Tag: pubmed

J Subst Use Addict Treat. 2023 Sep 29:209176. doi: 10.1016/j.josat.2023.209176. Online ahead of print.

ABSTRACT

INTRODUCTION: Buprenorphine is highly effective for the treatment of opioid use disorder (OUD), and, in recent years, the rates of patients maintained on buprenorphine requiring critical care have been steadily increasing. Currently, no unified guidance exists for buprenorphine management during critical illness. Likewise, we do not know if patients maintained on buprenorphine for OUD are prescribed medications for OUD (MOUD) following hospital discharge or if buprenorphine management influences mu opioid agonist dispensing.

METHODS: In our cohort of adults over the age of 18 with OUD, receiving buprenorphine formulations in the 3 months preceding their ICU admission, we sought to investigate the relationship between receipt of MOUD and non-MOUD opioid prescribing up to 12 months following hospital discharge. This was a single-center, retrospective cohort study approved by the MaineHealth institutional review board. The study analyzed differences in prescription rates between discharge and subsequent time points using chi square or Fisher’s exact test, as appropriate. We performed analyses using SPSS Statistical Software version 28 (IBM SPSS Inc., Armonk, NY) with significance set at p < 0.05.

RESULTS: We identified a statistically significant increase in MOUD prescribing 3 months posthospital discharge in patients who received MOUD at time of discharge (87.9 % vs 40 % p = 0.002.) The study found a significant increase in nonbuprenorphine opioid prescribing in patients who did not receive an MOUD prescription at time of discharge (24.2 % vs 70 % p = 0.007). This trend persisted at the 6-month and 12-month time points; however, it did not reach statistical significance. Additionally, the study identified a significant reduction in the incidence of non-MOUD opioid dispensing in patients prescribed MOUD at each time point measured (p = 0.007, p < 0.001. p < 0.001 and p = 0.008 at discharge, 3, 6, and 12 months, respectively).

CONCLUSIONS: These findings support continuing buprenorphine dispensing following hospital discharge.

PMID:37778703 | DOI:10.1016/j.josat.2023.209176

Am J Pharm Educ. 2023 Sep 29:100596. doi: 10.1016/j.ajpe.2023.100596. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aimed to understand pharmacy programs’ policies and processes of sharing APPE assessment information among preceptors and to determine the types of grading scales currently being used nationally.

METHODS: A 14-question survey was utilized to collect information on Experiential Education policies and practices regarding APPE evaluations and assessment data sharing. The survey was administered electronically to Experiential Education administrators at accredited schools of pharmacy nationally and gathered information on approach to APPE assessment, information sharing with future preceptors and open-ended responses on how struggling student learners are supported. Descriptive statistics were used to analyze quantitative responses, while qualitative open-ended comments were analyzed using thematic analysis.

RESULTS: A total of 95 responses were included in the analysis (67.9% response rate). The majority of programs (83.2%) reported not sharing student performance assessments with future preceptors. Themes that emerged from the analysis of open-ended comments included concerns about bias and privacy violations, and the benefits of sharing evaluations for preceptor preparation and longitudinal student growth. The grading approach varied, with 53.7% of programs using traditional tiered letter grades and 45.3% using a pass/fail grading system.

CONCLUSION: Most pharmacy programs do not share APPE assessment information with future preceptors due to concerns about bias and protecting student privacy. However, programs may be looking for alternative processes that address the need to facilitate student growth and to support struggling learners. Examples shared may provide stimulus and insight for Experiential Education Offices to engage in programmatic discussions about the approach to assessment sharing practices.

PMID:37778701 | DOI:10.1016/j.ajpe.2023.100596

Am J Obstet Gynecol MFM. 2023 Sep 29:101171. doi: 10.1016/j.ajogmf.2023.101171. Online ahead of print.

ABSTRACT

BACKGROUND: Nausea and vomiting of pregnancy, also referred to as morning sickness, affects over 70% of all pregnancies. Symptoms range from mild to severe and in some cases can be debilitating, resulting in a reduced quality of life. Moreover, prenatal cannabis use prevalence has doubled in the United States, while cannabis potency, measured by concentration of delta-9-tetrahydrocannabiniol, has increased from 10% in 2009 to 14% in 2019. State-level recreational legalization of cannabis may contribute to the liberalization of its use as well as a reduced risk perception. Further, the relatively recent discovery of cannabinoid hyperemesis syndrome may contribute to the mischaracterization of morning sickness in individuals who use cannabis during pregnancy. Though cannabis has well-documented antiemetic properties, there is insufficient research on the topic. Therefore, it is essential to establish a tangible understanding of the association between nausea and vomiting of pregnancy and prenatal cannabis use.

