More than half of opioids prescribed to pediatric patients after ambulatory knee surgery are unused

2021 ◽  
Vol 17 (4) ◽  
pp. 311-320
Author(s):  
Pamela Wendel, MD ◽  
Danya DeMeo, BS ◽  
Madison R. Heath, BS ◽  
Alexandra T. Mackie, BA, PB-BS ◽  
Haoyan Zhong, MPA ◽  
...  

Objective: To determine the number of opioid pills remaining after pediatric ambulatory knee surgery to provide insight into how many pills are actually used. Design: Prospective observational cohort study. Participants who were expected to be prescribed 20 (Group 1) versus 40 (Group 2) opioid pills according to the institutional policy (based on the type of surgery) were studied. Patient’s reported pain, medication use, and number of opioid pills remaining at postoperative days (PODs) 7 and 14. Participants were not randomly assigned to groups and no intervention was applied.Setting: An urban tertiary care musculoskeletal institution.Participants: Sixty adolescents between the ages of 12 and 19 undergoing ambulatory knee surgery.Interventions: Observational study, no experimental study intervention.Main outcome measure: The total number of opioid pills remaining.Results: By POD7, more than 70 percent of patients had stopped taking their prescribed opioid medication mainly because their knee pain was tolerable either without the opioid or by using other medications. By POD14, the mean number of pills taken was 6.3 ± 5.3 for Group 1 and 18.4 ± 13.9 for Group 2. The mean number of unused opioids was 13.5 ± 7.2 for Group 1 and 17.9 ± 13.7 for Group 2. Conclusions: Even with prescribing practice guidelines in place, opioids may be overprescribed and could be given in a smaller quantity without affecting the quality of acute postoperative pain control in adolescents undergoing ambulatory knee surgery. However, one needs to consider that some patients may need a larger than average amount in order to be appropriately treated for their level of pain and thus prescription amounts—preferably after reevaluation—should be individualized.

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
J Proff ◽  
B Merkely ◽  
R Papp ◽  
C Lenz ◽  
P.J Nordbeck ◽  
...  

Abstract Background The prevalence of chronotropic incompetence (CI) in heart failure (HF) population is high and negatively impacts prognosis. In HF patients with an implanted cardiac resynchronisation therapy (CRT) device and severe CI, the effect of rate adaptive pacing on patient outcomes is unclear. Closed loop stimulation (CLS) based on cardiac impedance measurement may be an optimal method of heart rate adaptation according to metabolic need in HF patients with severe CI. Purpose This is the first study evaluating the effect of CLS on the established prognostic parameters assessed by the cardio-pulmonary exercise (CPX) testing and on quality of life (QoL) of the patients. Methods A randomised, controlled, double-blind and crossover pilot study has been performed in CRT patients with severe CI defined as the inability to achieve 70% of the age-predicted maximum heart rate (APMHR). After baseline assessment, patients were randomised to either DDD-CLS pacing (group 1) or DDD pacing at 40 bpm (group 2) for a 1-month period, followed by crossover for another month. At baseline and at 1- and 2-month follow-ups, a CPX was performed and QoL was assessed using the EQ-5D-5L questionnaire. The main endpoints were the effect of CLS on ventilatory efficiency (VE) slope (evaluated by an independent CPX expert), the responder rate defined as an improvement (decrease) of the VE slope by at least 5%, percentage of maximal predicted heart rate reserve (HRR) achieved, and QoL. Results Of the 36 patients enrolled in the study, 20 fulfilled the criterion for severe CI and entered the study follow-up (mean age 68.9±7.4 years, 70% men, LVEF=41.8±9.3%, 40%/60% NYHA class II/III). Full baseline and follow-up datasets were obtained in 17 patients. The mean VE slope and HRR at baseline were 34.4±4.4 and 49.6±23.8%, respectively, in group 1 (n=7) and 34.5±12.2 and 54.2±16.1% in group 2 (n=10). After completing the 2-month CPX, the mean difference between DDD-CLS and DDD-40 modes was −2.4±8.3 (group 1) and −1.2±3.5 (group 2) for VE slope, and 17.1±15.5% (group 1) and 8.7±18.8% (group 2) for HRR. Altogether, VE slope improved by −1.8±2.95 (p=0.31) in DDD-CLS versus DDD-40, and HRR improved by 12.9±8.8% (p=0.01). The VE slope decreased by ≥5% in 47% of patients (“responders to CLS”). The mean difference in the QoL between DDD-CLS and DDD-40 was 0.16±0.25 in group 1 and −0.01±0.05 in group 2, resulting in an overall increase by 0.08±0.08 in the DDD-CLS mode (p=0.13). Conclusion First results of the evaluation of the effectiveness of CLS in CRT patients with severe CI revealed that CLS generated an overall positive effect on well-established surrogate parameters for prognosis. About one half of the patients showed CLS response in terms of improved VE slope. In addition, CLS improved quality of life. Further clinical research is needed to identify predictors that can increase the responder rate and to confirm improvement in clinical outcomes. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Biotronik SE & Co. KG


