Opioid prescribing trends: Changes after focused hospital resident education and after subsequent adoption of new state regulations

2021 ◽  
Vol 17 (1) ◽  
pp. 63-67
Author(s):  
Victoria Simmons, MD ◽  
Sejul Chaudhary, MD ◽  
Karen Hagglund, MS ◽  
R. David Hayward, PhD ◽  
Elango Edhayan, MD
Keyword(s):  
Educational Intervention ◽  
Opioid Use ◽  
State Regulations ◽  
Surgical Residents ◽  
Period 2 ◽  
Prescribing Trends ◽  
Before And After ◽  
History Of ◽  
Post Hoc ◽  
Regulation Changes

Objective: We examined changes in opioid prescriptions after outpatient laparoscopic cholecystectomy (LC) before and after (1) an educational intervention for surgical residents and (2) subsequent changes in state regulations for handling these prescriptions.Design: A single-institution retrospective review evaluated opioids prescribed on discharge in morphine milligram equivalents (MMEs) over three periods: Period 1, prior to educational intervention (October 1, 2017 to January 31, 2018); Period 2, after intervention and before regulation changes occurred (February 1, 2018 to May 31, 2018); and Period 3, after changes in regulations went into effect (June 1, 2018 to September 30, 2018).Setting: A large urban teaching hospital in Detroit, Michigan. Patients: All adults receiving outpatient LC during one of the study periods. Patients with a history of regular opioid use prior to surgery were excluded. There were 49 patients in Period 1, 57 in Period 2, and 51 in Period 3.Interventions: All general surgery residents participated in an education session focusing on problems related to opioid addiction, prescribing trends, and multimodal pain control options in February 2018.Main outcome measure: Mean MME per patient was compared between time periods.Results: Average MME was reduced from 87.11 in Period 1 to 65.96 in Period 2 to 51.80 in Period 3. Analysis of variance showed MME differed significantly among the periods. Scheffe post hoc t-tests showed MME prescribed during Periods 2 and 3 were each significantly lower than Period 1, whereas Periods 2 and 3 did not differ significantly.Conclusions: MME prescribed after outpatient LC significantly decreased after the educational intervention and remained low after state mandate went into effect.

scholarly journals Konstitusi dan Arah Kebijakan Pembangunan Hukum; Sebelum dan Sesudah Amendemen

2020 ◽  
Vol 1 (2) ◽  
pp. 70-77
Author(s):  
Syafruddin Muhtamar ◽  
Iswandi Rani Saputra
Keyword(s):  
Planning Process ◽  
Comparative Method ◽  
Logical Consequence ◽  
National Development ◽  
Development Planning ◽  
State System ◽  
Strategy Formulation ◽  
Period 2 ◽  
Before And After ◽  
History Of

This study aims to find out (1) the relevance of the mandate of the 1945 Constitution of the policy and legal development in GBHN RPJPN, (2) to the normative strategies of national development planning process in the period of the state system before and after amendment to the Constitution of 1945.  This study used a qualitative approach with a descriptive-comparative method. The results showed that (1) the formulation of policy towards development of the law, both the artifacts in the Guidelines of State Policy and RPJPN models, can be said to be substantially relevant to mandate of the Constitution, which applies in the context of each period; (2) there are fundamental differences in strategy formulation nomatif RPJPN GBHN with the preparation. This fundamental difference is the logical consequence of the amendments made to the Constitution of 1945 in the history of the Indonesian nation state system.

Factors Associated With The Prophylactic Effect of Placebo Injections in Subjects Enrolled in a Study of Botulinum Toxin For Migraine

Cephalalgia ◽  
2007 ◽  
Vol 27 (6) ◽  
pp. 528-534 ◽  
Author(s):  
TJ Schwedt ◽  
JG Hentz ◽  
DW Dodick
Keyword(s):  
Botulinum Toxin ◽  
Prospective Trial ◽  
Placebo Response ◽  
Episodic Migraine ◽  
Male Gender ◽  
Prophylactic Effect ◽  
Opioid Use ◽  
History Of ◽  
Post Hoc ◽  
Single Blind

