Opioid and Nerve Block Administration in Knee Arthroplasty: An Observational Retrospective Evaluation.

AIMS: Increasing opioid-related adverse events and deaths have amplified interest in non-opioid analgesic options. Peripheral nerve blocks (PNBs) are useful in pain management, especially in minimally invasive day surgeries. This evaluation sought to examine patterns of opioid use among adult patients undergoing total knee arthroplasty, stratified by use of PNBs. DESIGN: A retrospective, observational design. SETTINGS: A large tertiary medical center and community hospital in the Inland Northwest. PARTICIPANTS/SUBJECTS: A dataset of 8,493 adult patients undergoing elective total knee arthroplasty, 3,432 of which received a PNB while 5,061 did not. METHODS: A deidentified dataset was obtained to evaluate: (a) opioid use frequency, (b) average morphine milligram equivalents (MMEs) administered, (c) independent factors associated with opioid administration, and (d) time to first opioid administered in adults undergoing total knee arthroplasty while in the recovery room, stratified by use of PNBs. RESULTS: When controlling for general anesthesia, opioid use frequency was reduced when PNBs were administered (p < .05). The amount of MMEs consumed was 15 mg less in the group receiving a PNB (p < .001). In a linear regression model, PNBs reduced the MMEs consumed by 5 mg (p = .014). Time-to-first opioid was increased in patients receiving general anesthesia and PNBs with a hazards ratio of 0.70 (p < .001). CONCLUSIONS: Peripheral nerve blocks are an opioid-sparing technique in adult patients undergoing total knee arthroplasty. CLINICAL IMPLICATIONS: The results confirm best practices regarding opioid-sparing PNBs. Postoperative opioids are appropriate, but regimens incorporating PNB administration for total knee arthroplasty help reduce opioid use.

Pharmacologic Pain Management Trends among Adults Hospitalized with Cellulitis: An Evidence-Based Practice Project.

BACKGROUND: Nurses commonly administer opioids, following "as needed" order sets, to patients hospitalized for acute pain conditions like cellulitis. Practice guidelines recommend limiting opioid administration for acute pain management. At two hospitals in the Pacific Northwest, an opioid stewardship committee was formed to align with best practice. AIMS: The main objective was to describe changes to inpatient rates of opioid and non-opioid administration following implementation of evidence-based opioid stewardship efforts. DESIGN: Observational, retrospective, evidence-based practice project. SETTINGS: One 200-bed and one 680-bed hospital in Washington State. PARTICIPANTS/SUBJECTS: Data were included from patients aged 18 years or older hospitalized for cellulitis. METHODS: Demographic and pain-related data were extracted from the electronic health record (n = 4,523 encounters) guided by the symptom management framework. The proportion of patients receiving opioid or non-opioid medications before and after implementation of evidence-based practice opioid stewardship interventions was calculated descriptively. A logistic regression tested factors related to administration of an opioid medication. RESULTS: The proportion of patients receiving an opioid decreased following opioid stewardship efforts while those receiving non-opioid analgesics remained stable. Factors significantly influencing inpatient opioid administration were: average inpatient pain score, pre-hospital opioid prescription, length of stay, and year of hospitalization. CONCLUSIONS: Analgesic administration treating painful, acute cellulitis at two hospitals in the Pacific Northwest included opioid and non-opioid medications. The proportion of patients receiving opioids decreased following best practice opioid stewardship actions. Opportunities may exist for nurses to collaborate with providers to improve inpatient analgesic administration practices.

BMI influences relationships among health factors for adults with persistent pain who use prescription opioids.

BACKGROUND: Long-term use of prescription opioids for pain results in negative health outcomes. Overweight and pain are related, and adults with either condition commonly report poor sleep quality, high levels of depression, low levels of self-efficacy, and high pain interference and intensity. Insufficient research exists regarding how weight may influence pain outcomes in the context of common symptoms. PURPOSE: To investigate how body mass index (BMI) influences relationships between health factors and pain outcomes among adults with pain prescribed opioids. METHODS: The sample included 226 adults. Linear regression models tested relationships among variables and outcomes of pain intensity and pain interference. FINDINGS: BMI significantly strengthened relationships between health factors and pain interference but not pain intensity. DISCUSSION: Adults with persistent pain suffer worsened pain interference in the context of increased weight status. Nurses should consider addressing BMI as part of a holistic pain management care plan.

Biological correlates and predictors of insulin resistance among early adolescents.

