Amount Of Prescriptions Research Articles

Implementation and Effectiveness of Opioid Prescribing Guidelines After Hiatal Hernia Repair

IntroductionWe defined institutional opioid prescribing patterns, established prescribing guidelines, and evaluated the adherence to and effectiveness of these guidelines in association with opioid prescribing after hiatal hernia repair (HHR). MethodsA retrospective chart review was completed for patients who underwent transthoracic (open) or laparoscopic HHR between January and December 2016. Patient-reported opioid use after surgery was used to establish prescribing recommendations. Guideline efficacy was then evaluated among patients undergoing HHR after implementation (August 2018 to June 2019). Data are reported in oral morphine equivalents (OMEs). ResultsThe initial cohort included n = 87 patients (35 open; 52 laparoscopic) with a 68% survey response rate. For open repair, median prescription size was 338 mg OME (interquartile range [IQR] 250-420) with patient-reported use of 215 mg OME (IQR 78-308) (P = 0.002). Similarly, median prescription size was 270 mg OME (IQR 200-319) with patient-reported use of 100 mg OME (IQR 4-239) (P < 0.001) for laparoscopic repair. Opioid prescribing guidelines were defined as the 66th percentile of patient-reported opioid use. Postguideline implementation cohort included n = 108 patients (36 open; 72 laparoscopic). Median prescription amount decreased by 54% for open and 43% laparoscopic repair, with no detectable change in the overall refill rate after guideline implementation. Patient education, opioid storage, and disposal practices were also characterized. ConclusionsEvidence-based opioid prescribing guidelines can be successfully implemented for open and laparoscopic HHR with a high rate of compliance and without an associated increase in opioid refills.

The Association Between Opioid Prescribing and Opioid-Related Mortality Within Neighborhoods in Ontario, Canada: A Case-Control Study.

Recent Canadian data show that the prescribing of opioids has declined while the number of opioid deaths continues to rise. This study aimed to assess the relationship between neighborhood-level opioid prescription rates and opioid-related mortality among individuals without an opioid prescription. This was a nested case-control study using data in Ontario from 2013 to 2019. Neighborhood-level data were analyzed by using dissemination areas that consist of 400-700 people. Cases were defined as individuals who had an opioid-related death without an opioid prescription filled in the year prior. Cases and controls were matched using a disease risk score. After matching, there were 2,401 cases and 8,813 controls. The primary exposure was the total volume of opioids dispensed within the individual's dissemination area in the 90 days before the index date. Conditional logistic regression was used to examine the association between opioid prescriptions and the risk of overdose. There was no significant association between the total volume of opioid prescriptions dispensed in a dissemination area and opioid-related mortality. In subgroup analyses stratifying the cohort into prescription and nonprescription opioid-related mortality, the number of prescriptions dispensed was positively associated with prescription opioid-related mortality. There was also a significant inverse association between the increased total volume of opioids dispensed and nonprescription opioid mortality. Our results suggest that prescription opioids dispensed within a neighborhood can have both potential benefits and harms. The opioid epidemic requires a nuanced approach that ensures appropriate pain care for patients while also creating a safer environment for opioid use through harm-reduction strategies.

ОЦЕНКА КАЧЕСТВА ТЕРМОСТАБИЛЬНЫХ НАЧИНОК С ИСПОЛЬЗОВАНИЕМ ЯБЛОЧНОГО ПОРОШКА

Currently, special attention is paid to the development of technologies for thermostable fillings, character-ized by high consumer properties, functional orientation, the ability to retain shape and consistency after exposure to high temperatures, and the absence of syneresis during storage. The purpose of these studies was to assess the quality of the thermostable properties of the filling from apples using their recycled prod-ucts in technology. The objects of the study were apple peel powder and prototypes of thermostable fillings with its use in technology. A technology has been developed for obtaining powder from apple peel as an additional source of biologically active substances, pectins and dietary fibers, with its subsequent use in the formulation of a thermostable filling. As experimental variants, samples of filling with sugar replace-ment with apple peel powder in the amount of 5%, 10%, 15% of the prescription amount of sugar were ob-tained. The control was a sample of apple jam with added sugar, brewed according to the traditional uni-fied technology. The addition of powder in the amount of 5 and 10 (%) of the amount of sugar introduced into the formulation makes the consistency more plastic, 15% - compacts the mass of the filling, gives it a tightening. The sample with 10% sugar powder replacement was characterized by the best specific shape stability and thermal stability, the worst - control at all temperature conditions, which was characterized by spreadability. The possibility of using apple powder in the technology of thermostable filling has been established. The sample with the addition of powder in an amount of 10% of the prescription sugar con-tent was characterized by the best quality.

