Practice Patterns in Perioperative Nonopioid Analgesic Administration by Anesthesiologists in a Veterans Affairs Hospital

Pain Medicine ◽  
2019 ◽  
Author(s):  
Jereen Z Kwong ◽  
Seshadri C Mudumbai ◽  
Tina Hernandez-Boussard ◽  
Rita A Popat ◽  
Edward R Mariano
Keyword(s):  
Regression Models ◽  
Multinomial Logistic Regression ◽  
Multimodal Analgesia ◽  
Veterans Affairs ◽  
Future Directions ◽  
Logistic Regression Models ◽  
Risks And Benefits ◽  
Perioperative Pain Management ◽  
One Year ◽  
Nonopioid Analgesic

Abstract Objective Although multimodal analgesia (MMA) is recommended for perioperative pain management, previous studies have found substantial variability in its utilization. To better understand the factors that influence anesthesiologists’ choices, we assessed the associations between patient or surgical characteristics and number of nonopioid analgesic modes received intraoperatively across a variety of surgeries in a university-affiliated Veteran Affairs hospital. Methods We included elective inpatient surgeries (orthopedic, thoracic, spine, abdominal, and pelvic procedures) that used at least one nonopioid analgesic within a one-year period. Multivariable multinomial logistic regression models were used to estimate adjusted odds ratios and 95% confidence intervals (CIs). We also described the combinations of analgesia used in each surgical subtype and conducted exploratory analyses to test the associations between the number of modes used and postoperative outcomes. Results Of the 1,087 procedures identified, 33%, 53%, and 14% were managed with one, two, and three or more modes, respectively. Older patients had lower odds of receiving three or more modes (adjusted odds ratio [aOR] = 0.28, 95% confidence interval [CI] = 0.15–0.52), as were patients with more comorbidities (two modes: aOR = 0.87, 95% CI = 0.79–0.96; three or more modes: aOR = 0.81, 95% CI = 0.71–0.94). Utilization varied across surgical subtypes P < 0.0001). Increasing the number of modes, particularly use of regional anesthesia, was associated with shorter length of stay. Conclusions Our study suggests that age, comorbidities, and surgical type contribute to variability in MMA utilization. Risks and benefits of multiple modes should be carefully considered for older and sicker patients. Future directions include developing patient- and procedure-specific perioperative MMA recommendations.

scholarly journals Examining Risk Perceptions Among Daily Smokers Naïve to Reduced Nicotine Content Cigarettes

2018 ◽  
Vol 21 (7) ◽  
pp. 985-990 ◽  
Author(s):  
Melissa Mercincavage ◽  
Kirsten Lochbuehler ◽  
Andrea C Villanti ◽  
E Paul Wileyto ◽  
Janet Audrain-McGovern ◽  
...  
Keyword(s):  
Risk Perceptions ◽  
Regression Models ◽  
Multinomial Logistic Regression ◽  
Experimental Studies ◽  
Treatment Seeking ◽  
Logistic Regression Models ◽  
Nicotine Content ◽  
Risks And Benefits ◽  
Safety Risks ◽  
Educational Campaigns

Abstract Introduction The U.S. Food and Drug Administration (FDA) has stated its interest in reducing the addictiveness of combustible cigarettes by lowering their nicotine content. Delineating risk perceptions of reduced nicotine content (RNC) cigarettes prior to federal regulation may inform the content of future educational campaigns accompanying this policy. Methods Five hundred non–treatment-seeking, daily smokers naïve to RNC cigarettes (63.0% male, 51.6% nonWhite, mean [SD] cigarettes per day = 15.69 [7.58], age = 43.44 [11.46]) completed a 10-item RNC cigarette risk perception questionnaire at baseline in two, unrelated experimental studies. We used multinomial logistic regression models to identify demographic (eg, gender) and smoking-related (eg, nicotine dependence) correlates of RNC cigarette risk perceptions. Results Although the majority of participants did not misperceive RNC cigarettes as less harmful than regular or high nicotine cigarettes, a large portion of the sample held misperceptions about RNC cigarettes’ addictiveness (56.4%) and cessation aid potential (63.4%). More than 20% of the sample reported being unsure about RNC-related risks, especially tar content (51.8%). NonWhite smokers were 2.5 to 3 times more likely to be incorrect about multiple RNC cigarette risks (p = .002–.006). Conclusions If the FDA mandates a reduced nicotine content standard for cigarettes, educational campaigns will be needed to correct misperceptions about RNC cigarettes’ addictiveness and potential to aid cessation as well as inform consumers about their safety risks. Campaigns tailored toward nonWhite smokers may also be needed to correct misperceptions of RNC cigarette risks held by this subgroup. Implications The FDA has stated its interest in reducing cigarettes’ addictiveness by lowering their nicotine content, enabling smokers to quit. Our findings suggest that most smokers who have not used RNC cigarettes do not perceive these products as less addictive or as cessation tools, stressing a need for future educational campaigns to correct these misperceptions. Campaigns are also needed to educate uninformed smokers about RNC cigarettes and should consider targeting messages toward subgroups likely to hold misperceptions about the risks and benefits of using these products (eg, nonWhite smokers).

