Alcohol use disorder (AUD) is a highly prevalent health issue in the United States. The number of those receiving medication-assisted treatment (MAT) is limited, despite strong evidence for their effectiveness. The inpatient setting may represent an important opportunity to initiate MAT. The goal of this study was to summarize the data on naltrexone initiation in the emergency department or inpatient setting for the management of AUDs. We searched ClinicalTrials.gov, Ovid EBM Reviews, Ovid Embase, Ovid Medline, Ovid PsycINFO, Scopus, and Web of Science from inception through October 31, 2019. Search strategies were created using a combination of keywords (Supplemental Appendix 1, available online at http://www. mcpiqojournal.org) and standardized index terms related to naltrexone therapy for medically hospitalized patients with AUD. Two uncontrolled pre-post study designs evaluated naltrexone prescription rates, 30day readmission rates, and rehospitalization rates. Two authors independently abstracted data on study characteristics, results, and study-level risk of bias. The research team collaborated to assess the strength of evidence across studies. Two studies reported that implementing a protocol for naltrexone initiation increased MAT rates, with one study noting a substantial decrease in 30-day hospital readmissions. Overall, we found that there is a paucity of data on naltrexone initiation in the inpatient setting for AUDs. This likely reflects the nature of current clinical practice and prescriber comfortability. There is a need for further studies evaluating MAT initiation in the inpatient setting. Furthermore, efforts to increase provider knowledge of these therapeutic options are in need of further exploration.

Objectives: A growing body of evidence suggests that parental offending may be linked to poor physical health, mental health, and drug use problems in offspring. However, previous systematic reviews have limited their scope to the association between parental incarceration and child substance use and mental health problems. We extend this research by conducting a systematic literature review on the impact of any parental offending, more broadly, on child physical and mental health outcomes, including drug use problems. Methods: We searched relevant electronic databases and the reference lists of previous reviews for research examining the relationship between parental offending, excluding studies focused on incarceration alone, and health outcomes in offspring less than 18 years of age. Our search identified 1,279 unique studies, 19 of which met the criteria for inclusion. Results: Across this literature, associations were found between parental offending and poor physical health outcomes in young children and, more robustly, drug use in adolescence. The associations between parental offending and child health outcomes, particularly for child mental health, were found to be at least partially explained by other factors, such as child maltreatment and abuse. However, owing to methodological limitations, conclusions regarding the causal impact of parental offending on child health could not be confidently made. Conclusion: Parental offending may be useful marker for identifying children at risk of poor health outcomes who may benefit from intervention.

ObjectiveTo survey barriers in prescribing naltrexone for alcohol use disorder.MethodsA 12-question survey related to naltrexone prescribing patterns, perceptions, and knowledge was sent to 770 prescribers in the departments of internal medicine, family medicine, and psychiatry across a health system with sites in Arizona, Florida, and Minnesota.ResultsResponses were obtained and included for 146/770 prescribers (19.0% response rate). Most respondents were in the department of internal medicine (n = 94, 64.4%), but the departments of psychiatry (n = 22, 15.1%) and family medicine (n = 30, 20.5%) were also represented. Only 34 (23.3%) respondents indicated they had prescribed naltrexone in the previous 3 months. The most common reasons for not prescribing naltrexone were “unfamiliarity with naltrexone for treatment of alcohol use disorder” and “patients do not have appropriate follow-up or are not in a formal treatment program.” Compared with those representing internal/family medicine, psychiatry respondents were more likely to prescribe naltrexone and answer knowledge questions correctly.ConclusionIn this survey among primarily non-addiction-trained prescribers, a disparity was shown for prescribing naltrexone and in knowledge barriers between staff in internal/family medicine and psychiatry. There exist opportunities for education and quality improvement that promote the prescribing of naltrexone for alcohol use disorder by non-addiction specialists.

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This chapter explores the use of e-learning as a format for training communication skills within a degree level module in non-malignant palliative care. It discusses the need for such training before evaluating the benefits e-learning has to offer as a learning tool in the healthcare context. It describes how a ‘blended learning’ approach was taken with one study day combined with online interactive learning materials. Online exercises such as ‘drag and drop’ were used to facilitate students’ learning, together with the use of videos, external online links, and reflective diaries. The development of a summative assignment is discussed and its need to assess students’ use of these skills in clinical practice. Finally, the future developments of the e-learning platform to further enrich the students’ learning experience are presented. These include the use of online forums, both synchronous and asynchronous, which encourage peer-to-peer and peer-to-tutor communication.