scholarly journals Are Opioids Overprescribed to Pediatric Neurosurgery Patients? A Prospective Study on Prescribing Practices and Patient Use

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Leah Burroughs ◽  
Denise Ash ◽  
Laurie Ackerman
Keyword(s):  
Hospital Discharge ◽  
Pediatric Patients ◽  
Pediatric Neurosurgery ◽  
The United States ◽  
Medical Setting ◽  
Opioid Overdose ◽  
Neurosurgical Procedures ◽  
Accidental Ingestion ◽  
Opioid Medication ◽  
Opioid Medications

Background and Hypothesis: The opioid crisis continues to worsen in the United States with opioid overdose deaths reaching record highs in 2020. While a large body of literature exists surrounding the risks of opioids in adults, opioids also pose unique risks to pediatric patients, including accidental ingestion, nonmedical use, and acute cerebellitis causing death. Opioid medications prescribed in the medical setting are often an unwitting source of excess opioids, with half of pediatric overdoses in those under 2 years of age. Although legislative efforts have significantly limited opioid prescribing, recent studies suggest these medications may still be overprescribed. We hypothesized opioid medications are overprescribed to pediatric neurosurgery patients upon hospital discharge. Methods: Pediatric patients undergoing neurosurgical procedures at Riley Hospital for Children were identified prospectively. Surgery type, length of stay, and inpatient use of opioid medications were collected. Patients prescribed an opioid medication upon hospital discharge were contacted 7 days after discharge and asked to report the number of doses of opioid medication used. Results: Thirty patients were successfully contacted 7 days after hospital discharge. Patients underwent a variety of cranial and spinal procedures and the mean length of hospital stay was 3.9 days. An average of 24.9 doses of opioid medication were prescribed at hospital discharge, while an average of 3.8 doses were used by patients in the 7 days following hospital discharge. Twelve patients (40%) had used zero doses of the prescribed opioid medication at 7-day follow-up. Conclusions: Pediatric neurosurgery patients used only 15.3% of prescribed opioids in 7 days after hospital discharge. This creates an excess of leftover opioid medication that may increase the risk of accidental ingestion and misuse. The present study highlights the need for educational initiatives for providers to minimize excess opioids prescribed and for parents to safely dispose of leftover opioid medication.

scholarly journals Pediatric neurosurgery telemedicine clinics: a model to provide care to geographically underserved areas of the United States and its territories

2016 ◽  
Vol 18 (6) ◽  
pp. 753-757 ◽  
Author(s):  
Hector E. James
Keyword(s):  
Pediatric Patients ◽  
Pediatric Neurosurgery ◽  
Clinical History ◽  
The United States ◽  
Nursing Personnel ◽  
Cultural Barriers ◽  
University Of Florida ◽  
Clinic Patient ◽  
The University ◽  
Physical Findings

OBJECTIVE The author describes the creation, structuring, and development of a pediatric neurosurgery telemedicine clinic (TMC) to provide telehealth across geographical, time, social, and cultural barriers. METHODS In July 2009 the University of Florida (UF) Division of Pediatric Neurosurgery received a request from the Southeast Georgia Health District (Area 9–2) to provide a TMC to meet regional needs. The Children's Medical Services (CMS) of the State of Georgia installed telemedicine equipment and site-to-site connectivity. Audiovisual connectivity was performed in the UF Pediatric Neurosurgery office, maintaining privacy and HIPAA (Health Insurance Portability and Accountability Act) requirements. Administrative steps were taken with documentation of onsite training of the secretarial and nursing personnel of the CMS clinic. Patient preregistration and documentation were performed as required by the UF College of Medicine–Jacksonville. Monthly clinics are held with the CMS nursing personnel presenting the pertinent clinical history and findings to the pediatric neurosurgeon in the presence of the patient/parents. Physical findings and diagnostic studies are discussed, and management decisions are made. RESULTS The first TMC was held in August 2011. A total of 40 TMC sessions have been held through January 2016, with a total of 43 patients seen: 13 patients once; 13 patients twice; 8 patients for 3 visits; 2 for 4 visits; 2 for 6 visits; 2 for 5 visits; 2 for 7 visits; and 1 patient has been seen 8 times. CONCLUSIONS Pediatric patients in areas of the continental US and its territories with limited access to pediatric neurosurgery services could benefit from this model, if other pediatric neurosurgery centers provide telehealth services.

