Risultati per: Short Acting Opioid

Objectives
To investigate long-acting injectable (LAI) antipsychotic prescribing patterns and their associations with transition and continuation of care and healthcare resource utilisation (HCRU) for patients with schizophrenia in the USA.

Design
A retrospective cohort study.

Setting
Electronic health record data from adults in the USA with schizophrenia were extracted from the NeuroBlu Database V.21R2.

Participants
Adults (aged ≥18 years) with a schizophrenia diagnosis who initiated LAI antipsychotic treatment during psychiatric inpatient admission. The index date was the date of LAI initiation. Patients who had ≥1 primary, secondary or tertiary ICD-9/10 (International Classification of Diseases) diagnosis of schizophrenia at clinical sites that had both inpatient and outpatient facilities were included.

Primary outcome measures
Transition-of-care (eg, risk of rehospitalisation, number of hospital readmissions, number of outpatient visits post discharge), continuation-of-care (eg, first treatment path after discharge, time to index LAI discontinuation and number of patients who restarted LAIs after discontinuation) and HCRU endpoints (eg, length of stay of index hospitalisation and estimated cost for psychiatric outpatient visits pre-index and post-index) were the primary outcome measures.

Results
A total of 1197 patients were included who initiated an LAI in an inpatient setting. Of 339 patients with ≥3 months pre-index and post-index data, median time to rehospitalisation was 135 days. Patients discharged taking an LAI alone had lower frequency of rehospitalisation (incidence rate ratio (IRR)=0.62 (95% CI, 0.46 to 0.84)), lower risk of longer hospital stays (IRR=0.60 (95% CI, 0.43 to 0.84)), lower risk of becoming rehospitalised (HR=0.49 (95% CI, 0.35 to 0.69)) and lower risk of outpatient visits (IRR=0.50 (95% CI, 0.36 to 0.70)) versus patients co-prescribed an oral antipsychotic (LAI+OA). Patients discharged taking an LAI dosed once every 1–2 months or once every 2 weeks had lower frequency of rehospitalisation (IRR=0.85 (95% CI, 0.64 to 1.14)), lower risk of longer hospital stays (IRR=0.90 (95% CI, 0.70 to 1.15)) and lower risk of becoming rehospitalised versus an LAI dosed once every 2 weeks; risk of becoming rehospitalised was no different (HR=1.00 (95% CI, 0.76 to 1.32)) and risk of outpatient visits was greater (IRR=1.25 (95% CI, 0.96 to 1.63)). During hospitalisation, 73.4% of patients were co-prescribed an OA, most frequently risperidone, with their index LAI. From pre-admission to post-discharge, psychiatric clinic costs significantly increased (US$14 231, p

Objective
Short-chain fatty acids (SCFA) play a role in modulating glucose metabolism and are influenced by diet. Alterations in the SCFA-producing microbial ecosystem in individuals with type 1 diabetes (T1D) may contribute to impaired glycaemic control. This study investigated the relationships between serum SCFA levels, blood glucose control, and dietary habits in adults with T1D.

Design
Observational study.

Setting
The study was conducted at the diabetes outpatient clinic of Federico II University Teaching Hospital, Naples, Italy.

Population
The study included 198 adults with T1D (100 men and 98 women), aged 18–79 years.

Main outcome measures
Serum SCFA levels, blood glucose control, assessed by glycated haemoglobin (HbA1c) and continuous glucose monitoring (CGM) metrics, and dietary intake from a 7-day food record.

Results
SCFA levels showed significant sex-specific differences (p180 mg/dL) (32.2±12.6% vs 41.2±17.2%, low tertile; p=0.011) and improved glucose management indicator (7.1±0.6% vs 7.5±0.6%, low tertile; p=0.027). Regarding eating habits, higher acetate tertiles were associated with higher intakes of total fat (p=0.041), polyunsaturated fatty acids (p=0.049) and monounsaturated fatty acids (p=0.021) in men only.

Conclusion
These findings reveal a sex-specific association between serum propionate levels and blood glucose control in women with T1D. Importantly, this relationship appears independent of dietary factors.

Trial registration number
NCT05936242.

Objectives
This study aimed to further develop and cross-validate a short questionnaire to measure self-reported Positive Health in general (Dutch) populations for evaluative purposes, stemming from the original 42 items of the My Positive Health (MPH) dialogue tool. Positive Health refers to ‘health from the perspective of patients and citizens’ following the concept of Huber et al.

Design and setting
A cross-sectional study was performed among a panel representative for the general adult Dutch population living at home.

Participants
The response rate was 76%, 1327 of a total of 2457 respondents were female, and mean age (years) was 53.3±17.8.

