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https://www.readbyqxmd.com/read/29776702/naloxone-use-among-emergency-department-patients-with-opioid-overdose
#1
Catherine A Marco, William Trautman, Alexander Cook, Dennis Mann, Jordan Rasp, Oswald Perkins, Michael Ballester
BACKGROUND: Emergency department (ED) visits for unintentional opioid overdoses have increased dramatically. Naloxone hydrochloride (Narcan®) is an opioid antagonist commonly used to treat these overdoses. OBJECTIVE: This study was undertaken to identify experiences regarding naloxone use among ED patients with opioid overdose. METHODS: This prospective survey study was conducted at an urban level I trauma center. A survey was administered to eligible ED patients after unintentional opioid overdose...
May 16, 2018: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29752701/pain-agreements-and-healthcare-utilization-in-a-veterans-affairs-primary-care-population-a-retrospective-chart-review
#2
Cynthia Kay, Erica Wozniak, Alice Ching, Joanne Bernstein
INTRODUCTION: The prevalence of chronic pain is enormous. In America, the management of chronic pain and opioids remains a critical focus. Guidelines recommend pain agreements as part of the management of chronic pain and opioids; however, evidence of improvement in patient outcomes is lacking. An aspect of patient outcome includes utilization of healthcare resources, such as emergency department visits and hospitalizations. It remains uncertain whether the use of pain agreements lessens healthcare utilization...
May 11, 2018: Pain and Therapy
https://www.readbyqxmd.com/read/29751092/overdosing-of-benzodiazepines-z-drugs-and-falls-in-older-adults-costs-for-the-health-system
#3
María José Díaz-Gutiérrez, Mónica Martínez Cengotitabengoa, Cristina Bermúdez-Ampudia, Sainza García, Purificación López, Mayte Martínez-Cengotitabengoa, Ana González-Pinto
INTRODUCTION: Benzodiazepines and Z drugs (BZD/Z drugs) are commonly used for the treatment of insomnia and anxiety in older adults for long periods of time. Given the physiological and metabolic characteristics of this group of patients, they are more prone to the adverse effects of these drugs which include falls. The recommendations for use of BZD/Z drugs include the need to adjust the dose and select those with a short half-life, to avoid adverse events, which as well as potentially affecting patient outcome, increase healthcare costs...
May 8, 2018: Experimental Gerontology
https://www.readbyqxmd.com/read/29746361/prolonged-qrs-widening-after-aripiprazole-overdose
#4
Maryann Mazer-Amirshahi, Robert Porter, Kayla Dewey
BACKGROUND: Aripiprazole is an atypical antipsychotic with a long half-life. Overdose can result in protracted somnolence and cardiac disturbances, particularly QT interval prolongation. METHODS: This is a single case report of a 14-year-old boy who took an overdose of aripiprazole and developed QRS widening. CASE: A 14-year-old boy intentionally ingested 20 tablets of aripiprazole (5 mg). He was brought to the emergency department when his ingestion was discovered...
May 5, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29735614/emergency-providers-opioid-prescribing-behaviors-among-medicare-part-d-beneficiaries-in-north-carolina-2013-2014-medication-utilization-and-costs
#5
Brittany Williams, Geoffrey Mospan, Rebecca Seabock, Chris Gillette, Michelle DeGeeter
BACKGROUND This study sought to quantify utilization and costs associated with opioid prescribing by emergency providers for Medicare Part D beneficiaries in North Carolina and the United States from 2013 to 2014. METHODS This was a retrospective examination of the Medicare Provider Utilization and Payment Data: Part D Prescriber datasets from 2013-2014. The main variables of interest were total number of prescription claims and total Medicare Part D medication costs for opioid analgesic medications. Generalized estimating equations were used to analyze the data...
