Predictors of Weeks to Opioid Cessation after Lumbar Fusion: A Prospective Cohort Study.

BACKGROUND: Although the use of prescription opioid analgesics to treat acute, postoperative pain is a well-established practice, the role of opioids in the management of persistent, postoperative pain remains ill-defined. Nevertheless, high rates of long-term opioid use following lumbar fusion have been reported. AIM: The goal of this prospective, longitudinal study was to identify predictors of weeks to opioid cessation in a cohort of patients undergoing elective lumbar fusion. METHODS: Prior to surgery, participants self-reported demographic and clinical data and completed a validated measure of pain catastrophizing. Three months following surgery, participants self-reported prescription opioid use. RESULTS: Forty-four percent (n = 22) of participants reported opioid use 12 weeks following lumbar fusion. Bivariate analysis identified a strong correlation between weeks to opioid cessation and preoperative opioid use, r = .46, and a moderate correlation between weeks to opioid cessation and disability, r = .29. The multiple regression model predicting weeks to opioid cessation from age, sex, employment status, educational level, preoperative pain intensity, preoperative opioid use, disability status, and pain catastrophizing was significant, F(8, 38) = 2.254, p = .044, and accounted for 18% of the variance. Among preoperative patient characteristics, only preoperative opioid use significantly predicted weeks to opioid cessation, ß = .466; p = .005. CONCLUSION: Thus, nurses and nurse practitioners may be able to identify patients at risk for long-term opioid use following lumbar fusion by screening patients for preoperative opioid use.

Relationships Among Neonatal Mortality, Hospital Volume, Weekday Demand, and Weekend Birth.

Background Research findings indicate that hospital volume affects the quality of care, that quality and demand for care on weekends differs from weekdays, and that giving birth on the weekend increases odds of neonatal mortality. Purpose To explore relationships among neonatal mortality, hospital volume, weekday demand for services, and weekend birth and risk of neonatal mortality. Methods For this retrospective, population-based, cohort study design, data were obtained from 32,140 electronic birth certificate records matched with 92 death certificate records from the Texas Department of State Health Services for 2012. Statistical analyses include descriptive procedures, analysis of variance, bivariate correlation, t-test, logistic regression, and chi-square tests of association. Results Higher hospital birth volume and higher concentrations of births during the week were associated with fewer neonatal deaths. Weekend births were associated not only with higher rates of neonatal death but also with lower birth weight and ethnicity of the mother. Conclusions These findings suggest the need for further study of the ways hospital-level organization of services and resources interact with individual risk factors to play a significant role in raising the neonatal mortality risk associated with weekend birth.

Uso inercial de técnicas estadístico-inferenciales: su posible impacto en el hallazgo de resultados falsos en salud / Inertial use of statistical-inferential techniques: its possible impact on the finding of false health results

Objetivo:Sondear el grado en que importantes recursos estadísticos, en particular los valores p, los intervalos de confianza y los procedimientos para determinar tamaños muestral es, se emplean en la literatura biomédica de manera ritual. Metodología:se seleccionaron 25 artículos originales publicados en cada una de 4 revistas indexadas del campo biomédico. Para cada uno de ellos se evalúo si cumplían con las indicaciones de las guías STROBE y CONSORT en lo concerniente al tamaño de la muestra, así como el uso de los valores p, de los intervalos de confianza y la utilización de estos en la discusión del artículo. Resultados:el 97.0% de los artículos reporta el tamaño de la muestra, pero sólo el 62.9% explica cómo fue de-terminado. El valor p se usa con mayor frecuencia (68.0%) que los intervalos de confianza (63.9%). Solo el 15.5% usa los intervalos deconfianza en la discusión. Conclusión:las herramientas estadísticas más convencionales se emplean en buena medida de manera más ceremonial que funcional.

