Diagnosis Of Abuse Research Articles

Knowledge and attitude of physicians toward child abuse and reporting in a tertiary hospital in Riyadh.

Child abuse is a common global devastating issue for the patient and physician. It can lead to much unpleasant and danger and even death. One of the most essential parts of a doctor's job is to help people in need and a child should be top priority as they are dependent for protection and care. To analyze the experience and knowledge of Saudi residents from both specialty family medicine and pediatrics working in Riyadh city toward the recognition and diagnosis of child abuse and neglect and spot the light on the barriers that prevent its reporting and to assess the need for further training. A cross-sectional study was conducted in four major tertiary hospitals in Riyadh (KKUH, National Guard Hospital, King Fahad Medical City, Prince Sultan Medical City) from March 2019 to January 2020. Most participants did not have sufficient knowledge regarding the physical assessment of suspected child abuse and neglect. The result showed no significant difference in terms of knowledge and attitude between family physicians and pediatrics working in tertiary centers in Riyadh. The study concluded that the Saudi residents from both specialties, that is, family medicine and pediatrics, had insufficient knowledge regarding child abuse. In addition, the residents had positive attitudes toward child abuse prevention. Finally, the study recommends conducting awareness campaigns to increase the knowledge of physicians about child abuse and the predictive factors.

Prof K C Dube Poster Award

Introduction:The role of the family in the context of substance use among adolescents has been documented both as a risk and protective factor. However, Indian studies on parenting and family dynamics in adolescent substance use are limited. This is despite the difference between Western and Indian family systems, that emphasise collectivism and interdependence with limited individualism and autonomy. Our study aimed to assess family functioning and parenting practices in adolescents who used substances and to compare them with families of healthy adolescents.Methodology:This study employed a cross-sectional, comparative design. Forty adolescent-parent dyads were selected from adolescents registered for substance use treatment and compared with 40 healthy adolescent-parent dyads of matching age and socio-economic statusBoth adolescents and parents were screened for symptoms of psychiatric illnesses and detailed assessment was done by applying the following instruments: Adolescent Drug Abuse Diagnosis (ADAD), Alabama Parenting Questionnaire (APQ), Family Assessment Device (FAD) and Parenting Style 4 factor questionnaire.Results:Both groups had mostly nuclear families of upper-lower socio-economic status. Adolescents who used substances perceived a significantly poor functioning in their families in terms of problem solving, communication, roles, affective responsiveness, affective involvement, behavioral control and general functioning along with lower parental involvement, lesser positive parenting, poorer monitoring and greater inconsistency in discipline. Significantly greater number of parents of healthy adolescents were authoritative as compared to substance users, who were more permissive and neglectful. Substance use severity had a significant positive correlation with dysfunction in role-setting, affective involvement and general family functioning and negative correlation with positive parenting.Conclusion:Our findings indicate that several domains of parenting and family functioning bear significant effect on substance use in adolescents, and further in-depth research is required from similar family systems in order to call for inclusivity and trans-cultural applicability for existing family interventions.

Traumatic Head Injury and the Diagnosis of Abuse: A Cluster Analysis.

Data guiding abusive head trauma (AHT) diagnosis rest on case-control studies that have been criticized for circularity. We wished to sort children with neurologic injury using mathematical algorithms, without reference to physicians' diagnoses or predetermined diagnostic criteria, and to compare the results to existing AHT data, physicians' diagnoses, and a proposed triad of findings. Unsupervised cluster analysis of an existing data set regarding 500 young patients with acute head injury hospitalized for intensive care. Three cluster algorithms were used to sort (partition) patients into subpopulations (clusters) on the basis of 32 reliable (κ > 0.6) clinical and radiologic variables. P values and odds ratios (ORs) identified variables most predictive of partitioning. The full cohort partitioned into 2 clusters. Variables substantially (P < .001 and OR > 10 in all 3 cluster algorithms) more prevalent in cluster 1 were imaging indications of brain hypoxemia, ischemia, and/or swelling; acute encephalopathy, particularly when lasting >24 hours; respiratory compromise; subdural hemorrhage or fluid collection; and ophthalmologist-confirmed retinoschisis. Variables substantially (P < .001 and OR < 0.10 in any cluster algorithm) more prevalent in cluster 2 were linear parietal skull fracture and epidural hematoma. Postpartitioning analysis revealed that cluster 1 had a high prevalence of physician-diagnosed abuse. Three cluster algorithms partitioned the population into 2 clusters without reference to predetermined diagnostic criteria or clinical opinion about the nature of AHT. Clinical difference between clusters replicated differences previously described in comparisons of AHT with non-AHT. Algorithmic partition was predictive of physician diagnosis and of the triad of findings heavily discussed in AHT literature.