Methods
First, item reduction was carried out through content discussions following statistical output retrieved from factor structures and loadings, inter-item correlations and internal consistency (Cronbach’s alpha). Next, among the other half of the study population, measurement properties for the developed short questionnaire were calculated using goodness of fit indices from confirmatory factor analysis (CFA).

Results
The item reduction process (n=1199) resulted in a questionnaire of 22 items (PH22) with a four-factor structure and explained variance of 62.4%. Cronbach’s alpha values were 0.84, 0.92, 0.81 and 0.78 for the renamed factors ‘Physical fitness’ (5 items), ‘Contentment with self, others and life’ (nine items), ‘Daily life management’ (5 items) and ‘Future perspective’ (3 items), respectively. Cross-validation (n=1258) showed adequate goodness-of-fit indices of the PH22, based on both first-order and second-order CFA. The scores of the PH22 were normally distributed. No floor or ceiling effects were present.

Conclusions
A short 22-item questionnaire to measure self-reported Positive Health in a general (Dutch) population for evaluative purposes such as scientific or policy research at Positive Health or patient-centred interventions was developed and cross-validated, named PH22. This study supports its structural validity. To use this questionnaire in practice, its test-retest reliability and responsiveness should also be known. Future research has to reveal this.

Objectives
This study aimed to investigate the safety and effectiveness of opioid-free anaesthesia (OFA) versus conventional opioid anaesthesia (OA) for postoperative pain management and recovery in patients undergoing laparoscopic surgery.

Design
Systematic review and meta-analysis.

Data sources
The databases of PubMed, Embase, Cochrane Library and Web of Science were searched from inception to August 2023.

Eligibility criteria for selecting studies
We included any randomised controlled trial comparing OFA (at least two drugs or two more alternatives to opioids) with OA for laparoscopic surgery. The primary outcomes included postoperative pain scores, measured on a Numerical Rating Scale or Visual Analogue Scale ranging from 0 to 10, at 0–2 hours and 24 hours postoperatively; postoperative analgesic consumption, measured in morphine equivalent doses (mg); and quality of recovery, assessed using the QoR-40 score (ranging from 40 to 200). The secondary outcomes included the incidence of postoperative nausea and vomiting (PONV), antiemetic use, extubation time (measured in minutes), post-anaesthesia care unit discharge time (measured in minutes), shivering, bradycardia, hypotension and pruritus.

Data extraction and synthesis
Meta-analyses were performed using Stata16 software, using the DerSimonian and Laird’s method and inverse variance to summarise effect sizes for each outcome under a random effects model for all outcomes. Outcomes were reported as OR for binary outcome indicators and mean difference (MD) for continuous outcome indicators, with corresponding 95% CIs. I² coefficients were used to assess high, medium and low heterogeneity. RoB was used to assess the risk of bias of the included studies. GRADE assessed the certainty of the evidence using a systematic framework for rating the quality of evidence and strength of recommendations.

Results
Ultimately, 12 studies involving 983 patients undergoing laparoscopic surgery were included in this systematic evaluation and meta-analysis. The results of the meta-analysis showed an association of OFA with reduced early postoperative 0–2-hour pain response (MD –1.29; 95% CI –2.23 to –0.36; I²=92%; p

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

Objectives
Temporal trends in the incidence of ST-elevation myocardial infarction (STEMI) have been declining in many countries, while the incidence of non-ST elevation myocardial infarction (NSTEMI) has reached a plateau or even increased. The reasons for these changing trends have yet to be explained. We analysed these trends and short-term mortality from acute coronary syndromes in a nationwide cohort study over 35 years in Iceland.

Design
Retrospective cohort study using a national MI registry.

Setting
Iceland.

Participants
All cases of myocardial infarction in individuals aged 25–74 years in Iceland 1981–2015.

Methods
Each case was classified as STEMI, NSTEMI or no ECG taken. ECG recordings were classified according to Minnesota criteria.

Outcome measures
Trends of STEMI and NSTEMI incidence and 1-day and 28-day mortality were obtained from the National Death Registry.

Results
A total of 10 348 cases were identified (mean age 61 years, 76.4% male). These were categorised as STEMI (32.7%), NSTEMI (45.8%) and no ECG taken (21.5%). We detected a significant 3.7% annual decline in the incidence of first MI. The age-adjusted incidence of STEMI showed an 83.2% decline, most pronounced after 1994, while for NSTEMI the decline was 66.5%, reaching a plateau from the year 1989 onwards. In Iceland, the uptake of highly sensitive biomarkers was initiated in 1997 (cardiac troponin T) and 2012 (high-sensitive troponin T), respectively.