OBJECTIVE: To estimate the degree to which nausea and vomiting of pregnancy might be associated with prenatal cannabis use in a sample of pregnant people in Michigan, a state where recreational cannabis use became legal in December 2018.

STUDY DESIGN: A prospective study of participants from the Michigan Archive for Research on Child Health, a population-based pregnancy cohort recruited using a probability-based sampling approach. Participants were recruited from 22 prenatal clinics located throughout Michigan’s lower peninsula. Cross-sectional analyses were performed for data available between October 2017 and January 2022.

RESULTS: Among this sample of Michigan pregnant people, 14% (95% CI: 11-16%) reported cannabis use. Participants who experienced increasing morning sickness severity had higher odds of using cannabis (OR_adjusted= 1.2; 95% CI: 1.1, 1.2). When the sample was restricted to first trimester morning sickness and cannabis use, results remained statistically robust. When the direction of the association was reversed, we detected an increase in morning sickness severity among participants who used cannabis during pregnancy (ß_adjusted= 0.2; 95% CI: 0.1, 0.2). Lastly, we investigated the association between pre-pregnancy cannabis use and first trimester morning sickness. Findings suggest an increase in morning sickness severity among people who used cannabis in the three months prior to pregnancy compared to those who did not (ß_adjusted= 0.1; 95% CI: 0.003, 0.2) CONCLUSIONS: Findings from this study indicate a link between nausea and vomiting of pregnancy and prenatal cannabis use. This study also revealed that using cannabis in the three months prior to pregnancy is associated with first trimester morning sickness severity. The strengths of our study contribute to the scant epidemiological evidence in this area of research. More fine-grained, time-specific data on nausea and vomiting of pregnancy and prenatal cannabis use are necessary to draw inferences about cause-effect relationships. Our study might provide a basis to discourage cannabis use during pregnancy until more evidence is compiled.

PMID:37778699 | DOI:10.1016/j.ajogmf.2023.101171

Am J Obstet Gynecol. 2023 Sep 29:S0002-9378(23)00721-4. doi: 10.1016/j.ajog.2023.09.092. Online ahead of print.

ABSTRACT

BACKGROUND: Though cesarean delivery is the most common surgery performed in the United States, prescribing practices for analgesia vary. Strategies to manage postpartum pain have mostly focused on the immediate postpartum period when patients are still admitted to the hospital. At discharge, most providers prescribe a fixed number of opioid tablets. Most patients do not use all the opioids they are prescribed at hospital discharge. This leads to an excess of opioids in the community which can ultimately lead to misuse and diversion.

OBJECTIVE: To determine if a transition from universal opioid prescribing to a personalized, patient specific protocol decreases morphine equivalents prescribed at hospital discharge after cesarean delivery, while adequately controlling pain.

STUDY DESIGN: This is a prospective cohort study of patients undergoing cesarean delivery before and after implementation of a personalized opioid prescribing practice at time of hospital discharge. Each patient was prescribed scheduled ibuprofen and acetaminophen, with a prescription for oxycodone tablets equal to 5 times the morphine equivalents used in the 24 hours prior to discharge, calculated via an electronic order set. The prior traditional cohort were routinely prescribed 30 tablets of acetaminophen-codeine 300-30 milligrams. The primary outcome was morphine equivalents prescribed at discharge. A hotline to address pain control issues after discharge was established, and calls, emergency room visits, and re-admissions were examined. Statistical analyses included chi-square and Wilcoxon rank-sum with a P-value < 0.05 considered statistically significant.

RESULTS: 412 patients underwent cesarean delivery in the 6 weeks after initiation of the personalized prescribing protocol and were compared to 367 patients prior to the change. The median morphine equivalents prescribed at discharge was lower with personalized prescribing (37.5 [1^st quartile 0, 3^rd quartile 75] vs 135 [135, 135], P < 0.001). 176 (43%) patients were not prescribed opioids at discharge which was a substantial change as all 367 patients in the traditional cohort received opioids at discharge (P < 0.001). Nine hotline phone calls were received; none required additional opioids after a 24 hour trial of scheduled ibuprofen, which none had taken prior to the call. 11 (2.7%) patients presented to the emergency room for pain evaluation, of which none required re-admission or an outpatient prescription of opioids.

CONCLUSION: A personalized protocol for opioid prescriptions after cesarean delivery decreased total morphine equivalents and number of opioid tablets at discharge, without hospital re-admissions or need for rescue opioid prescriptions after discharge. Opioids released into our community will be reduced by over 90,000 tablets per year, without demonstrable adverse effect.

PMID:37778679 | DOI:10.1016/j.ajog.2023.09.092

J Shoulder Elbow Surg. 2023 Sep 29:S1058-2746(23)00712-7. doi: 10.1016/j.jse.2023.08.029. Online ahead of print.