2019 ◽  
Vol 13 (1) ◽  
pp. 8-14 ◽  
Author(s):  
Khalid Al Zubi ◽  
Yaser Albakar ◽  
Rana Nasser

Background: The progression of keratoconus is stabilized with the help of corneal collagen cross-linking (CXL) supported through photosynthesized riboflavin. Objective: This study aims to compare the effectiveness of the transepithelial procedure and epithelium off procedure of corneal collagen crosslinking among keratoconus patients in Jordan. Methods: The study recruited 80 patients suffering from progressive keratoconus, from a tertiary care setting in Jordan. These participants were randomly divided into two groups; group 1 with 40 participants subjected to transepithelial (Corneal collagen cross-linking) CXL; and 40 participants in group 2 received conventional epithelium off CXL. Results: Improvement was observed in the mean contact lens, which corrected distance visual acuity (CDVA) from logMAR 0.332 ± 0.09 (group 1), 0.35 ± 0.09 (group 2) to 0.241 ± 0.07 (group 1), 0.21 ± 0.07 (group 2), respectively at the end of follow-up (12 months). The mean pachymetry improved from 429.81 ± 18.96 μm (group 1), 430.08 ± 17.05 μm (group 2) to 436.5 ± 15.49 μm (group 1), 436.44 ± 12.53 μm (group 2), respectively, after twelve months. Additionally, the mean Sim K astigmatism declined from 7.0 ± 2.0 (group 1), 6.73 ± 1.98 (group 2) to 5.97 ± 1.88 (group 1), 5.53 ± 0.08 (group 2) respectively at twelve months post-treatment. Majority of the patients in group 2 experienced more pain as compared to group 1 participants. Conclusion: The effectiveness of a cross-linking procedure related to keratometry readings and corneal thickness showed that conventional (epithelium off) CXL method is more effective than transepithelial CXL.


2020 ◽  
Author(s):  
Tien-Yu Yang ◽  
Po-Yao Chuang ◽  
Tsan-Wen Huang ◽  
Kuo-Chin Huang

Abstract Background: The Kocher-Langenbeck (K-L) approach is the standard method for the treatment of posterior wall or column acetabular fractures. This approach allows direct access to the posterior structures of the acetabulum, but is limited cranially and caudally by the neurovascular bundle. The present study was conducted to assess the quality of reduction and the incidence of complications in patients who underwent the modified “one-incision two-window” K-L approach.Methods : This is a Retrospective case series with recruited thirteen consecutive patients from 2015 to 2017 who sustained an acute, displaced posterior wall or column acetabular fracture. All patients were treated with modified “one-incision two-window” K-L approach.Results: The mean operation time, mean intraoperative blood loss, and mean incision wound length were estimated to be 103.8 min (60-120 min), 373.1 mL (100-700 mL), and 9.7 cm (8.0-13.0 cm), respectively. The radiographic quality of reduction was graded as anatomical reduction (maximum residual displacement [MRD] ≤ 2 mm) in all cases, according to Matta’s criteria. Concerning the incidence of complications, there were no iatrogenic neurovascular injury, no surgical site infections, and no osteonecrosis of the femoral head or heterotopic ossification in this cohort. One patient with transverse posterior wall fracture (group 1) experienced deep vein thrombosis in the lesion leg. Another two patients with solitary posterior wall fracture (group 2) developed posttraumatic osteoarthritis, with one diagnosed as Tonnis grade I lesion and the other as Tonnis grade III lesion. With respect to the clinical treatment outcome, the mean visual analogue scale (VAS), mean modified Harris Hip Score (mHHS) and subjective satisfaction rate were 1.7 (1.0-2.0), 90.6 (81-100), and 84.6% (80%-90%), respectively. Although there was no significant difference in the satisfaction rate (82.9% vs. 87.0%, P = 0.941) at 12 months after surgery, group 1 patients had more increased VAS score (2.0 vs. 1.2, P = 0.016) and more decreased mHHS (87.7 vs. 94.6, P = 0.014) than group 2 patients. Conclusions: Our pilot study confirmed that the “one-incision two-window” K-L approach is a simple, safe, reliable, and effective way to manage acute, displaced posterior wall or column acetabular fractures.Level of evidence: Therapeutic study, level IV.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S I Sinam ◽  
R S Gangwar ◽  
B Banavalikar ◽  
D Padmanabhan ◽  
V Gangwar ◽  
...  