Computer Algorithms Support Physician Decisions in Traumatic Head Injury.

Computer Algorithms Support Physician Decisions in Traumatic Head Injury.

Oral cancer among Khat users: finding evidence from DNA analysis of nine cancer-related gene mutations

BackgroundKhat leaves contain the alkaloid cathinone. Research shows that khat might provoke toxicity, mutagenicity, as well as carcinogenicity.MethodsTwo groups were identified as khat abusers and were categorized by abuse time and diagnosis of oral squamous cell carcinoma (OSCC). Here, 41 participants from Group 2 were short-term khat users, and 42 participants were long-term khat users. The control group included 30 healthy individuals.The coding exons included nine cancer-related genes and were analysed. The histopathological research was conducted with H&E staining along with the TP53 protein expression by implementing immunohistochemical analyses.ResultsHere, 41 short-term khat users carried seven somatic mutations in four out of nine cancer-related genes: 29/41(70.73%) ARID1A, 24/41(58.53%) MLH1, 34/41(82.92%) PIK3CA and 36/41(87.80%) TP53. The 42 long-term khat users incorporated nine somatic mutations in five out of nin ecancer-related genes: 40/42(95.23%) ARID1A, 36/42(85.71%) ARID2, 29/42(69.04%) PIK3CA, 27/42(64.28%) MLH1, and 35/42(83.33%) TP53. Every khat user had somatic mutations related to OSCC affecting the gingiva and the lower lip. TP53 protein expression was confirmed in all immunohistochemical oral tests. Carcinoma was also positive in the histopathological analysis.ConclusionsKhat is a mutagenic and carcinogenic plant that provoked OSCC among short-term khat users (<15 years of use) and long-term users (>15 years of use).

Inpatient Mental Healthcare before and during the COVID-19 Pandemic.

Prior studies have demonstrated disruption to outpatient mental health services after the onset of the COVID-19 pandemic. Inpatient mental health services have received less attention. The current study utilized an existing cohort of 33 Veterans Health Affairs (VHA) acute inpatient mental health units to examine disruptions to inpatient services. It further explored the association between patient demographic, clinical, and services variables on relapse rates. Inpatient admissions and therapeutic services (group and individual therapy and peer support) were lower amongst the COVID-19 sample than prior to the onset of COVID-19 while lengths of stay were longer. Relapse rates did not differ between cohorts. Patients with prior emergent services use as well as substance abuse or personality disorder diagnoses were at higher risk for relapse. Receiving group therapy while admitted was associated with lower risk of relapse. Inpatient mental health services saw substantial disruptions across the cohort. Inpatient mental health services, including group therapy, may be an important tool to prevent subsequent relapse.

Variations in Guidelines for Diagnosis of Child Physical Abuse in High-Income Countries

The highly variable practices observed regarding the early detection and diagnostic workup of suspected child physical abuse contribute to suboptimal care and could be partially related to discrepancies in clinical guidelines. To systematically evaluate the completeness, clarity, and consistency of guidelines for child physical abuse in high-income countries. For this systematic review, national or regional guidelines that were disseminated from 2010 to 2020 related to the early detection and diagnostic workup of child physical abuse in infants aged 2 years or younger by academic societies or health agencies in high-income countries were retrieved. The definitions of sentinel injuries and the recommended diagnostic workup (imaging and laboratory tests) for child physical abuse were compared. Data were analyzed from July 2020 to February 2021. Within the 20 included guidelines issued in 15 countries, 168 of 408 expected statements (41%) were missing and 10 statements (4%) were unclear. Among 16 guidelines characterizing sentinel injuries, all of them included skin injuries, such as bruises, hematoma, or burns, but only 8 guidelines (50%) included intraoral injuries and fractures. All 20 guidelines agreed on the indication for radiological skeletal survey, head computed tomography, and head magnetic resonance imaging but differed for those of bone scintigraphy, follow-up skeletal survey, spinal magnetic resonance imaging, cranial ultrasonography, chest computed tomography, and abdominal ultrasonography and computed tomography. Additionally, 16 guidelines agreed on exploring primary hemostasis and coagulation but not on the tests to perform, and 8 guidelines (50%) mentioned the need to investigate bone metabolism. These findings suggest that guidelines for the diagnosis of child physical abuse in infants were often clear but lacked completeness and were discrepant on major issues. These results may help identify priorities for well-designed original diagnostic accuracy studies, systematic reviews, or an international consensus process to produce clear and standardized guidelines to optimize practices and infant outcomes.

