Latest news with #patientcentered
Medscape
4 days ago
- Health
- Medscape
Harm Reduction in Alcohol Use Disorder: Lessons From Sex Ed
This transcript has been edited for clarity. Matthew F. Watto, MD: Welcome back to The Curbsiders . I'm Dr Matthew Frank Watto, here with my great friend and America's primary care physician, Dr Paul Nelson Williams. We had an awesome episode with Dr Stephen Holt and our addiction medicine crew, where we had a higher-level focus on medications for alcohol use disorder (AUD), mainly in the outpatient setting. Paul, I think it's important to start off by saying that when we were young people coming up in this field, abstinence was pretty much the only approach in the treatment of AUD. The attitude was that if your patient was unable to reach absolute abstinence, you were a failure. We were also probably calling it "alcoholism" at the time. But now, I think we're starting to take a more realistic, patient-centered, and evidence-based approach by recognizing that abstinence is not realistic for everybody. Instead, just a reduction in alcohol use can improve outcomes, including mortality. You really have to meet the patient where they are in the process. And yes — for many patients, achieving complete abstinence would be most optimal for their overall health, but it may not be in the cards for them, and a reduction in use is worth shooting for. Anything to say about that, Paul? Paul N. Williams, MD: It's all true. I think keeping things patient-centered is always important. We also need to recognize that even if the patient's goal is abstinence, it's really hard. These medications are effective but they're far from perfect. Accept that there may be returns to use and that you may not be able to achieve complete abstinence; be okay with that outcome and support the patient throughout the process. It's critical to avoid viewing it as a treatment failure, regardless of what your patient's goals might be. Watto: We have three FDA-approved medications: Naltrexone (oral or intramuscular), disulfiram, and acamprosate. Paul, I was not familiar with targeted therapy. I thought you had to take these medications every day or once a month. Teach me something, Paul. Williams: With AUD, there are often triggers of alcohol use, and often patients can anticipate what these triggers might be. On the episode we talked about Thanksgiving dinner — where we know an uncle's going to get us angry — or the anniversary of a loved one's death or being in a social situation. There are times when someone will know and recognize that they're going to be more likely to drink alcohol. So rather than being on chronic medication, patients can take medications in advance of whatever this occasion might be to help reduce their potential for use. That can be done with naltrexone — the Sinclair Method — and it sounds like the data are especially good for nalmefene, but it's a European medication that is not approved in the United States. Dr Holt and our colleague, Carolyn Chan, also mentioned doing this with disulfiram as well. This method of taking medication in anticipation of a known trigger — maybe a day or two before — can help patients be less likely to drink alcohol during that time, and can help them avoid all the burdens and hassles that come with being on a chronic medication. It's a neat technique that is not used as commonly as it could be, at least in my experience. Watto: It sounded like Dr Holt advises patients to start the medication a couple days before the known trigger and to continue using the medication until they feel like things are settled again. But Paul, Dr Holt loves disulfiram — I was shocked! I did not know this about him, and I thought no one was using disulfiram anymore. Have you prescribed it, and did you know that it was still "in vogue"? Williams: I have prescribed it, but I don't know if it's "in vogue." It's got a bad reputation and it's not necessarily my first line, but Dr Holt has a lot of enthusiasm for it and he makes a really interesting point. He brought up the fact that the studies that looked at disulfiram were randomized, double-blinded control trials. However, if you're a participant who believes that what you're taking (placebo or not) might make you deathly ill when you drink alcohol, that potential of severe illness will inevitably change patient behavior, regardless of what treatment arm they fall into. That kind of defeats the purpose of studying the efficacy of disulfiram in comparison to placebo. But when you actually look at the results of open-label trials — where patients knew what treatment arm they were randomized into and participants receiving the placebo knew there wasn't a real threat of severe