Should Excess Topical Decongestant Use Raise a Red Flag? Rhinitis Medicamentosa and Opioid Use Disorder

2019 ◽  
Vol 129 (2) ◽  
pp. 164-169
Author(s):  
Aneesh Patel ◽  
Jessica R. Levi ◽  
Christopher D. Brook
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Opioid Use Disorder ◽  
Opioid Abuse ◽  
Opioid Use ◽  
Retrospective Case ◽  
Chronic Rhinitis ◽  
Icd 10 ◽  
Red Flag ◽  
Rhinitis Medicamentosa

Objective: The objective of this study was to determine whether patients with rhinitis medicamentosa (RM) have an increased odds of having an opioid use disorder (OUD) and which characteristics may predict this association. Methods: The authors conducted a retrospective case control study of patients 18 years and older who presented to the otolaryngology clinic at an academic medical center from January 2013 through December 2017. Cases, defined as patients who presented with excessive decongestant nasal spray usage based on history, were matched to control patients who presented with chronic rhinitis and did not report regular nasal decongestant usage. The charts were reviewed for patients that carried a problem of opioid abuse, identified using ICD-9 codes 304.XX or ICD-10 codes F11.XX. The primary outcome of this study was the odds of having an OUD. Secondary outcomes were assessed by summary statistics. Results: One hundred and thirty-one cases of RM were matched to 1871 controls of chronic rhinitis. Seven cases (5.3%) and 24 (1.3%) controls had a diagnosis of OUD, consistent with an odds ratio of 3.98 for opioid abuse in patients with RM (95% CI: 1.47-9.71). Oxymetazoline was used by 85.5% (n = 112) of patients with RM. Thirty-six patients (27.1%) with RM underwent nasal surgery following a diagnosis of RM, of which twenty patients (55.6%) were prescribed opioids following the procedure. Conclusions: RM is associated with increased odds of having an OUD.

scholarly journals The Financial Burden of Opioid-Related Abuse among Surgical and Non-Surgical Patients in Florida: A Longitudinal Study

2021 ◽  
Vol 18 (17) ◽  
pp. 9127
Author(s):  
Jing Xu ◽  
Nazik M. A. Zakari ◽  
Hanadi Y. Hamadi ◽  
Sinyoung Park ◽  
Donald Rob Haley ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Financial Burden ◽  
Opioid Abuse ◽  
Opioid Use ◽  
Retrospective Case ◽  
Discharge Data ◽  
Hospital Administrators ◽  
Icd 10 ◽  
Longitudinal Study Design ◽  
Insight Into

Florida is one of the eight states labeled as a high-burden opioid abuse state and is an epicenter for opioid use and misuse. The aim of our study was to measure multi-year total room charges and costs billed for opioid abuse-related events and to compare the costs of inpatient opioid abusers and non-opioid abusers for Florida hospitals from 2011 to 2017. We constructed a retrospective case-control longitudinal study design on inpatient administrative discharge data across 173 hospitals. Opioid abuse was defined using both ICD-9-CM and ICD-10-CM systems. We found a statistically significant association between opioid abuse diagnosis and total room charge. On average, opioid abuse status increased the room charges by 8.1%. We also noticed year-to-year variations in opioid abuse had a remarkable influence on hospital finances. We showed that since 2015, the differences significantly increased from 4–5% to 13–14% for both room charges and cost, which indicates the financial burden due to opioid abuse becoming more frequent. These findings are important to policymakers and hospital administrators because they provide crucial insight into Florida’s opioid crisis and its economic burden on hospitals.

scholarly journals Implementation of a medical student-run telemedicine program for medications for opioid use disorder during the COVID-19 pandemic

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Marcus Castillo ◽  
Brianna Conte ◽  
Sam Hinkes ◽  
Megan Mathew ◽  
C. J. Na ◽  
...  
Keyword(s):  
Medical Student ◽  
People Who Inject Drugs ◽  
Medical Center ◽  
Academic Medical Center ◽  
Opioid Use Disorder ◽  
Health Issues ◽  
Opioid Use ◽  
Academic Medical ◽  
Life Saving ◽  
Attending Physicians