ABSTRACT

BACKGROUND: The Walch classification is commonly utilized by surgeons when determining the treatment of osteoarthritis (OA). However, its utility in prognosticating patient clinical state before and after TSA remains unproven. We assessed the prognostic value of the modified Walch glenoid classification on preoperative clinical state and postoperative clinical and radiographic outcomes in total shoulder arthroplasty (TSA).

METHODS: A prospectively-collected, multi-center database for a single-platform TSA system was queried for patients with rotator cuff-intact OA and minimum 2 year follow-up after anatomic and reverse TSA (aTSA, rTSA). Differences in patient-reported outcome scores (PROMS) [SST, ASES, SPADI, VAS Pain, Shoulder Function score], combined patient-reported and clinical-input scores (Constant, UCLA, SAS), active range of motion (ROM) values (forward elevation [FE], abduction, external rotation [ER], internal rotation [IR], and radiographic outcomes (humeral and glenoid radiolucency line rates, scapula notching rate) were stratified and compared by glenoid deformity type per the Walch classification for aTSA and rTSA cohorts. Comparisons were performed to assess the ability of the Walch classification to predict the preop, postop, and improved state after TSA.

RESULTS: 1,008 TSAs were analyzed including 576 aTSA and 432 rTSA. Comparison of outcomes between Walch glenoid types resulted in 15 pairwise comparisons of 12 clinical outcome metrics, yielding 180 total Walch glenoid pairwise comparisons for each clinical state (preoperative, postoperative, improvement). Of the 180 possible pairwise Walch glenoid type / metric comparisons studied for aTSA and rTSA cohorts, <6% and < 2% significantly differed in aTSA and rTSA cohorts, respectively. Significant differences based on Walch type were seen after adjustment for multiple pairwise comparisons in the aTSA cohort for FE and ER preoperatively, the Constant score postoperatively, and for abduction, FE, ER, Constant score, and SAS score for pre- to postoperative improvement. In the rTSA cohort, significant differences were only seen in abduction and Constant score both postoperatively and for pre- to postoperative improvement. There were no statistically significant differences in humeral lucency rate, glenoid lucency rate (aTSA), scapular notching rate (rTSA), complication rates, or revision rates between Walch glenoid types after TSA.

CONCLUSION: Although useful for describing degenerative changes to the glenohumeral joint, we demonstrate a weak association between preoperative glenoid morphology according to the Walch classification and clinical state when evaluating patients undergoing TSA for rotator cuff-intact OA. Alternative glenoid classification systems or predictive models should be considered to provide more precise prognoses for patients undergoing TSA for rotator cuff-intact OA.

PMID:37778653 | DOI:10.1016/j.jse.2023.08.029

Vet J. 2023 Sep 29:106031. doi: 10.1016/j.tvjl.2023.106031. Online ahead of print.

ABSTRACT

Bovine respiratory disease (BRD) is one of the leading causes of mortality and morbidity in calves across diverse management systems. Despite expert opinion often citing the influence of housing environment on the level of respiratory disease in calf groups, there have been few reviews of environmental factors that predispose to BRD. This systematic review was undertaken to identify the measurable environmental variables associated with respiratory disease in housed preweaned calves. To achieve this Pubmed, CAB Direct and Scopus databases were searched. To be considered for inclusion, publications had to be fully published in English, published before 24 November, 2022 and include at least one measurable/ manipulated environmental variable and a standardized method of BRD detection. Twelve publications were included in this review. These examined a wide range of risk factors including air microbial count (four publications), air particulate matter (one publication); air endotoxins (one publication) and air ammonia (four publications). From the included publications, a statistically significant relationship to BRD was identified in 2/4 examining air microbial count, 1/1 examining air particulate matter, 1/1 examining air endotoxins and 2/4 examining air ammonia. This review indicated a paucity of evidence from the peer-review literature demonstrating a significant association between the many investigated exposure factors and BRD occurrence. An optimal environment for housed calves could not be clearly identified in this review.

PMID:37778652 | DOI:10.1016/j.tvjl.2023.106031

Hellenic J Cardiol. 2023 Sep 29:S1109-9666(23)00187-2. doi: 10.1016/j.hjc.2023.09.016. Online ahead of print.

NO ABSTRACT

PMID:37778638 | DOI:10.1016/j.hjc.2023.09.016

World Neurosurg. 2023 Sep 29:S1878-8750(23)01378-5. doi: 10.1016/j.wneu.2023.09.110. Online ahead of print.

