bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistent Postoperative Opioid Use
Authors: Jivraj Naheed K. , Raghavji Faizal , Bethell Jennifer , Wijeysundera Duminda N. , Ladha Karim S. , Bateman Brian T. , Neuman Mark D. , Wunsch Hannah 
Published: April 2020

Abstract

Background
While persistent opioid use after surgery has been the subject of a large number of studies, it is unknown how much variability in the definition of persistent use impacts the reported incidence across studies. The objective was to evaluate the incidence of persistent use estimated with different definitions using a single cohort of postoperative patients, as well as the ability of each definition to identify patients with opioid-related adverse events.

Methods
The literature was reviewed to identify observational studies that evaluated persistent opioid use among opioid-naive patients requiring surgery, and any definitions of persistent opioid use were extracted. Next, the authors performed a population-based cohort study of opioid-naive adults undergoing 1 of 18 surgical procedures from 2013 to 2017 in Ontario, Canada. The primary outcome was the incidence of persistent opioid use, defined by each extracted definition of persistent opioid use. The authors also assessed the sensitivity and specificity of each definition to identify patients with an opioid-related adverse event in the year after surgery.

Results
Twenty-nine different definitions of persistent opioid use were identified from 39 studies. Applying the different definitions to a cohort of 162,830 opioid-naive surgical patients, the incidence of persistent opioid use in the year after surgery ranged from 0.01% (n = 10) to 14.7% (n = 23,442), with a median of 0.7% (n = 1,061). Opioid-related overdose or diagnosis associated with opioid use disorder in the year of follow-up occurred in 164 patients (1 per 1,000 operations). The sensitivity of each definition to identify patients with the composite measure of opioid use disorder or opioid-related toxicity ranged from 0.01 to 0.36, while specificity ranged from 0.86 to 1.00.

Conclusions
The incidence of persistent opioid use reported after surgery varies more than 100-fold depending on the definition used. Definitions varied markedly in their sensitivity for identifying adverse opioid-related event, with low sensitivity overall across measures.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Primary Epiphyseal Osteomyelitis (PEO) in 18 Children: A Rare Entity With Atypical Features
Authors: Shah Maulin M. , Gupta Gaurav , Makadia Akash S. , Rabbi Qaisur 
Published: April 2020

Objectives:
The purpose of this study is to discuss the natural history and management of primary epiphyseal osteomyelitis (PEO), to differentiate clinico-radiologic features of PEO caused by Mycobacterium and other organisms, and to discuss their intermediate-term outcomes.

Methods:
Between 2006 and 2017, 18 patients of PEO were managed at our center. Blood investigations, x-rays, and magnetic resonance imaging of affected part were carried out. Surgical drainage of lesions was done to retrieve infective fluid and tissue for examination. Antibiotics were administered for 1 year in Mycobacterial PEO and for 6 weeks in bacterial PEO. Average follow-up of patients was 5.5 years (range, 2 to 11 y).

Results:
Boys were more commonly affected (11/18). Distal femur was the most common site involved (12/18). Eleven patients had Mycobacterium tuberculosis as the causative organism, 6 were positive for Staphylococcus aureus, and 1 for Brucella. Swelling and limp were predominant in patients with Tubercular PEO, whereas pain was more common in bacterial PEO. Nine of 11 patients with Tubercular PEO had penetration into the joint, whereas none in bacterial PEO. All patients recovered completely without residual movement restriction or growth alteration. On follow-up magnetic resonance imaging, 4 patients with Tubercular PEO had thinning of articular cartilage.

Conclusion:
High index of suspicion is required for early diagnosis of PEO. It is important to differentiate Tubercular from other bacterial PEO as it has more subtle symptoms and poor prognosis if left untreated. Aggressive surgical treatment followed by antibiotic therapy of appropriate duration is required to avoid complications related to joint destruction. To our knowledge, this is the largest reported series with longest follow-up.
Identifying the Most Appropriate ACDF Patients for an Ambulatory Surgery Center
Authors: Zuckerman Scott L. , Mummareddy Nishit , Lakomkin Nikita , Sivaganesan Ahilan , Asher Anthony , Devin Clinton J. 
Published: April 2020

Study Design:
Retrospective cohort analysis of prospectively collected data.