May 2018: North Carolina Medical Journal
https://www.readbyqxmd.com/read/29699589/suicidal-patients-presenting-to-secondary-and-tertiary-emergency-departments-and-referral-to-a-psychiatrist-a-population-based-descriptive-study-from-japan
#6
Izumi Chihara, Ryusuke Ae, Yuka Kudo, Ritei Uehara, Nobuko Makino, Yuri Matsubara, Teppei Sasahara, Yasuko Aoyama, Kazuhiko Kotani, Yosikazu Nakamura
BACKGROUND: In Japan, although many suicidal studies were previously conducted in tertiary emergency department (ED) settings, no published studies have reported on suicidal patients presenting to the secondary EDs. The aim of the study was to describe the characteristics of suicidal patients and the referral rates to a psychiatrist overall and by type of facility. METHODS: Questionnaires were sent to all secondary and tertiary EDs in Tochigi prefecture, Japan. Data were collected for cases who presented in September 2009...
April 25, 2018: BMC Psychiatry
https://www.readbyqxmd.com/read/29691274/negative-myoclonus-secondary-to-paroxetine-intake
#7
Pedro Correia, Joana Afonso Ribeiro, Conceição Bento, Francisco Sales
Outside the context of overdose and serotonin syndrome, seizures and myoclonic movements attributed to selective serotonin reuptake inhibitors (SSRIs) are rare and poorly documented. We present a 77-year-old man, with no history of epilepsy, presenting in the emergency department with whole body jerks since that morning. Two days earlier, due to a prescription mistake, he was started on paroxetine 20 mg instead of his usual fluoxetine 20 mg. The patient's electroencephalogram (EEG), performed in the emergency department, revealed a bilateral synchronous parieto-occipital fast spike activity pattern, which correlated consistently with negative myoclonus...
April 24, 2018: BMJ Case Reports
https://www.readbyqxmd.com/read/29679440/effects-of-a-prior-authorization-policy-for-extended-release-long-acting-opioids-on-utilization-and-outcomes-in-a-state-medicaid-program
#8
Shellie L Keast, Hyunjee Kim, Richard A Deyo, Luke Middleton, K John McConnell, Kun Zhang, Sharia M Ahmed, Nancy Nesser, Daniel M Hartung
BACKGROUND AND AIMS: In response to the opioid overdose epidemic, USA state Medicaid programs have adopted restrictive policies for opioid analgesics, yet effects on prescribing patterns and health outcomes are uncertain. This study aimed to examine effects of a prior authorization policy for extended-release/long-acting (ER/LA) opioids on opioid use in the Oklahoma, USA state Medicaid program. DESIGN: Retrospective difference-in-differences design study comparing changes in opioid use in Oklahoma Medicaid to control (Oregon Medicaid)...
April 20, 2018: Addiction
https://www.readbyqxmd.com/read/29678969/reducing-the-default-dispense-quantity-for-new-opioid-analgesic-prescriptions-study-protocol-for-a-cluster-randomised-controlled-trial
#9
Marcus A Bachhuber, Denis Nash, William N Southern, Moonseong Heo, Matthew Berger, Mark Schepis, Chinazo O Cunningham
INTRODUCTION: As opioid analgesic consumption has grown, so have opioid use disorder and opioid-related overdoses. Reducing the quantity of opioid analgesics prescribed for acute non-cancer pain can potentially reduce risks to the individual receiving the prescription and to others who might unintentionally or intentionally consume any leftover tablets. Reducing the default dispense quantity for new opioid analgesic prescriptions in the electronic health record (EHR) is a promising intervention to reduce prescribing...
April 20, 2018: BMJ Open
https://www.readbyqxmd.com/read/29677410/mapping-drug-overdose-demographic-and-socioeconomic-characteristics-in-the-community
#10
Brenda L Rooney, Mitchell T Voter, Christopher M Eberlein, Andrea J Schossow, Cathy L Fischer
INTRODUCTION: Drug use and drug overdose have increased at an alarming rate. OBJECTIVE: To identify demographic and neighborhood social and economic factors associated with higher risk of overdose. These findings can be used to inform development of community programs and appropriately devote resources to prevent and treat drug abuse. METHODS: The electronic health records of all patients seen in the emergency department or admitted to the hospital for a drug overdose in 2016 at Gundersen Health System in La Crosse, Wisconsin, were reviewed retrospectively...
