Program Queries Research Articles

Does Gen-AI have a role in public affairs education? Let’s ask ChatGPT

The academic literature has expanded significantly in recent times to consider how Gen-AI is transforming the learning process. However, there still remain gaps in the literature, first in applying selected individual Gen-AI applications to classroom learning, and second in focusing upon specific uses in public administration education. In addressing this gap, this research uses a sequence of assignment scenarios to examine how Gen-AI may be integrated into pedagogical approaches and align with course learning objectives. Using the Gen-AI application ChatGPT– which is a popular choice for students to consult for course assignments– an examination of results generated from program queries point toward both opportunities and challenges from the perspectives of teaching (instructors) and learning (students). The below discussion contributes to the literature by first developing three assignment scenarios (linked to learning objectives) to explore the utility of Gen-AI in the learning process, and second discusses various teaching and learning benefits and challenges which are premised on the need for moderation and carefully planned usage of Gen-AI technology in the classroom. This blending of pedagogical theory and practice suggests a need for instructors to teach students about the implications of technology usage and assignment originality in unison with the actual topical coverage of the content that is being presented.

The Influence of Training Pathway, Institution Type, Gender, and a Global Pandemic on Post Graduation Career Plans in Plastic Surgery.

Anecdotal statements are often made about what percentage of residents go into fellowship versus private practice versus academia after graduation. However, few objective studies have been completed on this topic. This project is designed to shed light on the career choices of plastic surgery residents immediately after graduation from 2018 to 2022. A secondary objective was to determine whether the COVID-19 pandemic had any measurable impact on postgraduation plans. After obtaining institutional review board approval, publicly available data were obtained from institution websites or via program queries. Comparison between pre-COVID-19 and post-COVID-19 (2018-2019 versus 2020-2022), integrated versus independent, and private versus public cohorts were analyzed using Fisher exact test. A two-sided P value less than 0.01 was considered statistically significant. Data were collected for 690 graduates across 64 plastic surgery training programs. Responses were obtained from 60 of 88 (68%) integrated and 30 of 47 (64%) independent programs. Most graduates pursued fellowship training (61%), followed by private practice (28%), academic practice (5%), or military post (1%). Independent residents were more likely to pursue private practice (40% versus 26%, P = 0.001), whereas integrated residents were more likely to pursue fellowship (49% versus 70%, P < 0.0001). Public institution graduates were more likely to go into private practice (37% versus 23%, P = 0.0002), whereas private institution residents were more likely to pursue fellowship (55% versus 72%, P < 0.0001). Public institutions were more likely to graduate women (45% versus 35%, P = 0.009). The COVID-19 pandemic (P = 0.31) had no impact on postgraduation plans. This study demonstrates that training pathway and institution type have a significant impact on postgraduation plans, whereas a global pandemic does not. This information can be used by educators, residents, and medical students as they plan for the future.

6. The Influence of Integrated vs Independent Pathway and Hospital Type on Plastic Surgery Post-Residency Plans Unchanged by Global Pandemic

Background: Statements are often made about what percentage of plastic surgery (PRS) residents go into fellowship vs. private practice vs. academia after graduation. However, few objective studies have been completed. This project is designed to illuminate career choices of PRS residents immediately after graduation from 2018-2022 and secondarily, determine if the pandemic had any measurable impact. Methods: Publicly available data was obtained from institution websites or program queries. Demographic data was collected including sex/gender, training pathway, primary residency, length of training, and post-residency fellowship vs private practice job vs academic job vs military appointment. Comparison of percentages between pre-Covid and post-Covid (2018-19 vs 2020-22), training pathways (independent vs integrated), institution type (private vs public) and program rank (per Doximity) were analyzed using Fisher’s exact test. P values were 2-sided and comparisons with P < 0.01 were considered significant. Statistical analysis was performed using SAS software. Results: Data was collected for 691 graduates across 64 training programs (28% independent, 71% integrated). Most graduates pursued fellowship-training (61%) followed by 28% direct to private practice, 5% direct to academic practice and 1% assumed a military post. Independent residents were more likely to pursue private practice (40%vs.26%, p=0.001), while integrated residents were more likely to pursue additional fellowship training (49%vs70%, p<0.0001). Public institution graduates are more likely to go into private practice (37%vs.23%, p=0.0002), while private institution residents are more likely to pursue fellowship (55%vs.72%, p<0.0001). However, pandemic (p=0.31) and institutional rank (p=0.11) showed no association. Conclusion: In this report, we present career choice trends amongst PRS trainees. We found independent residents more likely to pursue private practice, perhaps due to prolonged training period (minimum 8 years vs 6 years), while integrated residents were more likely to pursue fellowship training. Public/State institution graduates were more likely to pursue private practice, potentially influenced by more exposure to community faculty than trainees in private academic settings. This study demonstrates that training pathway and institution type have a significant impact on post-graduation plans, whereas global pandemic and institutional rank do not. This information can be used by programs and students as they plan for the future.