scholarly journals Morbidity associated with 30-day surgical site infection following nonshunt pediatric neurosurgery

2017 ◽  
Vol 19 (4) ◽  
pp. 421-427 ◽  
Author(s):  
Brandon A. Sherrod ◽  
Brandon G. Rocque
Keyword(s):  
Length Of Stay ◽  
Surgical Site Infection ◽  
Pediatric Patients ◽  
Pediatric Neurosurgery ◽  
Neurosurgical Procedures ◽  
Site Infection ◽  
Improvement Program ◽  
Superficial Infection ◽  
Index Procedure ◽  
Postoperative Length

OBJECTIVE Morbidity associated with surgical site infection (SSI) following nonshunt pediatric neurosurgical procedures is poorly understood. The purpose of this study was to analyze acute morbidity and mortality associated with SSI after nonshunt pediatric neurosurgery using a nationwide cohort. METHODS The authors reviewed data from the American College of Surgeons National Surgical Quality Improvement Program–Pediatric (NSQIP-P) 2012–2014 database, including all neurosurgical procedures performed on pediatric patients. Procedures were categorized by Current Procedural Terminology (CPT) codes. CSF shunts were excluded. Deep and superficial SSIs occurring within 30 days of an index procedure were identified. Deep SSIs included deep wound infections, intracranial abscesses, meningitis, osteomyelitis, and ventriculitis. The following outcomes occurring within 30 days of an index procedure were analyzed, along with postoperative time to complication development: sepsis, wound disruption, length of postoperative stay, readmission, reoperation, and death. RESULTS A total of 251 procedures associated with a 30-day SSI were identified (2.7% of 9296 procedures). Superficial SSIs were more common than deep SSIs (57.4% versus 42.6%). Deep SSIs occurred more frequently after epilepsy or intracranial tumor procedures. Superficial SSIs occurred more frequently after skin lesion, spine, Chiari decompression, craniofacial, and myelomeningocele closure procedures. The mean (± SD) postoperative length of stay for patients with any SSI was 9.6 ± 14.8 days (median 4 days). Post-SSI outcomes significantly associated with previous SSI included wound disruption (12.4%), sepsis (15.5%), readmission (36.7%), and reoperation (43.4%) (p < 0.001 for each). Post-SSI sepsis rates (6.3% vs 28.0% for superficial versus deep SSI, respectively; p < 0.001), wound disruption rates (4.9% vs 22.4%, p < 0.001), and reoperation rates (23.6% vs 70.1%, p < 0.001) were significantly greater for patients with deep SSIs. Postoperative length of stay in patients discharged before SSI development was not significantly different for deep versus superficial SSI (4.2 ± 2.7 vs 3.6 ± 2.4 days, p = 0.094). No patient with SSI died within 30 days after surgery. CONCLUSIONS Thirty-day SSI is associated with significant 30-day morbidity in pediatric patients undergoing nonshunt neurosurgery. Rates of SSI-associated complications are significantly lower in patients with superficial infection than in those with deep infection. There were no cases of SSI-related mortality within 30 days of the index procedure.

scholarly journals Illicit Opioid Intoxication: Diagnosis and Treatment

2011 ◽  
Vol 5 ◽  
pp. SART.S7090
Author(s):  
A. Fareed ◽  
S. Stout ◽  
J. Casarella ◽  
S. Vayalapalli ◽  
J. Cox ◽  
...  
Keyword(s):  
Signs And Symptoms ◽  
The United States ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Heroin Use ◽  
Treatment And Prevention ◽  
Pain Medications ◽  
Opioid Intoxication ◽  
Opioid Drugs ◽  
Opioid Medications

Opioid intoxications and overdose are associated with high rates of morbidity and mortality. Opioid overdose may occur in the setting of intravenous or intranasal heroin use, illicit use of diverted opioid medications, intentional or accidental misuse of prescription pain medications, or iatrogenic overdose. In this review, we focused on the epidemiology of illict opioid use in the United States and on the mechanism of action of opioid drugs. We also described the signs and symptoms, and diagnoses of intoxication and overdose. Lastly, we updated the reader about the most recent recommendations for treatment and prevention of opioid intoxications and overdose.