We set out to identify predictors for the prophylactic effect of placebo injections in subjects with migraine by post hoc analysis of 81 subjects with episodic migraine receiving single-blind placebo injections in a prospective trial of botulinum toxin. Possible predictors of placebo prophylaxis were compared among placebo responders (PRs) and placebo non-responders (PNRs). There were 34 PRs (42%) and 47 PNRs (58%). Male gender [odds ratio (OR) 5.83, 95% confidence interval (CI) 1.12, 30.14, P = 0.022], a history of opioid use (OR 4.44, 95% CI 1.47, 13.41, P = 0.005) and injections in the neck/shoulders (OR 2.44, 95% CI 0.93, 3.19, P = 0.033) were associated with placebo response. Of subjects with two or more of these signs, 88% were PRs compared with 31% of subjects with one or less. Male gender, opioid use and injections in the neck/shoulders are associated with placebo prophylaxis. These findings may have important implications for the design of future clinical trials and for the clinical management of migraineurs.

An Integrated Hospital Protocol for Persons With Injection-Related Infections May Increase Medications for Opioid Use Disorder Use but Challenges Remain

2020 ◽  
Vol 222 (Supplement_5) ◽  
pp. S499-S505
Author(s):  
Ellen F Eaton ◽  
Rachael A Lee ◽  
Andrew O Westfall ◽  
R E Mathews ◽  
Brandi McCleskey ◽  
...  
Keyword(s):  
Sociodemographic Factors ◽  
Infectious Complications ◽  
Opioid Use Disorder ◽  
University Of Alabama ◽  
Opioid Use ◽  
Addiction Medicine ◽  
Before And After ◽  
History Of ◽  
Infectious Diseases Consultation ◽  
The University

Abstract Background Hospital-based strategies that link persons with infectious complications of opioid use disorder (OUD) to medications for OUD (MOUD) are of great interest. The objective of this study is to determine whether a hospital-based protocol would increase the use of MOUD and to identify barriers to MOUD during admission and at the time of discharge. Methods This study included participants with a documented or suspected history of injection drug usage receiving care for an infection at the University of Alabama at Birmingham Hospital from 2015 to 2018. The protocol, the intravenous antibiotic and addiction team (IVAT), included Addiction Medicine and Infectious Diseases consultation and a 9-item risk assessment. We quantified MOUD use before and after IVAT and used logistic regression to determine factors associated with MOUD. We explored barriers to MOUD uptake using chart review. Results A total of 37 and 98 patients met criteria in the pre- and post-IVAT periods, respectively. With IVAT, the percentage with OUD receiving MOUD significantly increased (29% pre-IVAT and 37% post-IVAT; P = .026) and MOUD use was higher in “high risk” participants (62%). Clinical and sociodemographic factors were not associated with MOUD receipt. Conclusions A hospital-based protocol may increase the use of MOUD; however, the uptake of MOUD remains suboptimal (<50%).

scholarly journals Reduction in Narcotic Use After Lumbar Decompression and Fusion in Patients With Symptomatic Lumbar Stenosis or Spondylolisthesis

2018 ◽  
Vol 9 (6) ◽  
pp. 598-606 ◽  
Author(s):  
Owoicho Adogwa ◽  
Mark A. Davison ◽  
Victoria D. Vuong ◽  
Syed Khalid ◽  
Daniel T. Lilly ◽  
...  
Keyword(s):  
Multivariate Logistic Regression Analysis ◽  
Length Of Hospital Stay ◽  
Opioid Therapy ◽  
Lumbar Stenosis ◽  
Opioid Use ◽  
Lumbar Decompression ◽  
Period 2 ◽  
Before And After ◽  
Opioid Medications

