Hospital Addiction Medicine Consultation Service Orders and Outcomes by Patient Race and Ethnicity in an Urban, Safety-Net Hospital.

BACKGROUND: Hospital admissions involving substance use disorders are increasing and represent an opportunity to engage patients in substance use treatment. Addiction medicine consultation services improve access to medications for opioid use disorder (MOUD) and patient outcomes. However, as hospitals continue to adopt addiction medicine consultation services it is important to identify where disparities may emerge in the process of care. OBJECTIVE: To describe addiction medicine consultation service use by race and ethnicity as well as substance to identify opportunities to reduce substance use treatment disparities. DESIGN: Retrospective cohort study using 2016-2021 Electronic Health Record data from a large Midwest safety-net hospital. PARTICIPANTS: Hospitalized adults aged 18 or older, with one or more substance use disorders. MAIN MEASURES: Consultation orders placed, patient seen by consult provider, and receipt of MOUD by self-reported race. KEY RESULTS: Between 2016 and 2021, we identified 16,895 hospitalized patients with a substance use disorder. Consultation orders were placed for 6344 patients and 2789 were seen by the consult provider. Black patients were less likely (aOR = 0.58; 95% CI: 0.53-0.63) to have an addiction medicine consultation order placed and, among patients with a consultation order, were less likely (aOR = 0.74; 95% CI: 0.65-0.85) to be seen by the consult provider than White patients. Overall, Black patients with OUD were also less likely to receive MOUD in the hospital (aOR = 0.63; 95% CI: 0.50-0.79) compared to White patients. However, there were no differences in MOUD receipt among Black and White patients seen by the consult provider. CONCLUSIONS: Using Electronic Health Record data, we identified racial and ethnic disparities at multiple points in the inpatient addiction medicine consultation process. Addressing these disparities may support more equitable access to MOUD and other substance use treatment in the hospital setting.

Direct capture of neutralized RBD enables rapid point-of-care assessment of SARS-CoV-2 neutralizing antibody titer.

Neutralizing antibody (NAb) titer is a key biomarker of protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, but point-of-care methods for assessing NAb titer are not widely available. Here, we present a lateral flow assay that captures SARS-CoV-2 receptor-binding domain (RBD) that has been neutralized from binding angiotensin-converting enzyme 2 (ACE2). Quantification of neutralized RBD in this assay correlates with NAb titer from vaccinated and convalescent patients. This methodology demonstrated superior performance in assessing NAb titer compared with either measurement of total anti-spike immunoglobulin G titer or quantification of the absolute reduction in binding between ACE2 and RBD. Our testing platform has the potential for mass deployment to aid in determining at population scale the degree of protective immunity individuals may have following SARS-CoV-2 vaccination or infection and can enable simple at-home assessment of NAb titer.

Harnessing the value of reproductive hormones in cattle production with considerations to animal welfare and human health.

The human population is ever increasing while the quality and quantity of natural resources used for livestock production decline. This calls for improved product efficiency and the development of improved and sustainable cattle production methods to produce higher quality products to satisfy the demands of both the modern and transient world. The goal of this review was to summarize the interactions, challenges, and opportunities in cattle production relating to their endocrine system, and how reproductive hormones and others impact economically important traits, animal welfare, and human health. A comprehensive literature search was conducted with a focus on analysis of natural hormones and the use of exogenous hormone administration for reproduction, growth, and development of beef and dairy cattle. Hormones regulate homeostasis and enhance important traits in cattle, including fertility, growth and development, health, and the production of both meat and milk products. Reproductive hormones such as testosterone, estradiol, progesterone, and related synthetics like trenbolone acetate and zeranol can be strategically utilized in both beef and dairy cattle production systems to enhance their most valuable traits, but the impact of these substances must account for the welfare of the animal as well as the health of the consumer. This scientific review provides a comprehensive analysis of the bovine endocrine system's impact on food animals and product quality which is vital for students, researchers, livestock producers, and consumers. Although important advances have been made in animal science and related technological fields, major gaps still exist in the knowledge base regarding the influence of hormones on the production and welfare of food animals as well as in the public perception of hormone use in food-producing animals. Filling these gaps through transformative and translational research will enhance both fundamental and applied animal science to feed a growing population.

