Postoperative Opioid Prescribing Practice in Foot and Ankle Surgery

2021 ◽  
Author(s):  
Brandon M Brooks ◽  
Bradley M Brooks ◽  
Brady M Brooks ◽  
Adam E Fleischer ◽  
Robert G Smith ◽  
...  
Keyword(s):  
United States ◽  
Online Survey ◽  
The United States ◽  
Practice Variation ◽  
Foot And Ankle ◽  
Linear Regression Models ◽  
Time Of Surgery ◽  
Opioid Prescribing ◽  
Ankle Surgery ◽  
Prescribing Practice

Background: Clinicians, governmental agencies, patients, and pharmaceutical companies all contribute to the United States' opioid epidemic. These same stakeholders can make meaningful contributions to resolve the epidemic by identifying ineffective habits and encouraging change. The purpose of this study was to determine if postoperative opioid prescribing practice variation exists in foot and ankle surgery. We also aimed to identify if demographic characteristics of podiatric foot and ankle surgeons were associated with their postoperative opioid prescribing practices. Methods: We administered an open, voluntary, anonymous, online questionnaire distributed on the internet via Qualtrics, an online survey platform. The questionnaire consisted of six foot and ankle surgery scenarios followed by a demographics section. We invited Podiatric foot and ankle surgeons practicing in the United States to complete the questionnaire via email from the American Podiatric Medical Association's membership list. Respondents selected the postoperative opioid(s) that they would prescribe at the time of surgery, as well as the dose, frequency, and number of "pills" (dosage units). We developed multiple linear regression models to identify associations between prescriber characteristics and two measures of opioid quantity: dosage units and MME. Results: Eight hundred and sixty podiatric foot and ankle surgeons completed the survey. The median number of dosage units never exceeded 30 regardless of the foot and ankle surgery. Years in practice correlated with reduction in opioid dosage units prescribed at the time of surgery. Conclusions: Postoperative opioid prescribing practice variation exists in foot and ankle surgery. In comparison to the orthopedic community, podiatric foot and ankle surgeons prescribe approximately 25% fewer opioids at the time of surgery than orthopedic foot and ankle surgeons. Further research is warranted to determine if additional education is needed for young surgeons.

Time and State Legislation Have Decreased Opioid Prescribing in Elective Foot and Ankle Surgery in the United States

2021 ◽  
pp. 193864002110433
Author(s):  
Daniel J. Cunningham ◽  
Nicholas F. Kwon ◽  
Nicholas B. Allen ◽  
Andrew M. Hanselman ◽  
Samuel B. Adams
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Epidemic ◽  
Foot And Ankle ◽  
Opioid Prescription ◽  
State Legislation ◽  
Filling Volume ◽  
Opioid Prescribing ◽  
Ankle Surgery ◽  
The Impact

Background Legislation in the United States has been enacted to reduce opioid overuse and abuse in the setting of the opioid epidemic, and a notable target has been opioid overprescription. However, the impact of this legislation on elective foot and ankle surgery is largely unknown. The purpose of this study was to evaluate the impact of opioid-limiting legislation on opioid prescribing in elective foot and ankle surgery. Methods The 90-day perioperative opioid prescription filling in oxycodone 5-mg equivalents was identified in all patients 18 years of age and older undergoing nontrauma, nonarthroplasty foot and ankle surgery from 2010 to 2019 using a commercial database. States with and without legislation were identified, and opioid prescription filling before and after the legislation were tabulated. Unadjusted and adjusted analyses were performed to evaluate the impact of time and state legislation on perioperative opioid prescribing in this patient population. Results Initial and cumulative opioid prescribing decreased significantly from 2010 to 2019 (39 vs 35.7 initial and 98.1 vs 55.7 cumulative). States with legislation had larger and more significant reductions in initial and cumulative opioid prescribing compared with states without legislation over similar time frames (41.6 to 35.1 with legislation vs 40.6 to 39.1 without legislation initial prescription filling volume and 87.7 to 62.8 vs 88.6 to 74.1 cumulative prescription filling volume). Conclusion State legislation and time have been associated with large, clinically relevant reductions in 90-day perioperative cumulative opioid prescription filling, although reductions in initial opioid prescription filing have remained low. These results encourage states without legislation to enact restraints to reduce the opioid epidemic. Levels of Evidence: Level III: Retrospective, prognostic cohort study

scholarly journals Sleep Quality Among Informal Caregivers During the COVID-19 Pandemic: A Cross-Sectional Study

