Evidence-based opioid prescribing guidelines after lung resection: a prospective, multicenter analysis.

Background: Opioid prescribing guidelines have significantly decreased overprescribing and post-discharge use after cardiac surgery; however, limited recommendations exist for general thoracic surgery patients, a similarly high-risk population. We examined opioid prescribing and patient-reported use to develop evidence-based, opioid prescribing guidelines after lung cancer resection. Methods: This prospective, statewide, quality improvement study was conducted between January 2020 to March 2021 and included patients undergoing surgical resection of a primary lung cancer across 11 institutions. Patient-reported outcomes at 1-month follow-up were linked with clinical data and Society of Thoracic Surgery (STS) database records to characterize prescribing patterns and post-discharge use. The primary outcome was quantity of opioid used after discharge; secondary outcomes included quantity of opioid prescribed at discharge and patient-reported pain scores. Opioid quantities are reported in number of 5-mg oxycodone tablets (mean ± standard deviation). Results: Of the 602 patients identified, 429 met inclusion criteria. Questionnaire response rate was 65.0%. At discharge, 83.4% of patients were provided a prescription for opioids of mean size 20.5±13.1 pills, while patients reported using 8.2±13.0 pills after discharge (P<0.001), including 43.7% who used none. Those not taking opioids on the calendar day prior to discharge (32.4%) used fewer pills (4.4±8.1 vs. 11.7±14.9, P<0.001). Refill rate was 21.5% for patients provided a prescription at discharge, while 12.5% of patients not prescribed opioids at discharge required a new prescription before follow-up. Pain scores were 2.4±2.5 for incision site and 3.0±2.8 for overall pain (scale 0-10). Conclusions: Patient-reported post-discharge opioid use, surgical approach, and in-hospital opioid use before discharge should be used to inform prescribing recommendations after lung resection.

Template assisted highly ordered novel self assembly of micro-reservoirs and its replication.

A novel method is developed for template assisted fabrication of a regular assembly of microcavity arrays. Simple micropatterns on PDMS mold are used to create complex geometries via solvent vapor back pressure in a biodegradable polymer. Cavities are in turn replicated in complimentary PDMS mushroom like microstructures.

Blends of reverse enteric polymer with Enteric and pH-independent polymers: mechanistic investigations for tailoring drug release.

Blends of conventional reverse enteric polymer with enteric polymers result in insoluble polyelectrolyte complexes and hence cannot be used in film coatings. We report a new set of miscible blends of a new reverse enteric polymer (NREP) synthesized by us with enteric and pH-independent polymers. The nature of interactions between polymers in the blends has been established by analyzing Fourier transform infrared (FTIR) spectra. The extent of interaction has been investigated by thermal analysis and quantified in terms of parameters K1 and K2 in the Schneider equation. Based on these values, the interactions between NREP and these polymers have been ranked in the order EC (ethylcellulose) < ES (Eudragit S) < HPMCP (hydroxypropyl methylcellulose phthalate). The quantification of interactions in blends helps explain the release pattern of cefuroxime axetil (CA) at gastric pH and tailor the release of other drugs according to their pharmacokinetic characteristics. The understanding also provides a more rational approach for selection of polymers and their content in the coating compositions, rather than an empirical approach.

Designing a self-associated cationic polymer for enhanced compatibility, palatability, and gastric release of cefuroxime axetil.

Cefuroxime axetil (CA) has exhibited interactions with the polymers hydroxypropyl methylcellulose phthalate, cellulose acetate trimellitate, and Eudragit E resulting in the generation of unacceptable amounts of impurities and degradation. Formulations, which mask the bitter taste of CA and release it immediately in the stomach, have therefore not been possible. In an attempt to overcome the interaction with CA, we report a self-associated cationic polymer (NREP) containing methyl methacrylate (MMA), 2-hydroxy ethylmethacrylate (HEMA), and 4-vinyl pyridine (4-VP). The hydrogen bonding between the pyridine nitrogen and the hydroxyl groups of HEMA results in strong intrachain associations, prevents interactions between NREP and CA, and inhibits degradation of CA. This has been validated by differential scanning calorimetry, Fourier transform infrared spectroscopy, NMR, and high-performance liquid chromatography analysis. These self-associations restrict polymer chain motions, enhance biocompatibility, and lead to a higher Tg, which ensures that NREP does not become tacky in processes involving heat. The judicious choice of the hydrophobic and hydrophilic monomers renders the polymer hydrophobic enough as to mask the bitter taste of CA at near neutral pH. Incorporation of the basic monomer 4-VP ensures rapid dissolution of the polymer and release of CA at the acidic pH prevalent in the stomach. The work indicates an approach to design pH-sensitive polymers for dosage forms that meet the pharmacokinetic requirements of the drug.

Formation of linear polymers with pendant vinyl groups via inclusion complex mediated polymerization of divinyl monomers.

Ethylene glycol dimethacrylate (EGDMA) and ethylene glycol methacrylate 4-vinyl benzoate (EGMAVB) were shown to form 1:1 inclusion complexes with cyclodextrin and were characterized by instrumental techniques. Computational analysis showed that the bent conformation of the included divinyl monomer was more stable than its linear conformation. Complexation of the divinyl monomer with the first CD molecule offered substantial stabilization than with the second CD molecule. The vinyl group included in the CD cavity did not participate in polymerization. As a result, solvent soluble, linear polymers with pendant vinyl unsaturation per repeat unit were obtained. This was unequivocally established by the polymerization of a complex comprising CD and EGMAVB. The unreacted vinyl group can be polymerized in the subsequent step to yield cross-linked products.

Pericardiocentesis with extended catheter drainage: an effective therapy.

BACKGROUND: The most effective method for managing pericardial effusions has yet to be identified. This study evaluates the efficacy and safety of echocardiographic-guided placement of indwelling catheters into the pericardial space. METHODS: This study consists of a 5-year retrospective chart review of consecutive patients coded with benign or malignant pericardial effusions who presented for drainage procedures to a single surgeon at a 260-bed hospital. Complication, recurrence, and survival rates were studied. RESULTS: Between January 1996 and August 2001, a total of 29 pericardial drainage procedures were performed; eight of those also underwent talc sclerosis. Mean follow-up was 16 months. Three patients (10%) required conversion to thoracotomy; of those remaining, 25 of the 26 procedures were performed under local anesthesia with intravenous sedation. The identified etiologies for pericardial effusions were malignancy (76%), idiopathic (14%), postcoronary artery bypass grafting procedure (3%), viral pericarditis (3%), and uremia (3%). Echocardiographic features of tamponade were documented in 72%. Mean +/- SEM length of postprocedure in-hospital stay was 6.7 +/- 0.82 days. The overall complication rate was 10% (pneumothorax and cardiac injury). Recurrence rate within 30 days was 7%. Thirty-day mortality was 21%, and more than 90-day survival was 72%. CONCLUSIONS: Pericardiocentesis with extended catheter drainage is a safe treatment for management of clinically significant, malignant and benign, pericardial effusions and can be performed effectively under local anesthesia with intravenous sedation.