Study Design: Retrospective cohort study. Objectives: The purpose of this study is to assess change in opioid use before and after lumbar decompression and fusion surgery for patients with symptomatic lumbar stenosis or spondylolisthesis. Methods: A large insurance database was queried for patients with symptomatic lumbar stenosis or spondylolisthesis undergoing index lumbar decompression and fusion procedures between 2007 and 2016. This database consists of 20.9 million covered lives and includes private/commercially insured and Medicare Advantage beneficiaries. Opioid use 6 months preoperatively through 2 years postoperatively was assessed. Results: The study included 13 257 patients that underwent 1-, 2-, or 3-level posterior lumbar instrumented fusion. Overall, 57.8% of patients used opioids preoperatively. Throughout the 6-month preoperative period, 2 368 008 opioid pills were billed for (51.6 opioid pills/opioid user/month). When compared with preoperative opioid use, patients billed fewer opioid medications in the 2-year period postoperatively: 33.6 pills/patient/month (8 851 616 total pills). In a multivariate logistic regression analysis, obesity (odds ratio [OR] 1.10, 95% CI 1.004-1.212), preoperative narcotic use (OR 3.43, 95% CI 3.179-3.708), length of hospital stay (OR 1.02, 95% CI 1.010-1.021), and receiving treatment in the South (OR 1.18, 95% CI 1.074-1.287) or West (OR 1.26, 95% CI 1.095-1.452) were independently associated with prolonged postoperative (>1 year) opioid use. Additionally, males (OR 0.87, 95% CI 0.808-0.945) were less likely to use long-term opioid therapy. Conclusions: This study demonstrates that reduction in opioid use was observed postoperatively in comparison with preoperative values in patients with symptomatic lumbar stenosis or spondylolisthesis that underwent lumbar decompression with fusion. Further prospective studies that are more methodologically stringent are needed to corroborate our findings.

Print Media and the Political Reform in Ethiopia

2019 ◽  
Vol 14 ◽  
pp. 3356-3371
Author(s):  
Negesse Gessese
Keyword(s):  
Social Changes ◽  
Analysis Method ◽  
Sources Of Information ◽  
Attribution Of Responsibility ◽  
Societal Issues ◽  
Content Selection ◽  
Period 2 ◽  
Content Analysis Method ◽  
Before And After ◽  
Issue Frames

This research examines the agenda and frames used by the Reporter newspaper editorial coverage of issues and actors before and after the reform in Ethiopia. The study applies a quantitative content analysis method and examined 99 (Period 1 = 57 and Period 2 = 42) editorials in all periods. The source of data and the period of data collection were purposely selected. The results indicated that societal issues, government, and party issues were frequent in both periods. The professional journalist was the only Author in both periods. More government criticism and more reforms were mentioned before the reform. Compared with editorials published before and after the reform, noticeable changes were observed in government critique, attribution of responsibility frames, human interest frames and economic issue frames. However, content selection, sources of information, mentioned reforms, conflict relationship frames, and ideological frames didn’t have relationship with the date of publication. Finally, the Reporter editorials coverage did change significantly in many respects, although it is difficult to determine the causes of the changes—economic factors, reduced political control, social changes or globalization forces.

Study of Diabetic Mellitus and Knowledge of Lotion Foot Care on the Community

2018 ◽  
Vol 9 (3) ◽  
Author(s):  
Hariyadi DM ◽  
Athiyah U ◽  
Hendradi E ◽  
Rosita N ◽  
Erawati T ◽  
...  
Keyword(s):  
Blood Glucose ◽  
T Test ◽  
Small Scale ◽  
Scale Production ◽  
Foot Care ◽  
Diabetic Mellitus ◽  
Glucose Levels ◽  
Blood Glucose Levels ◽  
Before And After ◽  
History Of