Objectives:
Using a national cohort of patients undergoing elective anterior cervical discectomy and fusion (ACDF) in an inpatient/outpatient setting, the current objectives were to: (1) outline preoperative factors that were associated with complications, and (2) describe potentially catastrophic complications so that this data can help stratify the best suited patients for an ambulatory surgery center (ASC) compared with a hospital setting.

Summary of Background Data:
ASCs are increasingly utilized for spinal procedures and represent an enormous opportunity for cost savings. However, ASCs have come under scrutiny for profit-driven motives, lack of adequate safety measures, and inability to handle complications.

Methods:
Adults who underwent ACDF between 2008 and 2014 were identified in the National Surgical Quality Improvement Program (NSQIP) database. Inclusion criteria were: principal procedure ACDF [Current Procedural Terminology (CPT) 22551, 22552], elective, neurological/orthopedic surgeons, length of stayof 0/1 day, and being discharged home. The primary outcome was presence of any complication. The secondary outcome was occurrence of potentially catastrophic complications.

Results:
A total of 12,169 patients underwent elective ACDF with a length of stay of 0/1 day and were discharged directly home. A total of 179 (1.47%) patients experienced a complication. Multivariate logistic regression revealed the following factors were significantly associated with a complication: Charlson Comorbidity Index (CCI) >3, history of transient ischemic attack/cerebrovascular accident, abnormal bilirubin, and operative time of >2 hours. Approximate comorbidity score cutoffs associated with <2% risk of complication were: American Society of Anesthesiologists (ASA)≤2, CCI≤2, modified frailty index (mFI) ≤0.182. A total of 51 (0.4%) patients experienced potentially catastrophic complications.

Conclusions:
The current results represent a preliminary, pilot analysis using inpatient/outpatient data in selecting appropriate patients for an ASC. The incidence of potentially catastrophic complication was 0.4%. These results should be validated in multi-institution studies to further optimize appropriate patient selection for ASCs.
Scleral fixated secondary intraocular lenses: a review of recent literature
Authors: Patel Luv G. , Starr Matthew R. , Ammar Michael J. , Yonekawa Yoshihiro 
Published: April 2020

Purpose of review
A variety of techniques exist for secondary intraocular lens (IOL) implantation. Of note, scleral fixated intraocular lenses have become more popular with a variety of techniques, both with and without use of sutures. Herein, we focus on reviewing recently published studies describing the long-term outcomes of scleral fixation techniques.

Recent findings
Although initial papers describing novel techniques often report short-term outcomes, several studies have recently described intermediate and long-term outcomes for scleral fixated IOLs, albeit all being retrospective case series. Suture fixation methods with long-term follow-up, up to a minimum of 50 months, report dislocation rates between 0 and 15%. Sutureless scleral fixation techniques have increased in popularity the past several years. Although they appear to have a lower rate of IOL dislocation: several studies have reported 0% and one study 8%. The follow-up period for sutureless scleral fixation technique studies, however, is shorter with most studies reporting follow-up of less than a year. Rates of retinal detachment vary between individual studies, but are similar for both suture fixation and sutureless with the majority of studies reporting a rate between 0 and 5%. These studies show that long-term outcomes are important considerations in surgical decision-making.

Summary
Scleral fixation techniques have shown long-term durability and safety in recent retrospective studies. Comparison of techniques has been limited, and more robust studies may be required to provide stronger anatomic, functional, and comparative data.
Efficacy and toxicity comparison of nab-paclitaxel plus S-1 and nab-paclitaxel plus gemcitabine as first-line chemotherapy for metastatic pancreatic cancer
Authors: Guo Xi , Xu Yaolin , Ji Yuan , Fan Yue , Wang Dansong , Jin Dayong , Zhuang Rongyuan , Wu Lili , Lou Wenhui , Zhou Yuhong 
Published: April 2020

