Effects of Time of Arrival on Trauma Patient Outcomes.

BACKGROUND: Arriving during "off hours" to the hospital can put patients at greater risk of complications or mortality given lesser staff. Our goal was to investigate this in trauma patients with an Injury Severity Score (ISS) of >15. We hypothesized that the patients admitted late at night and/or during the weekend, would have worse outcomes, delays to the operating room (OR), and longer lengths of stay (LOS) compared to those who arrive on a weekday during the day. METHODS: We performed a retrospective study from 8/1/2019 to 8/1/2022 of all trauma patients with an ISS >15 at our Level 1 Trauma Center. Patients <18 years, dead on arrival, or transferred out were excluded. Univariate and multivariable analysis were performed comparing weekday vs weekend arrivals, day vs night shift arrivals, and with patients grouped as weekday day, weekday night, weekend day, and weekend night. The primary outcome was mortality. RESULTS: 953 patients met inclusion criteria. The patients that arrived on the weekend and at night were significantly younger than their counterparts. A significantly greater percentage of Black patients arrived during night shift. Mortality, hospital LOS, and ICU LOS did not differ based on day or time of arrival. CONCLUSION: Contrary to our hypothesis, our study did not find a significant difference in outcomes when evaluating based on a patient's time of arrival. This gives credence that our mature trauma center can provide the same level of care despite the time of a severely injured patient's time of arrival.

Rib Fractures and Frailty in Geriatric Trauma Patients.

As rib fractures are a common injury in the geriatric trauma population and can result in increased morbidity and mortality, we sought to understand predicting outcomes in this population. We hypothesized that frail geriatric rib fracture patients would have worse outcomes than their non-frail counterparts. This single-center retrospective study includes patients from July 2019 to June 2022 who were ≥65 years-old, had ≥ 2 rib fractures, and a documented Clinical Frailty Scale score. Univariate analysis was conducted comparing frail vs non-frail, and ≤3 rib fractures vs >3 rib fractures. Multivariate logistic regressions for risk of mortality and of frailty were performed. We found higher mortality in patients with >3 rib fractures on univariate analysis; however, this did not hold true on multivariate analysis. Frail patients were less likely discharged home and had a lower functional status at discharge. Further investigation is needed to effectively improve outcomes for geriatric trauma patients with rib fractures.

Mindfulness, mental health, and motives for eating tasty foods when not in metabolic need.

Habitual consumption of highly palatable foods when not in metabolic need (HPF eating) is linked to obesity. High HPF consumption is also linked to mental health disorder (MHD) symptoms. Mindfulness-based interventions are popular treatments for obesity and MHDs, but little is known about the relationship between trait mindfulness and motive-based HPF eating. Therefore, a total of 927 young adults completed a survey that included the Palatable Eating Motives Scale-7 (which identifies Coping-, Reward enhancement-, Social-, and Conformity-eating), the Mindful Attention Awareness Scale, the Perceived Stress Scale, and demographic and body mass index (BMI) questions. An MHD questionnaire allowed a comparison of HPF eating between participants with and without various MHDs. Regressions revealed that Coping-eating was independently associated with lower mindfulness and also greater perceived stress, higher BMI, and female sex. Of these variables, only lower mindfulness was independently associated with Reward-, Social-, and Conformity-eating. Coping- and Reward-eating were more frequent in participants with versus without an anxiety disorder, depression, ADD/ADHD, and PTSD. Coping-eating was also more frequent in participants with body dysmorphic disorder. These findings warrant investigations in participants with clinically validated diagnoses for DSM-specific MHDs. Results from such investigations and the uncovered nature of associations between motive-specific HPF eating and trait mindfulness could provide novel targets to improve mindfulness-based interventions for obesity and MHDs.

Improving harm reduction with a naloxone intervention in primary care to prescribe and educate a support person.

OBJECTIVE: To determine whether a pharmacistled intervention would increase the number of naloxone prescriptions and naloxone administration education in a primary care family medicine setting. DESIGN: Prospective quality improvement intervention in an academic family medicine clinic. METHODS: We surveyed providers about naloxone knowledge, prescribing habits, and prescribing barriers. We identified patients on chronic opioid therapy, through electronic health records for the year 2019. Overdose risk categories based upon morphine milligram equivalent doses and concomitant benzodiazepine use were used to determine patients who met criteria for naloxone. Pharmacists phoned qualified patients to discuss overdose risk and naloxone benefits. Patients who accepted naloxone prescriptions used their local pharmacy through a department-approved standing order set. RESULTS: From the survey results, there were 47 of 54 provider responses, and the majority noted that they do not routinely prescribe naloxone in high-risk patients. The predominant barriers were lack of time during visit and naloxone administration education. The population of patients from chart review included 93 high-risk patients with a mean age of 58 years. During the time of intervention, 71 patients remained eligible for naloxone coprescribing. Of the patients contacted, 29 (40 percent) accepted the intervention prescription, and subsequently, 22 picked up their prescription from the pharmacy. Sixteen received counseling with a support person. Twelve patients had naloxone already at home, and two received counseling with a support person. CONCLUSION: The naloxone prescribing intervention is achievable. The results of this intervention support identifying patients at increased risk of opioid overdose and offer education of a support person for naloxone in a large academic family medicine clinic.

Liraglutide, GLP-1 receptor agonist, for chronic weight loss.

INTRODUCTION: Since 1990, the prevalence of obesity has been steadily increasing in the United States. Over the past four years, new medications have become approved and available, allowing for more options in the management of chronic weight loss among overweight or obese patients. This review article summarizes the efficacy, safety, and clinical attributes of liraglutide among overweight or obese patients with or without comorbidities. Areas covered: A MEDLINE search, from 1970 to June 2016, was conducted using key terms-glucagon-like peptide-1 receptor agonist, liraglutide, overweight, and obesity. Published clinical trials, in the English-language and with primary endpoints related to weight loss, were reviewed and critiqued in this article. Expert commentary: Available as a subcutaneous daily injection, liraglutide is the first glucagon-like peptide-1 (GLP-1) receptor agonist indicated for obesity management, as adjunct therapy with lifestyle and behavioral modifications. Liraglutide 3 mg daily has been associated with greater weight loss than placebo or orlistat in patients without type 2 diabetes. Additionally, liraglutide has resulted in reductions in waist circumference, systolic and diastolic blood pressure, and improvements in lipid panel among overweight and obese patients with and without type 2 diabetes.

Innovation in clinical pharmacy practice and opportunities for academic--practice partnership.

Clinical pharmacy has a rich history of advancing practice through innovation. These innovations helped to mold clinical pharmacy into a patient-centered discipline recognized for its contributions to improving medication therapy outcomes. However, innovations in clinical pharmacy practice have now waned. In our view, the growth of academic­practice partnerships could reverse this trend and stimulate innovation among the next generation of pioneering clinical pharmacists. Although collaboration facilitates innovation,academic institutions and health care systems/organizations are not taking full advantage of this opportunity. The academic­practice partnership can be optimized by making both partners accountable for the desired outcomes of their collaboration, fostering symbiotic relationships that promote value-added clinical pharmacy services and emphasizing continuous quality improvement in the delivery of these services. Optimizing academic­practice collaboration on a broader scale requires both partners to adopt a culture that provides for dedicated time to pursue innovation, establishes mechanisms to incubate ideas, recognizes where motivation and vision align, and supports the purpose of the partnership. With appropriate leadership and support, a shift in current professional education and training practices, and a commitment to cultivate future innovators, the academic­practice partnership can develop new and innovative practice advancements that will improve patient outcomes.