Episodic prescribers (most prescribers in the ED) contributed to less than 3% of the total morphine milligram equivalents prescribed, compared to the top 5% of prescribers who were responsible for 48.8%. Efforts to curb the opioid supply may be better served by targeting high-quantity prescribers.

Prophylactic diphenhydramine reduces extrapyramidal symptoms in patients receiving bolus anti-emetic therapy (given over 2 minutes), but not when the anti-emetic is given as an infusion over 15 minutes.

Among patients with ICH, those on non-vitamin K oral anticoagulants had a lower in-hospital risk of mortality compared to warfarin (26.5% vs 32.6%). Compared to warfarin, those on NOACs were more likely to be discharged home (+3.3%), be functionally independent (+2.5%), and have the ability to ambulate independently at discharge (+1.8%).

Trimethoprim (TMP) was associated with increased risk of hyperkalemia and acute kidney injury (AKI) in adults over age 65.

Opiate use was associated with invasive pneumococcal disease.

Hold ACE-inhibitors (ACEi) or angiotensin receptor blockers (ARBs) in patients you know will need surgery. These drugs are not associated with mortality but are associated with, at times, profound, sustained hypotension after induction.

A probiotic, Lactobacillus reuteri DSM17938 (L.r.), helped breastfed infants with colic.  Now you actually have something to tell the desperate family that comes in with a colicky but otherwise normal baby.

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.

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.

A push to use cephalexin vs cefixime for uncomplicated pediatric UTI was successful at this medical center.  Whether this is an improvement in prescribing depends upon local E. coli resistance.