Prolonged Opioid Usage Following Hip Fracture Surgery in Opioid-Naïve Older Patients

BackgroundWhile the risk of long-term dependence following the opioid treatment of musculoskeletal injury is often studied in younger populations, studies in older patients have centered on short-term risks such as oversedation and delirium. This study investigated prolonged opioid usage after hip fracture in older individuals, focusing on prevalence, risk factors, and changes over time. MethodsIn this retrospective cohort study of 47,309 opioid-naïve patients aged ≥ 60 years who underwent hip fracture surgery (2009 to 2020), outpatient opioid use was evaluated in 3 postoperative time periods: P1 (day 0 to 30 postsurgery); P2 (day 31 to 90); and P3 (day 91 to 180). The primary outcome was prolonged outpatient opioid use, defined as having one or more opioid prescriptions dispensed in all 3 time periods. ResultsThe incidence of prolonged opioid usage among patients surviving to P3 was 6.3% (2,834 of 44,850). Initial prescription quantities decreased over time, as did the risk of prolonged opioid usage (from 8.0% in 2009 to 3.9% in 2019). In the multivariable analyses, risk factors for prolonged opioid usage included younger age, women, current/former smoking, fracture fixation (as compared to hemiarthroplasty), and anxiety. Prolonged opioid usage was less common among patients who were Asian or had a history of dementia. ConclusionsWhile prior research on the hazards of opioids in the elderly has focused on short-term risks such as oversedation and delirium, these findings suggest that prolonged opioid usage may be a risk for this older population as well. As initial prescription amounts have decreased, declines in prolonged opioid medication usage have also been observed.

Impact of Postsurgical Opioid Prescription Reduction in General Surgery Patients.

Purpose: Recent studies suggest a large percentage of post-surgical opioid prescriptions are not utilized. This surplus of opioids provides supply for diversion or entry into the waste cycle. Recommendations are available for general surgery procedures which may optimize prescribed quantity while maintaining patient satisfaction which this work was initiated to investigate. Methods: This retrospective patient survey was conducted with Institutional Review Committee approval following adjustments to discharge opioid prescription quantities in an individual General Surgeon practice. Patients were contacted via phone to assess the impact of the reduced opioid quantities. Patients were categorized based on whether they utilized the entire prescription or opioid remained. Data collected include baseline demographics, inpatient stay characteristics, opioid use patterns, and satisfaction with overall pain control. The primary endpoint was to determine if patients were satisfied with their pain control based on response. Secondary endpoints included if patient characteristics could be identified that signal larger opioid quantity use, and whether unused opioids were disposed. Results: Thirty patients utilized all opioid prescribed, 60 had some quantity remaining. Baseline data appear similar aside from age with younger patients using more opioid. Patients were satisfied with their overall pain control in 93% of respondents. A total of 960 opioid tablets (11.4 ± 4.8 tabs/patient) were not prescribed, 8% required refill. Opioid disposal yet to occur in 85% of patients. Conclusion: An evidence-based reduction in opioid discharge prescriptions following general surgery procedures resulted in nearly 1000 opioid tablets not being dispensed without having a negative impact on patient satisfaction.

Formulation study of duloxetine hydrochloride enteric-coated tablets

During storage, duloxetine hydrochloride may have an unexpected cross reaction with enteric coated acrylic resin, which may affect the product quality. Solve the problem of cross-reaction between the Duloxetine enteric-coated tablets core and coated enteric materials and improve the quality of the products. Duloxetine enteric-coated tablets’ core formulation and isolation layer prescription were designed and compared with duloxetine enteric-coated tablets sold on the market. Then, we measured the dissolution rate, content, and releasing rate of prepared duloxetine enteric-coated tablets. In the formulation of tablets core, prescription 3 had advantages in particle mobility, disintegration time, and dissolution rate. Prescription 5 was stable during the coating process, and the dissolution residue in the cup was relatively good, showing obvious dissolution advantages. Thus, prescription 5 was selected as the isolation layer prescription. The most suitable adhesive for the preparation of Duloxetine hydrochloride enteric-coated tablets was povione K30 dissolved in ethanol solution with 1/2 of the prescription amount. When 1.3 g colloidal silica was added to the prescription and the dosage of magnesium stearate was 1.48 g, the dissolution rate of the drug could be relatively improved. The ratio of sucrose and talc was 138/8.7, which could effectively configure the coating solution with a solid content of 15–20% to make the coating smooth.