Abnormal glucose metabolism is associated with obesity, insulin resistance (IR), and Type 2 diabetes mellitus. The purposes of this study were to describe anthropometric and laboratory markers of adolescents, examine correlates of IR, and test ability of anthropometric and laboratory markers to predict risk of exhibiting IR. A total of 150 early adolescents participated. Participants with obesity had increased IR, high-sensitivity C-reactive protein, triglycerides, and blood pressure. Waist circumference and triglycerides were predictive of IR. Multiple risk factors compound and lead to long-term health consequences among youth. Nurses can evaluate these factors to identify IR.

Interdisciplinary health science research collaboration: strengths, challenges, and case example.

The mandate for interdisciplinary health research is clear, but barriers persist and researchers are unprepared for collaborative roles. This article explores strengths/challenges/facilitative approaches for interdisciplinary research. Teen Eating and Activity Mentoring in Schools, an example of interdisciplinary research, uses comprehensive communication and information management to enhance interdisciplinary research.

Off-label Prescribing Trends for ADHD Medications in Very Young Children.

OBJECTIVE: This study examines off-label medication prescribing use and trends in children on Medicaid with ADHD with particular focus on the very young (under age 6 years). METHODS: This was an observational cohort study and retrospective analysis of ADHD medication prescriptions from Oregon Medicaid records (N = 83,190) in 2012. Manufacturer prescribing information was used to determine off-label designation. Children ages 3 to 18 years at the time of prescription who had continuous Medicaid enrollment of at least 10 months during the index year of 2012 were included in the sample frame. RESULTS: Children with ADHD were prescribed off-label medications primarily at the ages of 5 years and younger. Among children ages 3 to 5 years, 91.4% of prescriptions were off-label. After the age of 5 years, the percentage of off-label prescriptions dropped notably to 21%, reflecting the increase in availability of approved medications for the treatment of ADHD starting at age 6 years. In the 3- to 5-year-old age group, specific off-label and concerning medication-related observations included a high frequency of alpha agonist (e.g., guanfacine, clonidine) prescribing; the prescribing of untested formulations such as clonidine patches; prescribing of atomoxetine; and prescribing of large doses of stimulant medications. CONCLUSIONS: Most ADHD drugs prescribed for very young children are off-label, which is concerning owing to lack of safety and efficacy data in this vulnerable population.

Relationship of weight status and cardiometabolic outcomes for adolescents in the TEAMS study.

The increase in the prevalence of obesity among youth is alarming. Relationships exist between excess weight and adverse cardiometabolic markers. The aims of this study among adolescents in the Teen Eating and Activity Mentoring in Schools (TEAMS) project were to describe selected demographic characteristics, anthropometric measurements, and laboratory values of middle school students; contrast differences in rates of cardiometabolic markers for participants with body mass index (BMI) ≥ 95th percentile and <95th percentile; examine rates of exceeding cardiometabolic cutoffs by weight status; and predict the odds ratio for one or more adverse cardiometabolic outcomes when BMI ≥95th percentile. Students (N = 151) were significantly more likely to exceed cut-off points for high-density lipoprotein cholesterol (HDL-C) and blood pressure (BP) when BMI was ≥95th percentile. Students whose BMI was ≥the 95th percentile were nearly five times as likely to have the deleterious cardiometabolic outcomes of low HDL-C, high triglycerides, elevated homeostasis model assessment of insulin resistance (HOMA-IR), or elevated systolic BP than those whose BMI was

Obesity prevention in early adolescence: student, parent, and teacher views.

BACKGROUND: Obesity is a significant health problem among today's youth; however, most school-based prevention programs in this area have had limited success. Focus groups were conducted with seventh- to eighth-grade students, parents, and teachers to provide insight into the development of a comprehensive program for the prevention of adolescent obesity: the Teen Eating and Activity Mentoring in Schools project (TEAMS). METHODS: Questions addressed (1) beliefs about the relationship between early adolescent behavior and health; (2) early adolescents' physical activity habits, preferences, influences, and barriers; (3) early adolescents' dietary habits, preferences, influences, and barriers; and (4) recommendations for interventions to promote physical activity and healthy eating in early adolescence. RESULTS: Qualitative analyses revealed that early adolescents had a good understanding of the relationship between their behavior and their health, although they had a limited understanding of what constitutes healthy eating. Youth participants reported preferences for a number of healthy foods and physical activities, but identified numerous barriers preventing their engagement. The major difference between students, parents, and teachers reflected the operation of the fundamental attribution error with early adolescents attributing their unhealthy behaviors to situational factors, teachers blaming parents, and parents blaming their children. CONCLUSIONS: Implications of these findings for the development of school-based, integrated strategies for obesity prevention among early adolescents are discussed.