Conclusions
The different temporal trends in the incidence of STEMI and NSTEMI cannot be explained only by the uptake of highly sensitive biomarkers in 1997 and 2012. The change in population-level risk factor exposure is likely to have influenced atherosclerotic plaque burden and thrombotic mechanisms. Finally, increasing uptake of cardioprotective pharmacological and interventional therapy may have resulted in a primary preventive effect on plaque rupture and thrombosis and thus on the rates of STEMI and NSTEMI disproportionally.

Objectives
Accurately predicting short-term MACE (major adverse cardiac events) following primary percutaneous coronary intervention (PCI) remains a clinical challenge. This study aims to assess the effectiveness of four established risk scores in predicting short-term MACE after primary PCI.

Design
Prospective observational study.

Setting
The National Institute of Cardiovascular Diseases, Karachi, Pakistan.

Participants
We enrolled a cohort of consecutive adult patients diagnosed with ST-elevation myocardial infarction undergoing primary PCI over a 6-month period, from 1 January 2022 to 30 June 2022.

Outcome measures
All the patients were followed at intervals of 3 months up to 12 months, and MACE events were recorded. Thrombolysis in Myocardial Infarction (TIMI), Primary Angioplasty in Myocardial Infarction (PAMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) and Global Registry of Acute Coronary Events (GRACE) scores were obtained.

Results
A total of 2839 patients (79.3% male, mean age 55.6±11.2 years) were included. Over a median follow-up of 244 days, the composite MACE rate was 18.4% (521). All-cause mortality was 13.5% (384), reinfarction requiring revascularisation was 4.3% (121), heart failure-related rehospitalisation was 2.7% (76), stent thrombosis occurred in 5.6% (160) and cerebrovascular accident events were documented in 1% (28). The area under the curve for TIMI, PAMI, CADILLAC and GRACE scores was 0.682 (95% CI 0.655 to 0.709), 0.688 (95% CI 0.663 to 0.713), 0.686 (95% CI 0.66 to 0.711) and 0.695 (95% CI 0.669 to 0.72), respectively, for the prediction of MACE. On multivariable Cox regression, high-risk categories based on GRACE score were independent predictors of MACE with adjusted HR of 1.88 (95% CI 1.28 to 2.77; p=0.001).

Conclusions
A significant proportion of patients experienced short-term MACE after primary PCI. While none of the assessed scores demonstrated significant predictive power, the GRACE score exhibited comparatively better predictive ability than the TIMI, PAMI and CADILLAC scores.

Objectives
To describe the prevalence and patterns of opioid analgesic and pain medicine dispenses, and the impact of up-scheduling of low-dose (≤15 mg) codeine-containing products to Australians with accepted workers’ compensation time loss claims for musculoskeletal conditions between 2010 and 2019.

Design
Interrupted time series.

Setting
Workers’ compensation scheme in Victoria, Australia.

Population
Australians with accepted workers’ compensation time loss claims for musculoskeletal conditions between 2010 and 2019.

Main outcome measures
Number and proportion of workers dispensed pain medicines in the first year of claim and the monthly number, percentage of pain medicine dispenses and mean morphine equivalent dispense dose.

Results
Nearly one-third (28.4%, n=22 807) of our sample of 80 324 workers were dispensed any opioid in the first year since the workers’ compensation insurer received their claim. There were no significant step or trend changes in the number or percentage of pain medicines dispensed of up-scheduled low-dose codeine. Only 2.9% of workers were ever dispensed up-scheduled low-dose codeine, specifically 2.5% after up-scheduling (1 February 2018). After up-scheduling of low-dose codeine, workers were more likely to be dispensed opioids (excluding codeine) (prevalence ratio (PR) 1.21, 99% CI 1.13, 1.31) or other pain medicines (eg, pregabalin, paracetamol) (PR 1.11, 99% CI 1.03, 1.19) compared with the year prior. There was a significant 28.5% (99% CI 16.3, 41.9) step increase (ie, increase immediately after up-scheduling) in high-dose ( >15 mg) codeine with a significant trend decrease (–1.3%, 99% CI –2.5, –0.2).

Conclusion
Up-scheduling low-dose codeine to prescription-only medicines did not significantly change the dispensing of low-dose codeine-containing products to workers with accepted workers’ compensation time loss claims for musculoskeletal conditions.

Introduction
Acute sleep and circadian rhythm (SCR) disruption can lead to a range of negative physical and mental consequences, such as depression, delirium, respiratory dysfunction and increased mortality. In the intensive care unit (ICU), the unique environment can exacerbate disruptions in SCR. Few studies have identified the characteristics of SCR in the ICU, and the roles of patient characteristics, illness and medical interventions in ICU SCR remain unclear. A single-centre prospective cohort study, called SYNC study (Sleep and circadian rhYthm in iNtensive Care unit), will be conducted to explore the characteristics and associated factors of SCR and investigate the short-term prognosis among patients in the surgical ICU.