Evidence-Based Opioid Prescribing Guidelines and New Persistent Opioid Use After Surgery.

Evaluate the association of evidence-based opioid prescribing guidelines with new persistent opioid use after surgery. Patients exposed to opioids after surgery are at risk of new persistent opioid use, which is associated with opioid use disorder and overdose. It is unknown whether evidence-based opioid prescribing guidelines mitigate this risk. Using Medicare claims, we performed a difference-in-differences study of opioid-naive patients who underwent 1 of 6 common surgical procedures for which evidence-based postoperative opioid prescribing guidelines were released and disseminated through a statewide quality collaborative in Michigan in October 2017. The primary outcome was the incidence of new persistent opioid use, and the secondary outcome was total postoperative opioid prescription quantity in oral morphine equivalents (OME). We identified 24,908 patients who underwent surgery in Michigan and 118,665 patients who underwent surgery outside of Michigan. Following the release of prescribing guidelines in Michigan, the adjusted incidence of new persistent opioid use decreased from 3.29% (95% CI 3.15-3.43%) to 2.51% (95% CI 2.35-2.67%) in Michigan, which was an additional 0.53 (95% CI 0.36-0.69) percentage point decrease compared with patients outside of Michigan. Simultaneously, adjusted opioid prescription quantity decreased from 199.5 (95% CI 198.3-200.6) mg OME to 88.6 (95% CI 78.7-98.5) mg OME in Michigan, which was an additional 55.7 (95% CI 46.5-65.4) mg OME decrease compared with patients outside of Michigan. Evidence-based opioid prescribing guidelines were associated with a significant reduction in the incidence of new persistent opioid use and the quantity of opioids prescribed after surgery.

G. Khomych, A. Horobes, Yu. Nakonechna, I. Choni, N. Teslenko USE OF PECTIC -CONTAINING RAW MATERIALS IN DESSERT TECHNOLOGY

The article is devoted to the expansion of the assortment list of raw materials in the technology of food products and the use of pectin-containing fruit raw materials in the technology of desserts. The purpose of the article is to improve the technology of dessert products by using semi-finished products (puree, jelly juice) from blackcurrant, gooseberry, cranberry, chaenomeles fruits to enrich the nutritional and biological value, improve the structural and mechanical properties of finished products and maximize the resource potential of raw materials. The chemical composition of pectin-containing fruit raw materials and its processing products (pomace, puree, gelatinous juice) was studied and the presence of a high content of pectin and phenolic substances in their composition, which are mainly localized in the skin of fruits and berries. It is shown that gelling juices from fruit raw materials contain a higher content of pectin and phenolic substances compared to puree, which indicates the expediency of their use in the technology of jelly-like desserts. Based on the experimental studies, the effect of gelling juices from various types of pectin-containing fruit raw materials on the strength and structural-mechanical properties of desserts, and it was determined that the best indicators are characterized by samples of dessert products with the addition of 50% of gelling juice from the prescription amount of gelatin. The technology of making panna cotta dessert using gelatinous juices has been improved. It is recommended to use a compositional combination of gelling juice from pectin-containing fruit raw materials with gelatin as a structure- former to get a panna cotta dessert, because there is a complex interaction of pectin substances of fruit raw materials and gelatin, the nutritional and biological value of the finished products increases, the maximum use of the resource potential of the raw materials is achieved, which indicates the greening of production.