Guidelines for Diagnosis of Child Physical Abuse—Let’s Get Back to Work!

Guidelines for Diagnosis of Child Physical Abuse—Let’s Get Back to Work!

A point-of-care test device for MRSA rapid detection

Staphylococcus aureus (SA) is one of the most common pathogenic bacteria, and methicillin-resistant SA (MRSA) is an equally common drug-resistant bacteria. MRSA detection is of great significance for clinical diagnosis, medication guidance, and prevention of antibiotic abuse. Traditional MRSA detection using the culture method is time-consuming, laborious, and difficult to conduct rapid on-site detection. In this research, we developed a device for rapid MRSA detection, which can detect the nuc gene in SA and mecA gene in MRSA simultaneously for 30–40 min. After simple sample processing, the mixture can be directly loaded onto the chip device. The detection results can be directly determined by a color change, with a limitation of approximately 102 copies. This isothermal amplification chip device can be widely applied in many fields, with simple operation and low contamination.

Using Real World Data (RWD) to Identify Care Needs in an Adolescent and Young Adult (AYA) Lymphoma Population: A Match Cohort Study

Adolescent and young adult (AYA) patients with malignancies are a unique population within oncology with differences in survivorship outcomes as compared to adult and pediatric counterparts. The National Comprehensive Cancer Network (NCCN) identified eight critical domains in AYA care: mental health, cognitive function, physical exercise, fatigue, immunizations/infection prevention, pain, sexual function and sleep disorders. However, it can be difficult to establish a clinical benchmark of these domains at an institutional level without time-consuming chart review. With the advent of real-world data generated from the electronic medical record (EMR), feasible large scale data assessment can be used to identify care needs and direct future prospective studies and interventions.Here we demonstrate the feasibility of a match cohort study using EMR comparing metrics in the above NCCN domains in AYA lymphoma patients within the University of Rochester Medical Center. We identified 172 AYA lymphoma patients diagnosed between 2013 and 2019 and compared them to 516 controls over that time period using 3:1 control matching, both at time of diagnosis and one year post-diagnosis. Controls were identified within the EMR with exclusion criteria of no cancer diagnoses and fewer than an average of ten medical visits per year over the study period to control for other chronic disorders.Demographic characteristics for both groups were matched for age at diagnosis date, sex, and race. The resultant populations had an average age of 29 (SD 6), male predominance (58.72%), and Caucasian predominance (82.56%). The lymphoma group had a slightly higher rate of federally funded insurance as compared to controls (25% vs. 20%).In mental health domains, lymphoma group had a higher rate of depression at baseline (19.77% vs. 1.16%; p <0.0001) but anxiety was at comparable rates (8.72% vs. 10.85% p <0.46) with similar rates of antidepressant medication prescriptions (27.33% vs. 25.97% p < 0.75). At one year post-diagnosis, anxiety and depression rates were near identical but rates of antidepressant prescriptions had increased in the lymphoma group (30.81% vs. 22.65% p < 0.03.)In physical health domains, lymphoma group had similar rates of BMI in the overweight and obese range as compared to controls and less than five percent of the group had a sleep medicine, nutrition, or cognitive assessment at baseline or one year post-diagnosis. Vaccination rates, as measured by influenza and pneumovax adherence, were low both at diagnosis and at one year post- diagnosis in the lymphoma group (18.6% and 21.5%, respectively).In the pain domain, the lymphoma group had similarly low rates of alcohol abuse, opiate abuse and chronic pain diagnoses as compared to controls (between 1 and 4% without statistically significant differences). Interestingly, pain scores recorded at visits on the 0 to 10 scale were noticeably lower for the lymphoma group both at diagnosis and one year post-diagnosis (4.65% vs 11.24% p=0.009; 5.23% vs 11.43% p=0.02) however prescription of any analgesic medication was higher in the lymphoma group (76.16% vs. 40.98% p<0.0001; 63.95% vs. 30.62 p<0.0001).Lastly, in the reproductive and sexual health domain, the lymphoma group had high rates of consultation with reproductive endocrinology at diagnosis as compared to controls (31.40% vs. 1.74% p<0.0001) suggestive of early referral between initial suspicion of cancer and tissue diagnosis. The overall use of the services however were still at relatively low rates. Additionally, long-acting removable contraception rates, while higher in the lymphoma population (11.27% vs. 4.23 p<0.02) were still relatively low. Finally, rates of erectile dysfunction diagnoses were similar in lymphoma cases as compared to controls (0.99 vs. 0.66 p< 0.7128) without significant differences in tadalafil/sildenafil prescriptions at one year post-diagnosis (2.97% vs. 1.32% p<0.15)These data support the feasibility of using the electronic medical record to track institutional level ancillary markers of care for prospective study and population-specific interventions. Future studies will be directed at collaborations to address these care gaps and a prospective survey of AYA patients to identify patient-centered interventions improving care for this critical population. DisclosuresCasulo: Genentech: Research Funding; BMS: Research Funding; Gilead: Research Funding; Verastem: Research Funding.

