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Mortality in the United States varies widely by state (1). This report compares average age-adjusted death rates by sex, race and ethnicity, and five leading causes of death between a group of five states with the highest age-adjusted death rates (Alabama, Kentucky, Mississippi, Oklahoma, and West Virginia) and a group of five states with the lowest age-adjusted death rates (California, Connecticut, Hawaii, Minnesota, and New York) in 2017 (2). Age-specific death rates for the two groups are presented as we...
Medicolegal liability is an issue of concern for all physicians, including pathologists. Identification of the key clinical issues that tend to lead to medical malpractice litigation, as well as the settlement values for such claims, can be useful for prospective risk management. This review analyzes medical malpractice claims filed in state and federal courts as published in legal databases. Additionally, this review also analyzes the reported settlement values for such claims.
Despite the declaration of an opioid epidemic, opioid use remains prevalent. Side-effects of chronic opioid use continue to be problematic. Opioid-induced endocrinopathies have been well documented, yet opioid-induced adrenal insufficiency (OIAI) remains underappreciated. This review summarizes what is currently known regarding the prevalence, predictive factors for the development and effect of treatment of OIAI.
To identify the impact of non-opioid analgesics as adjuvants to opioid on opioid consumption and its side effects, as well as the analgesic effectiveness in adult patients in the ICU.
Opioid overdoses and opioid-related fatalities have increased dramatically in Wisconsin over the past decade. The observed rise in morbidity and mortality parallels increased opioid prescribing and greater use of illicit drugs such as heroin. Increased availability of both prescription and illicit opioids may increase the risk of exposure and overdose among the pediatric population.
Given the current opioid epidemic, national practice guidelines and many state laws are shifting the treatment paradigm for chronic, noncancer pain to a judicious use of opioids. This has prompted a need to teach family medicine residents how to appropriately taper opioids. We created a multifaceted approach to integrate teaching of opioid tapering into a family medicine curriculum with an emphasis on guided instruction. We assessed the degree to which this curriculum affected guideline-concordant opioid pr...
To describe changes in suspected heroin overdose emergency department (ED) visits. We analyzed quarterly and yearly changes in heroin overdoses during 2017-2018 by using data from 23 states and jurisdictions (including the District of Columbia) funded by the Centers for Disease Control and Prevention Enhanced State Opioid Overdose Surveillance program. The analyses included the Pearson χ test to detect significant changes. Both sexes, all age groups, and some states exhibited increases from quarter 1 (Q1...
Since 1999, the rate of opioid use disorder (OUD) has more than quadrupled, from 1.5 per 1,000 delivery hospitalizations to 6.5 (1), with similar increases in incidence of neonatal abstinence syndrome (NAS) observed for infants (from 2.8 per 1,000 live births to 14.4) among Medicaid-insured deliveries (2). CDC's response to the opioid crisis involves strategies to prevent opioid overdoses and related harms by building state capacity and supporting providers, health systems, and payers.* Recognizing systems ...
To measure the incidence of persistent opioid use following ureteroscopy (URS). Over 100 Americans die every day from opioid overdose. Recent studies suggest that many opioid addictions surface after surgery.
Attempts to discontinue opioid therapy to reduce the risk of overdose and adhere to prescribing guidelines may lead patients to be exposed to variability in opioid dosing. Such dose variability may increase the risk of opioid overdose even if therapy discontinuation is associated with a reduction in risk.
The purpose of this study is to determine the types of content and to what extent that individual State Boards of Nursing (SBON) in the U.S. are providing information and education for nurses to mitigate prescription opioid misuse and diversion by patients and the public.
Little is known about health disparities in access to low-dose computed tomography (LDCT) screening. We hypothesized the current capacity for LDCT screening would be exceeded by the number of at-risk individuals in Virginia.
The United States continues to face a public health crisis of opioid-related harm, the effects of which could be dramatically reduced through increased access to opioid agonist therapy with the medications methadone and buprenorphine. Despite overwhelming evidence of their efficacy, unduly restrictive federal, state, and local regulation significantly impedes access to these life-saving medications. We outline immediate, concrete steps that federal, state, and local governments can take to change law from b...
In view of the recent opioid crisis, ways to promote safe and effective opioid-related practices are needed. Faster intravenous (iv) opioid infusion rates can result in increased adverse effects and risk for nonmedical opioid use. Data on best practices regarding safe iv opioid administration for cancer pain are limited. This study examined iv opioid bolus infusion practices and perceptions about opioids in cancer pain among 4 groups of inpatient oncology nurses.
Practitioners and policy makers need evidence to facilitate the selection of effective prevention interventions that can address the ongoing opioid overdose epidemic in the United States.
Opioid prescriptions for chronic pain and subsequent opioid-related complications have risen dramatically in the US. Recent data suggest that medical marijuana laws have been associated with lower state-level opioid overdose mortality. In a national survey, we examined the prevalence of substitution of marijuana for opioids among US adults taking opioids for pain.Using GfK's KnowledgePanel, we conducted an Internet-based survey of a nationally representative sample of 16,280 adults in 2017 about individual ...
The opioid abuse epidemic has highlighted the risks associated with these medications.
The opioid epidemic continues to be a problem in the United States and prescription opioid overdose fatalities continue to rise. Chronic opioid use threatens military readiness and puts service members at risk for medical separation from military service. Orthopedic surgeons commonly prescribe opioid medications for postsurgical patients. Long-term opioid use can be the result of acute, postoperative opioid intake. Overprescribing may increase the risk of long-term opioid use, medication diversion and adver...
The United States is in the middle of an opioid epidemic. Gastrointestinal surgery has been ranked in the top 3 surgical subspecialties for highest opioid prescribing.
Lofexidine is a non-opioid treatment for opioid withdrawal syndrome. Its sympatholytic actions counteract the nor-adrenergic hyperactivity that occurs during abrupt opioid withdrawal.
Opioid pain medication continues to be an important treatment option for patients with moderate to severe cancer and non-cancer pain; however, limited evidence is available regarding differences in opioid use between these two populations. The objective of this analysis was to compare real-world opioid use patterns over time in these two populations.
Over the last decade, New York State has experienced one of the greatest increases in opioid overdose deaths in the United States, particularly from heroin and synthetic opioids. This study investigated spatial patterns in the distribution of county-level rates of overdose deaths in New York State and associations between prescriptions for opioid pain relievers, race, and overdose deaths from 2013-2015. Global and local Moran's I tests for spatial autocorrelation examined Bayesian smoothed rates of overdose...
The increased use of prescription opioid medications has contributed to an epidemic of sustained opioid use, misuse, and addiction. Adults of working age are thought to be at greatest risk for prescription opioid dependence.
Since 2016, 35 of 50 U.S. states have passed opioid-limiting laws. The impact on postoperative opioid prescribing and secondary outcomes following ACDF remains unknown.
The purpose of this review is to explore the effects of the opioid crisis on pediatric patients in the postoperative setting and provide recommendations for well-tolerated opioid prescribing practices.