The animal production industry is responsible for providing products like meat, dairy, and egg products to the growing human population of the world. Within each sector, there are production practices that can improve the overall productivity of the animals and contribute to their welfare. One such avenue for enhanced production is the inclusion of hormones. Hormones are naturally produced within the body by the endocrine system which helps initiate many life processes and transition the body to different stages of production. Hormones influence many important traits such as growth and development, milk production, fertility, and health within the cattle industry. Exogenous hormone use in animals has proven to improve a number of traits and qualities of animal products, but it has also struck up controversy. There are wide deficiencies in the full understanding of roles, applications, and implications of hormones in livestock, making it of high importance for further exploration. In this review, the mechanisms of hormones and their broad uses are explored to provide more context to the conversation of hormone use in animals. Knowledge of endocrinology is powerful and can aid in the advancement of fundamental science and animal development and production.

Differing perspectives of sputum and its expectoration: a qualitative study involving patients with cystic fibrosis and physiotherapists.

Sputum specimens are frequently requested from individuals with chronic suppurative conditions such as cystic fibrosis (CF). For a proportion of people, expectorating sputum can be difficult. Our goal was to explore the potential barriers and facilitators to expectorating sputum from the perspective of those with CF and physiotherapists involved in their care. Eighteen interviews were conducted with people who have CF and three focus groups with physiotherapists. Data were recorded, transcribed verbatim, and analysed using a framework approach. Variation emerged in perceptions between physiotherapists and people with CF in terms of sputum's impact on everyday life and the importance of its role in managing the condition. These differences were reflected in the following themes: (1) seepage of bodily boundaries, (2) discrediting nature of sputum, (3) embodied representation of chronic illness, and (4) non-production as a decisional balance. Differing views between participants could have arisen from the personal nature of sputum for people with CF, whilst physiotherapists may see sputum specimens as a necessary part of holistic management of this condition. Education could assist individuals in overcoming some of the barriers associated with expectorating, but physiotherapists may have to individualise the collection of sputum, recognising not everyone will be at ease with this procedure.

Assessment of single nucleotide polymorphisms in genes residing on chromosomes 14 and 29 for association with carcass composition traits in Bos indicus cattle.

Objective of this study was to assess the association of SNP in the diacylglycerol O-acyltransferase 1 (DGAT1), thyroglobulin (TG), and micromolar calcium-activated neutral protease (CAPN1) genes with carcass composition and meat quality traits in Bos indicus cattle. A population of Brahman calves (n = 479) was developed in central Florida from 1996 to 2000. Traits analyzed were ADG, hip height, slaughter weight, fat thickness, HCW, marbling score, LM area, estimated KPH fat, yield grade, retail yield, sensory panel tenderness score, carcass hump height, and cooked meat tenderness measured as Warner-Bratzler shear force at 7, 14, and 21 d postmortem. Single nucleotide polymorphisms previously reported in the TG and DGAT1 genes were used as markers on chromosome 14. Two previously reported and two new SNP in the CAPN1 gene were used as markers on chromosome 29. One SNP in CAPN1 was uninformative, and another one was associated with tenderness score (P < 0.05), suggesting the presence of variation affecting meat tenderness. All three informative SNP at the CAPN1 gene were associated with hump height (P < 0.02). The TG marker was associated with fat thickness and LMA (P < 0.05), but not with marbling score. No significant associations of the SNP in the DGAT1 gene were observed for any trait. Allele frequencies of the SNP in TG and CAPN1 were different in this Brahman population than in reported allele frequencies in Bos taurus populations. The results suggest that the use of molecular marker information developed in Bos taurus populations to Bos indicus populations may require development of appropriate additional markers.

Density-yield relationships and economic injury levels for Bemisia argentifolii (Homoptera: Aleyrodidae) in cantaloupe in Texas.

