Risultati per: Short Acting Opioid

Introduction
Countries are grappling with a rapidly worsening upsurge in the opioid-related overdose deaths, misuse and abuse. There is a dearth of data in Pakistan regarding the practices and competencies of pharmacists in handling opioid-related issues.

Study design
A cross-sectional study, conducted across Punjab, Pakistan.

Method
The study deployed a validated survey to evaluate the competencies and practices of the community and hospital pharmacists.

Results
504 community pharmacists and 279 hospital pharmacists participated in the survey with an overall response rate of 85.5%. Almost half of the respondents ‘never’ or ‘sometimes’ made clinical notes in a journal or dispensing software to monitor ongoing opioid use. Generally, pharmacists were reluctant to collaborate with physicians or notify police regarding the abuse/misuse of opioids. Hospital pharmacists achieved significantly higher mean competency scores than chain and independent community pharmacists (p

Objectives
Opioid use disorder (OUD) is a major public health concern in the USA, resulting in high rates of overdose and other negative outcomes. Methadone, an OUD treatment, has been shown to be effective in reducing the risk of overdose and improving overall health and quality of life. This study analysed the distribution of methadone for the treatment of OUD across the USA over the past decade and through the COVID-19 pandemic.

Design
Retrospective observational study using secondary data analysis of the Drug Enforcement Administration and Medicaid Databases.

Setting
USA.

Participants
Patients who were dispensed methadone at US opioid treatment programmes (OTPs).

Primary and secondary outcome measures
The primary outcomes were the overall pattern in methadone distribution and the number of OTPs in the USA per year. The secondary outcome was Medicaid prescriptions for methadone.

Results
Methadone distribution for OUD has expanded significantly over the past decade, with an average state increase of +96.96% from 2010 to 2020. There was a significant increase in overall distribution of methadone to OTP from 2010 to 2020 (+61.00%, p

Circulation, Ahead of Print. BACKGROUND:Strategies to increase cellular NAD+(oxidized nicotinamide adenine dinucleotide) level have prevented cardiac dysfunction in multiple models of heart failure, but molecular mechanisms remain unclear. Little is known about the benefits of NAD+-based therapies in failing hearts after the symptoms of heart failure have appeared. Most pretreatment regimens suggested mechanisms involving activation of sirtuin, especially Sirt3 (sirtuin 3), and mitochondrial protein acetylation.METHODS:We induced cardiac dysfunction by pressure overload in SIRT3-deficient (knockout) mice and compared their response with nicotinamide riboside chloride treatment with wild-type mice. To model a therapeutic approach, we initiated the treatment in mice with established cardiac dysfunction and found nicotinamide riboside chloride improved mitochondrial function and blunted heart failure progression. Similar benefits were observed in wild-type and knockout mice. Boosting NAD+level improved the function of NAD(H) redox-sensitive SDR (short-chain dehydrogenase/reductase) family proteins. Upregulation of Mrpp2 (mitochondrial ribonuclease P protein 2), a multifunctional SDR protein and a subunit of mitochondrial ribonuclease P, improves mitochondrial DNA transcripts processing and electron transport chain function. Activation of SDRs in the retinol metabolism pathway stimulates RXRα (retinoid X receptor α)/PPARα (proliferator-activated receptor α) signaling and restores mitochondrial oxidative metabolism. Downregulation of Mrpp2 and impaired mitochondrial ribonuclease P were found in human failing hearts, suggesting a shared mechanism of defective mitochondrial biogenesis in mouse and human heart failure.CONCLUSIONS:These findings identify SDR proteins as important regulators of mitochondrial function and molecular targets of NAD+-based therapy. Furthermore, the benefit is observed regardless of Sirt3-mediated mitochondrial protein deacetylation, a widely held mechanism for NAD+-based therapy for heart failure. The data also show that NAD+-based therapy can be useful in pre-existing heart failure.

Objectives
Increased use of opioids and their associated harms have raised concerns around prescription opioid use for pain management following surgery. We examined trends and patterns of opioid prescribing following elective orthopaedic surgery.

Design
Population-based study.

Setting
Ontario, Canada.

Participants
Ontario residents aged 66+ years who had elective orthopaedic surgery from April 2004 to March 2018.

