Grantham Burnham (gallonfire80)

This poster builds on the CDC pain management guidelines and the current ASAM recommendations for substance use assessment to build an integrated primary care model for holistic chronic pain management in an urban, underserved primary care clinic. Using a case from our Federally Qualified Health Care Center, which operates in a southwest Denver clinic, a program of integrated care assessment, diagnosis, and holistic treatment planning is outlined for this client with chronic pain, physical, and behavioral health issues. Using a comprehensive care approach for complex clients, which are typical presentations for urban, underserved clients, we discuss the utilization of best practices in medication management for chronic pain (Alternatives to Opioids (ALTOS), prescribed and complementary and alternative practices (e.g., PT, acupuncture, etc), and behavioral health services (psychiatric assessment and treatment, psychotherapy, support groups, etc) to improve outcomes for our clients.DISCLAIMER The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or U.S. Government. BACKGROUND Traumatic brain injuries (TBIs) have affected nearly 380,000 service members since 2000. selleck chemical Comorbid posttraumatic stress disorder (PTSD) may result from and/or exacerbate sequelae of mild TBI (mTBI) and is suspected to affect up to 65% of service members with TBI. Conventional treatments for mTBI/PTSD symptoms have limited efficacy and are associated with undesirable side effects. Repetitive transcranial magnetic stimulation (rTMS) has shown promise in treating PTSD symptoms and been identified as a potential mTBI therapy, but is untested as a therapy for comorbid mTBI/PTSD. METHODS This double-blinded, prospective randomized, sham-controlled study consists of 30 treatment sessions 5 weeks of daily sessions followed by a two week taper of 3 and 2 sessions, respectively. Sessions consist of 3500 pulses admine a tolerable and safe therapy. Future research should consider decreasing the demand of the study on patients schedules, and performing a comparison to other mTBI/PTSD treatments to determine what treatment is more efficacious.BACKGROUND ALKS 3831, a combination of olanzapine and samidorphan (OLZ/SAM) in development for schizophrenia, is intended to mitigate olanzapine-associated weight gain. This thorough QT (tQT) study evaluated OLZ/SAM effects on electrocardiogram parameters. METHODS In this randomized, double-blind, parallel-group study, 100 patients with stable schizophrenia were randomized 32 to either receive OLZ/SAM 10/10 mg (therapeutic dose) on days 2-4, 20/20 mg on days 5-8, and 30/30 mg (supratherapeutic dose) on days 9-13 with moxifloxacin-matching placebo on days 1 and 14, or a single dose of moxifloxacin 400 mg and matching placebo on days 1 and 14 (nested crossover design). Drug concentration relation to change from baseline in Fridericia-corrected QTc (ΔQTcF) was evaluated using a linear mixed-effect concentration-QTc (C-QTc) model. Adverse events were assessed. RESULTS The slope (90% CI) of the C-QTc was not significant for olanzapine or samidorphan (0.03 [-0.01, 0.08] and 0.01 [-0.01, 0.04] msec per ng/mL, respectively). Predicted placebo-corrected ΔQTcF (90% CI) was 2.33 (-2.72, 7.38) and 1.38 (-3.37, 6.12) msec at the observed geometric mean maximal concentration of olanzapine (62.6 ng/mL) and samidorphan (75.1 ng/mL), respectively, on day 13. A clinically relevant QT effect (ie, placebo-corrected ΔQTcF ≥10 msec) can be excluded for olanzapine and samidorphan concentrations up to ≈110 and ≈160 ng/mL, respectively. Assay sensitivity was confirmed by the C-QTc relationship of moxifloxacin. OLZ/SAM was well tolerated. CONCLUSIONS OLZ/SAM, in doses and plasma concentrations up to supratherapeutic levels, was well tolerated and had no clinically relevant effects on electrocardiogram parameters, including QT in