Publications

BACKGROUND: Opioid prescribing to post-operative patients in the acute hospital setting is well described; however, little is known about use of opioids in inpatient rehabilitation (IPR) settings. Understanding how opioids are prescribed across all inpatient settings is important to optimize opioid stewardship. The aim of this study was to determine the percentage of post-operative orthopedic patients prescribed opioids and prescribing patterns on discharge from an IPR ward.

DESIGN: Single-center retrospective audit.

SETTING: Tertiary metropolitan hospital.

PATIENTS: Patients who underwent an orthopedic surgical procedure between January and July 2020 and were subsequently transferred to an IPR center under the same health service.

MAIN OUTCOME MEASURES: Opioid prescribing data were obtained at three time points: on admission to the acute hospital, at the time of transfer from the acute hospital to IPR, and at the time of discharge from IPR. Doses were reported in oxycodone equivalent doses.

RESULTS: Of the 117 patients who were included in the audit (median age 84 years, median length of hospital stay 23 days), 115 (98 percent) were prescribed an opioid at the time of discharge from the acute hospital to IPR, and 69 patients (59 percent) were discharged from IPR with a prescription for an opioid.

CONCLUSIONS: A significant proportion of patients admitted to IPR were discharged with a prescription for an opioid. Further research is required to determine the appropriateness of continued opioid use in these patients, and ways to reduce the exposure of patients to opioids during and following IPR should be explored.

OBJECTIVE: The effects of opioid use disorder (OUD) are devastating and wide-ranging. Although the information in the >43,000 manuscripts on OUD are searchable, gaining a comprehensive grasp of this information is out of reach to most persons. We present a pilot study to use published data on OUD, repurpose it for rapid comprehension and distribution to the world.

DESIGN: Data from articles on OUD were entered into a data-tree and evaluated to achieve integration of information using the least number of notes.

SETTING: Literature on OUD. Experimental units: A total of 752 articles were selected from PubMed searches. Review articles, case reports, and short series with samples of less than ten were excluded.

OUTCOME MEASURES: The frequency of descriptive note types, and the total number of notes used with and without note sharing.

RESULTS: Four types of notes were found sufficient to describe extracted numeric data from an article; topic (20.1 percent), population (26.2 percent), description of numeric value (28.4 percent), and numeric value (25.3 percent). Notes were entered in parent-child relationships across hierarchical levels, descriptive analyses showed smooth expansion and reduction of notes across the database. Entry rules allowed sharing of parent notes across different numeric values, which reduced that total number of notes by 72.9 percent.

CONCLUSIONS: These results demonstrate a method of data extraction and integration that allows for readily understandable grouping of large amounts of data. This strategy yields a method to extract and make accessible all published data on OUD. We expect that common understanding will improve outcomes for patients and research objectives.

OBJECTIVE: Thoracic surgery is known to lead to post-operative opioid dependence in countries with high opioid consumption; however, there are limited reports from countries with moderate to low opioid consumption, such as Japan. This study aimed to investigate the prevalence and risk factors for persistent opioid use after thoracic surgery in Japan.

DESIGN: A retrospective cohort study using linked medical claims data from the National Health Insurance in Ibaraki Prefecture, Japan.

PATIENTS: Patients aged ≥18 who underwent thoracic (mediastinal or lung) surgery between October 2012 and September 2021 were included in this study.

MAIN OUTCOME MEASURES: Persistent opioid use was defined as prescription from 0 to 14 days after surgery and 91 to 180 days after surgery. We evaluated associated factors using multivariable logistic regressions.

RESULTS: Among the 6,041 patients who underwent thoracic surgery during the study period, 3,924 were included in the final analysis. The median age was 68 years (range, 64-71 years), and 2,316 (61.0 percent) were male. Persistent opioid use was recorded in 130 (3.3 percent). Multivariable analyses identified neoadjuvant therapy (chemotherapy or radiotherapy) (odds ratio [OR], 2.02; 95 percent confidence interval [CI], 1.09-3.77; p = 0.027) and thoracotomy (vs video-assisted thoracoscopic surgery) (OR, 1.50; 95 percent CI, 1.01-2.24; p = 0.046) as independent risk factors for persistent opioid use.

CONCLUSIONS: In a prefecture of Japan, 3.3 percent of patients who underwent thoracic surgery developed persistent opioid use. Neoadjuvant therapy (chemotherapy or radiotherapy) and thoracotomy were independent factors associated with persistent opioid use. Individualized perioperative pain management strategies should be considered for high-risk patients.

OBJECTIVE: To report the rate of prescription opioid use rates over a 5-year period for the population of Newfoundland and Labrador (NL), Canada, and to highlight patient demographics within this cohort.

DESIGN: This retrospective cohort design used population-based pharmacy network prescription data from the province of NL to identify patients who were prescribed opioids from June 1, 2017, to June 1, 2022.

SETTING: A cohort of adult and pediatric patients who were being prescribed opioids from June 1, 2017, to June 1, 2022, in NL.

PARTICIPANTS: Patients who were prescribed opioids from June 1, 2017, to June 1, 2022. Prescriptions without complete data and medications taken for pain control that were not defined as opioids were excluded from the analysis. Buprenorphine, buprenorphine-naloxone, and methadone were also excluded from the analysis, as these are often prescribed as a treatment for opioid use disorder.

