Hospitalizations for opioid-related overdose and timing of concurrent opioid and benzodiazepine use: A nested case-control study.

BACKGROUND: Concurrent opioid and benzodiazepine (BZD) use is a prevalent high-risk prescribing behavior that increases the risk of opioid overdose. However, there is limited evidence on the relationship between timing of concurrent use and risk of opioid overdose. OBJECTIVE: To evaluate the likelihood of opioid-related overdose across levels of duration, recency, and daily dose of concurrent use. DESIGN: A nested case-control study was conducted using Truven MarketScan claims data (2009-2018). PARTICIPANTS: Commercially insured adults (age 18-64 years old) with a new opioid dispensing in 2010-2018. MAIN MEASURES: Cases of opioid-related overdose were identified based on hospitalization diagnosis codes. Controls were matched to cases in a 10:1 ratio by age, sex, opioid start date, and cancer history. Concurrent use was classified based on duration, timing, and daily dose of overlapping opioids and BZDs during 90 days before the event. Conditional logistic regression models were used to evaluate the relationship between concurrent use and opioid-related overdose. KEY RESULTS: Among 11,137,866 dispensed a new opioid, a total of 3388 patients experienced opioid-related overdose and were matched to 33,893 controls. Cases and controls were 34 years old on average and 54% female. Patients with concurrent use were significantly more likely to have opioid-related overdose compared to patients receiving opioids, BZDs, or neither (OR 9.28; 95% CI 7.87, 10.93). Longer concurrent use of 1-7, 8-30, and 31-90 days was associated with 4.6, 12.1, and 26.7-fold higher likelihood of opioid-related overdose (p < 0.01). Patients with overlapping prescriptions during previous 0-30, 31-60, and 61-90 days were 13.2, 6.0, and 3.2-times more likely to experience an overdose (p < 0.01). CONCLUSIONS: Patients with an opioid-related overdose were more likely to be prescribed concurrent opioid and BZD across all levels of duration, timing, and daily dose. Future policies and quality measures should be pursued to prevent concurrent use unless medically necessary.

Continuity of Specialty Pharmacy Practice: A Survey of PGY-2 Pharmacy Residency Graduates.

BACKGROUND: Literature regarding career trajectory for postgraduate year 2 (PGY-2) pharmacy residency specialty-trained pharmacists is limited. OBJECTIVE: The objective of our study is to describe PGY-2 pharmacy residency training on career practice and satisfaction. METHODS: A cross-sectional study surveyed graduates of PGY-2 pharmacy residency programs. Respondents were identified by current PGY-2 residency program directors requesting participation from their program alumni. The primary outcome was whether PGY-2 residency-trained pharmacists continued working within their specialty or not. Secondary outcomes included alternative specialty areas, current satisfaction with their specialty, and the necessity of completing a PGY-2. RESULTS: Among 647 respondents, 84% completed their program in the past 6 years. The top 3 represented pharmacy specialties were critical care (19%), ambulatory care (14%), and oncology (13%). Most respondents continue to practice in the same specialty as their PGY-2 residency program (n = 572, 87%) compared with pharmacists who currently practice in other clinical specialties or areas of pharmacy (n = 83, 13%). Critical care (n = 28, 33%) had the largest specialty response no longer practicing in their PGY-2 residency program specialty with 42% (n = 12) now practicing within the emergency medicine specialty. The average satisfaction for their current specialty was 4.7 ± 0.82 (Likert scale of 1 = extremely dissatisfied to 5 = extremely satisfied). CONCLUSIONS: The vast majority PGY-2 pharmacy residency-trained pharmacists experienced training-practice concordance and are satisfied with their trained specialty. Among those with specialty training practice discordance, critical care training was most prevalent.

Bariatric surgery + medical therapy: Effective Tx for T2DM?

Short-term studies have indicated "Yes," but does a longterm randomized controlled trial give it a thumbs up?

Comparison of haloperidol, non-haloperidol antipsychotics, and no pharmacotherapy for the management of delirium in an inpatient geriatric palliative care population.

Antipsychotics are frequently used for treatment of delirium, although little evidence exists that they improve delirium outcomes. Our objective was to evaluate haloperidol (HAL) compared to non-haloperidol antipsychotics (NHAP) or no pharmacologic treatment (NP) in the management of delirium in older adults under the care of a palliative care consult service across a large, integrated health care system. A retrospective chart review examined data from September 2014-September 2015. All hospitalized patients ≥65 years old with a diagnosis of delirium during palliative care consultation were included (n = 304). Primary outcome was length of stay after delirium diagnosis. Secondary outcomes included delirium symptom length, sedation, and QTc prolongation. Univariate statistical tests, analysis of covariance, and multiple regression methods were used to compare groups. Post-delirium length of stay in the HAL, NHAP, and NP groups were 8.5, 7.0, and 6.8 days, respectively (p = 0.19). Delirium duration in the HAL, NHAP, and NP groups were 6.7, 6.0, and 4.9 days, respectively (p = 0.05). Safety outcomes were statistically different than the reference group (NHAP). Congruent with existing literature in other generalized patient populations, no significant difference in post-delirium length of stay existed in geriatric, palliative care population.

PURLs: When can exercise supplant surgery for degenerative meniscal tears?

Patients with a medial, degenerative meniscal tear and a minimal history of osteoarthritis make good candidates for physical therapy-- and there is an added benefit, too.