Poisoning deaths among late-middle aged and older adults: comparison between suicides and deaths of undetermined intent

2018 ◽  
Vol 31 (08) ◽  
pp. 1159-1169 ◽  
Author(s):  
Namkee G. Choi ◽  
Diana M. DiNitto ◽  
C. Nathan Marti ◽  
Bryan Y. Choi
Keyword(s):  
Substance Use ◽  
Regression Models ◽  
Mental Health Problems ◽  
Multinomial Logistic Regression ◽  
Accurate Determination ◽  
Health Problems ◽  
Life Stressors ◽  
Manner Of Death ◽  
Logistic Regression Models ◽  
Poisoning Deaths

ABSTRACTBackground:Given the rapid increase in prescription and illicit drug poisoning deaths in the 50+ age group, we examined precipitating/risk factors and toxicology results associated with poisoning deaths classified as suicides compared to intent-undetermined death (UnD) among decedents aged 50+.Methods:Data were from the 2005–2015 US National Violent Death Reporting System (N = 15,453). χ2 tests and multinomial logistic regression models were used to compare three groups of decedents: suicide decedent who left a suicide note, suicide decedent who did not leave a note, and UnD cases.Results:Compared to suicide decedents without a note (37.7% of the sample), those with a note (29.4%) were more likely to have been depressed and had physical health problems and other life stressors, while UnD cases (32.9%) were less likely to have had mental health problems and other life stressors but more likely to have had substance use and health problems. UnD cases were also more likely to be opioid (RRR = 2.65, 95% CI = 2.42–2.90) and cocaine (RRR = 2.59, 95% CI = 2.09–3.21) positive but less likely to be antidepressant positive. Blacks were more than twice as likely as non-Hispanic Whites to be UnDs. Results from separate regression models in the highest UnD states (Maryland and Utah) and in states other than Maryland/Utah were similar.Conclusions:Many UnDs may be more correctly classified as unintentional overdose deaths. Along with more accurate determination processes for intent/manner of death, substance use treatment and approaches to curbing opioid and other drug use problems are needed to prevent intentional and unintentional poisoning deaths.

scholarly journals Changes in Illegal Behavior During Emerging Adulthood

10.18060/2125 ◽  
2013 ◽  
Vol 14 (2) ◽  
pp. 458-476 ◽  
Author(s):  
Badiah Haffejee ◽  
Jamie Rae Yoder ◽  
Kimberly Bender
Keyword(s):  
Emerging Adulthood ◽  
Emerging Adults ◽  
Regression Models ◽  
Multinomial Logistic Regression ◽  
Work Practice ◽  
Social Work Practice ◽  
Mixed Methods Study ◽  
Logistic Regression Models ◽  
Illegal Behavior ◽  
Illegal Activities

Emerging adulthood marks a critical developmental juncture during which some individuals disengage from the illegal behavior of their adolescence while others continue to use substances and commit crimes. While risk factors for delinquency during adolescence are well studied, factors that influence persisting or desisting from illegal activities during emerging adulthood have not been fully explored. This mixed methods study utilizes a sample of college students aged 18-25 (N=74) and examines factors differentiating those who abstained from illegal behaviors, desisted from illegal behaviors, and persisted in illegal behaviors. Multinomial logistic regression models indicated peers offending and hours spent studying predicted desisting and peers offending predicted persisting (compared to the abstaining group). Three qualitative themes: family and peer bonds, morals and values, and fear of consequences further explained factors influencing emerging adults’ persisting and desisting choices. Implications for social work practice are explored.