Effectiveness of the training provided to healthcare professionals in Turkey to recognise the symptoms and risks of child abuse and neglect.

Healthcare professionals have a significant role to play in the early diagnosis of child abuse and neglect (CAN), which is important in terms of protecting children's health. The study aimed to measure the change in the participants' level of diagnosing the risks and symptoms of CAN before and after the training by providing a training program to healthcare professionals including the signs of CAN, symptoms and procedures to be followed in this case. All healthcare professionals working in a State Hospital and Family Health Centers in Tunceli, Turkey, and who volunteered to participate in the study were included in the study (n=125). The data were collected before and after the training by using the Personal Information Form and The Diagnosis Scale of the Risks and Symptoms of Child Abuse and Neglect (DSRSCAN). 39 participants (31.2%) reported that they had previously suspected CAN, and 35 (28%) stated that they had encountered CAN before. The mean DSRSCAN score of the healthcare professionals included in the study before the training was 3.38 (lowest =2.37, highest =3.55), while after the training, it went up to 3.60 (lowest =2.76, highest =5.00), and the difference between the pre-training and post-training DSRSCAN scores was determined to be statistically significant (p<0.001). It was determined that when healthcare professionals were trained on CAN, their awareness could be further strengthened. Hence, training programs for healthcare professionals on diagnosing and reporting CAN should be updated and increased.

The relationship between substance use, prior trauma history, and risk of developing post-traumatic stress disorder in the immediate aftermath of civilian trauma

Many reports have documented the relationship between post-traumatic stress disorder (PTSD) and substance use. Substance use is commonly comorbid with PTSD and is a risk factor for trauma exposure. The aim of this study was to prospectively examine how recent substance use, abuse, or dependence influenced the development of PTSD in the context of a prior trauma history, including child abuse, and the severity of initial trauma reactions. Participants (N = 81) were recruited and assessed at the emergency department of a large urban hospital in Miami and serum levels of common drugs of abuse were measured. Although substance use appeared to be a risk factor for trauma exposure, neither self-reported nor blood toxicology influenced the development of PTSD. Positive toxicology screens were more likely to be associated with a diagnosis of substance abuse or dependence, χ2 (1) = 4.11, p = .04. Participants with a history of physical abuse were more likely to have a positive toxicology screen, χ2 (1) = 4.03, p = .05. The majority of our trauma-exposed subjects (66%) were found to be positive for one or more illicit substances at presentation at the ED. The current findings provide support for the “high risk” hypothesis in which substance use is associated with increased trauma exposure.

