Post-op Rx for Opiates and Subsequent Abuse

Post-op Rx for Opiates and Subsequent Abuse

Total duration of opioid use was the strongest predictor of misuse. Each refill and additional week of opioid use increased the hazard of misuse by 44% and 19.9% respectively. Shorter prescriptions (<2 weeks) of high vs low dosage prescriptions had a lower hazard.

Opioid Use Among Pediatric Patients After Surgery

Opioid Use Among Pediatric Patients After Surgery

In opioid naïve patients 13-21 years of age, persistent opioid use was found in 4.8% of the post-surgical group vs 0.1% of those in the non-surgical group. Procedures associated with the highest risk of persistent opioid use were cholecystectomy and colectomy. Independent risk factors included older age, female sex, diagnoses of substance use disorder and chronic pain.

Dear CMS - Saying No Doesn't Make Me a Bad Doctor

Dear CMS - Saying No Doesn't Make Me a Bad Doctor

This may come as a shock, but when you tell patients no, it negatively impacts patient satisfaction.  But that doesn't make you a bad doctor, regardless of what CMS says.

Rhinovirus on RVP - What Does It Mean?

Rhinovirus on RVP - What Does It Mean?

Don't be falsely reassured if rhinovirus on a PCR viral panel is positive.  The incidence of UTI was unchanged if </= 90 days, and the incidence of invasive bacterial infection (IBI) was no different </= 28 days.  However, it may prove useful for risk stratifying infants for IBI in the 29 to 90-day age group.

Higher DBP In Arrest Impacts Survival

Higher DBP In Arrest Impacts Survival

Maintaining a diastolic blood pressure (DBP) of >/=25mm Hg in infants and >/= 30mm Hg in children over age 1 during CPR was associated with improved survival to discharge and improved neurologically intact survival.  This is possible only if a child arrests and has invasive BP monitoring in place but is a good reminder that high quality CPR in all patients drastically impacts survival.

Private to Public ED Dumps Hurt Patients

Private to Public ED Dumps Hurt Patients

Failure of private hospitals to care for the uninsured resulted in informal ED to ED referrals, which meant up to 20% increased volume in public EDs for certain diagnoses, particularly orthopedic issues.  This led to duplicate testing, increased cost, complications, delays in care, and poor treatment of the most vulnerable patients.

Prevalence of PE in Syncope

Prevalence of PE in Syncope

This large, retrospective study found the prevalence of PE in hospitalized patients discharged with a diagnosis of syncope was 0.15% to 2.1%; 0.35% to 2.63% at 90-day follow up.  This was much lower than the PESIT trial, at 17.3%.

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