2022 ◽  
Vol 8 ◽  
pp. 233372142110573
Author(s):  
Mary L. Greaney ◽  
Zachary J. Kunicki ◽  
Meghan M. Drohan ◽  
Caitlin C. Nash ◽  
Steven A. Cohen
Keyword(s):  
United States ◽  
Sleep Quality ◽  
Caregiver Burden ◽  
Online Survey ◽  
Behavioral Science ◽  
Informal Caregivers ◽  
The United States ◽  
Linear Regression Models ◽  
Cross Sectional ◽  
The Impact

Sleep is an integral component of health. The impact of the COVID-19 pandemic on sleep quality among informal caregivers, individuals who provide unpaid care or assistance to family members or friends, assisting older adults is not well understood. Therefore, informal caregivers in the United States providing care for individuals aged 50+ were recruited via Amazon’s Mechanical Turk, an online platform for enrolling study participants into social and behavioral science research, to complete an online survey. The sample of informal caregivers ( n = 835) was 69% male and 55% non-Hispanic. Multivariable linear regression models were constructed to assess the associations between sleep disturbance scores (SDS) and sleep-related impairment scores (SIS) and caregiving-related measures (hours caregiving/week, length of time spent caregiving, and caregiver burden), demographics, and region of the United States. The analysis determined that Black (β = 2.6, 95% CI [−4.3, −0.9]) and Asian informal caregivers (β = −1.8, 95% CI [−3.4, −0.3]) had lower mean SIS than White caregivers, the referent group. In addition, increasing caregiver burden was associated with increased SDS (β = 0.8, 95% CI [0.6, 1.0]) and SIS (β = 1.3, 95% CI [0.7, 1.6]). In conclusion, higher caregiver burden was associated with higher SIS and SDS, suggesting that informal caregivers' sleep should be assessed, and when needed interventions should be offered.

scholarly journals Opioid Prescribing Patterns of the American Orthopaedic Foot & Ankle Society

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0023
Author(s):  
Noortje Hagemeijer ◽  
Gabrielle Donahue ◽  
Gijs Helmerhorst ◽  
Daniel Guss ◽  
Gino Kerkhoffs ◽  
...  
Keyword(s):  
United States ◽  
Pain Management ◽  
Postoperative Pain ◽  
Management Practices ◽  
Postoperative Pain Management ◽  
The United States ◽  
Prescribing Patterns ◽  
Foot And Ankle ◽  
Opioid Prescribing ◽  
American Orthopaedic

Category: Other Introduction/Purpose: Amid the current opioid epidemic in the United States, surgeons are forced to more carefully manage postoperative pain prescriptions. Despite the enthusiastic engagement of physicians, politicians and the general public, however, clear guidelines for opioid prescribing postoperatively still do not exist, including after foot and ankle surgery. Given the ablity to improve patient outcomes by decreasing treatment variability in other realms of medicine, this study sought to quantify the postoperative opioid prescribing regimens of American foot and ankle surgeons as an initial step towards understanding prescription patterns and establishing a baseline regimen from which future guidelines may stem. Methods: A total of 1235 active and candidate members of the American Orthopaedic Foot & Ankle Society (AOFAS) from the United States and Canada were invited to fill out a postoperative pain management survey using a Research Electronic Data Capture (REDCap) web-based application. Surgeons were asked to report on their pain prescription regimens, including type and number of pills, after nine common foot and ankle procedures rated as minor, moderate, or major in severity. The presence of a regional block anesthesia was also recorded. Opioid prescriptions were then converted to the equivalent of 5 mg oxycodone pills for standardization and inter-prescriber comparison. Results: Two hundred twenty-four (18%) surgeons completed the survey. Because of highly skewed data results are reported as medians and the range. Postoperative opioid prescriptions, given in oxycodone 5 mg pill equivalents, were as follows: 39 (8-133) pills for minor procedure, 45 (10-180) pills for a moderate soft tissue procedure, 53 (16-186) pills for a moderate bony procedure, and 60 (20-200) pills for a major bony procedure. Conclusion: Wide variation between surgeons was noted in postoperative pain management. Median prescription opioid doses vary from 39 to 60 oxycodone pills depending on procedure type. It is likely that the amount of opioids prescribed is excessive for adequate pain management, especially for smaller procedures. We propose a post-operative pain regimen that limits the number of pills prescribed based on studies from other surgical specialties. Future studies are necessary to assess the efficacy of current postoperative pain management practices and to guide improved pain management that limits the use of opioids where possible.