Abstract Objectives The COVID-19 pandemic led to the closure of the IDEA syringe services program medical student-run free clinic in Miami, Florida. In an effort to continue to serve the community of people who inject drugs and practice compassionate and non-judgmental care, the students transitioned the clinic to a model of TeleMOUD (medications for opioid use disorder). We describe development and implementation of a medical student-run telemedicine clinic through an academic medical center-operated syringe services program. Methods Students advertised TeleMOUD services at the syringe service program on social media and created an online sign-up form. They coordinated appointments and interviewed patients by phone or videoconference where they assessed patients for opioid use disorder. Supervising attending physicians also interviewed patients and prescribed buprenorphine when appropriate. Students assisted patients in obtaining medication from the pharmacy and provided support and guidance during home buprenorphine induction. Results Over the first 9 weeks in operation, 31 appointments were requested, and 22 initial telehealth appointments were completed by a team of students and attending physicians. Fifteen appointments were for MOUD and 7 for other health issues. All patients seeking MOUD were prescribed buprenorphine and 12/15 successfully picked up medications from the pharmacy. The mean time between appointment request and prescription pick-up was 9.5 days. Conclusions TeleMOUD is feasible and successful in providing people who inject drugs with low barrier access to life-saving MOUD during the COVID-19 pandemic. This model also provided medical students with experience treating addiction during a time when they were restricted from most clinical activities.

scholarly journals Perioperative Factors Associated With Chronic Opioid Use After Spine Surgery

2021 ◽  
pp. 219256822110357
Author(s):  
Eric Y. Montgomery ◽  
Mark N. Pernik ◽  
Zachary D. Johnson ◽  
Luke J. Dosselman ◽  
Zachary K. Christian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spine Surgery ◽  
Medical Center ◽  
Lumbar Fusion ◽  
Academic Medical Center ◽  
Opioid Use ◽  
Retrospective Case ◽  
Opioid Prescription ◽  
Factors Associated ◽  
Chronic Opioid Use

Study Design: Retrospective case control. Objectives: The purpose of the current study is to determine risk factors associated with chronic opioid use after spine surgery. Methods: In our single institution retrospective study, 1,299 patients undergoing elective spine surgery at a tertiary academic medical center between January 2010 and August 2017 were enrolled into a prospectively collected registry. Patients were dichotomized based on renewal of, or active opioid prescription at 3-mo and 12-mo postoperatively. The primary outcome measures were risk factors for opioid renewal 3-months and 12-months postoperatively. These primarily included demographic characteristics, operative variables, and in-hospital opioid consumption via morphine milligram equivalence (MME). At the 3-month and 12-month periods, we analyzed the aforementioned covariates with multivariate followed by bivariate regression analyses. Results: Multivariate and bivariate analyses revealed that script renewal at 3 months was associated with black race ( P = 0.001), preoperative narcotic ( P < 0.001) or anxiety/depression medication use ( P = 0.002), and intraoperative long lumbar ( P < 0.001) or thoracic spine surgery ( P < 0.001). Lower patient income was also a risk factor for script renewal ( P = 0.01). Script renewal at 12 months was associated with younger age ( P = 0.006), preoperative narcotics use ( P = 0.001), and ≥4 levels of lumbar fusion ( P < 0.001). Renewals at 3-mo and 12-mo had no association with MME given during the hospital stay or with the usage of PCA ( P > 0.05). Conclusion: The current study describes multiple patient-level factors associated with chronic opioid use. Notably, no metric of perioperative opioid utilization was directly associated with chronic opioid use after multivariate analysis.

scholarly journals Characteristics and Outcomes Among Hospitalized COVID-19-Positive Patients in a Nonurban Environment