Primary and secondary outcome measures
Postoperative opioid use (short term: within 90 days of surgery, prolonged: within 180 days and chronic: within 1 year), specific opioids prescribed, average duration (days) and amount (morphine milligram equivalents) of the initial prescription by year of surgery.

Results
We included 464 460 elective orthopaedic surgeries in 2004/2005–2017/2018: 80% of patients used opioids within 1 year of surgery—25.1% were chronic users. There was an 8% increase in opioid use within 1 year of surgery, from 75.1% in 2004/2005 to 80.9% in 2017/2018: a 29% increase in short-term use and a decline in prolonged (9%) and chronic (22%) use. After 2014/2015, prescribed opioid amounts initially declined sharply, while the duration of the initial prescription increased substantially. Across categories of use, there was a steady decline in coprescription of benzodiazepines and opioids.

Conclusions
Most patients filled opioid prescriptions after surgery, and many continued filling prescriptions after 3 months. During a period of general increase in awareness of opioid harms and dissemination of guidelines/policies aimed at opioid prescribing for chronic pain, we found changes in prescribing practices following elective orthopaedic surgery. Findings illustrate the potential impact of guidelines/policies on shaping prescription patterns in the surgical population, even in the absence of specific guidelines for surgical prescribing.

Objectives
In this study, we aimed to identify the causes, predictors and gender disparities of 30-day and 90-day cardiovascular readmissions after COVID-19-related hospitalisations using National Readmission Database (NRD) 2020.

Setting
We used the NRD from 2020 to identify hospitalised adults with a principal diagnosis of COVID-19 infection.

Participants
We included subjects who were readmitted within 30 days and 90 days after index admission. We excluded subjects with elective and traumatic admissions. We used a multivariate Cox regression model to identify independent predictors of readmission.

Primary and secondary outcomes measures
Our outcomes were inpatient mortality, 30-day and 90-day cardiovascular readmission rates following COVID-19 infection.

Results
During the study period, there were 1 024 492 index hospitalisations with a primary diagnosis of COVID-19 infection in the 2020 NRD database, 644 903 (62.9%) were included for 30-day readmission analysis, and 418 122 (40.8%) were included for 90-day readmission analysis. Of patients involved in the 30-day analysis, 7140 (1.1%) patients had a readmission within 30 days; of patients involved in the 90-day analysis, 8379 (2.0%) had a readmission within 90 days due to primarily cardiovascular causes. Cox regression analysis revealed that the female sex (aHR 0.89; 95% CI 0.82 to 0.95; p=0.001) was associated with a lower hazard of 30-day cardiovascular readmissions; however, congestive heart failure (aHR 2.45; 95% CI 2.2 to 2.72; p

Purpose
To test an online training course for non-ophthalmic diabetic retinopathy (DR) graders for recognition of glaucomatous optic nerves in Vietnam.

Methods
This was an uncontrolled, experimental, before-and-after study in which 43 non-ophthalmic DR graders underwent baseline testing on a standard image set, completed a self-paced, online training course and were retested using the same photographs presented randomly. Twenty-nine local ophthalmologists completed the same test without the training course. DR graders then underwent additional one–to-one training by a glaucoma specialist and were retested. Test performance (% correct, compared with consensus grades from four fellowship-trained glaucoma experts), sensitivity, specificity, positive and negative predictive value, and area under the receiver operating (AUC) curve, were computed.

Results
Mean age of DR graders (32.6±5.5 years) did not differ from ophthalmologists (32.3±7.3 years, p=0.13). Online training required a mean of 297.9 (SD 144.6) minutes. Graders’ mean baseline score (33.3%±14.3%) improved significantly after training (55.8%±12.6%, p

Brief periods of incidental activity—non-exercise movement lasting less than 10 minutes that people engage in as a part of their typical day—were tied to a lower risk of all-cause mortality and major adverse cardiovascular events, according to an analysis of accelerometer data. The study included 103 684 White British participants from the UK Biobank who did not report exercising during their leisure time.

