Browsing by Author "Bouzaher, Malek H."

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    Systematic content analysis of patient evaluations of START NOW psychotherapy reveals practical strategies for improving the treatment of opioid use disorder
    Truong, Albert Y.; Saway, Brian F.; Bouzaher, Malek H.; Rasheed, Mustafa N.; Monjazeb, Sanaz; Everest, Soleille D.; Giampalmo, Susan L.; Hartman, David; Hartman, Cheryl; Kablinger, Anita S.; Trestman, Robert L. (2021-01-10)
    Background Clinical trials provide consistent evidence for buprenorphine’s efficacy in treating opioid use disorder (OUD). While the Drug Addiction Treatment Act of 2000 requires physicians to combine medication-assisted treatment (MAT) with behavioral intervention, there is no clear evidence for what form or elements of psychotherapy are most effective when coupled with MAT to treat OUD. This investigation involves focus groups designed to collect patient opinions about a specific psychotherapy, called START NOW, as well as general beliefs about various elements of psychotherapy for treating OUD. Our analysis reveals trends about patient preferences and strategies for improving OUD treatment. Methods Subjects included patients enrolled in buprenorphine/naloxone MAT at our institution’s office-based opioid treatment program. All subjects participated in a single START NOW group session, which was led by a provider (physician or nurse practitioner trained and standardized in delivering START NOW). Consented subjects participated in satisfaction surveys and audio-recorded focus groups assessing individual beliefs about various elements of psychotherapy for treating OUD. Results Overall, 38 different focus groups, 92 participation events, and 44 unique subjects participated in 1-to-6 different START NOW session/audio-recorded focus group sessions led by a certified moderator. Demographic data from 36/44 subjects was collected. Seventy-five percent (33/44) completed the START NOW Assessment Protocol, which revealed self-reported behavioral trends. Analysis of all 92 START NOW Satisfaction Questionnaire results suggests that subjects’ opinions about START NOW improved with increased participation. Our analysis of audio-recorded focus groups is divided into three subsections: content strategies for new psychotherapies, implementation strategies, and other observations. For example, participants request psychotherapies to target impulsivity and to teach future planning and build positive relationships. Conclusions The results of this study may guide implementation of psychotherapy and improve the treatment of OUD, especially as it relates to improving the modified START NOW program for treating OUD. Our study also reveals a favorable outlook of START NOW with increased participation, suggesting that any initial reticence to this program can be overcome to allow for effective implementation.
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    Traumatic intubation: An under-recognized cause of dysphagia
    Worden, Cameron P.; Bouzaher, Malek H.; Jeyakumar; Anita; Brickman, Todd M. (Elsevier, 2021-04-27)
    Dysphagia is a common complaint, which can have a profound impact on a patient’s health and quality of life. In the surgical patient, endotracheal intubation can result in trauma to structures of the upper aerodigestive tract, which may manifest as a variety of complaints, including dysphagia. In some cases, dysphagia may develop gradually over the course of several months following intubation, and thus may be misdiagnosed or mistakenly associated with other comorbid conditions. Herein, we present a perplexing case of a prior traumatic intubation leading to the development of dysphagia in an elderly woman as a result of progressive enlargement of a fibrovascular lesion likely occurring through the process of normal deglutition. This case highlights traumatic intubation as a potential and underrecognized cause of dysphagia that may elude even experienced clinicians. In the setting of dysphagia without other apparent etiologies, a patient’s medical records should be extensively reviewed for a history of difficult intubation or peri-intubation complaints.