clinics.
Methods: We com- pared a pre-intervention group of patients who were prescribed anti-coagulation (n = 98) with two post-intervention groups: CDT applied (n = 96) and not applied (n = 46). Outcomes included whether the CDT anticoagulation recommendations were followed and if the tool was perceived to be helpful or improve confidence in initiating management for new VTE by the SCC advanced practitioners and physicians.
Results: There was no significant difference between the pre- and post-intervention groups in how many of the CDT anticoagulation recommendations were followed (68.8% pre-intervention, 60.8% post- intervention tool applied, and 63.5% post-intervention tool not applied; χ2 [2, N = 161] = .921, p = .631). However, the tool was found to be helpful and improved confidence of the providers in initiating management for new VTE (pre median = 3, interquartile range [IQR] = 2, 3.5; post median = 3, IQR 3, 4; p = .033). Conclusion: This CDT provided evidence- based anticoagulation recommendations for cancer-associated VTE and enhanced familiarity with the standard of care. Further development of the CDT will be required to account for situations that resulted in deviation from the recommendations.

BMJ Evidence-Based Medicine

https://doi.org/10.1136/bmjebm-2019-111234

John Barrett, Barbara Turner, Susan Silva, Michael Zychowicz

Clinical pathways have been successfully implemented in the primary care setting in New Zealand, Australia and the UK. Despite wide adoption and decreased costs, these pathways have yet to translate evidence into clinical practice while also saving providers time—an important barrier for the translation of evidence at the point of care. The goal of this project was to determine if future development of a point-of- care mobile application should be undertaken with design principles using the theoretical framework of Hick’s law. Three new-to-practice providers participated in three plan-do-study-act cycles using these pathways installed on mobile devices to determine if they were a feasible, efficient and useful method to implement evidence. The project was a success with all three participants wishing to continue using the pathways after project completion. Participants felt the digital clinical pathways were the next evolution of the popular UpToDate software platform and helped them apply the latest evidence better than other available tools. While these results are promising, there were also limitations. Participants felt the lack of chart integration coupled with time constraints made full integration challenging and suggested launching the platform using a variety of delivery systems. The project’s findings suggest that future application development using the developed design principles would be worth further consideration. If this mobile application ultimately proved successful, the application framework could be implemented on a larger scale, thus improving patient outcomes and saving providers time.

The Journal for Nurse Practitioners

https://doi.org/10.1016/j.nurpra.2019.08.023

John Barrett, DNP, FNP-BC, Catherine Liebman, DO, CAQSM

Each year, musculoskeletal disease impacts an estimated 17% of the world’s population with significant burden on quality of life, health care resources, and lost workdays. Nurse practitioners (NPs) who gain skills in musculoskeletal conditions can decrease specialty referrals, increase revenue, and add more value to their clinic. Primary care providers, both in nursing and medicine, feel unprepared to handle many of these complaints. Although there is a lack of formal training during graduate education, an NP can still gain these skills. We recommend starting with a musculoskeletal group like the spine (ie, master anatomy, physical examination, diagnostic tests, and then treatment options). Once 1 body group has been completed, move on to the next. With a dedicated plan, the NP can be well on his or her way to being a valuable resource in musculoskeletal care.

Journal of Addictions Nursing

https://doi.org/10.1097/JAN.0000000000000142

John Barrett, MA, BSN, RN; Maria Jansen, PharmD; April Cooper, PharmD; Matthew Felbinger, PharmD, BCPS; Faith Waters, MSN, RN, NEA-BC

Background: Alcohol withdrawal can lead to severe complications including seizures, delirium tremens, and death if not treated appropriately. Nurses are critical to the safety and outcomes of these patients.
Objective: The objective of this retrospective study was to determine if nursing education on a community hospital’s alcohol withdrawal protocol led to improved nursing compliance.
Methods: This is a quality improvement project involving a two-part retrospective reviewVan initial needs assessment followed by nursing education and a subsequent posteducation retrospective review. The initial needs assessment included 65 patients. The subsequent posteducation group included 50 patients.
Results: Nursing compliance of 1-hour assessments increased after the educational intervention; however, there was no statistically significant difference in 6-hour assessment or medication administration protocol compliance between preeducation and posteducation groups. Conclusion: Nursing education is a good place to start in improving compliance with an alcohol withdrawal protocol, but physicians need to be included to increase standardization within the institution. Future study should look at the effectiveness of different assessment frequency intervals and its impact on patient-centered outcomes.

Columbo, Sri Lanka. Medical Teams International. 

John Barrett (contributing author)