TrExoLiSTS: Transiting Exoplanets List of Space Telescope Spectroscopy

We present the Space Telescope Science Institute Wide Field Camera 3 (WFC3) project webpage, Transiting Exoplanets List of Space Telescope Spectroscopy, TrExoLiSTS. It tabulates existing observations of transiting exoplanet atmospheres, available in the MAST archive made with Hubble Space Telescope (HST) WFC3 using the stare or spatial scan mode. A parallel page is available for all instruments aboard James Webb Space Telescope (JWST) using the spectral Time Series Observation mode. The webpages include observations obtained during primary transits, secondary eclipses and phase curves. TREXOLISTS facilitates proposal preparation for programs that are highly complementary to existing programs in terms of targets, wavelength coverage, as well as reduces duplication and redundant effort. Reference for the quality of the HST WFC3 visits taken more than 1.5 yr ago are made available via including diagrams of the direct image, white light curve and drift of the spectral time series across the detector. Future improvements to the webpage will include: Expanding program query to other HST instruments and reference for the quality of JWST visits.

Effect of Integrating Access to a Prescription Drug Monitoring Program Within the Electronic Health Record on the Frequency of Queries by Primary Care Clinicians

Tools that are directly integrated with the electronic health record (EHR) workflow can reduce the hassle cost of certain guideline-concordant practices, such as querying a prescription drug monitoring program (PDMP) before prescribing opioids. To investigate the effect of integrating access to a PDMP within the EHR on the frequency of program queries by primary care clinicians. The PRINCE (Prescribing Interventions for Chronic Pain Using the Electronic Health Record) randomized trial used a factorial cluster design at the clinic level in 43 primary care clinics in Minnesota. In all, 309 clinicians participated; 161 clinicians were given EHR-integrated access to PDMP at the intervention clinics, and 148 clinicians had the usual access at the control clinics. The intervention went live on August 27, 2020, and data were collected through March 3, 2021. Single sign-on access to the Minnesota PDMP was integrated into the EHR, allowing clinicians to query a patient's controlled substance prescription and dispensing history as recorded in the Minnesota PDMP directly from the patient's EHR record without logging into a separate web portal. Additionally, the integration tool alerted clinicians and reminded them to review the PDMP if a patient had 3 or more opioid prescriptions in the past year and 1 or more in the past 6 months. Clinics in the control group did not receive access to the EHR-integrated PDMP tool; instead, these participants logged into the PDMP web portal separately. Monthly PDMP query counts for primary care clinicians, overall and by modality (EHR-based, web-based, via a clinical delegate), adjusted for clinician characteristics, including type (physician, nurse practitioner, physician assistant), sex, and years in practice. Data were analyzed from August 2021 to May 2022. Of the 43 participating clinics with 309 clinicians, 21 clinics with 161 clinicians (102 [63.4%] women; 114 [70.8%] physicians; tenure, 10.6 [4.4] years) received the PDMP integration intervention. Baseline unadjusted monthly PDMP query rates for the average clinician were 6.6 (95% CI, 4.4-9.9) vs 8.8 (95% CI, 6.0-13.1) queries in the control vs the PDMP integration group, respectively. During the intervention, PDMP query rates for the average clinician were 6.9 (95% CI, 4.7-10.3) vs 14.8 (95% CI, 10.0-22.0) queries among the control vs the PDMP integration group, respectively. Compared with the control group, the EHR-integrated PDMP tool produced a 60% greater increase in the relative change in monthly PDMP queries (95% CI, 51%-70%). An increase in PDMP queries via the EHR-integrated PDMP tool drove this increase, while web-based and delegate queries declined by 39% more among the intervention compared with the control group (95% CI, 34%-43%). This cluster randomized clinical trial found that integrating access to the PDMP in the EHR increased PDMP-querying rates, suggesting that direct access reduced hassle costs and can dramatically improve adherence to guideline-concordant care practices among primary care clinicians. ClinicalTrials.gov Identifier: NCT04601506.