2021 ◽  
Author(s):  
Robert P Lennon ◽  
Theodore J Demetriou ◽  
M Fahad Khalid ◽  
Lauren Jodi Van Scoy ◽  
Erin L Miller ◽  
...  
Keyword(s):  
New York ◽  
Medical Center ◽  
Academic Medical Center ◽  
Military Medicine ◽  
Case Series ◽  
Outcome Data ◽  
Urban Environments ◽  
Urban Setting ◽  
Published Data ◽  
Retrospective Case

ABSTRACT Introduction Virtually all hospitalized coronavirus disease-2019 (COVID-19) outcome data come from urban environments. The extent to which these findings are generalizable to other settings is unknown. Coronavirus disease-2019 data from large, urban settings may be particularly difficult to apply in military medicine, where practice environments are often semi-urban, rural, or austere. The purpose of this study is compare presenting characteristics and outcomes of U.S. patients with COVID-19 in a nonurban setting to similar patients in an urban setting. Materials and Methods This is a retrospective case series of adults with laboratory-confirmed COVID-19 infection who were admitted to Hershey Medical Center (HMC), a 548-bed tertiary academic medical center in central Pennsylvania serving semi-urban and rural populations, from March 23, 2020, to April 20, 2020 (the first month of COVID-19 admissions at HMC). Patients and outcomes of this cohort were compared to published data on a cohort of similar patients from the New York City (NYC) area. Results The cohorts had similar age, gender, comorbidities, need for intensive care or mechanical ventilation, and most vital sign and laboratory studies. The NYC’s cohort had shorter hospital stays (4.1 versus 7.2 days, P &lt; .001) but more African American patients (23% versus 12%, P = .02) and higher prevalence of abnormal alanine (&gt;60U/L; 39.0% versus 5.9%, P &lt; .001) and aspartate (&gt;40U/L; 58.4% versus 42.4%, P = .012) aminotransferase, oxygen saturation &lt;90% (20.4% versus 7.2%, P = .004), and mortality (21% versus 1.4%, P &lt; .001). Conclusions Hospitalists in nonurban environments would be prudent to use caution when considering the generalizability of results from dissimilar regions. Further investigation is needed to explore the possibility of reproducible causative systemic elements that may help improve COVID-19-related outcomes. Broader reports of these relationships across many settings will offer military medical planners greater ability to consider outcomes most relevant to their unique settings when considering COVID-19 planning.

Multi-Disciplinary Skull Base Conference and its Effects on Patient Management

2021 ◽  
pp. 000348942110212
Author(s):  
Nathan Kemper ◽  
Scott B. Shapiro ◽  
Allie Mains ◽  
Noga Lipschitz ◽  
Joseph Breen ◽  
...  
Keyword(s):  
Skull Base ◽  
Medical Center ◽  
Academic Medical Center ◽  
Significant Proportion ◽  
Internal Auditory Canal ◽  
Patient Characteristics ◽  
Management Plan ◽  
Case Review ◽  
Retrospective Case ◽  
Lateral Skull Base

Objective: Examine the effects of a multi-disciplinary skull base conference (MDSBC) on the management of patients seen for skull base pathology in a neurotology clinic. Methods: Retrospective case review of patients who were seen in a neurotology clinic at a tertiary academic medical center for pathology of the lateral skull base and were discussed at an MDSBC between July 2019 and February 2020. Patient characteristics, nature of the skull base pathology, and pre- and post-MDSBC plan of care was categorized. Results: A total of 82 patients with pathology of the lateral skull base were discussed at a MDSBC during an 8-month study period. About 54 (65.9%) had a mass in the internal auditory canal and/or cerebellopontine angle while 28 (34.1%) had other pathology of the lateral skull base. Forty-nine (59.8%) were new patients and 33 (40.2%) were established. The management plan changed in 11 (13.4%, 7.4-22.6 95% CI) patients as a result of the skull base conference discussion. The planned management changed from some form of treatment to observation in 4 patients, and changed from observation to some form of treatment in 4 patients. For 3 patients who underwent surgery, the planned approach was altered. Conclusions: For a significant proportion of patients with pathology of the lateral skull base, the management plan changed as a result of discussion at an MDSBC. Although participants of a MDSBC would agree of its importance, it is unclear how an MDSBC affects patient outcomes.