Circulation, Volume 148, Issue Suppl_1, Page A13817-A13817, November 6, 2023. Background:Blood pressure (BP) variability (BPV) is recognized as an independent factor associated with cardiovascular (CV) events. However, monitoring very short-term BPV, which occurs within seconds or minutes remains challenging, and its prognostic impact has yet to be established. In a previous study, we reported that pulse transit time (PTT) enabled monitoring beat-to-beat BP, which is useful for evaluating very short-term BPV during sleep.Aims:This study aimed to clarify the prognostic relevance of PTT-based very short-term BPV during sleep.Methods and Results:We conducted a prospective study involving 206 consecutive hospitalized patients (mean 67.6 years old, 78.1% male) with ischemic heart disease. PTT-driven BP was continuously recorded during the night. To assess very short-term BPV, we defined the PTT index as the average number of acute transient rises in systolic BP (≥12 mmHg) within 30 s/h, and the standard deviation (SD) of PTT-BP was calculated. We followed up with patients for a median of 759 days and observed 49 CV events, including cardiac death, worsening heart failure, acute coronary syndrome, and ischemic stroke. Kaplan-Meier analysis revealed that patients with higher PTT index, as well as higher SD of mean and diastolic PTT-BP were associated with increased CV events (Figure). In a multivariate Cox proportional hazards analysis, after adjusting for confounding variables, PTT index, as well as SD of mean and diastolic PTT-BP were independently associated with increased risks of adverse events (hazard ratio, 1.019, 1.245, and 1.244; P = 0.02, 0.04, and 0.09, respectively).Conclusions:PTT-index and SD of mean and diastolic BP during the night, which represent measures of very short-term BPV, predicted the future risk of CV events in patients with ischemic heart disease through the PTT-driven approach and may serve as a target to reduce the residual risk in such patients.

Circulation, Volume 148, Issue Suppl_1, Page A13839-A13839, November 6, 2023. Introduction:Cardiovascular (CV) involvement in multisystem inflammatory syndrome in children (MISC) is frequent (80-85%). Data on 2D speckle tracking echocardiography and its value in predicting CV outcomes are limited.Hypothesis:We hypothesized that an association exists between 2D speckle tracking strain/strain rate parameters at admission and adverse CV outcomes during hospitalization (inotropic support, major arrhythmias, cardiac arrest, ECMO, death, or transplant).Methods:We performed a multicenter (33 centers) cohort study on MISC patients hospitalized from 03/2020 to 11/2021 with at least one echocardiogram read by the Core Lab. The association between each 2D speckle tracking strain parameter and adverse CV outcomes was assessed by logistic regression.Results:Of 349 patients (median age 8.7 years [IQR 5.3,12.9]), 122 (35%) had decreased left ventricle (LV) ejection fraction (EF) and 156 (45%) had depressed LV 4-chamber longitudinal strain (LS) or basal circumferential strain (CS) during hospitalization. Worst EF and strain occurred around 5 days of illness. Of those with abnormal LS or CS strain, 50% normalized in ≤1 week, 95% within 50 days. Adverse CV outcomes occurred in 121 (35%) patients. Patients with adverse outcomes were older (p=0.003), more likely to have an underlying metabolic/genetic disorder (p=0.015), abnormal troponin (p

Circulation, Volume 148, Issue Suppl_1, Page A14558-A14558, November 6, 2023. Introduction:Atrial fibrillation (AF) is the most common cardiac arrhythmia, characterized by erratic heart beats. AF increases the risk of thromboembolic events particularly stroke. Percutaneous left atrial appendage closure (LAAC) is an alternative option to prevent embolic stroke in patients with AF who have contraindication to anticoagulants. Up to our knowledge, this is the first National Readmission Database (NRD) study to elucidate the difference in readmission rates between rheumatic vs non-rheumatic AF patients who underwent LAAC.Methods:We utilized the Nationwide Readmissions Database (NRD) between the years 2016-2020. The study involved hospitalizations with rheumatic mitral valve disease (R-MVD) and non-rheumatic mitral valve disease (NR-MVD) who underwent LAAC using ICD-10 diagnostic codes. We deemed this as the index admission. We excluded patients less than 18 years old and October-December hospitalizations from 90-day readmission analysis, due to lack of adjoining period to assess readmission.Results:Among 9,150 patients with mitral valve disease who underwent LAAC in their index hospitalizations, 9,122 were discharged alive. 4,200 patients (45.8%) were readmitted in 90-days. R-MVD 90-day readmission rate compared to NR-MVD (52.3% vs 40.7% respectively, p