Effects of State Opioid Prescribing Laws on Use of Opioid and Other Pain Treatments Among Commercially Insured U.S. Adults.

There is concern that state laws to curb opioid prescribing may adversely affect patients with chronic noncancer pain, but the laws' effects are unclear because of challenges in disentangling multiple laws implemented around the same time. To study the association between state opioid prescribing cap laws, pill mill laws, and mandatory prescription drug monitoring program query or enrollment laws and trends in opioid and guideline-concordant nonopioid pain treatment among commercially insured adults, including a subgroup with chronic noncancer pain conditions. Thirteen treatment states that implemented a single law of interest in a 4-year period and unique groups of control states for each treatment state were identified. Augmented synthetic control analyses were used to estimate the association between each state law and outcomes. United States, 2008 to 2019. 7694514 commercially insured adults aged 18 years or older, including 1976355 diagnosed with arthritis, low back pain, headache, fibromyalgia, and/or neuropathic pain. Proportion of patients receiving any opioid prescription or guideline-concordant nonopioid pain treatment per month, and mean days' supply and morphine milligram equivalents (MME) of prescribed opioids per day, per patient, per month. Laws were associated with small-in-magnitude and non-statistically significant changes in outcomes, although CIs around some estimates were wide. For adults overall and those with chronic noncancer pain, the 13 state laws were each associated with a change of less than 1 percentage point in the proportion of patients receiving any opioid prescription and a change of less than 2 percentage points in the proportion receiving any guideline-concordant nonopioid treatment, per month. The laws were associated with a change of less than 1 in days' supply of opioid prescriptions and a change of less than 4 in average monthly MME per day per patient prescribed opioids. Results may not be generalizable to non-commercially insured populations and were imprecise for some estimates. Use of claims data precluded assessment of the clinical appropriateness of pain treatments. This study did not identify changes in opioid prescribing or nonopioid pain treatment attributable to state laws. National Institute on Drug Abuse.

Remote interviews for medical residency selection during the initial COVID-19 crisis: a national survey

BackgroundMedical training programs candidate’s interview is an integral part of the residency matching process. During the coronavirus disease 2019 (COVID-19) pandemic, conducting these interviews was challenging due to infection prevention restrains (social distancing, namely) and travel restrictions. E-interviews were implemented by the Saudi Commission for Healthcare Specialties (SCFHS) since the matching cycle of March 2020 to hold the interviews in a safer virtual environment while maintaining the same matching quality and standards.AimThis study was conducted to assess the medical training residency program applicants’ satisfaction, stress, and other perspectives for the (SCFHS) March 2020 Matching-cycle conducted through an urgently implemented E-interviews process.MethodA cross-sectional, nationwide survey (Additional file 1) was sent to 4153 residency-nominated applicants to the (SCFHS) March 2020 cycle.ResultsAmong the 510 candidates who responded, 62.2% applied for medical specialties, 20.2% applied for surgical specialties, and 17.6% applied for critical care and emergency specialties. Most respondents (61.2%) never had previous experience with web-based video conferences. Most respondents (80.2%) used the Zoom application to conduct the current E-interviews, whereas only 15.9% used the FaceTime application. 63.3% of the respondents preferred E-interviews over in-person interviews, and 60.6% rated their experience as very good or excellent. 75.7% of the respondents agreed that all their residency program queries were adequately addressed during the E-interviews. At the same time, 52.2% of them agreed that E-interviews allowed them to represent themselves accurately. 28.2% felt no stress at all with their E-interviews experience, while 41.2% felt little stressed and only 8.2% felt highly stressed. The factors that were independently and inversely associated with applicants’ level of stress with E-interviews experience were their ability to represent themselves during the interviews (p = 0.001), cost-savings (p < 0.001), their overall rating of the E-interviews quality (p = 0.007) and the speed of the internet connection (p < 0.006).ConclusionVideoconferencing was implemented on an urgent basis during the COVID-19 pandemic in the medical residency application process in Saudi Arabia. It was perceived as an adequate and promising tool to replace in-person interviews in the future. Applicants’ satisfaction was mainly driven by good organization, cost-saving, and their ability to present themselves. Future studies to enhance this experience are warranted.