Stones and Moans: Higher Number of Nephrolithiasis Related Encounters Increases the Odds of Opioid Misuse

ObjectiveTo evaluate the association between kidney stones and risk of subsequent opioid misuse. MethodsThe Healthcare Cost and Utilization Project's (HCUP) inpatient, ambulatory, and emergency department databases from 4 states were queried to identify associations with a primary diagnosis code related to kidney stones followed by a diagnosis of opioid abuse, dependence, or overdose between 2005, and 2015. Logistic regression was performed to determine the strength and significance of the relationship between number of primary kidney stone episodes and subsequent diagnosis of opioid misuse. ResultsThe final cohort included 783,929 patients across 4 states. On multivariable analysis the number of primary stone encounters (PSE) was strongly associated with the risk of developing an opioid-related disorder (ORD) when adjusting for relevant covariates (odds ratio 1.3). Patients seen in the emergency department (OR 1.4) and those treated in Iowa (OR 2.9) were at higher risk for ORD than those seen in different contexts or states. Younger age increased the strength of this association. Higher income (OR 0.7) and non–white race (OR 0.7) reduced the risk of ORD, while a diagnosis of chronic pain (OR 3.5) increased risk. ConclusionRisk of subsequent diagnosis of ORD is increased in patients who have multiple episodes of care related to kidney stones.

Epidemiological Data of Drug Abuse in Kirkuk Governorate; A Descriptive Study

Background: Drug abuse is the self-administration of any drug in a manner that diverts from approved medical or social patterns within a given culture. Legal or licit drugs and substances are socially accepted and their use does not constitute any criminal offence. Objective: To determine types of drugs which are abused, to demonstrate the sociodemographic profile of the abusers, the sources of starting drugs consumption and the associated psychiatric disorders among them. Patients and Methods: A descriptive study of (372) patients with drug abuse consisting of (285) males and (87) females. The study was done in Kirkuk city between December 2012 and January 2014. Diagnosis of drug abuse was made according to the Diagnostic Statistical Manual of diseases-Fourth Text Revised (DSM-IVTR). Results: The majority of the patients were singles (56.4%), (83.6%) with the age range of (17-38) years, (64%) were illiterate and primary school educate, (72%) were unemployed, (70%) from urban area. (17%), (16%), (13%), of the patients abused, Tramadol, poly drugs, and Alprazolam respectively. (18%) of the patients were diagnosed anxiety disorders, and (3.7%) of the patients were diagnosed with somatoform. Conclusions: Drug abuse is a growing problem in Iraq. Unaware of medical professional of some drugs with potential risks of abuse, unsupervised prescription and easy access of these drugs, in addition to the characteristic groups of high risks of abuse, such as young males, poorly educated, unemployed, those who were exposed to stressful factors and psychiatric patients. All these need to be addressed by medical, legal and social authorities.

Brief report: Cannabis and opioid use disorder among heart failure admissions, 2008-2018.

BackgroundIn the United States, both cannabis use disorder (CUD) and opioid use disorder (OUD) have increased in prevalence. The prevalence, demographics, and costs of CUD and OUD are not well known in heart failure (HF) admissions. This study aimed to use a national database to examine the prevalence, demographics, and costs associated with CUD and OUD in HF.MethodsThis study used the National Inpatient Sample from 2008 to 2018 to identify all primary HF admissions with and without the co-diagnosis of OUD or CUD using International Classification for Diagnosis, diagnosis codes. Demographics, costs, and trends were examined.ResultsBetween 2008 and 2018, we identified 11,692,995 admissions for HF of which 84,796 (0.8%) had a co-diagnosis of CUD only, and 67,137 (0.6%) had a co-diagnosis of OUD only. The proportion of HF admissions with CUD significantly increased from 0.3% in 2008 to 1.3% in 2018 (p<0.001). The proportion of HF admissions with OUD significantly increased from 0.2% in 2008 to 1.1% in 2018 (p<0.001). Patients admitted with HF and either CUD or OUD were younger, more likely to be Black, and from lower socioeconomic backgrounds (p<0.001, all). HF admissions with OUD or CUD had higher median costs compared to HF admissions without associated substance abuse diagnoses ($8,611 vs. $8,337 for CUD HF and $10,019 vs. $8,337 for OUD HF, p<0.001 for both).ConclusionsAmong discharge records for HF, CUD and OUD are increasing in prevalence, significantly affect underserved populations and are associated with higher costs of stay. Future research is essential to better delineate the cause of these increased costs and create interventions, particularly in underserved populations.