Evaluation of the prescription amount of narcotic analgesics based on cancer pain relief management

Abstract Background A basic plan for promoting pain relief management for cancer patients was formulated in Japan, and proper use of narcotic analgesics is being promoted to relieve cancer pain. We aimed to explore the relationship between age and opioid narcotic dose in cancer patients and examine the effects of healthcare systems and social policies to prevent opioid abuse and addiction in a national cohort in Japan. Methods Data were collected from April 2014 to March 2019 from the nationwide health insurance claims open database in Japan. Prescription data were collected for opium alkaloids and synthetic narcotics. A multivariate logistic regression analysis was performed based on the age groups and in- or out-of-hospital prescription quantities (mg), taking into account equivalences in quantities of opioids prescribed yearly on the hypothesized relationships between variables. Results The average annual quantities of opium alkaloid prescribed gradually decreased by 2.8% (mg = 10,249,115) over six years, especially in in-hospital prescriptions. On the other hand, in-hospital annual prescriptions of synthetic narcotics increased by 24.1% (mg = 2,135,568), out-of-hospital opium alkaloid by 1.3% (mg = 37,565,229), and synthetic narcotics by 25.9% (mg = 1,404,641). Among the demographic variables, cancer patients aged 65 years or older were significantly associated with the types of opioid variables (p &amp;lt; .001) and annual reductions in prescribed amounts (p &amp;lt; .001). Conclusions Treatment with opium alkaloids and synthetic narcotics increased among outpatients in the years examined; however, the trend varied across age groups. Our findings suggest that improvements in early detection and treatment have resulted in a rise in the number of cancer patient survivors, thereby leading to an increase in narcotic analgesic dose. The palliative care for cancer patients will contribute as an epidemiological indicator to review the evidence-based health-related impact on public health. Key messages • Treatments other than medical intervention should also be considered, taking into account the increase in the number of outpatient opioid prescription recipients due to increased cancer survival. • Social interventions to prevent opioid abuse during cancer pain relief will contribute to preventing substance abuse by promoting collaboration between clinicians and local communities.

Associations of early childhood medication exposure and molar incisor hypomineralization (MIH): A routine data analysis

ObjectivesMolar incisor hypomineralization (MIH) has become a major oral health problem of widely unknown origin. Besides genetic predisposition, exposure to certain drugs in early childhood are suspected to be associated with MIH. Aim of this routine data analysis was to examine associations of MIH and exposure to medication as well as perinatal factors. MethodsIndividuals with MIH were identified in claims data using a validated predefined specific treatment pattern. The database was a comprehensive routine data set of a major national health insurance company (BARMER, Germany). Based on this treatment pattern a MIH group and an unaffected control group were formed for analysis. Various medical data including medical diagnoses and prescriptions were available. Associations were examined comparing results for a set of variables in both groups. Differences between the groups were tested for significance using T-tests (P<0.01). ResultsBetween 2010 to 2019, a total of 298,502 children between 6 and 9 years of age were included in this analysis. 22,947 were assigned to the MIH group. For individuals in this group, significantly larger prescription quantities in the main ATC (Anatomical, Therapeutic, Chemical) groups J (antiinfectives for systemic use), R (respiratory system) and S (sensory organs) were found in the first 4 years of life compared to MIH unaffected individuals. With antibiotics, there were both significantly larger prescription quantities and significantly higher numbers of respective prescriptions in the first 4 years of life. The differences amounted up to about 10.62% in frequently used antibiotics to be found in ATC J01D (other beta-lactam antibacterials) for the number of prescriptions in the 4th year of life. No association was found for premature birth, mode of delivery or the use of antipyretic or anti-inflammatory medication. ConclusionsWhile perinatal factors do not seem to be associated with MIH development, early life exposure to antibiotics might play a role. Clinical Significance StatementAlthough causal relations can still not be proven, a responsible use of the unquestionably beneficial antibiotics is encouraged from a clinical point of view.

Effects of Opioid Prescribing Cap Laws on Opioid and Other Pain Treatments Among Persons with Chronic Pain.