Factors Related to Prescription Drug Monitoring Program Queries for Veterans Receiving Long-Term Opioid Therapy.

State prescription drug monitoring programs (PDMPs) identify controlled medications dispensed across providers and systems. Department of Veterans Affairs (VA) policy requires electronic health record documentation of PDMP queries at least annually for VA patients receiving controlled medications; however, queries are not uniformly conducted. We examined factors associated with PDMP queries for veterans receiving long-term opioid therapy. Veterans with a VA provider who received long-term opioid therapy between August 2015 and August 2016 within a four-state region were identified; 9,879 were due for a PDMP query between August 2016 and February 2017. Likelihood of veterans' PDMP queries during this follow-up period was modeled as a function of patient, provider, and facility characteristics of interest in mixed-effects modified Poisson models estimating relative risk and 95% confidence intervals. Multivariable models controlled for potential confounders identified through the use of directed acyclic graphs. PDMP queries were documented for 62.1% of veterans that were due for a PDMP query. Veterans were more likely to be queried if they were Hispanic or if they received methadone, had average daily milligram morphine equivalents >20, or received urine drug screening during the studied period. Veterans were less likely to be queried if they had a rural address, mail order medication, or cancer diagnosis. Likelihood of PDMP queries was also lower for veterans whose opioid-prescribing provider was an oncologist or working in a low-complexity facility. Adherence to PDMP query policy within the VA varied by patient, clinician, and facility factors. Mechanisms to standardize the conduct of PDMP queries may be needed.

Opioid Prescribing and Opioid Risk Mitigation Strategies in the Veterans Health Administration.

The Veterans Health Administration (VHA) has taken a multifaceted approach to addressing opioid safety and promoting system-wide opioid stewardship. To provide a comprehensive evaluation of current opioid prescribing practices and implementation of risk mitigation strategies in VHA. VHA is the largest integrated health care system in the United States. VHA prescribing data in conjunction with implementation of opioid risk mitigation strategies are routinely tracked and reviewed by VHA's Pharmacy Benefits Management Services (including Academic Detailing Service) and the Pain Management Program Office. Additional data are derived from the Partnered Evidence-Based Policy Resource Center (PEPReC) and from a 2019 survey of interdisciplinary pain management teams at VHA facilities. Prescribing data are reported quarterly until first quarter fiscal year 2020 (Q1FY2020), ending December 31, 2019. VHA opioid dispensing peaked in 2012 with 679,376 Veterans receiving an opioid prescription, and when including tramadol, in 2013 with 869,956 Veterans. Since 2012, the number of Veterans dispensed an opioid decreased 56% and co-prescribed opioid/benzodiazepine decreased 83%. Veterans with high-dose opioids (≥ 100 mg morphine equivalent daily dose) decreased 77%. In Q1FY2020, among Veterans on long-term opioid therapy (LTOT), 91.1% had written informed consent, 90.8% had a urine drug screen, and 89.0% had a prescription drug monitoring program query. Naloxone was issued to 217,469 Veterans and resulted in > 1,000 documented overdose reversals. In 2019, interdisciplinary pain management teams were fully designated at 68%, partially designated at 28%, and not available at 4% of 140 VA parent facilities. Fifty percent of Veterans on opioids at very high risk for overdose/suicide received interdisciplinary team reviews. VHA clinicians have greatly reduced their volume of opioid prescribing for pain management and expanded implementation of opioid risk mitigation strategies. VHA's integrated health care system provides a model for opioid stewardship and interdisciplinary pain care.