illness — there's good evidence for disulfiram's efficacy in an observed setting. Dr Holt had a lot of personal success with disulfiram, so he was a big advocate for it. Our conversation certainly made me more inclined to prescribe it than I had been prior to the episode, but it's probably still not my first choice. Watto: I thought that was a really smart point about how, typically, randomized, blinded trials are our gold standard, but in this case the placebo becomes very strong in a blinded setting when the patient is not sure whether their treatment will cause them to get horribly ill if they drink. The standard dose of disulfiram is 250 mg. If patients don't become sick after drinking at that dose, Dr Holt said he would up the dose to 500 mg. That usually isn't common, but some patients just don't have that typical response at the standard dose and must be metabolizing alcohol some other way. However, most patients need to be really careful. Patients should avoid all alcohol-containing products, including mouthwash, vanilla extract, and many types of aftershave. The contraindications for disulfiram include: Pregnancy Cognitive impairment, as patients may not remember if they took their medications or not Severe cardiovascular disease, as a reaction can cause ischemia Advanced liver disease (eg, cirrhosis with Child-Pugh class B or C) Dr Holt would still use disulfiram for patients with mild cirrhosis who are considered Child-Pugh class A but recommends following the liver closely. I looked disulfiram up on LiverTox and there is some concern about acute medication-induced hepatitis that could be really serious. So, if a patient already has a sick liver at baseline, you probably don't want to give them this medication. Williams: Beyond the fact that I feel like this medication sometimes feels a little bit moralistic or kind of punitive for people who are drinking, as though it's just a sort of built-in punishment, my larger concern with prescribing disulfiram is the potential for hepatotoxicity. However, that may have been overstated in my brain. Watto: If I had a patient without contraindications, I would at least have a conversation to see if it's the right person, because it does take drinking off the table. Even if they're having cravings, they know they'll get violently ill if they drink and they don't want to end up in an ER for IV fluids because they're vomiting. I think it works, but it requires a little bit of a tricky conversation. But I do think this episode made me reconsider disulfiram as an agent to prescribe. Williams: It goes back to your original point of shared decision-making: We need to make sure we're making informed decisions together and matching treatments with patients' goals. If a patient is interested in disulfiram after a detailed conversation, I would not try to talk them out of it. I'm more inclined to reach for it now after speaking with Dr Holt. Watto: So, Paul, what off-label medications might listeners consider for AUD treatment? Williams: There's a bazillion, and there have been lots of small studies looking at different options and combinations. If you're unable to use the FDA-approved medications, topiramate is the one medication Dr Holt would reach for. It's even highlighted in the Veterans Affairs/Department of Defense guidelines. It can be a tricky medication because it has to be titrated slowly; we're talking about increments of 25 mg. As such, you have to have a patient who can follow directions, is committed to taking a medication, and is fairly well organized, which is not always the case when someone has an underlying AUD. There's also a lot of intolerable side effects for a lot of folks; patients might experience somnolence and paresthesias, so you have to be a little bit cautious with those. However, topiramate does have evidence to support its use. We talk a good bit about gabapentin as well, Matt. It's something that we've all prescribed for a million different reasons. Dr Holt is a fan of it, specifically for alcohol withdrawal, but also there is some evidence for its use with AUD. It seems helpful, especially in combination with, say, naltrexone. I'm more inclined to reach for that. We touched briefly on baclofen, and I've known people who have been enthusiastic about it as an option. There is evidence to support its use, but it's not one we talked too much about this episode. Watto: We also talked a little bit about combination therapy. There's not really strong evidence for it. I know you mentioned that sometimes you might use naltrexone and gabapentin together, but the evidence overall for something like naltrexone and acamprosate didn't seem to pan out. Williams: It's not well supported — correct.