Cancer inpatient malnutrition risk, documentation, and ICD-10 coding in an academic medical center.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 12107-12107
Author(s):  
Aynur Aktas ◽  
Lenna Finch ◽  
Danielle Boselli ◽  
Declan Walsh ◽  
Kunal C. Kadakia ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Stage Iv ◽  
Academic Community ◽  
Primary Site ◽  
Disease Stage ◽  
Cancer Site ◽  
Black Race ◽  
Stage Iv Disease ◽  
Icd 10

12107 Background: Malnutrition (MN) is common in hospitalized cancer patients but often underdiagnosed. We evaluated the prevalence of MN risk, dietitian documented MN (DDMN), and physician coded malnutrition (PCMN) in a consecutive cohort of cancer inpatients in an academic, community-based medical center. Methods: Electronic medical records (EMR) were reviewed for inpatients with a solid tumor diagnosis staged I-IV and admitted to Atrium Health Carolinas Medical Center at least once between 1/1/2016 to 5/21/2019. All data were collected from the first admission EMR encounter closest to the cancer diagnosis date. High MN risk was a score ≥2 on the Malnutrition Screening Tool (MST) completed by an RN at admission. Registered Dietitian (RD) assessments were reviewed for DDMN and grade (mild, moderate, severe). PCMN diagnosis was based on MN ICD-10 codes extracted from the medical coder’s discharge summary. Multivariate logistic regression models identified associations between clinic-demographic factors and the prevalence of DDMN and PCMN with stepwise selection. Results: N=5,143; 48% females. Median age 63 (range 18-102) years. 70% White; 24% Black, 3% Latino. Most common cancers: thoracic 19% and digestive system (14% other, 11% colorectal). 28% had known stage IV disease. The MST was completed in 79%. Among those with MST ≥2 (N=1,005; 25%), DDMN and PCMN prevalence was 30% and 22%, respectively. In the entire cohort, 8% had DDMN; 7% PCMN; 4% both. Prevalence of MN risk, DDMN, and PCMN by cancer site are in the Table. DDMN (N=420) was mild 2%, moderate 16%; severe 66%; unspecified 16%. On discharge, PCMN (N=360) was mild 10%; moderate 0%; severe 69%; unspecified 21%. Male gender (OR 1.27 [1.01, 1.59]), Black race (OR 1.57 [1.25, 1.98]), stage IV disease (v. I-III) (OR 3.08 [2.49, 3.82]), and primary site were all independent predictors of DDMN (all p<0.05); Black race (OR 1.46 [1.14, 1.87]), stage IV disease (OR 2.70 [2.15, 3.39]), and primary site were independent predictors of PCMN (all p<0.05). Conclusions: 25% of cancer inpatients were at high risk for MN. Primary site, disease stage, and race were independent predictors of a greater risk. MN appears to be under-diagnosed compared to population studies. This is the first study to report the prevalence of MN in a large cancer inpatient database with a representative population.[Table: see text]

scholarly journals Use of ICD-10 Codes for Identification of Injection Drug Use–Associated Infective Endocarditis Is Nonspecific and Obscures Critical Findings on Impact of Medications for Opioid Use Disorder

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Laura R Marks ◽  
Nathanial S Nolan ◽  
Linda Jiang ◽  
Dharushana Muthulingam ◽  
Stephen Y Liang ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Drug Use ◽  
Injection Drug Use ◽  
Opioid Use Disorder ◽  
Injection Drug ◽  
Diagnosis Code ◽  
Opioid Use ◽  
Diagnosis Codes ◽  
All Cause Mortality ◽  
Icd 10