Examining the Effect of a Whole Health Primary Care Pain Education and Opioid Monitoring Program on Implementation of VA/DoD-Recommended Guidelines for Long-term Opioid Therapy in a Primary Care Chronic Pain Population.

To describe the core elements of a Whole Health Primary Care Pain Education and Opioid Monitoring Program (PC-POP) and examine its effectiveness at increasing adherence to six of the Veteran Affairs/Department of Defense (VA/DoD) recommended guidelines for long-term opioid therapy (LOT) among chronic noncancer patients seen in primary care (i.e., urine drug screens [UDS], prescription drug monitoring program [PDMP] queries, informed consent, naloxone education/prescriptions, morphine equivalent daily dose [MEDD], and referrals to nonpharmacological pain interventions). A within-subjects comparison of outcomes was conducted between pre- and post-PC-POP enrollees (N = 25), as was a a between-subjects comparison to a comparison group (N = 25) utilizing a six-month range post-index date of 10/1/2018 (i.e., between-subjects comparison at Time 2). A convenience sample of adult veterans with chronic noncancer pain receiving opioid therapy consecutively for the past three months in primary care. Results showed increased concordance with VA/DoD guidelines among those enrolled in the PC-POP, characterized by increased documentation of urine drug screens, prescription drug monitoring program queries, informed consent, naloxone education/prescriptions, and a decrease in MEDD among patients enrolled in the PC-POP. The PC-POP shows promise for increasing guideline-concordant care for providers working in primary care.

Opioid prescription practice behavior among medical and surgical specialty physicians

ABSTRACT Background: The overprescribing of opioids is growing and prescribing rates are highest among pain medicine and surgical specialties. Objective: To evaluate the opioid prescription practice behavior among medical specialty physicians (MSP) and surgical specialty physicians (SSP). Methods: A survey was sent to all physicians at two major institutions. The primary outcome measure was total opioid prescription rate and duration per specialty. The secondary outcome measure was pre-evaluation, counseling, multimodal pain management, and Prescription Drug Monitoring Program (PDMP) query rate. Result: 84.0% (n = 217) of MSP and 93.0% (n = 129) of SSP prescribed opioids during the past year. Prescribing opioids for >2 weeks was significantly more common in MSP vs. SSP (34% vs.14%, p < .001). More MSP than SSP expressed concerns about patients developing opioid dependence (90% vs. 77%, p = .004). MSPs were more likely than SSPs to evaluate the patient’s history of substance abuse and to provide counseling for proper opioid use and disposal (p < .05). Only 58% (N = 176) of the MSP and 50% (N = 63) of SSP queried the PDMP every time before prescribing opioids (p = .092). Conclusion: >2- week opioid prescriptions were significantly more common in MSP, but they were also much more likely to thoroughly discuss opioid use and abuse with patients compared to SSP. A more compliant use of PDMP is encouraged.

Changes in Opioid Prescribing Patterns: A Survey of the Florida Society of Plastic Surgeons.

With thousands of people in the United States dying of opioid overdose each month, the opioid epidemic has become a serious public health concern. Legislators have attempted to address this problem at various levels of the government. Evaluation of outcomes of these measures is a necessary part of resolving the epidemic. Our survey was designed to evaluate the impact of measures enacted in Florida State in 2018 upon prescribing practices of plastic surgeons. The survey was prepared electronically using the online Qualtrics platform. Survey questions were multiple choice and inquired regarding changes in prescribing practices after enactment of mandatory query of the prescription drug monitoring program database and prescribing limits in Florida. The survey was distributed by e-mail 1 year after these laws took effect. Two survey reminder e-mails were sent at 2-week intervals after the initial message. Results were collected for an additional 3 weeks after the final correspondence. Thirty-two survey responses were received after distribution to the 156 members of the Florida Society of Plastic Surgeons, for a response rate of 20.5%. Twenty-two respondents reported changing their prescribing practices. The most common change reported was decreased number of tablets prescribed. Most respondents reported they believe that mandatory prescription drug monitoring program query and prescribing limits will be effective. This included 17 (53.1%) and 18 (56.3%) respondents, respectively. Results from our survey indicate that Florida plastic surgeons have adjusted their prescribing practices in response to recently enacted legislation. Most plastic surgeons reported decreased number of tablets of opioids prescribed. Many also reported incorporating nonopioid analgesics. Further study will be necessary to determine the impact of these changes on rates of opioid overdose.