Objective: To evaluate the degree in which important statistical resources,particularly p-values, confidence intervals and procedures for determiningsample sizes, are used in the biomedical literature through a ritual way.Methodology:A total of 25 original articles published in each of 4journals indexed in the biomedical field were selected. For each of them,it was assessed whether they follow the instructions of the STROBE andCONSORT guidelines regarding the sample size, as well as the use of p-values, confidence intervals, and the use of these in the discussion of thearticle. Results:The 97.0% of the articles reported thesample size, but only 62.9% explained how it wasdetermined. The p-value is used more frequently(68.0%) than the confidence intervals (63.9%). Only15.5% uses confidence intervals in the discussionsection.Conclusion:the most conventional statistical toolsare used more in ceremonial way rather than in afunctional one.

The Biopsychosocial Model of Low Back Pain and Patient-Centered Outcomes Following Lumbar Fusion.

Lumbar fusion is a surgical procedure performed to eliminate painful motion in a spinal segment by joining, or fusing, two or more vertebrae. Although the surgery has a high rate of producing radiographic fusion, many patients report pain, functional disability, an inability to return to work, and prolonged opioid pain reliever use following the procedure. Using the biopsychosocial model of low back pain as a framework, this review of the literature describes the biological, psychological, and social factors that have been associated with these negative outcomes. The findings suggest that at least some of the variability in postoperative outcomes may be due to preoperative patient characteristics, and evidence the theorized relationship between biopsychosocial factors and low back disability. The review also highlights a gap in the literature regarding biopsychosocial predictors of prolonged opioid use following lumbar fusion.

Statistical tools in published articles of a public health journal in 2013 and 2014: bibliometric cross-sectional study.

INTRODUCTION: Research projects use statistical resources to express in numerical or graphic terms different magnitudes like frequencies, differences or associations. OBJECTIVES: The purpose of this paper is to describe the statistics tools utilization, with special emphasis in the use of conventional statistical tests and confidence intervals, to communicate results in a renowned public health peer reviewed journal in Colombia. METHODS: We included the 84 articles published in the journal between 2013 and 2014. RESULTS: The most used resource is frequency analysis (89.3%), followed by p values (65.5%) and confidence intervals (53.6%); 48.9% of the papers used confidence intervals together with p values; 29.8% use neither of them; 16.7% of the articles only used p values and 4.8% only confidence intervals. CONCLUSIONS: Descriptive statistics is a tool widely used in research results presentation; the critics and caveats suggesting to avoid the exclusive use of the statistical signification test in the results presentation are not followed in the analysis and presentation of the research results.

INTRODUCCIÓN : El desarrollo de proyectos de investigación suele demandar del uso de herramientas matemáticas para expresar en términos numéricos o gráficos diversas magnitudes, tales como frecuencias, diferencias, o asociaciones. OBJETIVOS: El presente estudio se propone describir la utilización que se hace de las herramientas estadísticas básicas, haciendo especial énfasis en el uso de las pruebas de significación estadística y los intervalos de confianza, para la presentación de resultados de investigación en los artículos publicados en una reconocida revista de la salud pública en Colombia. MÉTODOS: Se realizó una revisión de los 84 artículos originales publicados en dicha revista entre 2013 y 2014. RESULTADOS: El recurso más empleado es la utilización de análisis de frecuencias (89,3%), seguido de los valores p (65,5%) y los intervalos de confianza (53,6%); el 48,9% de los artículos utiliza a la vez intervalos de confianza y valores p para la presentación de resultados y el 29,8% ninguno de los dos. El 16,7% de los artículos sólo utiliza valores p y el 4,8% sólo intervalos de confianza. CONCLUSIONES: La estadística descriptiva es una herramienta que se utiliza con asiduidad en la presentación de resultados y que las críticas y advertencias sugiriendo que se evite el uso exclusivo de las pruebas de significación estadística en la presentación de resultados no son cabalmente tenidas en cuenta en el análisis y presentación de los resultados de investigación.

Development of an Online Data Applications Course Using an Interprofessional Education Model.