Reliability and validity of DSM-IV and DSM-5 methamphetamine use disorder diagnoses using the Chinese Version of the Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA)

BackgroundThe Semi-structured Assessment for Drug Dependence and Alcoholism (SSADDA) was developed to assess substance-use disorders and other psychiatric traits. We translated the SSADDA into Chinese and evaluated its inter-rater reliability and concurrent validity in diagnosing DSM-IV methamphetamine (MA) dependence and DSM-5 MA-use disorder (MUD). MethodsThe sample comprised 231 participants who were interviewed using the Chinese SSADDA and the Mini-International Neuropsychiatric Interview (Chinese MINI) for concurrent validation. Of the 231 participants, 191 were interviewed by two different interviewers two weeks apart. We evaluated the inter-rater reliability and concurrent validity of the diagnoses using percent agreement and Cohen's kappa coefficient (κ). Cohen’s linear weighted kappa was used to assess the reliability of DSM-5 MUD severity. ResultsIt showed good inter-rater reliability and no significant differences among the DSM-5 MUD (κ = 0.71), DSM-IV MA abuse or dependence (κ = 0.72), and the DSM-IV diagnoses of MA dependence (κ = 0.66) and abuse (κ = 0.68) tested separately. The weighted kappa was 0.67 across the three DSM-5 MUD severity levels. The reliability of each individual diagnostic criterion for DSM-5 MUD ranged from fair to excellent (κ = 0.41–0.80), except for “repeated attempts to quit/control use” (κ = 0.38). The concurrent validity based on MINI-derived diagnoses ranged from good to excellent (κ = 0.65–0.78). ConclusionsThis study shows that the Chinese version of SSADDA has good reliability and validity among Chinese MA users.

Influence of psychosocial and sociodemographic factors in the surgical management of traumatic cervicothoracic spinal cord injury at level I and II trauma centers in the United States.

Socioeconomic factors can bias clinician decision-making in many areas of medicine. Psychosocial characteristics such as diagnosis of alcoholism, substance abuse, and major psychiatric disorder are emerging as potential sources of conscious and unconscious bias. We hypothesized that these psychosocial factors, in addition to socioeconomic factors, may impact the decision to operate on patients with a traumatic cervicothoracic fracture and associated spinal cord injury (SCI). We performed a cohort analysis using clinical data from 2012-2016 in the American College of Surgeons (ACS) National Trauma Data Bank at academic level I and II trauma centers. Patients were eligible if they had a diagnosis of cervicothoracic fracture with SCI. Using ICD codes, we evaluated baseline characteristics including race; insurance status; diagnosis of alcoholism, substance abuse, or major psychiatric disorder; admission drug screen and blood alcohol level; injury characteristics and severity; and hospital characteristics including geographic region, non-profit status, university affiliation, and trauma level. Factors significantly associated with surgical intervention in univariate analysis were eligible for inclusion in multivariate logistic regression. We identified 6,655 eligible patients, of whom 62% underwent surgical treatment (n=4,137). Patients treated non-operatively were more likely to be older; be female; be Black or Hispanic; have Medicare, Medicaid, or no insurance; have been assaulted; have been injured by a firearm; have thoracic fracture; have less severe injuries; have severe TBI; be treated at non-profit hospitals; and be in the Northeast or Western U.S. (all P<0.01). After adjusting for confounders in multivariate analysis, only insurance status remained associated with operative treatment. Medicaid patients (OR=0.81; P=0.021) and uninsured patients (OR=0.63; P<0.001) had lower odds of surgery relative to patients with private insurance. Injury severity and facility characteristics also remained significantly associated with surgical management following multivariate regression. Psychosocial characteristics such as diagnosis of alcoholism, substance abuse, or psychiatric illness do not appear to bias the decision to operate after traumatic cervicothoracic fracture with SCI. Baseline sociodemographic imbalances were explained largely by insurance status, injury, and facility characteristics in multivariate analysis.