Many states have adopted laws that limit the amount or duration of opioid prescriptions. These limits often focus on prescriptions for acute pain, but there may be unintended consequences for those diagnosed with chronic pain, including reduced opioid prescribing without substitution of appropriate non-opioid treatments. To evaluate the effects of state opioid prescribing cap laws on opioid and non-opioid treatment among those diagnosed with chronic pain. We used a difference-in-differences approach that accounts for staggered policy adoption. Treated states included 32 states that implemented a prescribing cap law between 2017 and 2019. A total of 480,856 adults in the USA who were continuously enrolled in medical and pharmacy coverage from 2013 to 2019 and diagnosed with a chronic pain condition between 2013 and 2016. Among individuals with chronic pain in each state: proportion with at least one opioid prescription and with prescriptions of a specific duration or dose, average number of opioid prescriptions, average opioid prescription duration and dose, proportion with at least one non-opioid chronic pain prescription, average number of such prescriptions, proportion with at least one chronic pain procedure, and average number of such procedures. State laws limiting opioid prescriptions were not associated with changes in opioid prescribing, non-opioid medication prescribing, or non-opioid chronic pain procedures among patients with chronic pain diagnoses. These findings do not support an association between state opioid prescribing cap laws and changes in the treatment of chronic non-cancer pain.

Development of technology for production of marshmallow with enhanced nutritional value

Pastilles, along with marmalade, are characterized by a high nutritional value compared to other confectionery products and are one of the most popular food products. However, the high sugar content and the use of coloring and flavoring food additives limits their use in the diet of pregnant and lactating women, as well as people leading a healthy lifestyle. The paper presents the results of research on the development of marshmallow technology enriched with dietary fiber, vitamins and minerals. The authors justified the reduction of the prescription amount of sugar by replacing part of it with Jerusalem artichoke syrup. At the same time, the amount of added sugar in the finished product decreases without worsening the properties of the products familiar to the consumer. Studies have also been conducted on the introduction of quince puree into the recipe of marshmallows and the replacement of part of applesauce with banana puree and chicory powder. Organoleptic quality indicators of the developed marshmallow were characterized by a pleasant pronounced aroma and taste. The analysis of the nutritional value of marshmallows showed that marshmallows with banana have a high content of dietary fiber (1.1 times), vitamins B1, B2, PP (1.1-1.6 times), carotene (2.8 times), as well as phosphorus (3 times), magnesium (1.9 times), calcium (b 1.3 times) and potassium (1.3 times), and marshmallows with quince - an increased content of dietary fiber (2.3 times), phosphorus (3 times), calcium (1.3 times), iron (1.1 times), magnesium (1.1 times), carotene (15.4 times), vitamin B2 (1.2 times) and C (2.6 times) in comparison with the control sample of marshmallow " Vanil'nyj". The presented marshmallow technologies can be recommended for the nutrition of pregnant and lactating women, as well as for expanding the range of pastille products of preventive nutrition

Predictors of opioid-free discharge after laparoscopic cholecystectomy

BackgroundPost-discharge opioid requirement after laparoscopic cholecystectomy (LC) is minimal, yet postoperative opioid prescriptions vary and opioid-free discharges are rare. Study DesignAdult patients who underwent LC from 01/2019-12/2019 were reviewed. Univariate and multivariable logistic regression analyses were performed to identify predictors of opioid-free discharge. ResultsOf 393 included patients, 330 were discharged with opioids (median 12 oxycodone 5 mg pills) and 63 were discharged without opioids. One opioid-free discharge patient called for a prescription. Older age (OR = 1.02, 95% CI = 1.002–1.041) and non-elective procedure (OR = 0.35, 95% CI = 0.2291–0.8521) were independent predictors of opioid-free discharge. ConclusionSignificant opportunities for opioid reduction or elimination after discharge from LC exist. Non-elective procedure and older age are predictors of opioid-free discharge, and should be considered when individualizing prescription quantities as surgeons strive to reduce or eliminate opioid overprescription.

Reduction in unnecessary postoperative opioid prescription among patients undergoing inpatient gynecologic surgery by standardizing postoperative prescribing practices (499)