Development of a data applications course with an interdisciplinary focus presented challenges for nurses participating in the design of a post-master's certificate program in informatics. In this article, we describe our use of an interprofessional education model to create the course and discuss our experiences in teaching the course for the first time. We identify our challenges and plan to address them in future semesters.

Los valores preyy pospandriales de alt, urea y creatinina no cambian significativamette / Pre and ostpandrrial values of alt, urea and creatinine do not change signifcaantly

Introducción: Para el laboratorio clínico es importante tener una muestra que cumpla con los requerimientos para el análisis, por tal razón el laboratorio de química clínica exige a los pacientes ayuno de 8 horas para practicarse el análisis de urea, ALT y creatinina ya que el metabolismo de los alimentos puede verse reflejado en cambios en el suero y causar interferencia en la lectura de estos analitos. El objetivo de este trabajo es revisar qué tanta interferencia se produce cuando se lee la muestra 2 horas después del desayuno. Materiales y Métodos: Para el presente estudio se tomaron muestras de sangre total pre y posprandiales para el análisis de ALT, urea y creatinina en suero y establecer las posibles interferencias que podrían causar la glucosa, el colesterol y los triglicéridos en dicho análisis. Para el análisis de varianza se utilizó el test de ANOVA, y para determinar el tipo de interferencia y su significancia se utilizó el interferograma. Resultados: El test de ANOVA no mostró diferencias significativas en los resultados, y el interferograma no arrojó diferencias significativas para ninguno de los analitos de interés en este estudio. Discusión: El análisis de ALT, urea y creatinina en condiciones posprandiales sufre interferencia positiva en algunos de los pacientes a causa de la glucosa, el colesterol y los triglicéridos contenidos en la muestra, dicha interferencia no resulta significativa, lo que sugiere que no es necesario acudir en ayunas a la toma de la muestra cuando se toma 2 horas siempre posterior al desayuno con ayuno previo de 8 horas.

Introduction: For the clinical laboratory is important to have a sample that meets the requirements for analysis, reason why the clinical chemistry laboratory demands its patients to fast 8 hours in order to take the urea, creatinine and ALT analyses since the metabolism of food may be reflected in the serum changes and may cause interference in the reading of these analytes. The purpose of this work is to review how much interference occurs when the sample is read 2 hours after breakfast. Materials and Methods: Total, pre and postprandial blood samples for ALT, urea and serum creatinine analysis were taken for this study in order to establish the possible interferences glucose, cholesterol and triglycerides may cause in the analysis. The ANOVA test was used for the variance analysis and interferogram was used in order to determine the type of interference and its significance. Results: ANOVA test showed no significant differences in the results and interferogram did not show significant differences for any of the analytes of interest in this study. Discussion: The ALT, urea and creatinine analysis in fed postpandrial conditions suffer positive interference in some patients due to glucose, cholesterol and triglycerides contained in the sample. This interference is not significant which suggests that it is not necessary to fast when the sample is going to be taken when it can be taken 2 hours after breakfast with a previous 8 hour fast.

Cautious use of administrative data for decubitus ulcer outcome reporting.

The purpose of this study is to demonstrate that caution should be exercised when using administrative data, exclusively, to report quality and safety outcomes. Investigators identified hospital-acquired decubitus ulcers using Agency for Health-care Research and Quality (AHRQ) patient safety indicator definitions. As validation of this method, investigators abstracted 123 medical charts of patients identified through AHRQ methodology as having hospital-acquired decubitus ulcers. Abstraction of these cases produced a change in rate from 23.3 decubitus ulcers per 1000 patients, derived through administrative data, to a true rate of 7.9 decubitus ulcers per 1000 patients, a 66% reduction. Investigators found 2 additional flaws (1 internal and 1 methodological) that further decreased the decubitus ulcer rate to 6.14 per 1000, a 74% variance. The results of this study suggest that administrative data, when used alone, are not sufficient in measuring the true rate of hospital-acquired decubitus ulcers.

Sociodemographic factors associated with weekend birth and increased risk of neonatal mortality.