The Financial Burden of Opioid-Related Abuse among Surgical and Non-Surgical Patients in Florida: A Longitudinal Study.

Florida is one of the eight states labeled as a high-burden opioid abuse state and is an epicenter for opioid use and misuse. The aim of our study was to measure multi-year total room charges and costs billed for opioid abuse-related events and to compare the costs of inpatient opioid abusers and non-opioid abusers for Florida hospitals from 2011 to 2017. We constructed a retrospective case-control longitudinal study design on inpatient administrative discharge data across 173 hospitals. Opioid abuse was defined using both ICD-9-CM and ICD-10-CM systems. We found a statistically significant association between opioid abuse diagnosis and total room charge. On average, opioid abuse status increased the room charges by 8.1%. We also noticed year-to-year variations in opioid abuse had a remarkable influence on hospital finances. We showed that since 2015, the differences significantly increased from 4–5% to 13–14% for both room charges and cost, which indicates the financial burden due to opioid abuse becoming more frequent. These findings are important to policymakers and hospital administrators because they provide crucial insight into Florida’s opioid crisis and its economic burden on hospitals.

Psychological disorders confer poor functional outcomes after reverse total shoulder arthroplasty

Reverse total shoulder arthroplasty (RTSA) is being used to treat a number of shoulder disorders. The purpose of the present study was to investigate the correlation between psychological disorders, drug and alcohol abuse, and postoperative complications and outcomes after RTSA. A total of 128 patients who underwent an RTSA between January 2010 and February 2017 were identified. American Shoulder and Elbow Surgeons, SST, ROM, complications, radiographic outcomes and patient satisfaction were collected. Follow-up occurred at a minimum of 2 years postoperatively (average of 3.68 years). Statistical analysis evaluated the effects of multiple risk factors: psychological disorders, substance abuse, and preoperative diagnoses. Psychological disorder diagnosis correlated with statistically significant lower American Shoulder and Elbow Surgeons function (P= .027) and Simple Shoulder Test (P= .029) scores compared with those without a psychological disorder. It also conferred poor functional outcomes based on external rotation (P= .012). Complications, especially major complications, were more prevalent in patients with psychological diagnoses than without. A history of substance abuse correlated with a lower external rotation (P= .025). Both a preoperative psychological diagnosis and a history of substance abuse conferred worse objective and functional outcomes scores after RTSA.

Methamphetamine-Associated Heart Failure Hospitalizations Across the United States: Geographic and Social Disparities.

BackgroundAlthough methamphetamine abuse is associated with the development of heart failure (HF), nationwide data on methamphetamine‐associated HF (MethHF) hospitalizations are limited. This study evaluates nationwide HF hospitalizations associated with substance abuse to better understand MethHF prevalence trends and the clinical characteristics of those patients.Methods and ResultsThis cross‐sectional period‐prevalence study used hospital discharge data from the National Inpatient Sample to identify adult primary HF hospitalizations with a secondary diagnosis of abuse of methamphetamines, cocaine, or alcohol in the United States from 2002 to 2014. All 2014 MethHF admissions were separated by regional census division to evaluate geographical distribution. Demographics, payer information, and clinical characteristics of MethHF hospitalizations were compared with all other HF hospitalizations. Total nationwide MethHF hospitalizations increased from 547 in 2002 to 6625 in 2014 with a predominance on the West Coast. Methamphetamine abuse was slightly more common among primary HF hospitalizations compared with all‐cause hospitalizations (7.4 versus 6.4 per 1000; Cohen h=0.012; P<0.001). Among HF hospitalizations, patients with MethHF were younger (mean age, 48.9 versus 72.4 years; Cohen d=1.93; P<0.001), more likely to be on Medicaid (59.4% versus 8.8%; Cohen h=1.16; P<0.001) or uninsured (12.0% versus 2.6%; Cohen h=0.36; P<0.001), and more likely to present to urban hospitals (43.8% versus 28.3%; Cohen h=0.32; P<0.001) than patients with non‐methamphetamine associated HF. Patients with MethHF had higher rates of psychiatric comorbidities and were more likely to leave the hospital against medical advice.ConclusionsMethHF hospitalizations have significantly increased in the United States, particularly on the West Coast. Coordinated public health policies and systems of care are needed to address this rising epidemic.