An Analysis of Specialty-Specific Microsurgical Head and Neck Reconstruction: A Look at a Single Institution and National Trends Over a Decade.

Head and neck free flap (HNFF) reconstructions have historically utilized a multidisciplinary approach between otolaryngology head and neck surgery (OHNS) and plastic surgery (PS). However, there seems to be a trend toward both the extirpative and reconstructive portions being performed by OHNS. We aimed to elucidate the volume trend in HNFF reconstruction over the last decade. Data were collected by 3 modalities: electronic medical record search of patients who underwent HNFF surgery at our institution (2013-2018), survey data from microsurgery fellowship programs (2007-2017), and National Surgical Quality Improvement Program (NSQIP) query of cases receiving designated HNFF Current Procedural Terminology codes (2011-2016). Data were analyzed with trends in HNFF reconstruction as our primary outcome. At our institution, HNFF reconstructions increased 4-fold (59-227). Percentage of cases by PS decreased from 18.6% to 6.0%, whereas that of OHNS increased 81.4% to 94.0% (P = 0.009). Survey data, completed by microsurgery fellowship program directors (23/81 [27.2%]), revealed the number of OHNS programs in 2007 performing 100 or more HNFF cases compared with PS was 40% (6/15) to 12.5% (1/8) (P = 0.172). By 2016, that number increased significantly for OHNS to 73.3% (11/15), whereas that of PS remained stagnant at 12.5% (1/8) (P = 0.005). According to NSQIP data, the percentage of cases performed by PS in 2011 was 52%, which was greater than OHNS's share of 43%. The other 5% was allotted to either orthopedic, oral and maxillofacial surgery, or general surgery. In 2013, those numbers reached a peak for PS at 55% and a nadir for OHNS at 36%. However, by 2016, the percentage of HNFF cases reversed. where 58% of cases were performed by OHNS and only 38% by PS. When comparing the 2011 data to the 2016 data, OHNS had a 134% increase, whereas PS had a 27% decrease (P = 0.003). Head and neck free flap reconstruction has grown dramatically over the last 10 years. Plastic surgeons are performing fewer cases, whereas otolaryngology head and neck surgeons perform more as indicated by institutional, microsurgery fellowship program director survey, and NSQIP data.

Automatic force plate contact detection protocol for computerized gait analysis

BackgroundThe usability and evaluability of a computerized gait analysis requires correct force plate foot contact, with the force measuring plates embedded in the ground, in order to obtain kinetic data. Research questionThis article describes a technical development that facilitates the process flow of computerized gait analysis. Software has been developed that automatically recognizes, counts and documents the correct force plate foot contacts MethodsA software program has been developed. Programming was done in Microsoft® C# using the ViconDatastreemSDK.dotNet® Dynamic Link Library (DLL) developed by Vicon®. The program queries the positions of the foot markers and the electrical signals of the force plates. Results and significanceThe program, which runs parallel to the Vicon® data acquisition software, simultaneously displays the information about the correct force plate foot contacts in a graphical user interface (GUI). After the measurement, an automatically generated protocol of the evaluable walks is available in tabular form

Order From Chaos: An Initiative to Improve Opioid Prescribing in Rheumatology Using Lean A3.