March 2018: WMJ: Official Publication of the State Medical Society of Wisconsin
https://www.readbyqxmd.com/read/29674328/catastrophic-circulatory-collapse-after-inadvertent-subcutaneous-injection-of-treprostinil
#11
John J Radosevich, Mohan Dutt, Jeremy Feldman
PURPOSE: A case of life-threatening cardiovascular collapse after inadvertent subcutaneous injection of undiluted treprostinil is reported. SUMMARY: A 29-year-old, 76-kg woman with group 1 pulmonary arterial hypertension managed with subcutaneous treprostinil infusion arrived at the emergency department (ED) with headache, nausea, vomiting, and a syncopal episode. Her vital signs were stable on presentation. Admission orders were placed, and the appropriate 3-mL syringe containing 7...
April 19, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29628190/prognostic-utility-of-initial-lactate-in-patients-with-acute-drug-overdose-a-validation-cohort
#12
Randy Cheung, Robert S Hoffman, David Vlahov, Alex F Manini
STUDY OBJECTIVE: Previous studies have suggested that the initial emergency department (ED) lactate concentration may be an important prognostic indicator for inhospital mortality from acute drug poisoning. We conduct this cohort study to formally validate the prognostic utility of the initial lactate concentration in a larger, distinct patient population with acute drug overdose. METHODS: This observational, prospective, cohort study was conducted during 5 years at 2 urban teaching hospitals...
April 6, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29602664/rate-of-patients-at-elevated-risk-of-opioid-overdose-visiting-the-emergency-department
#13
Justin Ray Pedigo, Charles F Seifert
OBJECTIVE: To determine the rate of patients visiting the emergency department who are at risk of opioid overdose. METHODS: The electronic records of a 412 bed tertiary care county teaching hospital were searched for emergency department (ED) visits from January 1, 2013 to October 31, 2016 to find patients on at least 100mg morphine equivalents (MME) of oral opioid therapy, or an opioid in combination with a benzodiazepine. Records were also searched for patients with a positive urinalysis for opioids when no opioid was present on their home medication list...
March 22, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29564929/hepatotoxicity-after-paracetamol-overdose-in-a-patient-with-cystic-fibrosis-despite-early-acetylcysteine-and-utility-of-microrna-to-predict-hepatotoxicity
#14
Anselm Wong, Benjamin Cheung, Charlotte Nejad, Michael Gantier, Andis Graudins
CASE DETAILS: A 19-year-old girl presented to the emergency department following overdose of 10 g of paracetamol on a background history of cystic fibrosis. Paracetamol concentration was below the nomogram line, but was treated with acetylcysteine seven hours post-overdose given her symptomatology. Nineteen hours following her overdose she developed hepatotoxicity, despite early initiation of acetylcysteine. She was discharged well six days post-ingestion. On presentation, delta miRNA-122-miR483 was 20 times that of control patients, however, alanine aminotransferase was normal...
March 22, 2018: Clinical Toxicology
https://www.readbyqxmd.com/read/29538652/frequently-used-drug-types-and-alcohol-involvement-in-intentional-drug-overdoses-in-ireland-a-national-registry-study
#15
Caroline Daly, Eve Griffin, Darren M Ashcroft, Roger T Webb, Ivan J Perry, Ella Arensman
Background: Intentional drug overdose (IDO) is the most common form of hospital-treated self-harm, yet no national study has systematically classified the range of drugs involved using a validated system. We aimed to determine the profile of patients engaging in overdose, to identify drugs frequently used and to quantify the contributions of multiple drug use and alcohol involvement. Methods: Between 2012 and 2014, the National Self-Harm Registry, Ireland recorded 18 329 presentations of non-fatal IDO to Irish emergency departments...