Abstract Background No International Classification of Diseases, 10th revision (ICD-10), diagnosis code exists for injection drug use–associated infective endocarditis (IDU-IE). Instead, public health researchers regularly use combinations of nonspecific ICD-10 codes to identify IDU-IE; however, the accuracy of these codes has not been evaluated. Methods We compared commonly used ICD-10 diagnosis codes for IDU-IE with a prospectively collected patient cohort diagnosed with IDU-IE at Barnes-Jewish Hospital to determine the accuracy of ICD-10 diagnosis codes used in IDU-IE research. Results ICD-10 diagnosis codes historically used to identify IDU-IE were inaccurate, missing 36.0% and misclassifying 56.4% of patients prospectively identified in this cohort. Use of these nonspecific ICD-10 diagnosis codes resulted in substantial biases against the benefit of medications for opioid use disorder (MOUD) with relation to both AMA discharge and all-cause mortality. Specifically, when data from all patients with ICD-10 code combinations suggestive of IDU-IE were used, MOUD was associated with an increased risk of AMA discharge (relative risk [RR], 1.12; 95% CI, 0.48–2.64). In contrast, when only patients confirmed by chart review as having IDU-IE were analyzed, MOUD was protective (RR, 0.49; 95% CI, 0.19–1.22). Use of MOUD was associated with a protective effect in time to all-cause mortality in Kaplan-Meier analysis only when confirmed IDU-IE cases were analyzed (P = .007). Conclusions Studies using nonspecific ICD-10 diagnosis codes for IDU-IE should be interpreted with caution. In the setting of an ongoing overdose crisis and a syndemic of infectious complications, a specific ICD-10 diagnosis code for IDU-IE is urgently needed.

Opioid use in the acute setting: A survey of providers at an academic medical center

2018 ◽  
Vol 14 (3) ◽  
pp. 203-210 ◽  
Author(s):  
Douglas R. Oyler, PharmD ◽  
Kristy S. Deep, MD ◽  
Phillip K. Chang, MD
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Healthcare Providers ◽  
High Risk Patient ◽  
Opioid Analgesics ◽  
Opioid Use ◽  
Cross Sectional ◽  
Academic Medical ◽  
Clinical Scenarios ◽  
Nonopioid Analgesics

Objective: To examine attitudes, beliefs, and influencing factors of inpatient healthcare providers regarding prescription of opioid analgesics.Design: Electronic cross-sectional survey.Setting: Academic medical center.Participants: Physicians, advanced practice providers, and pharmacists from a single academic medical center in the southeast United States.Main Outcome Measures: Respondents completed survey items addressing: (1) their practice demographics, (2) their opinions regarding overall use, safety, and efficacy of opioids compared to other analgesics, (3) specific clinical scenarios, (4) main pressures to prescribe opioids, and (5) confidence/comfort prescribing opioids or nonopioids in select situations.Results: The majority of the sample (n = 363) were physicians (60.4 percent), with 69.4 percent of physicians being attendings. Most respondents believed that opioids were overused at our institution (61.7 percent); nearly half thought opioids had similar efficacy to other analgesics (44.1 percent), and almost all believed opioids were more dangerous than other analgesics (88.1 percent). Many respondents indicated that they would modify a chronic regimen for a high-risk patient, and use of nonopioids in specific scenarios was high. However, this use was often in combination with opioids. Respondents identified patients (64 percent) and staff (43.1 percent) as the most significant sources of pressure to prescribe opioids during an admission; the most common sources of pressure to prescribe opioidson discharge were to facilitate discharge (44.8 percent) and to reduce follow-up requests, calls, or visits (36.3 percent). Resident physicians appear to experience more pressure to prescribe opioids than other providers. Managing pain in patients with substance use disorders and effectively using nonopioid analgesics were the most common educational needs identified by respondents.Conclusion: Most individuals believe opioid analgesics are overused in our specific setting, commonly to satisfy patient requests. In general, providers feel uncomfortable prescribing nonopioid analgesics to patients.