<b>Objectives:</b> In this quality improvement initiative, we sought to reduce the amount of unutilized and unnecessary opioid prescriptions given to patients following gynecologic surgery. <b>Methods:</b> Opioid-naïve patients over the age of 18 years who underwent inpatient gynecologic surgery at our institution were included in this quality improvement initiative. A 3-month pre-intervention evaluation of the number of opioid pills prescribed, the number of pills taken, acetaminophen and non-steroidal anti-inflammatory taken, and additional refills, were obtained by contacting patients via phone 7-10 days following discharge. After 100 consecutive patients were contacted and data collected, we standardized discharge opioid prescriptions to supply a total of 10 tablets to eligible patients. One hundred patients were contacted in this post-intervention phase, and data were collected. Appropriate statistical tests were utilized to compare between the pre- and post-intervention groups. <b>Results:</b> A total of 197 patients completed our survey when contacted following discharge (97 pre-intervention, 100 post-intervention). In the pre-intervention group, the median number of opioids prescribed was 22 pills (range: 0-60) and in the post-intervention group was 10 (range 0-60) (p< 0.001). The median number of pills consumed pre-intervention was 2 (range: 0-51) and 3 in the postintervention group (range: 0-50) (p = 0.668). Among all 197 patients, 75 patients (38.1%) took no opioids following discharge (40.6% of patients pre-intervention, 35.6% of patients post-intervention). There were no differences among the pre- and post-intervention groups with respect to age, the type of procedure performed, type of incision, post-discharge acetaminophen consumed, post-discharge NSAID consumed, or additional pain medication refill. <b>Conclusions:</b> Standardizing prescribing patterns following inpatient gynecologic surgery dramatically reduces unnecessary and unused opioids while having no effect on opioid consumption or the need for a refill. More than one-third of patients undergoing gynecologic surgery require no opioids following discharge. Efforts to individualize opioid prescriptions are needed to further reduce unnecessary opioid prescriptions.

Preoperative Patient Education and Smaller Prescription Quantity Reduce Opioid Use After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: Results of a Prospective Study.

Most opioids prescribed postoperatively are unused. Leftover opioids are a major source of nonmedical opioid use among adolescents. Postoperative opioid use has also been associated with prescription quantity. Our purpose was to evaluate the effect of preoperative patient education and implementation of evidence-based prescribing guidelines on opioid use and pain level after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). AIS patients aged 10 to 17 years undergoing PSF were prospectively enrolled [postintervention cohort (POST-INT)]. Previous data on 77 patients showed median consumption of 29 doses of oxycodone after PSF [preintervention cohort (PRE-INT)]. All eligible patients during the study period were discharged with 30 doses of oxycodone and standard nonopioid analgesics. Only study participants received education on postoperative pain control. Demographics, radiographic/surgical data, pain level, and patient-reported outcomes were collected. Requests for opioid refills were documented. Forty-nine patients were enrolled. POST-INT was divided into low (L, ≤8 doses), average (AVE, 9-25), and high (H, >25) opioid use groups. Demographics, radiographic/surgical data, pain level, and patient-reported outcomes were similar between the groups. However, there was a difference in days of oxycodone use, doses consumed in the first week, and leftover doses ( P <0.001). Comparison to the PRE-INT L (≤16 doses), AVE (17 to 42), and high (H, >42) use groups showed that POST-INT L and AVE consumed less oxycodone (L: P =0.002; AVE: P <0.001). Also, the overall POST-INT cohort had fewer mean days of oxycodone use (5.6 vs. 8.9, P <0.001) and doses used in the first week (14 vs. 23, P <0.001) compared with the PRE-INT cohort. Subanalysis showed fewer study participants requested and received an opioid refill [3/49 patients (6%)] compared with eligible patients who declined to participate, withdrew, or missed enrollment [8/35 patients (23%)] ( P =0.045). Preoperative patient education and smaller prescription quantity successfully reduced opioid use while maintaining excellent pain control after PSF for AIS. Setting expectations regarding postoperative pain management is critical, as nonstudy participants were significantly more likely to request an opioid refill. Level II-therapeutic.

Long term effects of digital education among healthcare professionals in paediatric dermatology: Opportunities for improving care.

BackgroundTopical corticosteroids (TCS) are the cornerstone of treatment for patients with atopic dermatitis (AD). Unfortunately, anxiety and misplaced beliefs on TCS, known as corticophobia, is common among health care professionals (HCPs) and could influence their practices, resulting in suboptimal patient care.ObjectivesTo investigate the effects of digital education (DE) on the knowledge of TCS, practices and corticophobia among HCPs in paediatric dermatology.MethodsHCPs registered for an interactive online masterclass on paediatric dermatology including the treatment of AD and TCS were invited to participate in a survey on knowledge of TCS, self‐reported practices and corticophobia. Corticophobia was measured using the TOPICOP‐P questionnaire (range: 0%–100%, with higher scores indicating more corticophobia). Participants received the survey before, directly after, and 6 months after DE.ResultsOf the 86 participants, 66 (77%) completed the survey before the masterclass, 76 (88%) directly after, and 34 (40%) 6 months after. Key components of knowledge on TCS and self‐reported practices improved greatly after DE, such as correct prescription amount of TCS (45%, 91%, 88%) and application instructions (56%, 99%, 94%). Overall corticophobia decreased after DE with median scores dropping from 33% before DE to 25% after DE (p < 0.01) and remained 25% 6 months later.ConclusionInteractive DE for HCPs is an efficient tool to attain prolonged improvements of knowledge on TCS, practices, and corticophobia. All these factors are important for optimal care for patients. This study shows great opportunities for improving care by investing in HCPs.