March 12, 2018: European Journal of Public Health
https://www.readbyqxmd.com/read/29538267/assessment-of-emergency-department-antibiotic-discharge-prescription-dosing-errors-for-pediatric-patients-in-a-community-hospital-health-system
#16
Linda Barstow, Erika Herman, Heidi Phillips, Patrick Maloney
OBJECTIVES: We quantify and describe emergency department antibiotic discharge prescription dosing errors for pediatric patients in a community hospital health system. METHODS: This was a retrospective chart review evaluating emergency department discharge prescriptions written between July 1, 2014, and June 30, 2015. Pediatric patients who received a prescription for an oral antibiotic were included in error analysis if they had a weight updated in the electronic medical record during the encounter...
March 12, 2018: Pediatric Emergency Care
https://www.readbyqxmd.com/read/29530654/safety-of-a-brief-emergency-department-observation-protocol-for-patients-with-presumed-fentanyl-overdose
#17
Frank X Scheuermeyer, Christopher DeWitt, Jim Christenson, Brian Grunau, Andrew Kestler, Eric Grafstein, Jane Buxton, David Barbic, Stefan Milanovic, Reza Torkjari, Indy Sahota, Grant Innes
STUDY OBJECTIVE: Fentanyl overdoses are increasing and few data guide emergency department (ED) management. We evaluate the safety of an ED protocol for patients with presumed fentanyl overdose. METHODS: At an urban ED, we used administrative data and explicit chart review to identify and describe consecutive patients with uncomplicated presumed fentanyl overdose (no concurrent acute medical issues) from September to December 2016. We linked regional ED and provincial vital statistics databases to ascertain admissions, revisits, and mortality...
March 9, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29523371/opportunities-for-prevention-and-intervention-of-opioid-overdose-in-the-emergency-department
#18
EDITORIAL
Debra E Houry, Tamara M Haegerich, Alana Vivolo-Kantor
No abstract text is available yet for this article.
June 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/29518069/vital-signs-trends-in-emergency-department-visits-for-suspected-opioid-overdoses-united-states-july-2016-september-2017
#19
Alana M Vivolo-Kantor, Puja Seth, R Matthew Gladden, Christine L Mattson, Grant T Baldwin, Aaron Kite-Powell, Michael A Coletta
INTRODUCTION: From 2015 to 2016, opioid overdose deaths increased 27.7%, indicating a worsening of the opioid overdose epidemic and highlighting the importance of rapid data collection, analysis, and dissemination. METHODS: Emergency department (ED) syndromic and hospital billing data on opioid-involved overdoses during July 2016-September 2017 were examined. Temporal trends in opioid overdoses from 52 jurisdictions in 45 states were analyzed at the regional level and by demographic characteristics...
March 9, 2018: MMWR. Morbidity and Mortality Weekly Report
https://www.readbyqxmd.com/read/29508897/hydromorphone-use-for-acute-pain-misconceptions-controversies-and-risks
#20
REVIEW
Maryann Mazer-Amirshahi, Sergey Motov, Lewis S Nelson
Hydromorphone (HM) is a potent opioid analgesic that is commonly administered in the emergency department (ED) and other acute care settings, such as medical surgical wards. In recent years, there has been a significant increase in the ED administration of HM relative to other opioids. Although HM is an effective analgesic, its use has been commonly implicated in adverse drug events and medication errors. In addition, intravenous HM has potent euphoric effects that may contribute to its abuse liability. There are limited data regarding how acute parenteral administration of opioid analgesics in the setting of high rates of preexisting chronic opioid use (medical or nonmedical) may contribute to or reinforce addictive behavior, making the potential contribution of rising HM administration to subsequent prescription opioid abuse and overdose uncertain...
January 2018: Journal of Opioid Management
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