The Opioid Analgesic Reduction Study (OARS): A Comparison of Opioid vs. Non-Opioid Combination Analgesics for Management of Post-Surgical Pain Study Protocol for a Double-Blind Randomized Multi-Center Clinical Trial

Background: Everyday people die unnecessarily from opioid overdose-related addiction. Dentists are among the leading prescribers of opioid analgesics. Opioid seeking behaviors have been linked to receipt of initial opioid prescriptions following the common dental procedure of third molar extraction. With each opioid prescription a patient’s risk for opioid misuse or abuse increases. With an estimated 56 million tablets of 5 mg hydrocodone annually prescribed after third molar extractions in the United States, 3.5 million young adults may be unnecessarily exposed to opioids by dentists who are inadvertently increasing their patient’s risk for addiction.Methods: A double blind, stratified randomized, multi-center clinical trial has been designed to evaluate whether a combination of over-the-counter non-opioid containing analgesics is not inferior to the most prescribed opioid analgesic. The impacted 3rd molar extraction model is being used due to the predictable severity of the post-operative pain and generalizability of results. Within each site/clinic and gender type (male/female), patients are randomized to receive either OPIOID (hydrocodone/acetaminophen 5/300 mg) or NON-OPIOID (ibuprofen/acetaminophen 400/500 mg). Outcome data include pain levels, adverse events, overall patient satisfaction, ability to sleep, and ability to perform daily functions. To develop clinical guidelines and a clinical decision making tool, pain management, extraction difficulty and number of tablets taken is being collected enabling an experimental decision making tool to be developed. Discussion: The proposed methods address the short comings of other analgesic studies. Although prior studies have tested short-term effects of single doses of pain medications, patients and their dentists are interested in managing pain for the entire post-operative period, not just the first 12 hours. After surgery, patients expect to be able to perform normal daily functions without feeling nauseous or dizzy and they desire a restful sleep at night. Parents of young people are concerned with the risks of opioid use and misuse, either related to treatments received or to subsequent use of leftover pills. Upon successful completion of this clinical trial, dentists, patients, and their families will be better able to make informed decisions regarding post-operative pain management.Trial registration: ClinicalTrials.gov NCT04452344. Registered on June 20, 2020

The Utility of Pharmacogenetics Testing in Psychiatric Populations

The implementation of pharmacogenetic tests including multiple gene variants has shown promising potential as a decision-making tool for optimizing psychopharmacological treatment regimens and reducing treatment costs. However, the varying clinical validity of gene variants included in pharmacogenetic test batteries, and inconsistencies in their translation into medical recommendations between commercially available pharmacogenetic tests, complicates their rational implementation. Thus, there is a need for well-designed, reproducible studies documenting the clinical significance of the various genetic variants.

Prognostic scores and early management of septic patients in the emergency department of a secondary hospital: results of a retrospective study

Background Sequential Organ Failure Assessment (SOFA) and other illness prognostic scores predict adverse outcomes in critical patients. Their validation as a decision-making tool in the emergency department (ED) of secondary hospitals is not well established. The aim of this study was to compare SOFA, NEWS2, APACHE II, and SAPS II scores as predictors of adverse outcomes and decision-making tool in ED. Methods Data of 121 patients (age 73 ± 10 years, 58% males, Charlson Comorbidity Index 5.7 ± 2.1) with a confirmed sepsis were included in a retrospective study between January 2017 and February 2020. Scores were computed within the first 24 h after admission. Primary outcome was the occurrence of either in-hospital death or mechanical ventilation within 7 days. Secondary outcome was 30-day all-cause mortality. Results Patients older than 64 years (elderly) represent 82% of sample. Primary and secondary outcomes occurred in 40 and 44%, respectively. Median 30-day survival time of dead patients was 4 days (interquartile range 1–11). The best predictive score based on the area under the receiver operating curve (AUROC) was SAPS II (0.823, 95% confidence interval, CI, 0.744–0.902), followed by APACHE II (0.762, 95% CI 0.673–0.850), NEWS2 (0.708, 95% CI 0.616–0.800), and SOFA (0.650, 95% CI 0.548–0.751). SAPS II cut-off of 49 showed the lowest false-positive rate (12, 95% CI 5–20) and the highest positive predictive value (80, 95% CI 68–92), whereas NEWS2 cut-off of 7 showed the lowest false-negative rate (10, 95% CI 2–19) and the highest negative predictive value (86, 95% CI 74–97). By combining NEWS2 and SAPS II cut-offs, we accurately classified 64% of patients. In survival analysis, SAPS II cut-off showed the highest difference in 30-day mortality (Hazards Ratio, HR, 5.24, 95% CI 2.99–9.21, P < 0.001). Best independent negative predictors of 30-day mortality were body temperature, mean arterial pressure, arterial oxygen saturation, and hematocrit levels. Positive predictors were male sex, heart rate and serum sodium concentration. Conclusions SAPS II is a good prognostic tool for discriminating high-risk patient suitable for sub-intensive/intensive care units, whereas NEWS2 for discriminating low-risk patients for low-intensive units. Our results should be limited to cohorts with a high prevalence of elderly or comorbidities.

Correspondence Between Technology Options Available for Chemical Industries and the Levels of the Waste Management Hierarchy: A Case Study Approach

The Waste Management Hierarchy is used as a guiding principle for waste management of industrial solid waste. Further, it is extended for the management of industrial liquid effluents as well. The Waste Management Hierarchy consists of the five levels namely; waste prevention, reuse, recycling, recovery, and disposal. This five-tiered Waste Management Hierarchy has been adopted by the European Union under the Waste Framework Directive as a decision-making tool. This paper explores some of the technology options known and available and categorizes them according to the five levels of the Waste Management Hierarchy. This paper presents brief case studies that highlight some benefits to those who embrace this decision-making tool.

Artificial Intelligence as a Decision Making Tool for Military Leaders

Capable of processing the volume, variety, accuracy and speed of data at rates and precision impossible for humans to achieve, artificial intelligence-enabled systems offer great potential in supporting the decision making. However, the impact of the use of AI will not be solely for future leaders, but will also affect those they lead. This article means to highlight these possible effects on leaders, by presenting some important connections between AI and leadership.

Technology Selection Assistance Tool for Positive Energy Districts

Positive energy districts (PEDs) consist of more than three interconnected buildings that annually produce more renewable energy than what is consumed within the district boundaries. To achieve the annual surplus of energy, implementation of renewable-driven and innovative technologies is needed. However, most cities struggle in deciding what technologies are more suitable for their environment due to the lack of information and experience in a holistic approach. A decision-making tool has been developed within MAKING-CITY, with the collaboration of ATELIER project, to assist in the PED technology selection process, empowering cities with information and recommendations, in line with their district context and city objectives.