Associated Press
12-06-2025
- Health
- Associated Press
Dr. Danny Sarubin Named Top Dentist by Baltimore Magazine
PIKESVILLE, MD / ACCESS Newswire / June 12, 2025 / Sarubin Family Dental is proud to announce that Dr. Danny Sarubin has been recognized as a Top Dentist by Baltimore Magazine in its annual peer-nominated issue highlighting the region's most trusted dental professionals. This prestigious honor reflects Dr. Sarubin's dedication to delivering high-quality, patient-centered care and his respected standing among fellow dental practitioners in the Baltimore area. Each year, Baltimore Magazine conducts a comprehensive survey of thousands of dentists across the region, asking them to identify who they would recommend if a family member or friend needed dental care. The result is a carefully vetted list of the area's top-performing dentists, selected by their peers based on excellence in skill, ethics, patient relationships, and community reputation. 'It's a privilege to be included among so many outstanding professionals in our field,' said Dr. Sarubin. 'What matters most to me is the trust of my patients and colleagues. This recognition reflects the values our entire team holds-treating every person who walks through our doors with care, integrity, and respect.' Dr. Sarubin leads a team of dedicated dental professionals at Sarubin Family Dental, a practice that has become a cornerstone of the Pikesville community. Known for its friendly atmosphere and personalized service, the practice offers a full spectrum of dental care, including preventive, restorative, cosmetic, Invisalign and implant dentistry for patients of all ages. With a focus on patient comfort and the latest advancements in dental technology, Sarubin Family Dental is committed to helping patients achieve and maintain healthy, confident smiles. This recognition by Baltimore Magazine not only celebrates Dr. Sarubin's clinical excellence but also underscores the deep-rooted commitment to compassionate care that defines the practice. To learn more about Dr. Sarubin and the services offered at Sarubin Family Dental, visit or call (410) 594-9500 to schedule an appointment. SOURCE: press release
Globe and Mail
10-06-2025
- Health
- Globe and Mail
Linical Celebrates 20 Years of Advancing Clinical Research and Patient Wellbeing
OSAKA, Japan , /CNW/ -- Linical, a leader in clinical research services, is proud to celebrate its 20th anniversary — a milestone that reflects two decades of dedication to improving health outcomes through high-quality, patient-centered research. Since its founding in 2005 in Japan , the company has grown from a small team with a bold vision into a global organization supporting clinical trials in more than 30 countries. From the beginning, Linical set out to do more than manage clinical studies — the company set out to make a meaningful impact on patients' lives. Over the years, Linical's services have expanded to include full-service clinical trial management, site selection and feasibility, regulatory support, biometrics, pharmacovigilance, and drug development strategies. Throughout this growth, Linical's core mission has remained the same: to advance science while prioritizing patient safety and wellbeing. "What began as a small startup with a few dedicated professionals from the pharmaceutical industry has grown into a global force in clinical research," said Kazuhiro Hatano , President and CEO of Linical. "We've never lost sight of the fact that at the heart of every clinical trial is a patient who is hoping for a better future. That's what continues to drive us." Over the past two decades, Linical has supported hundreds of clinical studies across a range of therapeutic areas including oncology, neurology, immunology, and rare diseases. By leveraging technology and data-driven processes, the company has delivered faster study start-up times, improved site performance, and enhanced trial quality. Its investments in decentralized trial capabilities and digital tools have positioned the company at the forefront of innovation, especially in an era where flexibility and accessibility in research are more critical than ever. The company attributes its success to a collaborative culture, strong partnerships with sponsors and sites, and an unwavering focus on patients. "Clinical research is ultimately about people," added Mr. Hatano. "It's about the people participating in trials, the investigators treating them, and the sponsors developing new therapies. We're proud to be part of that ecosystem, helping turn scientific discovery into real-world impact." As it marks its 20th year, Linical is also looking ahead. The arrival of artificial intelligence is transforming the clinical research industry. With continued investment in global operations, advanced analytics, and patient-focused technologies, the company plans to further strengthen its ability to deliver efficient, high-quality clinical trials that bring new treatments to market faster. "We're proud of what we've achieved, but we're even more excited about the future," said Mr. Hatano. "Our work is far from done, and we remain committed to our purpose: improving lives through research." About Linical: Linical is a global provider of clinical research services, supporting biopharmaceutical companies in bringing innovative therapies to patients across APAC, Europe , and North America . With a focus on quality, technology, and patient wellbeing, Linical delivers tailored solutions for clinical trials across all phases and numerous therapeutic areas.
Yahoo
31-05-2025
- Business
- Yahoo
FirstHealth achieves ISO 9001 certification
PINEHURST — FirstHealth of the Carolinas recently earned ISO 9001 certification from DNV, a globally recognized accrediting body. 'This achievement underscores FirstHealth's unwavering dedication to delivering high-quality, patient-centered care across its network of hospitals and clinics,' a news release said. ISO 9001 is one of the most widely recognized quality management system standards, emphasizing principles such as strong customer focus, leadership involvement, process approach and continual improvement. By aligning with these principles, FirstHealth aims to enhance patient satisfaction and operational efficiency. The certification process involved a comprehensive evaluation of FirstHealth's quality management systems, including patient care protocols, administrative procedures and continuous improvement initiatives. This rigorous assessment ensures that the organization meets international standards for quality and safety. 'Achieving ISO 9001 certification reflects our organization's commitment to continuous improvement and excellence in patient care,' Cindy McDonald, chief quality officer for FirstHealth of the Carolinas, said. 'This milestone is a testament to the hard work and dedication of our entire team, who strive daily to uphold the highest standards in health care.'