A range of infestation levels of the whitefly Bemisia argentifolii Bellows & Perring were established across experimental field plots of cantaloupe by varying insecticide treatments to evaluate the relationships between whitefly density and crop yield and quality. High levels of whitefly adults and immatures were associated with significant reductions in fruit yield, a decrease in fruit size, and an increase in the percentage of fruits with sooty mold. Yield loss rates (kg/ha/adult or nymph) decreased in a nonlinear fashion with increasing whitefly numbers. Estimated economic injury levels varied as a function of whitefly density, whitefly stage, control cost, crop cultivar, and crop season. Estimates of economic injury levels for one ($31.2/ha), five ($156/ha), and 10 ($312/ha) insecticide treatments ranged from 0.02 to 0.39, from 0.12 to 1.96, and from 0.24 to 3.92 adults/leaf, and from 0.20 to 5.43, from 0.98 to 27.17, and from 1.97 to 54.35 nymphs/6.45 cm2, respectively.

Why older age predicts lower acceptance of physician-assisted suicide.

BACKGROUND: Prior research has shown that older Americans have less accepting attitudes toward the legalization of physician-assisted suicide (PAS). OBJECTIVE: The current study tests nine explanations for why older Americans are less accepting of PAS. DESIGN: Survey questionnaires in two settings: a small rural community and an internal medicine clinic in western Wisconsin (n = 1,311). RESULTS: Overall, 57% of this sample supported legalization of PAS while 31% opposed and 12% were in the middle. Two of the nine factors significantly (and negatively) predicted attitudes toward PAS: religious beliefs and belief that life's transitions have value. One factor is shown to mediate the relationship between age and PAS. Older subjects' greater focus on religious beliefs was able to significantly explain their lower levels of acceptance of PAS, as compared to younger subjects. CONCLUSION: Findings from this study support other PAS studies, which indicate that most Americans support the legalization of PAS. More importantly, it clarifies the role of age--that is, age is not important in and of itself. Rather, it is important as a predictor of religious beliefs which in turn predict negative attitudes and unique influences on the thinking of American adults concerning the legalization of PAS.

Health care in big cities--the McGill experience.

Big cities encounter problems which are peculiar to them: population mix, housing conditions, social structure, infrastructure including transport, etc, which manifest in hospitals. From the beginning of the 20th century, big cities have been served by many providers of hospital care. Common to most cities is the change in the principles and methods of care, e.g. home care, and the notion that traditional hospital services are no longer the only answer to the needs of the population of large cities. Over the last decade, plans and projects have been devised to address the problems of excessive bed capacity, insufficient and excessive specialised units and difficulties in administration of payment systems.

Harm reduction: concepts and practice. A policy discussion paper.

This paper provides an overview of the context, definition, and key features of the harm reduction approach, and provides several examples of current programs in various countries. Both licit and illicit drugs are included in these illustrations. Some of the critical issues, and the strategies needed to advance harm reduction, are discussed. [Translations are provided in the International Abstracts Section of this issue.]

Legal forum. Economic credentialing of physicians. New criteria and evaluation of physicians.

As managed care and integrated health care delivery systems have developed, the credentialing of physicians, historically a function of the medical profession, has moved to other organizations and individuals. The criteria for credentialing and appointment to hospital staffs and care provider panels has been expanded to include economics and care providers' use of hospital or health organization resources. The rights, responsibilities, and liabilities of those in this enhanced credentialing process are now being played out.

Influencing the prescribing behaviour of physicians: a metaevaluation.

Many different interventions have been used to influence the prescribing behaviour of physicians, and qualitative evaluations (metaethnography) of such interventions have been reported. So far quantitative evaluations of such interventions have not been reported; this study is an attempt in that direction. Twenty-six published studies (January 1979-September 1991) on the interventions for influencing the prescribing behaviour of physicians were pooled and effect sizes were extracted. Mean effect size (Zr) was 0.559 and Cohen's d = 0.886. Estimated Fail-Safe N was 89. Success rates of interventions varied from 1% to 99%.