OBJECTIVE: To learn whether weekend risk of neonatal mortality is related to selected sociodemographic factors. DESIGN: A retrospective cohort design. Logistic regression was used to obtain odds ratios, and analysis of variance and chi-square to identify differences in values and incidence of key variables. SAMPLES: The data were derived from matched Texas birth and infant death certificates from 1999 through 2001. MAIN OUTCOME MEASURES: A subset of deaths up to 28 days of life attributable to conditions originating in the perinatal period. These deaths were called neonatal mortality-p. RESULTS: Women who were White, married, had Medicaid assistance, and had private prenatal care were less likely to deliver on weekends. Odds of neonatal mortality-p increased 36.5% when a birth took place on the weekend. The weekend crude odds of neonatal mortality-p increased for all racial/ethnic groups, but the differences were not statistically significant. CONCLUSIONS: The likelihood of delivering on the weekend increases with certain sociodemographic factors. This fact is important because the risk of neonatal mortality is higher among weekend births.

Culturally competent nursing care: listening to the voices of Mexican-American women.

Mexican-Americans represent the fastest-growing minority population group in the United States. Gaining a cultural perspective of health care in the Mexican-American population necessitates listening to the voices of women because they assume primary responsibility for maintaining family health. The Transcultural Assessment Model developed by Giger and Davidhizar (2004) provides the framework for this exploration of Mexican-American women's health care views. From this model the investigators developed an interview guide based on social organization and environmental control. Thematic analysis of interviews with six Mexican-American women revealed the importance of the family, religion, and locus-of-control in the health beliefs, attitudes, and lifestyle practices of this culture. Using the voices of Mexican-American women the investigators seek to promote an understanding of the culture as a guide for nursing care. The purpose of this article is to increase awareness of the Mexican-American cultural phenomena of social organization and environmental control which can guide the nurse to provide culturally competent care that meets the needs of Mexican-American women and their families.

Weekend birth and higher neonatal mortality: a problem of patient acuity or quality of care?

OBJECTIVE: To address the differences in neonatal mortality among births to teenage mothers on weekdays and weekends. DESIGN: A retrospective descriptive design. Rates of neonatal mortality linked to maternal risk factors, low birth weight, gestational age, day of the week of the birth, and ethnicity/race were examined. PATIENTS/PARTICIPANTS: The population consisted of all recorded births to teenage mothers (< 20 years of age) in Texas in 1999 and 2000 (N = 111,749). These births were linked to death certificates for a subset of neonatal deaths within the same time period (n = 397). MAIN OUTCOME MEASURES: The outcome of interest was any death attributed to conditions originating in the perinatal period and recorded as such on the infant death certificate. RESULTS: Neonatal mortality was higher among the births on weekends than those during the week. Maternal risks and patient acuity levels of mothers and babies were not consistently higher on weekends. However, when risk factors were present, weekend births were more dangerous for Hispanics than for other ethnic or racial groups. CONCLUSIONS: Differences in patient acuity did not satisfactorily explain higher neonatal mortality rates on weekends. Thus, quality of care indicators such as lower hospital staffing and reduced availability of services on weekends may be critical sources of unnecessary neonatal deaths.

Birth certificate methods in five hospitals.

This study evaluated the methods of data collection of birth certificate information by five high-delivery hospitals in northern Texas. Research purposes were to identify sources and methods of birth certificate data collection and identify the most-reliable methods. This descriptive study involved interviews of each hospital's data collectors and review of 1999 Texas birth certificate data. Medical record clerks, whose training varied, but usually consisted of orientation by another medical record clerk, collected birth certificate data within 24 hours of birth. There was no standard method for training, nor was there a minimum level of education required. In four of the five hospitals studied, a birth certificate clerk collected most of the information with limited input from other medical sources. The information obtained on birth certificates therefore varied according to the collector and the priority placed upon the accuracy of information. Birth certificate data contain questionable reliability, which undermines data use in research, funding, and policy decisions.