Real-world pharmacological treatment of patients with postpartum depression in China from 2016 to 2020: A cross-sectional analysis

ObjectiveTo determine the use and tendency of drugs for postpartum depression (PPD) in nine cities across China in 2016–2020 in order to provide a reference for drug use in the clinic. MethodsThe prescription data of drugs for PPD outpatients in nine cities (Beijing, Chengdu, Guangzhou, Harbin, Hangzhou, Shanghai, Shenyang, Tianjin and Zhengzhou) across China in 2016–2020 were extracted from the Hospital Prescription Analysis Cooperation Project database of the Hospital Pharmacy Professional Committee of Chinese Pharmaceutical Association. A cross-sectional analysis was then conducted of patient age, total prescription quantity, average prescription amount, defined daily doses (DDDs) of drugs, defined daily cost (DDC) of drugs and so on. ResultsIn 2016–2020, more than half of PPD patients in these nine cities were distributed in first-tier cities (Beijing, Shanghai and Guangzhou), and were mainly aged 30–39 years. During the five-year period, the prescription quantity, total prescription amount and average prescription amount increased by 20.95%, 35.41% and 11.02%, respectively. In terms of prescription frequency and prescription amount, selective serotonin reuptake inhibitors (SSRIs) ranked first, followed by serotonin-norepinephrine reuptake inhibitors (SNRIs). With regard to DDDs, escitalopram, sertraline, paroxetine and venlafaxine ranked high, and sertraline was top year by year. The DDC of vortioxetine and milnacipran was greatest, while that of escitalopram, olanzapine and quetiapine declined sharply after being included in the China centralized drug-procurement program. ConclusionThe number of PPD patients and the total prescription amount in the nine cities across China increased in 2016–2020. SSRIs and SNRIs were the main drugs for PPD treatment. Due to the national centralized drug-procurement policy, there has been a great reduction in the DDC, lightening the economic burden on patients.

Prescription Patterns, Associated Factors, and Outcomes of Opioids for Operative Foot and Ankle Fractures: A Systematic Review.

Pain management after foot and ankle surgery must surmount unique challenges that are not present in orthopaedic surgery performed on other parts of the body. However, disparate and inconsistent evidence makes it difficult to draw meaningful conclusions from individual studies. In this systematic review, we asked: what are (1) the patterns of opioid use or prescription (quantity, duration, incidence of persistent use), (2) factors associated with increased or decreased risk of persistent opioid use, and (3) the clinical outcomes (principally pain relief and adverse events) associated with opioid use in patients undergoing foot or ankle fracture surgery? We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for our review. We searched PubMed, Embase, Scopus, Cochrane, and Web of Science on October 15, 2021. We included studies published from 2010 to 2021 that assessed patterns of opioid use, factors associated with increased or decreased opioid use, and other outcomes associated with opioid use after foot or ankle fracture surgery (principally pain relief and adverse events). We excluded studies on pediatric populations and studies focused on acute postoperative pain where short-term opioid use (< 1 week) was a secondary outcome only. A total of 1713 articles were assessed and 18 were included. The quality of the 16 included retrospective observational studies and two randomized trials was evaluated using the Methodological Index for Non-Randomized Studies criteria and the Jadad scale, respectively; study quality was determined to be low to moderate for observational studies and good for randomized trials. Mean patient age ranged from 42 to 53 years. Fractures studied included unimalleolar, bimalleolar, trimalleolar, and pilon fractures. Proportions of postoperative persistent opioid use (defined as use beyond 3 or 6 months postoperatively) ranged from 2.6% (546 of 20,992) to 18.5% (32 of 173) and reached 39% (28 of 72) when including patients with prior opioid use. Among the numerous associations reported by observational studies, two or more preoperative opioid prescriptions had the strongest overall association with increased opioid use, but this was assessed by only one study (OR 11.92 [95% confidence interval (CI) 9.16 to 13.30]; p < 0.001). Meanwhile, spinal and regional anesthesia (-13.5 to -41.1 oral morphine equivalents (OME) difference; all p < 0.01) and postoperative ketorolac use (40 OME difference; p = 0.037) were associated with decreased opioid consumption in two observational studies and a randomized trial, respectively. Three observational studies found that opioid use preoperatively was associated with a higher proportion of emergency department visits and readmission (OR 1.41 to 17.4; all p < 0.001), and opioid use at 2 weeks postoperatively was associated with slightly higher pain scores compared with nonopioid regimens (β = 0.042; p < 0.001 and Likert scale 2.5 versus 1.6; p < 0.05) in one study. Even after noting possible inflation of the harms of opioids in this review, our findings nonetheless highlight the need for opioid prescription guidelines specific for foot and ankle surgery. In this context, surgeons should utilize short (< 1 week) opioid prescriptions, regional anesthesia, and multimodal pain management techniques, especially in patients at increased risk of prolonged opioid use. Level III, therapeutic study.