Integrated health care systems: emerging models.

Health care institutions and professionals are transforming the organizational structure of the nation's delivery system. Buyers and payers of health care are seeking more effective and efficient services for their dollars. Several new model organizational structures seek to put the providers who are aligning themselves with one another into a better position to deal with today's marketplace.

Consumer involvement in nonprescription medicine purchase decisions.

As self-medication with nonprescription drugs becomes increasingly popular and important in this era of escalating health care costs and growing consumer sophistication, the degree of consumer involvement in the purchase decision becomes an important factor. High involvement suggests active information-seeking behavior and, therefore, a greater likelihood of appropriate nonprescription drug use. The authors assess consumer involvement in nonprescription medicine purchase decisions and the use of expert sources of information.

Economic credentialing survey of university teaching hospitals.

Economic credentialing, the process of applying economic criteria to the determination of initial appointments or reappointments of physicians to hospital medical staffs, has become a major issue in hospital medical staff relations. Nearly all major academic health center hospitals have the ability to perform economic analyses of faculty/physician clinical practices, and more than one-third of their CEOs see nothing wrong with terminating or denying hospital privileges for excessive use of hospital resources. Sixty-eight percent of surveyed academic health center respondents currently develop and review physician practice profiles, but only 35 percent of these respondents include economic data.

Immunisation state of young children admitted to hospital and effectiveness of a ward based opportunistic immunisation policy.

OBJECTIVE: To study the need for and effectiveness of a ward based opportunistic immunisation policy. DESIGN: A six month prospective study. SETTING: An acute medical paediatric ward of an inner city teaching hospital. SUBJECTS: 296 children admitted to the ward who lived within Central Manchester Health Authority boundaries and were aged from 5 months to 6 years. MAIN OUTCOME MEASURES: Completion of immunisation schedule appropriate for age. RESULTS: 56 children were three or more months behind with immunisations. The parent's history was not reliable for 18 children. Accessing health authority immunisation records was not difficult. The main reasons for falling behind were the mobility of the families (15 children), lack of motivation (14), and frequent minor illnesses (9). 40 children were immunised before discharge, but three could not be because of valid contraindications. Of the 16 children requiring more immunisations after discharge, only four obtained them at the correct time and five children not at all. CONCLUSION: An opportunistic immunisation policy is an important means of immunising a vulnerable group of children who would often default on routine immunisations, and such policies should operate whenever possible. Our ward based policy can achieve immunisation of three quarters of possible children without change or inconvenience to the daily ward work, but efficacy relies on adequate levels of enthusiastic staff. The system can be improved by having accurate and updated immunisation records available in the hospital, and by encouraging nursing staff to participate.

The use of pharmacy personnel to positively impact hospital finances.

Cutting the pharmacy budget is a tool widely used by hospital administrators as an effective way to contain their institutional costs. The authors of this article utilized data published by the Lilly Hospital Pharmacy Surveys to support their contention that drug costs, more than personnel costs, are responsible for the increased expenditures attributed to this department. The application of pharmacists' knowledge to improve the rational use of drugs is advocated for better overall cost-containment and better patient care.

Use and abuse of performance indicators.

An audit was performed by this department after allegations by the regional health authority of low productivity. It was found that the health authority had underestimated the number of operations performed in 1983 by only 5%, but an inexact classification and grading of operations had led to errors in the performance indicators of 19.8% for the "weighted number of operations" and 34.5% for the "number of major operations per consultant." When the throughput of orthopaedic departments in districts was compared by the regional health authority it was found that such errors in performance indicators had been further compounded by the inconsistent use of population data and incorrect data on medical staffing. Medical practitioners and the health authorities are alerted to this amplification of inaccurate data. Other methods for assessing trauma and orthopaedic surgery are proposed, such as a simplification of the Office of Population Censuses and Surveys classification of surgical operations, grading operations based on time spent in the operating theatre, and provision of computer programs to code for diagnosis and operation when writing discharge summaries.