Circulation, Volume 148, Issue Suppl_1, Page A13366-A13366, November 6, 2023. Introduction:Atrial fibrillation (AF) is the most common arrythmia with significant health system burden and emergency room/hospital admissions. We conducted this study to understand the efficacy of managing AF with first line short term outpatient amiodarone followed by catheter ablation (pulmonary vein isolation). Amiodarone was continued for 6 months post catheter ablation (CA). We looked at a primary end point of recurrence of AF and the drug side effects during the year post CA.Hypothesis:If this strategy of short-term amiodarone with early ablation of AF is effective, then we could incorporate this in an AF management care plan.Methods:In this retrospective cohort study, we used TriNetX database to collect data on patients with amiodarone initiation with CA and those who were given Dofetilide or Sotalol, followed by CA. We collected data between March 1, 2020, and June 1, 2021. We created a propensity score matching of a 1:1 to match on the covariates: Age, Male, Female, CAD, Heart Failure, Diabetes, COPD, BMI. The endpoint is occurrence of AF within 365 days of medication initiation.Results:A total of 40,640 patients were included in the analysis. Of those patients, Cohort 1 comprised amiodarone initiation with catheter ablation (n=176) compared to Dofetilide or Sotalol which had (n=40,474). After the propensity match, we included 176 individual patients in each cohort. The amiodarone group had more men (79.5% vs 58.8, P

Circulation, Volume 148, Issue Suppl_1, Page A12639-A12639, November 6, 2023. Introduction:The optimal power and duration settings for radiofrequency (RF) atrial fibrillation (AF) ablation is unclear. We compared low-power long-duration (LPLD), high-power short-duration (HPSD), and very HPSD (vHPSD) settings for AF ablation.Hypothesis:Ablation utilizing HPSD and vHPSD are expected to have shorter procedural times than LPLD and may have improved arrhythmic outcomes.Aims:To compare LPLD, HPSD, and vHPSD ablation by network meta-analysisMethods:This network meta-analysis (NMA) was structured according to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Medline, Scopus and Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies. Observational and randomized studies were included. Eligible studies compared outcomes in AF patients who underwent first-time RF ablation with the following settings: vHPSD (70-90 Watts for 3-10 seconds), HPSD (45-60 W, 5-10 s), or LPLD (20-40 W, 20-60 s).Results:Thirty-six studies comprising 10375 patients were included (33% female). Frequentist NMA showed LPLD tended towards a lower odds of freedom from arrhythmia (FFA) vs. HPSD (OR 0.93, 95% CI 0.86-1.00). There was no difference in FFA between vHPSD vs. HPSD. Splitwise interval estimates showed a lower odds of FFA in LPLD vs. vHPSD on direct (OR 0.78, 95% CI 0.65-0.93) and network estimates (OR 0.85, 95% CI 0.73-0.98). Frequentist NMA showed less total procedural (TP) time with HPSD vs. LPLD (generic variance 1.06, 95% CI 0.83-1.29) and no difference between HPSD vs. vHPSD.Conclusion:This NMA shows improved procedural times in HPSD and vHPSD vs. LPLD. Although HPSD tended towards improved odds of FFA compared to LPLD, the result was not statistically significant. The odds of FFA in LPLD was lower vs. vHPSD on direct and network estimates on splitwise interval analysis. Randomized clinical trials are needed to validate HPSD and vHPSD settings.

Circulation, Volume 148, Issue Suppl_1, Page A13422-A13422, November 6, 2023. Case report:Short QT syndrome (SQTS) is an inherited disease characterized by abnormally short QTc intervals, which can lead to ventricular fibrillation(VF). However, the number of patients with SQTS are relatively low, and the optimal treatment for SQTS remains unclear. We experienced a family with SQTS inducing frequent sudden death of three sons. We identified KCNH2-H70Y in mother and three sons with QTc intervals 344, 300, 326, 322msec, respectively. Second son suffered cardiac arrest when he was 25-year-old. VF was recorded in the hospital, and the patient was successfully resuscitated. While recommended to implantable cardioverter defibrillator (ICD), oldest and third son suffered sudden death during nighttime sleep at their age 36 and 34. Functional analysis showed that cells expressing H70Y had significantly larger IKrdensities than WT. Also we identified SLC4A3 mutation in this family.Conclusions:Asymptomatic SQTS patients with family history may be recommended ICD implantation more strongly than class 2b. Registry studies of SQTS should be performed and solid guidelines should be established due to patients with poor prognosis of SQTS.