Lofexidine: A Novel Treatment Option for Opioid Withdrawal Symptoms

2020 ◽  
Vol 35 (10) ◽  
pp. 413-418
Author(s):  
Olga Hilas ◽  
Tina Caliendo
Keyword(s):  
Prescription Drugs ◽  
Treatment Plan ◽  
The United States ◽  
Opioid Withdrawal ◽  
Withdrawal Symptoms ◽  
Opioid Overdose ◽  
Health Issues ◽  
Emerging Therapies ◽  
Opioid Medications ◽  
Overdose Deaths

Substance misuse in adults 60 years of age and older is one of the fastest-growing health issues in the United States. Alcohol and prescription drugs are among the most commonly misused agents. With growing concern for opioid-overdose deaths and the use of opioids in the treatment of persistent pain in older adults, it is imperative that practitioners are aware of emerging therapies used to manage the symptoms that may result after discontinuation of opioid medications. This review highlights the first nonopioid treatment plan for the management of opioid withdrawal symptoms with a novel pharmacologic mechanism.

Lofexidine: A Novel Treatment Option for Opioid Withdrawal Symptoms

2020 ◽  
Vol 35 (10) ◽  
pp. 413-418
Author(s):  
Olga Hilas ◽  
Tina Caliendo
Keyword(s):  
Prescription Drugs ◽  
Treatment Plan ◽  
The United States ◽  
Opioid Withdrawal ◽  
Withdrawal Symptoms ◽  
Opioid Overdose ◽  
Health Issues ◽  
Emerging Therapies ◽  
Opioid Medications ◽  
Overdose Deaths

Substance misuse in adults 60 years of age and older is one of the fastest-growing health issues in the United States. Alcohol and prescription drugs are among the most commonly misused agents. With growing concern for opioid-overdose deaths and the use of opioids in the treatment of persistent pain in older adults, it is imperative that practitioners are aware of emerging therapies used to manage the symptoms that may result after discontinuation of opioid medications. This review highlights the first nonopioid treatment plan for the management of opioid withdrawal symptoms with a novel pharmacologic mechanism.

Neuroblastoma with intracerebral metastases and the need for neurosurgery: a single-center experience

2020 ◽  
Vol 25 (1) ◽  
pp. 51-56
Author(s):  
Steffen Fleck ◽  
Sascha Marx ◽  
Clara Bobak ◽  
Victoria Richter ◽  
Stephan Nowak ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Neurosurgical Procedures ◽  
Normal Brain ◽  
Indications For Surgery ◽  
Single Center ◽  
Neurosurgical Procedure ◽  
Oncological Treatment ◽  
Single Center Experience ◽  
Stage 4 ◽  
Neurosurgical Treatment

OBJECTIVEIntracerebral metastases in neuroblastoma patients are rare, and information about the indication for and the outcome of neurosurgical procedures in this setting is scarce in the literature. The authors’ aim in the present study was to report a single-center experience with the neurosurgical treatment of intracerebral metastases in neuroblastoma.METHODSThis study is a retrospective single-center analysis of all neurosurgical strategies used in the treatment of intracerebral metastases in neuroblastoma patients.RESULTSBetween 2009 and 2017, 237 pediatric patients (94 girls, 143 boys) with a mean age of 39 months at diagnosis were treated for neuroblastoma. Five (2.1%) of the 237 patients had a neurosurgical procedure for intracerebral metastases. The metastases occurred a mean of 46 months after initial diagnosis. All of these patients had neuroblastoma stage 4. Indications for surgery were recurrent metastases after initial successful oncological treatment or progression of the metastasis under oncological treatment as well as deterioration of neurological function. Intraoperatively, the tumor usually had a distinguishable dissection plane but was infiltrative to adjacent nerves in some spots. Mean overall survival after the neurosurgical procedure was 22 months. Furthermore, in another 3 patients, a neurosurgical procedure was done for an intracranial but extracerebral metastasis.CONCLUSIONSNeurosurgical procedures for intracerebral metastases in neuroblastoma patients are rare and were performed in 2.1% of patients in the present study. Intracerebral metastases occurred during disease progression, and the prognosis after surgery was very limited. The main indications for surgery were rapid neurological deterioration or recurrence of the metastasis after initial successful oncological treatment. Intraoperatively, the metastases usually had a distinguishable dissection plane from the normal brain tissue.