The prevention of Diabetic Mellitus (DM) and its complications is the main aim of this study, in addition to the training of lotion foot care application and the development of small scale industry. The research team delivered knowledge in the form of training on Diabetic Mellitus, healthy food, treatment and prevention of complications, and small-scale production of cosmetic products. The aim of this study was to determine the correlation between training on diabetic and lotion foot care application as preventive measures against diabetic complications on the patient's blood glucose levels in the community of residents in Banyuurip Jaya, Surabaya. It was expected from this training that the knowledge of the residents increases and people living with diabetic undergo lifestyle changes and therefore blood sugar levels can be controlled. The parameters measured in this research were blood glucose levels, the anti diabetic drug types consumed, and compliance on diabetics. This study used the data taken from 60 patients with DM over a period of one month. Questionnaires and log books was used to retrieve data and changes in blood glucose levels in diabetic patients. The results showed the demographic data of patients with type 2 diabetic of 85% female and 15% male, with the range of patients aged of 61-70 years of 46.67% and had history of diabetic (90%). The history of drugs consumed by respondents was anti diabetic drugs such as metformin (40%), glimepiride (33.37%) and insulin (6.67%). In addition, the increased knowledge of DM patients after being given the training compared to before training was shown in several questions in the questionnaire. A statistical analysis using t-test analyzed a correlation between training provided in order to enhance understanding of the patient, as well as correlation with blood glucose levels. A paired T-test showed that there was a relationship between the knowledge of trainees before and after training (p less than 0.05). An interesting result was that there was no relationship between blood glucose levels before and after training provided (p> 0.05).

The Challenges in Dealing with Organized Crime and its Consequences in Modern Societies in Albania, Kosovo and Macedonia – the Balkan Peninsula

2015 ◽  
Vol 5 (1) ◽  
pp. 161
Author(s):  
Bashkim Selmani ◽  
Bekim Maksuti
Keyword(s):  
Organized Crime ◽  
Balkan Peninsula ◽  
Human Mind ◽  
Negative Consequences ◽  
The Public ◽  
Before And After ◽  
History Of ◽  
European Standards ◽  
Organized Crime Groups ◽  
Further Development

The profound changes within the Albanian society, including Albania, Kosovo and Macedonia, before and after they proclaimed independence (in exception of Albania), with the establishment of the parliamentary system resulted in mass spread social negative consequences such as crime, drugs, prostitution, child beggars on the street etc. As a result of these occurred circumstances emerged a substantial need for changes within the legal system in order to meet and achieve the European standards or behaviors and the need for adoption of many laws imported from abroad, but without actually reading the factual situation of the psycho-economic position of the citizens and the consequences of the peoples’ occupations without proper compensation, as a remedy for the victims of war or peace in these countries. The sad truth is that the perpetrators not only weren’t sanctioned, but these regions remained an untouched haven for further development of criminal activities, be it from the public state officials through property privatization or in the private field. The organized crime groups, almost in all cases, are perceived by the human mind as “Mafia” and it is a fact that this cannot be denied easily. The widely spread term “Mafia” is mostly known around the world to define criminal organizations.The Balkan Peninsula is highly involved in these illegal groups of organized crime whose practice of criminal activities is largely extended through the Balkan countries such as Kosovo, Albania, Macedonia, Serbia, Bosnia, Croatia, Montenegro, etc. Many factors contributed to these strategic countries to be part of these types of activities. In general, some of the countries have been affected more specifically, but in all of the abovementioned countries organized crime has affected all areas of life, leaving a black mark in the history of these states.

scholarly journals The Effects of Toothbrush Wear on the Surface Roughness and Gloss of Resin Composites with Various Types of Matrices

2021 ◽  
Vol 9 (1) ◽  
pp. 8
Author(s):  
Murtadha AlAli ◽  
Nikolaos Silikas ◽  
Julian Satterthwaite
Keyword(s):  
Surface Roughness ◽  
Pairwise Comparisons ◽  
Resin Composites ◽  
Hybrid Resin ◽  
Before And After ◽  
Post Hoc ◽  
Main Effects ◽  
Toothbrush Wear