Methods and analysis
Patients from a surgical ICU at a tertiary teaching hospital will be enrolled. SCR will be assessed by both objective and subjective indicators, including melatonin secretion rhythm, activity rhythm, sleep pattern and perceived sleep quality. Data on eight potential factors that influence SCR, including light exposure, noise level, pain level, nighttime disturbances, mechanical ventilation, sedative and analgesic use, meal pattern and restraints, will be collected. These data will be gathered in the first 3 days after ICU admission. Short-term prognostic indicators, including anxiety, depression, cognitive function, insomnia, activities of daily living, ICU stay, hospital stay and hospital mortality will be collected during the hospital stay and at 1 month after discharge.

Ethics and dissemination
The study has been approved by the Ethics Committee of Zhongshan Hospital, Fudan University (B2024-076R). The results of this study will be published in peer-reviewed journals.

Trial registration number
NCT06346613.

Annals of Internal Medicine, Ahead of Print.

Annals of Internal Medicine, Ahead of Print.

This cross-sectional study examines prescription claims for contraceptives and medications for opioid use disorder among commercially insured women in the US from 2016 to 2021.

Introduction
Despite the current opioid crisis resulting in tens of thousands of deaths every year, buprenorphine, a medication that can reduce opioid-related mortality, withdrawal, drug use and craving, is still underprescribed in the emergency department (ED) for treatment of opioid use disorder (OUD). The EMergency department-initiated BuprenorphinE for opioid use Disorder (EMBED) trial introduced a clinical decision support (CDS) tool that improved the proportion of ED physicians prescribing buprenorphine but did not affect patient-level rates of buprenorphine initiation. The present trial aims to build on these findings by optimising CDS use through iterative improvements, refined interventions and clinician feedback to enhance OUD treatment initiation in EDs.

Methods and analysis
The Adaptive Decision support for Addiction Treatment (ADAPT) trial employs the Multiphase Optimization Strategy (MOST) framework to refine a multicomponent CDS tool designed to facilitate buprenorphine initiation for OUD in ED settings. Using a pragmatic, learning health system approach in three phases, the trial applies plan–do–study–act cycles for continuous CDS refinement. The CDS will be updated in the preparation phase to reflect new evidence. The optimisation phase will include a 2x2x2 factorial trial, testing the impact of various intervention components, followed by rapid, serial randomised usability testing to reduce user errors and enhance CDS workflow efficiency. In the evaluation phase, the optimised CDS package will be tested in a randomised trial to assess its effectiveness in increasing ED initiation of buprenorphine compared with the original EMBED CDS.

Ethics and dissemination
The protocol has received approval from our institution’s institutional review board (protocol #2000038624) with a waiver of informed consent for collecting non-identifiable information only. Given the minimal risk involved in implementing established best practices, an independent study monitor will oversee the study instead of a Data Safety Monitoring Board. Findings will be submitted to ClinicalTrials.gov, published in open-access, peer-reviewed journals, presented at national conferences and shared with clinicians at participating sites through email notification.

Trial registration number
NCT06799117.

Objectives
Advances in the treatment of opioid use disorder (OUD) have seen the development of long-acting injectable opioid substitutes which could improve outcomes for people with OUD. However, comparative quantitative analysis of individual outcomes is lacking. The present study sought to investigate factors associated with prescribing long-acting injectable buprenorphine (LAIB), and changes in outcome variables compared with oral medication for OUD.

Design
Cross-sectional retrospective analysis of electronic health records.

Setting
Community substance use treatment service Via. Six sites shared their data between 15 August 2022 and 15 August 2023.

Participants
Anonymised data were extracted for 235 people receiving LAIB and 266 people receiving oral medication for OUD.

Primary and secondary outcomes
Prescribing data, sociodemographic information (age, sex, indices of multiple deprivation decile of individual’s residence, primary and secondary substance, number of previous treatment episodes, employment and ethnicity) and treatment outcome profiles (substance use, physical and mental health, quality of life, employment) were extracted and analysed. To examine predictors of receiving LAIB (vs medication for OUD), we conducted logistic regression including the demographic predictors. Psychological health, physical health and quality of life scores were analysed using Welch’s t-tests.

Results
LAIB was associated with positive changes in quality of life between the first and last assessments. Demographic and situational factors were predictors of LAIB initiation, indicating the potential for increasing health inequalities in substance use treatment.

Conclusions
LAIB is associated with changes in quality of life over a 1-year period. Further research is needed to investigate the aetiology of improved well-being and outcomes over time.