Abstract
To compare efficacy and safety of nab-paclitaxel plus gemcitabine (AG) with nab-paclitaxel plus S-1 (AS) as first-line treatment for metastatic pancreatic cancer, we conducted a retrospective analysis by reviewing medical records of 53 metastatic pancreatic cancer patients in our institution. They received either AG (nab-paclitaxel 125 mg/m2 on days 1, 8 and gemcitabine 1000 mg/m2 on days 1, 8) or AS (nab-paclitaxel 125 mg/m2 on days 1, 8 and S-1 80–120 mg on days 1–14) chemotherapy. We found that AS had higher objective response rate (36% vs 21.4%), better disease control rate (84% vs 75%), prolonged time to progression (TTP, 7.1 vs 5 months), and improved overall survival (OS, 15.3 vs 12 months) when compared with AG. In Cox proportional hazards model, sex was significantly associated with TTP (P value = .031) and metastatic sites plus treatment after progression were significantly associated with OS (P value = .028 and .01, respectively). The incidence rate of chemotherapy-related adverse events was similar in both groups. Neutropenia (50% and 60%, all grade; 21.4% and 36%, grade 3 or 4, in AG and AS group) and sensory neuropathy (21.4% and 24%, all grade; 3.6% and 4%, grade 3 or 4, in AG and AS group) were the most common hematologic and non-hematologic toxicity. Thus, we believed that AS is a reasonable and convenient alternative for patients treated with AG as first-line chemotherapy for metastatic pancreatic cancer.
Nonprofit Hospitals' Response to the Opioid Epidemic in Urban Communities: A Content Analysis of Hospitals' Community Health Needs Assessments and Implementation Strategies
Authors: Singh Simone , Kiessling Karalyn , Rhodes Jordan 
Published: April 2020

Context:
Addressing the opioid epidemic requires a coordinated community response; yet, the role that nonprofit hospitals play in these efforts has not been systematically examined.

Objective:
To explore hospital-initiated strategies to address opioid use in urban communities most affected by the opioid epidemic.

Design:
We conducted content analysis of publicly available community health needs assessments (CHNAs) and accompanying implementation strategies of 140 nonprofit hospitals. We employed a qualitative approach using open coding methods to explore the extent to which hospitals identified opioid use as a community health need and engaged in interventions to address opioid use in their communities. We also conducted bivariate analysis to compare organizational and community characteristics of hospitals that did and did not engage in strategies to address opioid use.

Setting:
One hundred forty nonprofit hospitals in urban areas with high opioid death rates across 25 states.

Results:
Almost 70% of CHNAs identified opioid use as a community health need, and 63% of implementation strategies included at least 1 hospital-initiated activity to address this need. More than 90% of these implementation strategies involved providing additional capacity for and access to treatment. Bivariate analysis showed that hospitals that engaged in activities to address opioid use did not differ meaningfully from hospitals that did not engage in such activities, with 2 exceptions. Hospitals that relied on consultants to prepare the CHNA were more likely to engage in activities to address opioid use as were hospitals located in Medicaid expansion states.

Conclusions:
Nonprofit hospitals are taking action to address the opioid epidemic in their communities, most commonly by providing additional treatment capacity for patients with opioid use. While an important contribution, hospitals need incentives to develop a more comprehensive response to the opioid epidemic that extends beyond medical care to include the social and economic determinants of this crisis.
Proper Disposal of Prescription Opioids in Southwest Virginia: Assessment of Patient, Physician, and Medical Student Beliefs and Practices
Authors: Bouzaher Malek H. , Miller Thomas K. 
Published: April 2020

Context:
Southwestern Virginia demonstrates the highest regional mortality rate from prescription opioid overdoses. Nationally, 65% of patients misusing opioid medications received them from friends and family, underscoring the need for effective disposal of unused narcotics.

Objectives:
(1) To understand patient, provider, and medical student beliefs and misconceptions regarding proper methods of opioid disposal; (2) to characterize discrepancies that exist between patient self-reported habits and medical student/provider perceptions of opioid usage, disposal, and diversion.

Design:
Descriptive, cross-sectional, observational study.

Setting:
Large, nonprofit health care organization and allopathic medical school in Southwestern Virginia.

Participants:
All ambulatory patients 18 years or older presenting for elective consultation at health system orthopedics department; all institutionally employed physicians with active system e-mail addresses; and all current students at the associated medical school.

Main Outcomes/Measures:

Patients: The number who had received information regarding proper methods of opioid disposal, intended disposal method, methods of disposal considered appropriate, comfort level with opioid disposal, and demographic data. Physicians and Medical Students: The number who had received instruction regarding proper methods of opioid disposal, acceptable means of opioid disposal, most appropriate disposal method, disposal method most likely to be employed by patients, practice profile/prescribing data, and medical school year.