Endoscopic Frontal Sinus Obliteration: A New Technique for the Treatment of Chronic Frontal Sinusitis

2005 ◽  
Vol 133 (4) ◽  
pp. 551-555 ◽  
Author(s):  
Feodor Ung ◽  
Raj Sindwani ◽  
Ralph Metson
Keyword(s):  
Frontal Sinus ◽  
Medical Center ◽  
Academic Medical Center ◽  
Invasive Technique ◽  
Control Group ◽  
Endoscopic Drainage ◽  
Frontal Sinusitis ◽  
Retrospective Case ◽  
Additional Surgery ◽  
Sinus Obliteration

OBJECTIVES: Patients who fail endoscopic drainage procedures for chronic frontal sinusitis often require obliteration of the frontal sinus with abdominal fat. The purpose of this study was to evaluate an endoscopic technique for frontal sinus obliteration. STUDY DESIGN AND SETTING: Retrospective case-control. Thirty-five patients underwent frontal sinus obliteration using either an endoscopic (n = 10) or conventional osteoplastic flap (n = 25) technique from 1994 to 2004 at an academic medical center. RESULTS: Patients undergoing endoscopic obliteration had less blood loss (P = 0.006), decreased operative time (P = 0.016), and a shorter hospital stay (P = 0.003) compared to osteoplastic control subjects. All 3 surgical complications occurred in the control group. No patients required additional surgery for frontal sinusitis. CONCLUSIONS: The endoscopic approach to frontal sinus obliteration appears to reduce patient morbidity and should be considered in the surgical management of advanced frontal sinus disease. SIGNIFICANCE: This is the first report of a minimally-invasive technique for frontal sinus obliteration.

scholarly journals Two Data-Driven Approaches to Identifying the Spectrum of Problematic Opioid Use: A Pilot Study within a Chronic Pain Cohort

2021 ◽  
Author(s):  
Lori Schirle ◽  
Alvin D Jeffery ◽  
Ali Yaqoob ◽  
Sandra Sanchez-Roige ◽  
David C. Samuels
Keyword(s):  
Language Processing ◽  
Medical Center ◽  
Academic Medical Center ◽  
Correlation Coefficients ◽  
Pilot Project ◽  
Data Driven ◽  
Risk Scores ◽  
Opioid Use ◽  
Academic Medical ◽  
Manual Review

Background: Although electronic health records (EHR) have significant potential for the study of opioid use disorders (OUD), detecting OUD in clinical data is challenging. Models using EHR data to predict OUD often rely on case/control classifications focused on extreme opioid use. There is a need to expand this work to characterize the spectrum of problematic opioid use. Methods: Using a large academic medical center database, we developed 2 data-driven methods of OUD detection: (1) a Comorbidity Score developed from a Phenome-Wide Association Study of phenotypes associated with OUD and (2) a Text-based Score using natural language processing to identify OUD-related concepts in clinical notes. We evaluated the performance of both scores against a manual review with correlation coefficients, Wilcoxon rank sum tests, and area-under the receiver operating characteristic curves. Records with the highest Comorbidity and Text-based scores were re-evaluated by manual review to explore discrepancies. Results: Both the Comorbidity and Text-based OUD risk scores were significantly elevated in the patients judged as High Evidence for OUD in the manual review compared to those with No Evidence (p = 1.3E-5 and 1.3E-6, respectively). The risk scores were positively correlated with each other (rho = 0.52, p < 0.001). AUCs for the Comorbidity and Text-based scores were high (0.79 and 0.76, respectively). Follow-up manual review of discrepant findings revealed strengths of data-driven methods over manual review, and opportunities for improvement in risk assessment. Conclusion: Risk scores comprising comorbidities and text offer differing but synergistic insights into characterizing problematic opioid use. This pilot project establishes a foundation for more robust work in the future.

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