Circulation, Volume 148, Issue Suppl_1, Page A12810-A12810, November 6, 2023. Introduction:Valvular heart disease(VHD) is a significant cause of morbidity and mortality among the elderly. While the use, merits, and demerits of mechanical heart valves (MHV) and bioprosthetic heart valves(BHV) to treat VHD are well-documented in the literature, there needs to be more data on the outcomes following events of NSTEMI.Methods:We explored the 2016-2020 National Inpatient Sample for patients ages≥60 years hospitalized for a primary diagnosis of NSTEMI via their ICD-10 codes. We further retained those with a presence of MHV or BHV, and differences in outcomes between the two groups were evaluated.Results:Our study found 32775 adults of age 60 and more hospitalized with NSTEMI, which included 23670 (72.2%) cases with MHV, while 9105 (27.8%) patients had a BHV. No differences in mean Charlson Comorbidity Index (CCI) scores were found between the two groups (mean CCI in MHV patients: 4.14 vs. 4.22 in those with BHV, p=0.233). Compared to cases with BHV, those with MHV showed higher odds of acute kidney injury (aOR 1.108, p

Circulation, Volume 148, Issue Suppl_1, Page A13239-A13239, November 6, 2023. Background:Atrial fibrillation (AF) ablation with high-power short duration (HP-SD) setting has been widely recognized to decrease the procedure time and to improve the ablation outcome.Hypothesis:We hypothesized that AF ablation with HP-SD setting can minimize the change in periprocedural thrombotic markers and the risk of silent stroke (SS).Aims:The aim of the present study is to investigate the impact of HP-SD setting ablation for AF on thrombotic markers and SS.Methods:We enrolled 101 AF patients: HP-SD group (n =67) using 50W; and Conventional ablation group (n = 34) using 30 to 40W. D-dimer, thrombin antithrombin complex (TAT) and total plasminogen activator inhibitor-1 (tPAI-1) were analyzed pre, post and 1 day after procedure. Magnetic resonance imaging was performed 1 day after procedure.Results:Left atrial (LA) dwelling time was significantly shorter in HP-SD group (P

Circulation, Volume 148, Issue Suppl_1, Page A16404-A16404, November 6, 2023. Background:The type and severity of symptoms perceived by heart failure (HF) patients may be a useful prognostic predictor, but the impact of symptom perception on clinical events among HF patients has not been fully tested. Aim: To assess the symptoms perceived by HF patients using the Heart Failure Somatic Perception Scale (HFSPS) and to test whether symptom perception predicts short-term prognosis in HF patients.Methods:Using the prospective observational design, we collected data from 315 outpatients with HF (mean age 73 ± 13 years, 72% male). Data included sample characteristics, BMI, BNP, comorbidities, ADL, depressive symptoms, symptom perception assessed by HFSPS at baseline, and clinical composite outcomes (readmission, all-cause death, and emergency department visits) at three months. HFSPS is a scale that assesses the degree to which 18 physical symptoms perceived by HF patients are bothersome in daily life. The study subjects were classified into low, medium, and high HFSPS total score groups. The impact of HFSPS on clinical composite outcomes was analyzed using the Cox proportional hazard model, considering the influence of covariates.Results:The mean overall HFSPS score was 11.7 ± 12.3 points, with 87 patients (28%) in the low HFSPS group, 151 (48%) in the medium group, and 77 (24%) in the high group. Symptoms reported were nocturia (74.6%), shortness of breath (58.4%), fatigue (54.6%), malaise (44.5%), and cough (42.9%). Three-month composite event rate was 25.7%, with statistically significant differences between the HFSPS groups (16.1% in the low group, 23.2% in the medium group, and 41.6% in the high group (p=0.001). The results of analysis using the Cox proportional Hazard model using age, gender, BMI, BNP, comorbidities, depression, and ADL as covariates, the high HFSPS group had a significantly higher incidence of clinical composite. The incidence of clinical composite outcomes at three months was significantly higher in the high HFSPS group than in the other groups (HR=2.090 (95% CI=1.067-4.096), p=0.032).Conclusions:Symptom perception, which can be regarded as a patient-reported outcome, is a promising predictor of short-term prognosis in HF patients.