Abstract Background Reflex syncope (RS), the most common cause of syncope is usually recurrent, associated with decreased quality of life, and frustrates both the clinicians and the patients with a paucity of effective treatment options. Purpose To assess the effectiveness of yoga therapy on the recurrence of reflex syncope. Methods Subjects with recurrent RS (>3 episodes) and positive head-up tilt test were enrolled prospectively, and randomized to conventional therapy with physical maneuvres (Group 1) and yoga therapy (Group 2). Group 1 patients were taught physical counter-pressure maneuvers as per guidelines. Group 2 patients were taught yoga for 7 sessions by a certified Yoga instructor/therapist, and then advised to perform yoga for 60 minutes at least five days/week for six months. The Yoga module consisted of Pranayama (breathing techniques), Asanas (Postures) and Dhyana (Meditation) for 60 minutes/session. Both groups were followed up monthly for 6 months in the syncope clinic noting down the recurrences and the quality of life using the syncope functional status questionnaire score. Result The study group consisted of 97 patients (group 1: 46 patients and group 2: 51 patients) enrolled prospectively between June 2015 to February 2017. The mean age was 33.1±16.6 years, with male: female ratio 1.1:1, and a mean of 6.4±6.06 syncope episodes (group 1: 6.8±8.0 vs. group 2: 6.0±4.0; p=0.551). The mean duration of symptoms was 17.1±20.71 months (group 1: 16.1±22.8 months vs. group 2: 17.8±19.1 months; p=0.694). There was a significant decrease in the recurrences of syncope in the yoga group compared to the conventional group at three months (group 1: 1.8±1.4 vs group 2: 0.8±0.9, P<0.001) as well as six months follow-up (group 1: 3.38±3.0 vs group 2: 0.98±1.23, P<0.001). The quality of life score at 6 months improved in 20 patients in group 1 and in 45 patients in group 2 (<0.001). Conclusion Guided yoga therapy is superior to conventional measures in reducing the number of syncopal episodes and improves the quality of life in patients with reflex syncope. Yoga therapy should be considered as treatment strategy for patients with reflex syncope.


2021 ◽  
Vol 11 (3) ◽  
pp. 219-225
Author(s):  
Pavel S. Kyzlasov ◽  
Eugeniy V. Volokitin ◽  
Ali T. Mustafayev ◽  
Evgeny V. Pomeshkin

AIM:To assess the degree of changes in complaints, dynamics of biochemical parameters of lipid metabolism, penile hemodynamics in patients with ED during therapy with EDELIM in comparison with PDE-5 inhibitors. Assess the tolerability of the drug based on the analysis of reported adverse events. MATERIALS AND METHODS:The study was prospective comparative observational cohort. The study included 60 patients over 18 years old with complaints of persistent, at least 1 month, erectile dysfunction. The patients were divided into 2 groups: group 1 patients with ED received Edelim on a regular basis, one capsule 2 times daily for 3 months; group 2 patients with ED received generic tadalafil 5 mg daily for 1 month, then 1 month break, then 5 mg per day for 1 month. RESULTS:The mean age of the patients was 38.4 9.2 years. In group 1, significant differences were noted in the all hemodynamic and biochemical indicators, except for HDL levels (2.2 0.4 vs. 2.3 0.4 mmol/L;p= 0.067). In group 2, significant differences were noted in the dynamics of the IIEF-5 scale, the level of HDL, and the blood flow velocity in the right and left cavernous arteries. There were no significant differences in blood flow in the left and right dorsal arteries, levels of total cholesterol, LDL, triglycerides, glucose, HbA1c, systolic blood pressure. In the 1st group of patients, there were no adverse events, in the 2nd group, in 3 patients mild side effects. CONCLUSIONS:The improvement in the quality of erection in the group of patients taking Edelim is associated with decrease in the lipid profile, glucose, glycated hemoglobin, which can be regarded as a variant of pathogenetic conservative treatment of ED.


2020 ◽  
Vol 9 (3) ◽  
pp. 187-194
Author(s):  
Natalia Garcia Santaella ◽  
◽  
Maiara Gabriela Gonçales ◽  
Lázara Joyce Oliveira Martins ◽  
Bárbara Margarido Brondino ◽  
...  