Commercial Fishing as an Occupational Determinant of Opioid Overdoses and Deaths of Despair in Two Massachusetts Fishing Ports, 2000–2014

2021 ◽  
pp. 104829112110234
Author(s):  
Scott Fulmer ◽  
Shruti Jain ◽  
David Kriebel
Keyword(s):  
United States ◽  
Cause Of Death ◽  
Death Certificate ◽  
The United States ◽  
Opioid Overdose ◽  
Commercial Fishing ◽  
Opioid Epidemic ◽  
Death Certificate Data ◽  
Deaths Of Despair

The opioid epidemic has had disproportionate effects across various sectors of the population, differentially impacting various occupations. Commercial fishing has among the highest rates of occupational fatalities in the United States. This study used death certificate data from two Massachusetts fishing ports to calculate proportionate mortality ratios of fatal opioid overdose as a cause of death in commercial fishing. Statistically significant proportionate mortality ratios revealed that commercial fishermen were greater than four times more likely to die from opioid poisoning than nonfishermen living in the same fishing ports. These important quantitative findings suggest opioid overdoses, and deaths to diseases of despair in general, deserve further study in prevention, particularly among those employed in commercial fishing.

scholarly journals Assessing the Relationships Between COVID-19 Stay-at-Home Orders and Opioid Overdoses in the State of Pennsylvania

2021 ◽  
pp. 002204262110063
Author(s):  
Brian King ◽  
Ruchi Patel ◽  
Andrea Rishworth
Keyword(s):  
Age Groups ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Policy Recommendations ◽  
Opioid Use ◽  
Fentanyl Analogs ◽  
Measure Change ◽  
Using Data ◽  
At Home

COVID-19 is compounding opioid use disorder throughout the United States. While recent commentaries provide useful policy recommendations, few studies examine the intersection of COVID-19 policy responses and patterns of opioid overdose. We examine opioid overdoses prior to and following the Pennsylvania stay-at-home order implemented on April 1, 2020. Using data from the Pennsylvania Overdose Information Network, we measure change in monthly incidents of opioid-related overdose pre- versus post-April 1, and the significance of change by gender, age, race, drug class, and naloxone doses administered. Findings demonstrate statistically significant increases in overdose incidents among both men and women, White and Black groups, and several age groups, most notably the 30–39 and 40–49 ranges, following April 1. Significant increases were observed for overdoses involving heroin, fentanyl, fentanyl analogs or other synthetic opioids, pharmaceutical opioids, and carfentanil. The study emphasizes the need for opioid use to be addressed alongside efforts to mitigate and manage COVID-19 infection.

scholarly journals “It’s way more than just writing a prescription”: A qualitative study of preferences for integrated versus non-integrated treatment models among individuals with opioid use disorder

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Elizabeth C. Saunders ◽  
Sarah K. Moore ◽  
Olivia Walsh ◽  
Stephen A. Metcalf ◽  
Alan J. Budney ◽  
...  
Keyword(s):  
Qualitative Study ◽  
The United States ◽  
Opioid Use Disorder ◽  
Integrated Treatment ◽  
Medical Setting ◽  
Integrated Models ◽  
Opioid Use ◽  
Medical Settings ◽  
Psychosocial Services ◽  
Treatment Models

