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Janzow GE, Harding C, Flores M, Borodovsky J, Steinkamp J, Marsch LA, Schuman-Olivier Z. Assessing the feasibility, usability and acceptability of the MySafeRx platform among individuals in outpatient buprenorphine treatment: Lessons learned from a pilot randomized controlled trial. Drug Alcohol Depend Rep 2022; 3:100045. [PMID: 36845988 PMCID: PMC9949338 DOI: 10.1016/j.dadr.2022.100045] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
Abstract
Background Increasing buprenorphine/naloxone (B/N) access for opioid use disorder (OUD) is essential yet ensuring adherence and preventing diversion remains challenging. This study examines the feasibility, usability, and acceptability of MySafeRx, a mobile platform integrating motivational coaching, adherence monitoring, and electronic dispensing during office-based B/N treatment. Methods In this multi-site randomized controlled trial, MySafeRx provided coaching and supervised self-administration of B/N by mobile recovery coaches (MRCs) via videoconference. Referred adults (ages 18-65) with OUD were randomized to 1) 42-days of adjunctive MySafeRx treatment (n = 13) or 2) a standard care control group (n = 14). Results The randomized sample was 63% female and 100% White. Twelve of 13 MySafeRx participants completed at least one MRC session. The mean system usability score reported by MySafeRx participants was 78.4 (n = 12). Participants indicated they would recommend MySafeRx to a friend (mean= 4.1 of 5), and that the dispenser (4.1 of 5) and videoconferencing (4.2 of 5) were easy to use. The MRC component had the highest acceptability (4.4 of 5). MRCs observed B/N self-administration for an average of 64.3% of the required study days (men: 68.9%; women: 57.9%). On average, men (n = 4) met with MRCs on 32±14 days versus 47±6 days for women (n = 8). Exploratory analyses did not show significant differences between intervention and control groups. Conclusions Despite the small sample, this study supports usability and acceptability of MySafeRx. Increased adherence monitoring, even with remote coaching had limited appeal, which impacted feasibility due to slow recruitment, especially as community prescribing with relaxed monitoring requirements became more widespread.
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Affiliation(s)
- Grace E. Janzow
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Cassandra Harding
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Michael Flores
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Jacob Borodovsky
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, EverGreen Center, Suite 315, NH 03766, Lebanon
| | - Jackson Steinkamp
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
| | - Lisa A. Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, EverGreen Center, Suite 315, NH 03766, Lebanon
| | - Zev Schuman-Olivier
- Cambridge Health Alliance, Harvard Medical School, Department of Psychiatry, 1035 Cambridge Street, Suite 21A – CMC, Cambridge, MA 02141, United States
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth College, EverGreen Center, Suite 315, NH 03766, Lebanon
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Shelby RD, Janzow GE, Mashburn-Warren L, Galley J, Tengberg N, Navarro J, Conces M, Bailey MT, Goodman SD, Besner GE. A novel probiotic therapeutic in a murine model of Clostridioides difficile colitis. Gut Microbes 2020; 12:1814119. [PMID: 32954922 PMCID: PMC7524353 DOI: 10.1080/19490976.2020.1814119] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
For prophylactic therapy, mice received an oral antibiotic cocktail followed by clindamycin injection, followed by probiotic administration (planktonic vs. biofilm state), followed by C. difficile oral gavage. For treatment therapy, mice received antibiotics and C. difficile first, followed by probiotic administration. Clinical sickness scores (CSS) and intestinal histologic injury scores (HIS) were assigned. In the Prophylactic Therapy model, CSS: 67% of untreated mice exposed to C. difficile demonstrated CSS ≥ 6, which is consistent with C. difficile infection (p< .001 compared to unexposed mice). In mice treated with planktonic Lr, 55% had a CSS ≥ 6, but only 19% of mice treated with Lr in its biofilm state had CSS ≥ 6 (p< .001). Mice receiving Lr + DM-Maltose lost the least amount of weight compared to mice receiving saline (p = .004676) or to mice receiving Lr (p= .003185). HIS: 77% of untreated mice exposed to C. difficile had HIS scores ≥4, which is consistent with C. difficile infection. In mice treated with planktonic Lr, 62% had HIS ≥4, but only 19% of mice treated with Lr in its biofilm state had HIS ≥4. (p< .001). Additionally, mice treated with Lr in its biofilm state had better survival compared to untreated mice and to mice treated with planktonic Lr (p ≤ 0.05). Similar findings for weight loss, CSS, HIS and survival were obtained for Treatment Therapy. A single dose of Lactobacillus reuteri in its biofilm state reduces the severity and incidence of experimental C. difficile infection when administered as both prophylactic and treatment therapy.
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Affiliation(s)
- Rita D. Shelby
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Grace E. Janzow
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Lauren Mashburn-Warren
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Jeffrey Galley
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Natalie Tengberg
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Jason Navarro
- Department of Pathology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Miriam Conces
- Department of Pathology, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Michael T. Bailey
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Steven D. Goodman
- Center for Microbial Pathogenesis, The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Gail E. Besner
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, OH, USA,CONTACT Gail E. Besner Department of Pediatric Surgery, Nationwide Children’s Hospital, Columbus, Ohio43205, USA
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