Objective: To evaluate the perception and acceptance of using polyhexanide (PHMB) and chlorhexidine digluconate (CLX) in individuals at a risk of developing oral mucositis induced by chemoradiotherapy. Materials and Methods: This is a randomised comparative study. Participants were randomised into two groups: Group 1 (PHMB 0.2%) and Group 2 (CLX 0.12%), these groups performed a mouth rinse with the respective solutions for 1 minute every 12 hours during an antineoplastic treatment cycle. The participants were evaluated at three different times: before (t0), during (t1) and after a cycle of antineoplastic treatment (t2). Severity of oral mucositis (OM), mouth pain, quality of life (OHIP-14), oral hygiene index and assessment of the acceptance of the substances in the mouth were assessed. Results: There were 23 individuals, 12 in Group 1 (G1) and 11 in Group 2 (G2). Both groups presented with OM in all three evaluations. Reported mouth pain was lower in G1 than in G2. The PHMB had a better acceptance (p=0.012) than the CLX for the time of mouth rinse at t0. There was a lower impact in the quality of life from oral health in the physical pain aspect (p=0.019) and in social incapacity (p=0.037) in G1 than in G2. Conclusions: PHMB has the same acceptance compared to CLX and is a good option for antiseptic mouth rinse with less adverse effects


2020 ◽  
Author(s):  
Tien-Yu Yang ◽  
Kuo-Chin Huang

Abstract Abstract The Kocher-Langenbeck (K-L) approach is the standard method for the treatment of posterior wall or column acetabular fractures. This approach allows direct access to the posterior structures of the acetabulum, but is limited cranially and caudally by the neurovascular bundle. The present study was conducted to assess the quality of reduction and the incidence of complications in patients who underwent the modified “one-incision two-window” K-L approach. Methods : This is a Retrospective case series with recruited thirteen consecutive patients from 2015 to 2017 who sustained an acute, displaced posterior wall or column acetabular fracture. All patients were treated with modified “one-incision two-window” K-L approach. Results: The mean operation time, mean intraoperative blood loss, and mean incision wound length were estimated to be 103.8 min (60-120 min), 373.1 mL (100-700 mL), and 9.7 cm (8.0-13.0 cm), respectively. The radiographic quality of reduction was graded as anatomical reduction (maximum residual displacement [MRD] ≤ 2 mm) in all cases, according to Matta’s criteria. Concerning the incidence of complications, there were no iatrogenic neurovascular injury, no surgical site infections, and no osteonecrosis of the femoral head or heterotopic ossification in this cohort. One patient with transverse posterior wall fracture (group 1) experienced deep vein thrombosis in the lesion leg. Another two patients with solitary posterior wall fracture (group 2) developed posttraumatic osteoarthritis, with one diagnosed as Tonnis grade I lesion and the other as Tonnis grade III lesion. With respect to the clinical treatment outcome, the mean visual analogue scale (VAS), mean modified Harris Hip Score (mHHS) and subjective satisfaction rate were 1.7 (1.0-2.0), 90.6 (81-100), and 84.6% (80%-90%), respectively. Although there was no significant difference in the satisfaction rate (82.9% vs. 87.0%, P = 0.941) at 12 months after surgery, group 1 patients had more increased VAS score (2.0 vs. 1.2, P = 0.016) and more decreased mHHS (87.7 vs. 94.6, P = 0.014) than group 2 patients. Conclusions: Our pilot study confirmed that the “one-incision two-window” K-L approach is a simple, safe, reliable, and effective way to manage acute, displaced posterior wall or column acetabular fractures.


2021 ◽  
pp. 026835552110307
Author(s):  
Ufuk Aydın ◽  
Mesut Engin ◽  
Tamer Türk ◽  
Yusuf Ata

Background There are opinions that telangiectasis and reticular veins are asymptomatic and constitute a cosmetic problem only. However, it has been proven that telangiectasis and reticular veins also affect the quality of life and are symptomatic. Methods Ninety consecutive female patients who were admitted to our outpatient clinic and did not have insufficiency in deep, superficial and perforating veins were included in this study. All participants were divided into three groups as the compression group (Group 1), medical treatment group (Group 2), and sclerotherapy group (Group 3). The initial complaint severities of all patients were noted. Except for patient compliance assessment, baseline, 1st month (T1), 3rd month (T2) and 6th month (T3) evaluation records were kept in all three groups. Results The study began with a total of 90 patients, 30 patients in each group. The mean ages of Groups 1, 2 and 3 were 39.73 ± 8.51 years, 39.30 ± 8.67 years, and 40.77 ± 9.45 years, respectively. The rates of decrease in pain, itching, restless leg, and muscle cramps were similar among the patient groups at all times (P > 0.05). The rate of reduction in swelling was similar between the groups at T1 and T2 (P > 0.05), while there was a significant difference between the groups at T3 (P = 0.009). The groups significantly differed in terms of appearance concern at all times (P = 0.002 for T1, P < 0.001 for T2 and T3). Conclusion We showed that symptoms such as swelling and heaviness in leg can be improved with medical treatment, but the patient's cosmetic satisfaction can increase with sclerotherapy.