An Assessment of the Cues College Students Interpret From a Sexual Partner to Determine They Are Refusing

2021 ◽  
pp. 088626052199793
Author(s):  
Tiffany L. Marcantonio ◽  
Danny Valdez ◽  
Kristen N. Jozkowski
Keyword(s):  
United States ◽  
College Students ◽  
Sexual Partner ◽  
Online Survey ◽  
The United States ◽  
Sexual Partners ◽  
Sexual Scripts ◽  
Nonverbal Cues ◽  
Sexual Experiences ◽  
Verbal Cues

The purpose of this study was to assess the cues college students use to determine a sexual partner is refusing vaginal-penile sex (i.e., refusal interpretations). As a secondary aim, we explored the influence of item wording ( not willing/non-consent vs refusal) on college students’ self-reported refusal interpretations. A sample of 175 college students from Canada and the United States completed an open-ended online survey where they were randomly assigned to one of two wording conditions ( not willing/non-consent vs refusal); students were then prompted to write about the cues they used to interpret their partner was refusing. An inductive coding procedure was used to analyze open-ended data. Themes included explicit and implicit verbal and nonverbal cues. The refusal condition elicited more explicit and implicit nonverbal cues than the not willing/non-consent condition. Frequency results suggested men reported interpreting more explicit and implicit verbal cues. Women reported interpreting more implicit nonverbal cues from their partner. Our findings reflect prior research and appear in line with traditional gender and sexual scripts. We recommend researchers consider using the word refusal when assessing the cues students interpret from their sexual partners as this wording choice may reflect college students’ sexual experiences more accurately.

Opioid prescribing to preteen children undergoing ambulatory surgery in the United States

Surgery ◽  
2021 ◽  
Author(s):  
Randi S. Cartmill ◽  
Dou-Yan Yang ◽  
Benjamin J. Walker ◽  
Yasmin S. Bradfield ◽  
Tony L. Kille ◽  
...  
Keyword(s):  
United States ◽  
Ambulatory Surgery ◽  
The United States ◽  
Opioid Prescribing

scholarly journals Social stress and risk of declining cognition: a longitudinal study of men and women in the United States

2021 ◽  
Author(s):  
Jutta Lindert ◽  
Kimberley C. Paul ◽  
E. Lachman Margie ◽  
Beate Ritz ◽  
Teresa Seeman
Keyword(s):  
United States ◽  
Adverse Effects ◽  
Executive Functioning ◽  
Episodic Memory ◽  
Social Status ◽  
Social Stress ◽  
The United States ◽  
Subjective Social Status ◽  
Linear Regression Models ◽  
Men And Women