Results:
In total, 64% of patients (n = 255/750) had never received instruction from a physician regarding opioid disposal; 56% of physicians (n = 212/732) and 78% (n = 80/171) of medical students indicated that they never received formal instruction regarding methods of disposal. The majority of physicians believed that their patients are most likely to use in-home methods of disposal or store prescription medications for future use; 61% of patients indicated a preference for accessible disposal facilities.

Conclusions:
The discrepancy between patient and physician responses highlights a lack of communication regarding disposal of unused opioid medications and is a target for future intervention.
Early Evidence of an Opioid Education Campaign: A Case Study of Rhode Island
Authors: Rath Jessica M. , Hair Elizabeth C. , Barton Alexis A. , Kreslake Jennifer M. , Geraci John , Palmerini Maureen , Coderre Tom , Vallone Donna M. 
Published: April 2020

Context:
The opioid crisis poses a significant burden at a national level, and certain states have seen particularly high rates of misuse, addiction, and overdose. In 2017, Rhode Island reported opioid-related deaths nearly twice the national average.

Objective:
To test message efficacy and evaluate the effectiveness of campaign messaging to shift attitudes/beliefs related to opioid misuse in Rhode Island.

Design:
In phase 1, near-final versions of 6 advertisements were shown to a sample of the target audience via an online survey portal to assess responses to the messages (N = 1210). Phase 2 of the study employed a pre/posttest design whereby 2 cross-sectional surveys were conducted, first prior to the campaign launch (N = 456) and another survey 6 months later in Rhode Island (N = 433).

Setting:
Phase 1 was conducted online using a nationally representative panel, and phase 2 included a convenience sample of participants in Rhode Island recruited to undergo an online survey.

Participants:
Eighteen- to 29-year-old members of a nationally representative online panel (phase 1) and 15- to 34-year-olds living in the state of Rhode Island during data collection periods.

Main Outcome Measure(s):
Empathy and destigmatization (“someone like me could become addicted...” and “those who are dependent on prescription opioids are victims”) and perceived risk of developing dependence on opioids.

Results:
In both phases, there was an increase in empathy (“someone”) (phase 1: pretest [31%], posttest [42%; z = 5.5, P < .0001] and phase 2 [34% baseline vs 41% follow-up; z = 2.0, P = .04]) and destigmatization (“victims”) (phase 1: pretest [54%], posttest [58%; z = 2.2, P = .01] and phase 2 [46% baseline vs 54% follow-up; z = 2.2, P = .03]). There was also an increase in perceived risk: phase 1 (pretest [65%], posttest [75%; z = 5.4, P < .0001]) and phase 2 (66% baseline vs 74% follow-up; z = 2.5, P = .01).

Conclusions:
This study demonstrated the potential efficacy of a media campaign to shift young adults' opioid-related attitudes.
A Three-part Quality Improvement Initiative to Increase Patient Satisfaction and Reduce Appointment Time
Authors: Manohar Sujal , McLeod Crystal 
Published: April 2020

Introduction:
PediPlace, a busy pediatric not-for-profit clinic in Lewisville, Tex., struggles with prolonged patient wait times. This quality improvement (QI) project aimed to reduce appointment lengths and improve the patient experience.

Methods:
PediPlace introduced 3 interventions: improved patient tracking to measure timing on the electronic health record interface, elimination of script repetition between medical assistants and providers, and patient art kits.

Results:
From over 2,000 surveys indicated that patients were more satisfied; the percentage of negative survey comments decreased from 20% in 2017 and 2018 to under 10% in 2019. The overall rating of the clinic rose from 3.8 to 4.75 (on a scale of 1–5) after QI interventions as well. The number of patients not checked out declined from 49 errors in October–December 2018 to 25 errors in January–March 2019, indicating that this part of the initiative was initially successful. However, subsequent months experienced higher error rates. Analysis of over 20,000 appointments from June 2018 to July 2019 showed that appointment length did not change after interventions.