ObjectiveUse an established quality improvement method, Lean A3, to improve the process of opioid prescribing in an academic rheumatology ambulatory clinic.MethodsThis retrospective pre‐postintervention analysis of rheumatology records included patients prescribed opioids at least once during the study period. Lean A3 was used to develop a Controlled Substance Visit Protocol to standardize eight recommended elements of the opioid prescribing workflow. Analyses included changes in the recommended workflow elements and changes in opioid prescribing volume.ResultsImprovements were observed in seven of the eight recommended elements. Patient education, including treatment agreements and consent forms (39% completion for both preimplementation) increased to 78% and 80%, respectively (P < 0.001 for both). Risk assessment, as measured by the Current Opioid Misuse Measure, increased from 0.5% to 76% (P < 0.001). Best practices in prescribing, including prescribing in multiples of seven to avoid weekend refill requests, increased from 1% to 79% (P < 0.001). Monitoring parameters, including standardized functional assessment (0% vs. 86%), prescription drug monitoring program queries (49% vs. 84%), and urine testing (1% vs. 32%) all increased (P < 0.001). Visits scheduled at least quarterly for patients on chronic opioids did not change (P = 0.18). Overall, the number of patients prescribed opioids (185 vs. 160; P < 0.001) and annual prescription opioid morphine milligram equivalents (MMEs) (1 933 585 MME vs. 1 386 368 MME; P < 0.001) decreased.ConclusionThe Lean A3 method is a successful quality improvement tool for improving and sustaining opioid prescribing within a single academic rheumatology clinic. This method has potential applicability to similar clinics interested in improving opioid prescribing.

EventDB: an event-based indexer and caching system for BESIII experiment

Beijing Spectrometer (BESIII) experiment has produced hundreds of billions of events. The traditional event-wise accessing of BESIII Offline Software System is not effective for the selective accessing with low rate during a physics analysis. In this paper, an event-based data management system (EventDB) is introduced, which can effectively alleviate the problems of low efficiency of data processing and low utilization of resources. Firstly, an indexing system based on NoSQL database is designed. By extracting specified attributes of events, the events interested to the physicists are selected and stored into the database, whilst the real data of event is still stored in ROOT files. For those hot events, the real event data can also be cached into EventDB to improve the access performance. The data analysis workflow of HEP experiments is needed to change if the EventDB system is applied. The analysis program queries the corresponding event index from database, then get event data from database if the event is cached, or get data from ROOT files if it is not cached. Finally, the test on more than one hundred billion physics events shows the query speed was greatly improved over traditional file-based data management systems.

Adaptive Static Analysis via Learning with Bayesian Optimization

Building a cost-effective static analyzer for real-world programs is still regarded an art. One key contributor to this grim reputation is the difficulty in balancing the cost and the precision of an analyzer. An ideal analyzer should be adaptive to a given analysis task and avoid using techniques that unnecessarily improve precision and increase analysis cost. However, achieving this ideal is highly nontrivial, and it requires a large amount of engineering efforts. In this article, we present a new learning-based approach for adaptive static analysis. In our approach, the analysis includes a sophisticated parameterized strategy that decides, for each part of a given program, whether to apply a precision-improving technique to that part or not. We present a method for learning a good parameter for such a strategy from an existing codebase via Bayesian optimization. The learnt strategy is then used for new, unseen programs. Using our approach, we developed partially flow- and context-sensitive variants of a realistic C static analyzer. The experimental results demonstrate that using Bayesian optimization is crucial for learning from an existing codebase. Also, they show that among all program queries that require flow- or context-sensitivity, our partially flow- and context-sensitive analysis answers 75% of them, while increasing the analysis cost only by 3.3× of the baseline flow- and context-insensitive analysis, rather than 40× or more of the fully sensitive version.

Assessment of outcomes following high-dose opioid tapering in a Veterans Healthcare System.