Domestic Violence Reported to the Police: Correlates of Victims’ Reporting Behavior and Support to Legal Proceedings

2016 ◽  
Vol 31 (3) ◽  
pp. 402-415 ◽  
Author(s):  
Rémi Boivin ◽  
Chloé Leclerc
Keyword(s):  
Domestic Violence ◽  
Logistic Regression ◽  
Regression Models ◽  
Multinomial Logistic Regression ◽  
The Other ◽  
Individual Factors ◽  
Initial Report ◽  
Logistic Regression Models ◽  
Legal Proceedings ◽  
History Of

This article analyzes reported incidents of domestic violence according to the source of the complaint and whether the victim initially supported judicial action against the offender. Almost three quarters of incidents studied were reported by the victim (72%), and a little more than half of victims initially wanted to press charges (55%). Using multinomial logistic regression models, situational and individual factors are used to distinguish 4 incident profiles. Incidents in which the victim made the initial report to the police and wished to press charges are the most distinct and involve partners who were already separated at the time of the incident or had a history of domestic violence. The other profiles also show important differences.

scholarly journals Releasing the conceptual spring to construct multiplicative reasoning

2020 ◽  
Author(s):  
Karen Zwanch ◽  
Jesse L. M. Wilkins
Keyword(s):  
Logistic Regression ◽  
Educational Research ◽  
Regression Models ◽  
Middle Grades ◽  
Multinomial Logistic Regression ◽  
American Educational Research Association ◽  
Research Association ◽  
Multiplicative Reasoning ◽  
Logistic Regression Models ◽  
Quantitative Verification

Abstract Constructing multiplicative reasoning is critical for students’ learning of mathematics, particularly throughout the middle grades and beyond. Tzur, Xin, Si, Kenney, and Guebert [American Educational Research Association, ERIC No. ED510991, (2010)] conclude that an assimilatory composite unit is a conceptual spring to multiplicative reasoning. This study examines patterns in the percentages of students who construct multiplicative reasoning across the middle grades based on their fluency in operating with composite units. Multinomial logistic regression models indicate that students’ rate of constructing an assimilatory composite unit but not multiplicative reasoning in sixth and seventh grades is significantly greater than that in eighth and ninth grades. Furthermore, the proportion of students who have constructed multiplicative reasoning in sixth and seventh grades is significantly less than the proportion of those who have constructed multiplicative reasoning in eighth and ninth grades. One implication of this is the quantitative verification of Tzur, Xin, Si, Kenney, and Guebert’s (2010) conceptual spring. That is, students who construct assimilatory composite units early in the middle grades are likely to construct multiplicative reasoning; students who do not construct assimilatory composite units early in the middle grades likely do not construct multiplicative reasoning in the middle grades.

scholarly journals Variations in the Use of Perioperative Multimodal Analgesic Therapy

2016 ◽  
Vol 124 (4) ◽  
pp. 837-845 ◽  
Author(s):  
Karim S. Ladha ◽  
Elisabetta Patorno ◽  
Krista F. Huybrechts ◽  
Jun Liu ◽  
James P. Rathmell ◽  
...  
Keyword(s):  
Multimodal Therapy ◽  
Secondary Analysis ◽  
Multimodal Analgesia ◽  
The United States ◽  
Research Database ◽  
Logistic Regression Models ◽  
Analgesic Therapy ◽  
Predicted Probability ◽  
Perioperative Pain Management ◽  
Hospital Characteristics

Abstract Background Practice guidelines for perioperative pain management recommend that multimodal analgesic therapy should be used for all postsurgical patients. However, the proportion of patients who actually receive this evidence-based approach is unknown. The objective of this study was to describe hospital-level patterns in the utilization of perioperative multimodal analgesia. Methods Data for the study were obtained from the Premier Research Database. Patients undergoing below-knee amputation, open lobectomy, total knee arthroplasty, and open colectomy between 2007 and 2014 were included in the analysis. Patients were considered to have multimodal therapy if they received one or more nonopioid analgesic therapies. Mixed-effects logistic regression models were used to estimate the hospital-specific frequency of multimodal therapy use while adjusting for the case mix of patients and hospital characteristics and accounting for random variation. Results The cohort consisted of 799,449 patients who underwent a procedure at 1 of 315 hospitals. The mean probability of receiving multimodal therapy was 90.4%, with 95% of the hospitals having a predicted probability between 42.6 and 99.2%. A secondary analysis examined whether patients received two or more nonopioid analgesics, which gave an average predicted probability of 54.2%, with 95% of the hospitals having a predicted probability between 9.3 and 93.2%. Conclusions In this large nationwide sample of surgical admissions in the United States, the authors observed tremendous variation in the utilization of multimodal therapy not accounted for by patient or hospital characteristics. Efforts should be made to identify why there are variations in the use of multimodal analgesic therapy and to promote its adoption in appropriate patients.

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