Conclusions:
There was no difference in appointment lengths between Hispanic/Latino patients and other patients, and an encouraging finding that suggests PediPlace providers are effective bilingual communicators. Furthermore, anecdotal evidence indicated that the art kits were positively received. The interventions appeared to improve the patient experience but did not impact appointment length. PediPlace plans to continue QI initiatives in the future.
Brief Report: Relationship Between Nonalcoholic Fatty Liver Disease and Cardiovascular Disease in Persons With HIV
Authors: Kaplan Alyson , Simon Tracey G. , Henson Jacqueline B. , Wang Thomas , Zheng Hui , Osganian Stephanie A. , Rosenblatt Russell , Lake Jordan , Corey Kathleen E. 
Published: April 2020

Background:
Nonalcoholic fatty liver disease (NAFLD) and HIV are independently associated with cardiovascular disease (CVD). However, the factors associated with NAFLD in persons living with HIV (PWH) and whether CVD is more frequent in PWH with NAFLD are currently unknown.

Methods:
From the Partners HealthCare Research Patient Data Registry, we identified PWH with and without NAFLD between 2010 and 2017. NAFLD was defined using validated histological or radiographic criteria. CVD was defined by an ICD-9 diagnosis of coronary artery disease, myocardial infarction, coronary revascularization, peripheral vascular disease, heart failure, transient ischemic attack, or stroke and was confirmed by clinician review. Multivariable logistic regression was performed to examine the relationship between NAFLD and CVD.

Results:
Compared with PWH without NAFLD (n = 135), PWH with NAFLD (n = 97) had higher body mass index and more frequently had hypertension, obstructive sleep apnea, diabetes mellitus, dyslipidemia, coronary artery disease, and CVD (P < 0.01 for all). PWH with NAFLD were also more likely to have CD4+ T-cell counts (CD4) <200 cells/mm3. In multivariable models, the presence of NAFLD was significantly associated with CVD (adjusted odds ratio 3.08, 95% confidence interval: 1.37 to 6.94) and CD4 <200 cells/mm3 (adjusted odds ratio 4.49, 95% confidence interval: 1.74 to 11.55).

Conclusion:
In PWH, CVD was independently associated with prevalent NAFLD after controlling for traditional CVD risk factors. NAFLD was also associated with CD4 <200 cells/mm3, suggesting that immune dysfunction may be related to NAFLD. Both CVD and low CD4+ count as risk factors for NAFLD require prospective evaluation.
Simulation-Based Examination of Arterial Line Insertion Method Reveals Interdisciplinary Practice Differences
Authors: Golden Antoinette , Alaska Yasser , Levinson Andrew T. , Davignon Kristopher R. , Lueckel Stephanie N. , Lynch Kenneth A. , Jay Gregory , Kobayashi Leo 
Published: April 2020

Introduction
Arterial cannulation is frequently performed on intensive care unit (ICU) and operating room patients; a 1% complication rate has been reported. Investigators applied simulation to study clinical providers' arterial catheter (AC) insertion performance and to assess for interdisciplinary and intradisciplinary variation that may contribute to complications.

Methods
Anesthesia, medical critical care, and surgical critical care providers with AC insertion experience were enrolled at 2 academic hospitals. Each subject completed a simulated AC insertion on an in situ task trainer. Using a Delphi-derived checklist that incorporated published recommendations, expert opinion, and institutional requirements, 2 investigators completed offline video reviews to compare subjects' technical performance.

Results
Ten anesthesia, 11 medical ICU (MICU, 1 excluded), and 10 surgical ICU (SICU) subjects with significant between-group differences in training level and AC insertion experience were enrolled for 2 years. Differences in procedural planning, equipment preparation, and patient preparation steps did not attain significance across groups except for anesthesia participants using only ad hoc AC kits, and MICU and SICU subjects preferentially using commercial kits (P < 0.001). Time-outs were completed by 1 anesthesia subject, 5 MICU subjects, and 4 SICU subjects (P = 0.29, NS). For proceduralist preparation steps, fewer anesthesiology subjects donned gowns (P < 0.001). Only MICU subjects used ultrasound guidance (P = 0.0053), and only MICU (100%) and SICU (100%) subjects sutured ACs in place. Overall observance of sterile technique was similar across groups at 70% to 100% (P = 0.32).

Conclusions
Simulated AC insertions revealed procedural performance variability that may derive from individual provider differences, discipline-based practice parameters, and setting-specific cultural factors.