Objective: To evaluate and compare the surface roughness and gloss of a DMA-free composite and Bis-GMA-free composite with a DMA-based composite before and after toothbrushing simulation. Materials and Methods: Fifteen dimensionally standardised composite specimens of three nano-hybrid resin composites (Tetric EvoCeram, Admira Fusion, and Venus Diamond) were used. Five specimens from each composite were polished and then subjected to a toothbrushing simulator. Surface roughness (Ra) and gloss were measured before toothbrushing and after 5000, 10,000, 15,000, and 20,000 toothbrushing cycles. The data was analysed using 5 × 3 ANOVA to assess surface roughness and gloss values and pairwise comparisons in the form of Tukey post hoc tests were performed to interpret main effects. Results: For all tested materials, surface roughness increased, and gloss decreased after toothbrushing abrasion. Surface roughness (Ra) values ranged from 0.14 to 0.22 μm at baseline and increased to between 0.41 and 0.49 μm after 20,000 toothbrushing cycles. Gloss values ranged between 31.9 and 50.6 GU at baseline and between 5.1 and 19.5 GU after 20,000 toothbrushing cycles. The lowest initial Ra value was detected in Venus Diamond and the highest initial gloss value was detected in Tetric EvoCeram. Conclusions: Simulated toothbrushing abrasion led to an increase in surface roughness and a decrease in gloss for all tested materials. Venus Diamond had the smoothest surface and Tetric EvoCeram had the glossiest surface after polishing and following 20,000 cycles of toothbrushing abrasion. Admira Fusion demonstrated the roughest surface and had the lowest gloss values before and after toothbrushing abrasion.

scholarly journals Educational intervention for liver transplantation candidates

2013 ◽  
Vol 21 (1) ◽  
pp. 419-425 ◽  
Author(s):  
Karina Dal Sasso Mendes ◽  
Orlando de Castro e Silva Junior ◽  
Luciana da Costa Ziviani ◽  
Fabiana Murad Rossin ◽  
Márcia Maria Fontão Zago ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Patient Education ◽  
Research Design ◽  
Educational Intervention ◽  
Research Data ◽  
Intervention Method ◽  
Final Sample ◽  
Education Strategy ◽  
Before And After ◽  
Quasi Experimental

OBJECTIVE: The objective in this study was to analyze candidates' knowledge on the liver transplantation process before and after putting in practice an educational intervention. METHOD: A quasi-experimental, one-group pretest-posttest research design was adopted. The final sample included 15 subjects. Research data were collected between January and March 2010 in three phases, which were: pretest, implementation of the educational intervention (two meetings) and posttest. RESULTS: The results evidenced significant cognitive gains after the intervention, with improvements in the participants' performance . CONCLUSIONS: The research presents evidence that putting in practice a patient education strategy can enhance candidates' knowledge on the liver transplantation process and consequently contribute to a successful treatment.

Evaluation of Changes in Depression Levels of Bruxism Patients Treated With Botulinum Toxin-A

2021 ◽  
pp. 232020682110065
Author(s):  
Deniz Erdil ◽  
Nilsun Bagis ◽  
Hakan Eren ◽  
Melike Camgoz ◽  
Kaan Orhan
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Age Groups ◽  
Treatment Method ◽  
Definitive Treatment ◽  
Toxin A ◽  
Physiological Factors ◽  
Before And After ◽  
The Mean ◽  
Post Hoc

Aim: Bruxism is defined as the involuntary recurrent masticatory muscle activity characterized by gnashing, grinding, clenching of teeth, and/or pushing the mandible. Factors creating its etiology are peripheral (morphological) or central (physiopathological and physiological), and exogenous. Recently, among physiological factors, depression and bruxism were considered to be related. A definitive treatment method does not exist for bruxism; however, botulinum toxin-A (BT-A) application is an up-to-date and effective way of treatment. The present study is aimed to evaluate the levels of depression in bruxism patients treated with BT-A application. Materials and Methods: A total of 25 individuals (23 females and 2 males) who were diagnosed as bruxism patients were included in the study. 25 U of BT-A for each masseter muscle was injected into the patients. Patients were prospectively observed for a possible change in depression levels by using Beck’s Depression Inventory. The inventory was implemented before and six months after the BT-A application. Depression levels before and six months after the injection were compared. A paired t-test was used to compare “before” and “after” treatment values. One-way analysis of variance and post-hoc Tukey tests were used to evaluate the change in Beck’s Depression Inventory scores according to age groups. Results: The mean total score was 7.80 ± 8.10 before the treatment and 7.16 ± 6.52 six months after the treatment. The decrease in the mean score was not statistically significant ( P > .05). Conclusion: In conclusion, despite the decrease in the mean Beck’s Depression Inventory scores, a statistically significant decrease in the depression levels of patients was not observed.

Sign in / Sign up

Export Citation Format

Share Document