Fast Company
07-05-2025
- Health
- Fast Company
Why human-centered design is vital in healthcare research
The Fast Company Impact Council is an invitation-only membership community of leaders, experts, executives, and entrepreneurs who share their insights with our audience. Members pay annual dues for access to peer learning, thought leadership opportunities, events and more. At the Exceptional Women Alliance, we enable high-level women to mentor each other to achieve personal and professional happiness through sisterhood. As the nonprofit organization's founder, chair, and CEO, I am honored to interview and share insights from thought leaders who are part of our peer-to-peer mentoring program. This month, I'm pleased to introduce Roslyn Schneider, MD, a physician, and driver of person centeredness in healthcare, medical education, and the biopharmaceutical industry. She has practiced medicine as a pulmonologist, launched blockbuster medicines while at biopharmaceutical companies, and worked with companies and coalitions to embed patient and community involvement across the medical product development and commercialization lifecycle. Here is some of what we talked about. Roslyn Schneider, MD: My personal and family encounters with our healthcare system, clinical practice during the height of the AIDS epidemic, and seeing the value of partnerships with patients as lived experience experts, have been my greatest influences. As a child I was misdiagnosed, in large part, because physicians dismissed concerns from my parents who were immigrants with little formal education, but who knew there was something wrong. As an adult, I practiced and taught at a New York City hospital in the 1980's and 90's when we had limited treatments for HIV infection. People who were in the prime of their lives were dying, battling a poorly understood, devastating illness, and the community challenged the pace of medication development and access. I saw the power of their advocacy and activism with businesses, health authorities, and researchers, at the intersection with medical practice and science. That power resulted in transformation of a uniformly fatal illness, to a chronic illness in much of the world today, and it forever changed how medical products are developed, approved, and accessed. These experiences were front and center for me, as my teams have partnered with patients and patient organizations in an intentional, iterative manner, from the early stages of development and at key points in its lifecycle, for as long as a particular product is available. Q: What's the role of physician and community engagement in precision medicine? Schneider: During my four decades since graduating medical school, medicine has become increasingly precise. Deliberately engaging with patients who are lived experience experts, will help us ensure that these treatments are not only precise, but personal. Precision therapies, whether in clinical trials or commercially available, are specifically aimed toward genetic or other targets. We must be careful not to fall so in love with the science, that we don't consider how participation in the clinical research or use of these products may or may not fit with people's health goals and life goals. Maintaining community relationships, active listening to understand care gaps and preferences, co-creation, and prioritizing outcomes that matter most to patients are critical as we develop all types of medicines and medical technologies. Q: You've been a leader in and a consultant for small, medium, and large-sized global companies. Where is the industry compared to its patient-centric goals, and what might we expect in the next decade? Schneider: It's tempting to be satisfied with how much more patient engagement there is in medical product development now compared with earlier days, but we are not yet where we need to be. In periods of resource constraints and economic pressures, companies might, shortsightedly, consider reducing their engagement with patients as partners to achieve savings. There's a regression of thinking that this is somehow non-essential to successful outcomes for patients and for businesses. That happens despite the financial models of the value of patient engagement, and many real-life examples of shortened business timelines, reduction of costly, avoidable amendments to clinical research protocols, and more favorable product labeling, and more effective patient support programs. Data from the Tufts Center for the Study of Drug Development are consistent with what I hear from professionals and patients in relevant working groups I participate in. Data show that most companies today are piloting or sometimes implementing patient-centered elements in clinical development, yet the minority are doing so routinely. 'Patients are waiting' is an outdated slogan. I have confidence that lived experience experts and professionals across the globe will continue to find innovative ways to embed patient engagement into standard processes and utilize metrics that will resonate with stakeholders and decision makers at the grassroots level, the executive suite, and in the boardroom.