Shifting practice in pediatric prescription opioid use in the emergency department for fractures

ObjectivesJudicious opioid use is important for balancing patient comfort and safety. Although opioid use is well studied in adult populations, pediatric opioid prescription practices are less understood and there are very few guidelines regarding its usage. The purpose of this study was to investigate pediatric opioid prescription trends by emergency medicine physicians over the last ten years, including assessing proxies for the adequacy of pain control and risk of any opioid-related adverse events including overdose. MethodsA retrospective analysis was performed of all patients age 0 to 18 who presented to an urban county hospital emergency department (ED) between 2007 and 2017 for acute fracture care. Data collected included age, opioids given in the ED, opioid prescriptions from the ED, adverse events, and secondary opioid prescriptions. Opioid prescription quantities were assessed in morphine equivalents (Meqs). ResultsOut of 4713 patients diagnosed with acute fracture, opioid prescriptions from the ED were given to 1772 patients (37.6%), with a mean quantity of 107.0 Meqs (SD = 69.1). Over the ten-year period studied, prescription rates declined from 54.8% in 2007 to 13.6% in 2017. Although 201 (4.3%) fracture patients had a second fracture-related ED visit, only 27 visits (0.57%) were for inadequate pain control, with no significant differences in year-to-year analysis. During the ten-year study period, there were zero opioid overdoses reported among pediatric fracture patients. ConclusionsA major shift has occurred in the last ten years, as emergency medicine physicians now favor non-opioid pain management regimens over opioids for the majority of pediatric fracture patients. There was no increase in the rate of inadequate pain control requiring a return to the ED, even as opioid prescription rates declined during the study period.

Prevalence of Chronic Opioid Use in the Elderly After Hip Fracture Surgery.

While interest has focused on opioid use after total hip arthroplasty, little research has investigated opioid use in elderly patients after hip fracture. We hypothesize that a substantial number of opioid-naïve elderly patients go on to chronic opioid use after hip fracture surgery. We reviewed a consecutive series of 219 patients 65 years and older who underwent surgical fixation between January 1, 2016 and February 28, 2019 for a native hip fracture. Patients were excluded for polytrauma, periprosthetic or pathologic fractures, recent major surgery, or death within 90 days of their hip surgery. The state prescription monitoring database was used to determine opioid use. Overall, 58 patients (26%) were postoperative chronic opioid users. Of the initial 188 opioid-naïve patients, 43 (23%) became chronic users. Of the 31 preoperative opioid users, 15 (48%) continued as chronic users. Chronic postoperative users were more likely to be White (76% vs 91%, P= .04), younger (78 vs 82 years, P= .003), and preoperative opioid users (odds ratio 3.3, P= .007). Arthroplasty vs fixation did not affect the rate of chronic opioid use (P= .22). Chronic opioid use is surprisingly common after hip fracture repair in the elderly. Twenty-three percent of opioid-naïve hip fracture patients became chronic users after surgery. Continued vigilance is needed by orthopedic surgeons to limit the amount and duration of postoperative narcotic prescriptions and to monitor for continued use.