ABSTRACT

OBJECTIVE: Cervical stability may deteriorate and kyphotic spinal deformities may develop in cervical spondylotic myelopathy (CSM) after laminectomy or laminoplasty. This study aimed to investigate the therapeutic efficacy of the “bilateral osteoligamentous decompression via unilateral hemilaminectomy approach (UHBOLD)” technique in CSM patients.

METHODS: The study included 34 adult patients who underwent UHBOLD surgery for CSM between 2016 and 2022. A record was made for all patients of age, gender, number of operated levels, preoperative and postoperative long-term follow-up VAS scores, Nurick grade values and mJOA scores, kyphosis angles measured on X-ray, and spinal canal areas measured on T2-weighted MR axial images.

RESULTS: Preoperative VAS scores of the patients were 6 (4-9), Nurick grade values were 3 (2-5), mJOA scores were 10.50±3.42, kyphosis angles were -13.34±13.69 degrees and spinal canal areas were 87.11±28.30 mm². In postoperative long-term follow-up of these patients, VAS scores were 2 (1-5), Nurick grade values were 1 (0-5), mJOA scores were 13.94±3.09, kyphosis angles were -15.07±12.78 degrees and spinal canal areas were 149.65±42.57 mm². A statistically significant difference was determined between the preoperative and the postoperative long-term follow-up VAS scores, Nurick grade values, mJOA scores, and spinal canal areas (p<0.001). Kyphosis angles were not different (p=0.198) and no instability was observed in any patient in long-term follow-up.

CONCLUSIONS: The UHBOLD technique performed in multilevel CSM patients did not cause any change in cervical lordosis angle in long-term follow-up, did not cause cervical kyphotic deformity or cervical instability, and significantly improved Nurick grade values, and VAS and mJOA scores.

PMID:37778625 | DOI:10.1016/j.wneu.2023.09.110

World Neurosurg. 2023 Sep 29:S1878-8750(23)01374-8. doi: 10.1016/j.wneu.2023.09.107. Online ahead of print.

ABSTRACT

OBJECTIVE: Microvascular decompression (MVD) as a treatment for trigeminal neuralgia (TGN) has high success rate but is associated with risks of complication. This study analyzes Twitter to provide insights into discussions surrounding MVD for patients with TGN.

METHODS: A Twitter search performed in April 2022 yielded 491 tweets from 426 accounts. Tweets and accounts were classified thematically, and descriptive statistics were used for various social media metrics. Using a natural language processing machine learning algorithm, sentiment analysis (SA) was performed to evaluate patient perspectives before and after surgery, and a multivariate regression model was used to identify predictors of higher engagement metrics (likes, retweets, quote tweets, replies).

RESULTS: Most accounts were patients, caregivers and other members of the public (70%). The most encountered themes were research (47%) and personal experiences (33.4%). SA of tweets about patient experiences showed that 40.2% of tweets were positive, 31.1% were neutral and 28.7% were negative. Negative tweets decreased significantly in post-operative tweets and mostly discussed complications or failure of surgery (63%). On multivariate analysis, only inclusion of media (photo or video) in a Tweet was associated with higher engagement metrics.

CONCLUSION: This study provides a comprehensive review of Twitter use discussing MVD in TGN and is the first to assess patient satisfaction after treatment using SA. The data presented on patient perspectives on social media could help physicians establish direct lines of communication with patients, fostering a more patient-focused care.

PMID:37778624 | DOI:10.1016/j.wneu.2023.09.107

World Neurosurg. 2023 Sep 29:S1878-8750(23)01375-X. doi: 10.1016/j.wneu.2023.09.108. Online ahead of print.

ABSTRACT

OBJECTIVE: This study aims to assess the impact of the workshops organized during Neuroendocon 23 on the perspective and confidence of neurosurgeons toward endoscopy in an LMIC.

METHODS: Neuroendocon 23 had cranial and spinal endoscopy cadaveric workshops with 30 delegates each. A pre and post-workshop survey was disseminated among the delegates, and statistical analysis was performed with SPSS (version 26) using p<0.05.

RESULTS: A total of 24 delegates (40%) consented to participate in the study, with only one female respondent (4.17%). After the cranial endoscopy workshop, there was an increase in the level of confidence of delegates in cranial endoscopic approaches (p <0.001). Similarly, after the spine endoscopy workshop, the respondents had increased confidence in managing spine conditions with the endoscopic approach (p = 0.040), to the extent that they preferred the endoscopic over the microsurgical technique (p <0.001). All respondents (n = 24, 100%) believed that endoscopy should be promoted in LMICs and integrated into residency curricula.

CONCLUSION: Cranial and spinal endoscopy cadaveric workshops could be the first step in stimulating the interest of neurosurgeons in endoscopy.

PMID:37778622 | DOI:10.1016/j.wneu.2023.09.108