To assess the impact of tapering of chronic high dose opioid therapy in veterans prompted by the implementation of the Opioid Safety Initiative in 2013. IRB and VA Office of Research and Development-approved retrospective, observational chart review. North Florida/South Georgia Veterans Health System Patients: Veterans on high dose opioid therapy (≥300 mg of morphine equivalents per day) for chronic non-cancer pain as of 1/1/2012 with an opioid agreement discontinuation note documented in the medical record were included. Veterans treated for cancer pain or under palliative care were excluded. Descriptive outcomes include rate of opioid discontinuation, average duration of tapering, and rate of relapse. Differences before and after discontinuation assessed include healthcare utilization, monitoring via urine drug screens and state prescription drug monitoring program (PDMP) queries, non-opioid analgesics, benzodiazepines, and non-pharmacologic modalities. Forty-three patients were included. The mean duration of therapy was 7.8 years and 81.4 percent were on methadone prior to tapering. Opioids were tapered to discontinuation in 28 patients (65 percent) with long-term abstinence in 71 percent. The mean duration of tapering was 81 days and the median/mode was 30 days. Statistically significant differences after tapering include decreased PDMP queries, increased non-opioid analgesics, decreased benzodiazepine prescriptions, and increased use of mental health services (p < 0.05). There were zero adverse outcomes identified in those tapered and one death in the group who sought non-VA care for continuation. This study suggests that moderate speed tapering in high-risk veterans on chronic high-dose opioid therapy can be achieved, but caution is warranted in ensuring adequate follow-up and monitoring. Clinical pharmacy services may improve tapering outcomes by providing more frequent follow-up, monitoring via state PDMP queries to identify patients who have relapsed, and dispensing naloxone for increased safety.

Effect of Automated Prescription Drug Monitoring Program Queries on Emergency Department Opioid Prescribing

We assess whether an automated prescription drug monitoring program intervention in emergency department (ED) settings is associated with reductions in opioid prescribing and quantities. We performed a retrospective cohort study of ED visits by Medicaid beneficiaries. We assessed the staggered implementation (pre-post) of automated prescription drug monitoring program queries at 86 EDs in Washington State from January 1, 2013, to September 30, 2015. The outcomes included any opioid prescribed within 1 day of the index ED visit and total dispensed morphine milligram equivalents. The exposure was the automated prescription drug monitoring program query intervention. We assessed program effects stratified by previous high-risk opioid use. We performed multiple sensitivity analyses, including restriction to pain-related visits, restriction to visits with a confirmed prescription drug monitoring program query, and assessment of 6 specific opioid high-risk indicators. The study included 1,187,237 qualifying ED visits (898,162 preintervention; 289,075 postintervention). Compared with the preintervention period, automated prescription drug monitoring program queries were not significantly associated with reductions in the proportion of visits with opioid prescribing (5.8 per 1,000 encounters; 95% confidence interval [CI] -0.11 to 11.8) or the amount of prescribed morphine milligram equivalents (difference 2.66; 95% CI -0.15 to 5.48). There was no evidence of selective reduction in patients with previous high-risk opioid use (1.2 per 1,000 encounters, 95% CI -9.5 to 12.0; morphine milligram equivalents 1.22, 95% CI -3.39 to 5.82). The lack of a selective reduction in high-risk patients was robust to all sensitivity analyses. An automated prescription drug monitoring program query intervention was not associated with reductionsin ED opioid prescribing or quantities, even in patients with previous high-risk opioid use.

Influence of hypertension, diabetes, hyperlipidemia, and obstructive lung disease on multiple sclerosis disease course

Background: Comorbidities are known to affect multiple sclerosis (MS) patients in a number of ways, including delaying time to diagnosis and reducing health-related quality of life. Objective: To determine the impact of hypertension, hyperlipidemia, diabetes mellitus, and obstructive lung disease on disease course in MS patients. Methods: The Knowledge Program is a database linked to our electronic medical record allowing capture of patient and clinician reported outcomes. Through Knowledge Program query and chart review, we identified all relapsing-remitting MS patients seen between 1 January 2010 and 29 May 2012 and acquired their magnetic resonance imaging (MRI) results and comorbidities. Linear and logistic regression models with adjustment for important covariates were used to determine whether the comorbidities affected outcomes over a 3-year period. Results: Hypertension, diabetes, and obstructive lung disease, but not hyperlipidemia, impacted clinical outcomes, including walking speed, self-reported disability, and depression. Hypertension had the greatest effect. The presence of multiple comorbidities had a cumulative effect on clinical outcomes. MRI outcomes were unaffected by comorbidities. Conclusion: This 3-year longitudinal study revealed that all comorbidities tested except hyperlipidemia impacted clinical outcomes and a cumulative effect with multiple comorbidities was observed. Consideration of comorbid conditions is essential in MS patient care.