Abstract Background Increasingly, treatment for opioid use disorder (OUD) is offered in integrated treatment models addressing both substance use and other health conditions within the same system. This often includes offering medications for OUD in general medical settings. It remains uncertain whether integrated OUD treatment models are preferred to non-integrated models, where treatment is provided within a distinct treatment system. This study aimed to explore preferences for integrated versus non-integrated treatment models among people with OUD and examine what factors may influence preferences. Methods This qualitative study recruited participants (n = 40) through Craigslist advertisements and flyers posted in treatment programs across the United States. Participants were 18 years of age or older and scored a two or higher on the heroin or opioid pain reliever sections of the Tobacco, Alcohol, Prescription Medications, and Other Substances (TAPS) Tool. Each participant completed a demographic survey and a telephone interview. The interviews were coded and content analyzed. Results While some participants preferred receiving OUD treatment from an integrated model in a general medical setting, the majority preferred non-integrated models. Some participants preferred integrated models in theory but expressed concerns about stigma and a lack of psychosocial services. Tradeoffs between integrated and non-integrated models were centered around patient values (desire for anonymity and personalization, fear of consequences), the characteristics of the provider and setting (convenience, perceived treatment effectiveness, access to services), and the patient-provider relationship (disclosure, trust, comfort, stigma). Conclusions Among this sample of primarily White adults, preferences for non-integrated versus integrated OUD treatment were mixed. Perceived benefits of integrated models included convenience, potential for treatment personalization, and opportunity to extend established relationships with medical providers. Recommendations to make integrated treatment more patient-centered include facilitating access to psychosocial services, educating patients on privacy, individualizing treatment, and prioritizing the patient-provider relationship. This sample included very few minorities and thus findings may not be fully generalizable to the larger population of persons with OUD. Nonetheless, results suggest a need for expansion of both OUD treatment in specialty and general medical settings to ensure access to preferred treatment for all.

Preparing pharmacists to increase naloxone dispensing within community pharmacies under the Pennsylvania standing order

2020 ◽  
Author(s):  
Heather M Santa ◽  
Samira G Amirova ◽  
Daniel J Ventricelli ◽  
George E Downs ◽  
Alexandra A Nowalk ◽  
...  
Keyword(s):  
Community Pharmacists ◽  
The United States ◽  
Health Concern ◽  
Community Pharmacies ◽  
Opioid Overdose ◽  
Patient Counseling ◽  
Opioid Use ◽  
Overdose Prevention ◽  
Standing Order ◽  
Overdose Deaths

Abstract Purpose Opioid misuse and overdose deaths remain a public health concern in the United States. Pennsylvania has one of the highest rates of opioid overdose deaths in the country, with Philadelphia County’s being 3 times higher than the national average. Despite several multimodal interventions, including use of SBIRT (screening, brief intervention, and referral to treatment) methods and naloxone distribution, the rate of overdose deaths remains high. Methods To gain insights on strategies for improving access to naloxone and naloxone distribution by pharmacists in Philadelphia County, a study was conducted in 11 community pharmacies (chain and independent) in Philadelphia. Twenty-four pharmacists were recruited and completed SBIRT and naloxone trainings. Each pharmacy elected to have at least 1 pharmacy champion who received additional training on and helped develop pharmacy site–specific naloxone dispensing protocols. Results Pre-post survey results showed a reduction in stigmatizing attitudes regarding naloxone dispensing and an increase in pharmacists’ understanding of the standing order and appropriate naloxone use. There was an increase in pharmacists’ self-reported confidence in their ability to appropriately identify, discuss, and dispense naloxone to patients. All pharmacies increased their average monthly dispensing rate following protocol implementation. Conclusion Pharmacists who received both trainings were more likely to change naloxone dispensing practices, leading to an overall increase in naloxone dispensing by community pharmacists. The study addressed overall gaps in pharmacists’ knowledge, reduced stigma, and prepared pharmacists to address opioid use and overdose prevention with their patients. The described pharmacist-led patient counseling and intervention service for overdose prevention may be explored as a model for other community pharmacies to adopt to improve naloxone dispensing and similar interventions to reduce overdose deaths.

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