AbstractLimited research is available on the relationship between social stress and risk of declining cognition. We sought to examine whether social stress has adverse effects on risk of declining episodic memory and executive functioning in aging individuals. We used data from the MIDUS study, a national probability sample of non-institutionalized, English speaking respondents aged 25–74 living in the 48 contiguous states of the United States. The initial wave (1995) included 4963 non-institutionalized adults aged 32–84 (M = 55, SD = 12.4). We used an analytic sample from MIDUS-II (1996/1997) and MIDUS-III (2013) (n = 1821). The dependent variables are episodic memory and executive functioning, which were assessed with the Brief Test for Cognition (BTACT). The independent variables were social stress variables (subjective social status, family and marital stress, work stress and discrimination). To evaluate episodic memory and executive functioning changes over a time period of 10 years, we estimated adjusted linear regression models. Women report significantly lower subjective social status and more discrimination stress than men across all age groups. Controlling for education and income, age, and baseline episodic memory and executive functioning, lower subjective social status had additional adverse effects on declines in episodic memory in men and women. Marital risk had adverse effects on episodic memory in men but not in women. Daily discrimination had adverse effects on executive functioning on all individuals. Public health strategies should focus on reducing social stress in a socio-ecological perspective. Especially, subjective social status and discrimination stress might be a target for prevention efforts.

scholarly journals Household COVID-19 risk and in-person schooling

Science ◽  
2021 ◽  
pp. eabh2939
Author(s):  
Justin Lessler ◽  
M. Kate Grabowski ◽  
Kyra H. Grantz ◽  
Elena Badillo-Goicoechea ◽  
C. Jessica E. Metcalf ◽  
...  
Keyword(s):  
United States ◽  
Online Survey ◽  
Positive Association ◽  
The United States ◽  
Mitigation Measures ◽  
Office Work ◽  
School Based ◽  
Increased Risk ◽  
Extra Curricular Activities ◽  
Low Levels

In-person schooling has proved contentious and difficult to study throughout the SARS-CoV-2 pandemic. Data from a massive online survey in the United States indicates an increased risk of COVID-19-related outcomes among respondents living with a child attending school in-person. School-based mitigation measures are associated with significant reductions in risk, particularly daily symptoms screens, teacher masking, and closure of extra-curricular activities. A positive association between in-person schooling and COVID-19 outcomes persists at low levels of mitigation, but when seven or more mitigation measures are reported, a significant relationship is no longer observed. Among teachers, working outside the home was associated with an increase in COVID-19-related outcomes, but this association is similar to other occupations (e.g., healthcare, office work). While in-person schooling is associated with household COVID-19 risk, this risk can likely be controlled with properly implemented school-based mitigation measures.

scholarly journals Abortion attempts without clinical supervision among transgender, nonbinary and gender-expansive people in the United States

2021 ◽  
pp. bmjsrh-2020-200966
Author(s):  
Heidi Moseson ◽  
Laura Fix ◽  
Caitlin Gerdts ◽  
Sachiko Ragosta ◽  
Jen Hastings ◽  
...  
Keyword(s):  
United States ◽  
Clinical Supervision ◽  
Online Survey ◽  
Clinical Care ◽  
Insurance Coverage ◽  
Health Insurance Coverage ◽  
The United States ◽  
Physical Trauma ◽  
Abortion Care ◽  
And Gender

BackgroundTransgender, nonbinary and gender-expansive (TGE) people face barriers to abortion care and may consider abortion without clinical supervision.MethodsIn 2019, we recruited participants for an online survey about sexual and reproductive health. Eligible participants were TGE people assigned female or intersex at birth, 18 years and older, from across the United States, and recruited through The PRIDE Study or via online and in-person postings.ResultsOf 1694 TGE participants, 76 people (36% of those ever pregnant) reported considering trying to end a pregnancy on their own without clinical supervision, and a subset of these (n=40; 19% of those ever pregnant) reported attempting to do so. Methods fell into four broad categories: herbs (n=15, 38%), physical trauma (n=10, 25%), vitamin C (n=8, 20%) and substance use (n=7, 18%). Reasons given for abortion without clinical supervision ranged from perceived efficiency and desire for privacy, to structural issues including a lack of health insurance coverage, legal restrictions, denials of or mistreatment within clinical care, and cost.ConclusionsThese data highlight a high proportion of sampled TGE people who have attempted abortion without clinical supervision. This could reflect formidable barriers to facility-based abortion care as well as a strong desire for privacy and autonomy in the abortion process. Efforts are needed to connect TGE people with information on safe and effective methods of self-managed abortion and to dismantle barriers to clinical abortion care so that TGE people may freely choose a safe, effective abortion in either setting.

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