Author(s):  
Pratibha Surathi ◽  
Nitish Kamble ◽  
Ketaki Swapnil Bhalsing ◽  
Ravi Yadav ◽  
Pramod Kumar Pal

AbstractBackground: Several factors determine the choice of medications in patients with Parkinson’s disease (PD). We aimed to analyze the pattern of prescription of drugs in patients with PD before attending a tertiary-care center. Methods: The study included chart review of 800 PD patients attending the Department of Neurology of the National Institute of Mental Health and Neurosciences in Bangalore, India. Results: The mean age at onset was 51.1±11.8 years. The mean duration of illness was 41.7±43.6 months. At first visit, 79.4% (group 1, n=635) of patients were on medications, 10% (group 2, n=80) were on medications but later discontinued, and 10.6% (group 3, n=85) were drug-naïve. Overall, levodopa was prescribed in 94.8%, trihexyphenidyl in 40.4%, dopamine agonists in 23.2%, and amantadine in 17.2% either as monotherapy or in combination. In group 1, 37.8% were on monotherapy, with levodopa being the most commonly used agent (33.1%), followed by trihexyphenidyl (2.2%), dopamine agonists (1.6%), and amantadine (0.6%). Among those on polytherapy, levodopa plus trihexyphenidyl was the preferred combination (23.9%). In group 2, levodopa monotherapy was also most common (72.5%), followed by trihexyphenidyl monotherapy (7.5%). Conclusions: Levodopa and trihexyphenidyl were the most commonly prescribed drugs in our patients. A higher use of trihexyphenidyl could be due to its easy availability, low cost, and better tolerability in our patients, who were relatively young at the time of onset of their disease. The choice of antiparkinsonian medications at the primary and secondary care levels in India may be inappropriate, and newer guidelines tailored to the Indian context are warranted.


2020 ◽  
Author(s):  
Tien-Yu Yang ◽  
Kuo-Chin Huang

Abstract Abstract The Kocher-Langenbeck (K-L) approach is the standard method for the treatment of posterior wall or column acetabular fractures. This approach allows direct access to the posterior structures of the acetabulum, but is limited cranially and caudally by the neurovascular bundle. The present study was conducted to assess the quality of reduction and the incidence of complications in patients who underwent the modified “one-incision two-window” K-L approach. Methods : This is a Retrospective case series with recruited thirteen consecutive patients from 2015 to 2017 who sustained an acute, displaced posterior wall or column acetabular fracture. All patients were treated with modified “one-incision two-window” K-L approach. Results: The mean operation time, mean intraoperative blood loss, and mean incision wound length were estimated to be 103.8 min (60-120 min), 373.1 mL (100-700 mL), and 9.7 cm (8.0-13.0 cm), respectively. The radiographic quality of reduction was graded as anatomical reduction (maximum residual displacement [MRD] ≤ 2 mm) in all cases, according to Matta’s criteria. Concerning the incidence of complications, there were no iatrogenic neurovascular injury, no surgical site infections, and no osteonecrosis of the femoral head or heterotopic ossification in this cohort. One patient with transverse with posterior wall fracture (group 1) experienced deep vein thrombosis in the lesion leg. Another two patients with solitary posterior wall fracture (group 2) developed posttraumatic osteoarthritis, with one diagnosed as Tonnis grade I lesion and the other as Tonnis grade III lesion. With respect to the clinical treatment outcome, the mean visual analogue scale (VAS), mean modified Harris Hip Score (mHHS) and subjective satisfaction rate were 1.7 (1.0-2.0), 90.6 (81-100), and 84.6% (80%-90%), respectively. Although there was no significant difference in the satisfaction rate (82.9% vs. 87.0%, P = 0.941) at 12 months after surgery, group 1 patients had more increased VAS score (2.0 vs. 1.2, P = 0.016) and more decreased mHHS (87.7 vs. 94.6, P = 0.014) than group 2 patients. Conclusions: Our pilot study confirmed that the “one-incision two-window” K-L approach is a simple, safe, reliable, and effective way to manage acute, displaced posterior wall or column acetabular fractures.


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