RESULTS: Between 27,344 (5.2 percent of NL population) and 57,562 (11 percent of NL population) opioid pain patients in NL were identified from 2017 to 2022, with 2018 having the highest number of opioid pain patients (11 percent). During this period, patients with opioid prescriptions averaged from 55 to 58 years of age. Data also showed more female users of prescription opioids than males, and there were no significant differences between urban and rural locations. The most prevalent type of prescriber during the period of observation was general practitioners (n = 1,131), followed by pharmacists (n = 476) and dentists (n = 237).

CONCLUSIONS: In comparison to national averages in Canada, NL had lower prescription opioid use rates. This study acts as a first step to better understand opioid use and prescribing practices in NL.

Opioids are known to come with some relatively benign side effects, not including their addictive potential. This review will look at some of the side effects that occur when patients, especially chronic pain patients, take opioids chronically. These side effects include both hyperalgesia and allodynia caused by opioids. Overdose and factors, including hyperalgesia and allodynia, that make a patient more likely to overdose, is the other topic that will be covered. Not much research has been done with human subjects regarding treatment of opioid induced hyperalgesia or allodynia, but some of this research will also be briefly explored throughout this review.

Despite the contribution of the µ-agonist fentanyl to the United States's opiate overdose epidemic, no human studies specifically address the ability of extended-release preparations of the opiate antagonist naltrexone (NTX) to block fentanyl's life-threatening µ-agonist-mediated respiratory depression. This paper presents three case histories of clinically necessary opiate challenges in opiate-abusing patients implanted with extended-release NTX (ER-NTX). It also reviews the sparse literature and is the first evidence that antagonist blood levels from ER-NTX preparations can completely block the lethal µ-agonist effects of at least 1,000 mcg of intravenous fentanyl.

In 2020, emergency operations resources in the United States began responding to the presence of coronavirus disease 2019 and its variants. Mitigation efforts to control the spread of the coronavirus by these organizations included vaccination, increased sanitation, social distancing, and physical barriers such as masks and shields. Due to the nature of the coronavirus and emergency operations requirements, these approaches have proven not be 100 percent effective in fully meeting those needs. This manuscript discusses the use of radio frequency identification technology to help protect emergency operations personnel against coronavirus transmission.

This study examined the relationship between family-work role conflict and work self-efficacy among Israeli mothers during the Swords of Iron War emergency, focusing on coping resources such as optimism and conflict management strategies. The participants included 182 working mothers of young children experiencing heightened stress due to the ongoing war. Of the three examined coping strategies, routine maintenance was most prevalent, followed by reorganization of work and family roles, and seeking help from the environment. Routine maintenance was the only strategy directly related to work self-efficacy. Optimism contributed indirectly to work self-efficacy through routine maintenance. It is concluded that maintaining a routine is crucial for coping with role conflict during community emergencies, as it enhances work self-efficacy both directly and indirectly by fostering optimism. Practical recommendations include training women in adopting routine strategies, fostering optimism, and emphasizing the importance of maintaining routine during prolonged periods of community stress.

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic thrust individuals from nonhealthcare occupations, such as public transit, into the role of frontline essential workers. Unlike frontline healthcare workers, these individuals lacked the training, experience, supplies, equipment, and supervision that would typically be expected for healthcare and first response personnel during a pandemic. New York City transit workers were particularly impacted due to high rates of mortality, illness, and quarantine and isolation, yet data are sparse on their perceptions of worksite preparedness and response.

METHODS: Data from six focus groups with 25 unique participants, all in public-facing transit roles and members of the Transport Workers Union-Local 100 were analyzed using a modified grounded theory approach. Both inductive and deductive analyses were conducted using the Constant Comparative Method.

RESULTS: Roughly 3 years after the start of the COVID-19 pandemic, participants continued to feel overlooked and unappreciated in their role as frontline workers. Three themes emerged from the data, including (1) lack of recognition as an essential worker, (2) lack of trust in the workplace, and (3) fear and concern regarding workplace safety and security.

CONCLUSIONS: The pandemic exacerbated longstanding workplace tensions and contributed to distrust, decreased worker satisfaction, high levels of fear regarding future pandemics, and concern regarding workplace safety. Representatives of workers, managers, and union leadership should cooperate on joint labor and management safety committees to build a climate of safety and trust. They should work closely with Metropolitan Transit Authority Safety leadership, with input from emergency managers, and infection control and industrial hygiene experts to develop a robust pandemic plan that can be rapidly implemented in the next pandemic event.

OBJECTIVES: Emergency personnel, including firefighters, play a crucial role in providing emergency care in diverse and challenging environments. With over 1,058,700 active firefighters in the United States, occupational safety assessment is vital due to high injury rates, especially from overexertion. By analyzing muscle activity and video feedback, this study aimed to improve first responders' occupational health and safety during lifting and transferring of patients.

METHODS: This study focused on 37 first responders from the City of Fairfield Fire Department, Ohio. Participants underwent video-assisted feedback sessions aimed at improving body mechanics during sit-to-stand transfers. Surface electromyography measured erector spinae (ES) and gluteus maximus (GM) muscle activation preintervention and post-intervention.

RESULTS: Statistical analysis revealed no significant difference in ES or GM muscle activation levels post-intervention. However, participants showed improved bilateral muscle activation symmetry, potentially reducing strain during lifting tasks. Video feedback emphasized neutral spine positioning, proximity to patients, and proper hand placement, aligning with ergonomic principles.

CONCLUSIONS: While statistical significance in muscle activation levels was not achieved, improved symmetry suggests potential benefits in injury prevention. Video feedback, coupled with expert guidance, enhances awareness of ergonomic techniques among first responders, promoting safer work practices.