Validating an opioid prescribing algorithm in post-operative pediatric surgical oncology patients.

PURPOSE: We developed an algorithm to decrease opioid prescriptions for pediatric oncology patients at discharge following surgery, based on a retrospective analysis to decrease variability and over-prescribing. The aim of this study was to prospectively test the algorithm. METHODS: Opioid-naïve patients undergoing surgery for tumor resection at a single institution were included. A prescribing algorithm was developed based on surgical approach, day of discharge, and inpatient opioid use. Prospectively collected data included outpatient opioid consumption and patient/family satisfaction. Total home dose prescribed was equal to that used in the 8 or 24 h, depending on length of stay and operative approach, prior to discharge, divided into 0.15 mg/kg doses. RESULTS: The algorithm was used in 121 patients and correctly predicted outpatient opioid requirements for 102 patients (84.3%). For 15 (12.4%) patients, the algorithm over-estimated opioid need by an average of 0.38 OME/kg. Four (3.3%) patients required additional opioids. Using this algorithm, we decreased overall opioid prescriptions from 6.17 to 0.21 OME/kg (p < 0.001), and all but one patient/family reported being satisfied with post-operative pain control. CONCLUSION: Using an algorithm based on inpatient opioid use, outpatient opioid needs can be accurately predicted, thereby reducing excess opioid prescriptions without detriment to patient satisfaction. TYPE OF STUDY: Prospective Quality Initiative Study. LEVEL OF EVIDENCE: Level III.

Estimación del riesgo cardiovascular según el algoritmo de Framingham en sujetos con síndrome metabólico, definido por los criterios del NCEP-ATP-III / Cardiovascular risk assesment using the Framingham risk scoring in subjects with metabolic syndrome according to the ATP-III-NCEP definition

Objetivo: Estimar el riesgo a 10 años de enfermedad coronaria (EC), aplicando las tablas de Framingham a una población diagnosticada de síndrome metabólico (SM), según la definición del National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP-III) y compararlo con el de una población sin esta condición. Material y método: Analizamos los datos de una encuesta conducida durante el año 2005 en 160 sujetos (36 varones y 124 mujeres) sin antecedentes personales de diabetes mellitus ni EC, en edades comprendidas entre 20 y 79 años, que asistieron por diferentes razones a una parte de la consulta ambulatoria de Endocrinología del Hospital Teodoro Maldonado Carbo, Instituto Ecuatoriano de Seguridad Social, en Guayaquil (Ecuador). El SM fue definido según los criterios del NCEP-ATP-III y la estimación del riesgo a 10 años de EC se determinó de acuerdo con el algoritmo de Framingham. Resultados: No se encontraron diferencias significativas en las 3 categorías de riesgo general para EC a 10 años entre sujetos con y sin SM tanto varones como mujeres. En el grupo con SM, un mayor porcentaje de mujeres (p 80%) y no encontramos diferencias significativas entre varones y mujeres con y sin SM en las diferentes categorías de riesgo. Sin embargo, ciertos estudios han demostrado que el algoritmo de Framingham y el NCEP-ATP-III subestiman el riesgo en mujeres, principalmente en aquellas con una historia familiar de EC prematura o SM, por lo que puede no ser suficiente para una evaluación adecuada y se debería contar con otras herramientas que puedan predecir el riesgo cardiovascular con mayor fiabilidad (AU)

Objective: To estimate the 10-year risk for CHD, using Framingham scoring in the Ecuadorean population diagnosed with metabolic syndrome (MS), as defined by the third report of the National Cholesterol Education Program-Adult Treatment Panel III (ATP-III-NCEP) in North America and to compare the risk identified with that in a population without MS. Material and method: We analyzed data from a survey conducted in 2005 in 160 adults (36 men and 124 women) without diabetes mellitus or CHD, aged between 20 and 79 years living in the city of Guayaquil, who were evaluated at the Endocrinology Outpatient Clinic of Hospital Teodoro Maldonado Carbo, Instituto Ecuatoriano de Seguridad Social Guayaquil (Ecuador) for distinct reasons. MS was defined following the NCEP-ATP-III criteria. Risk assessment for determining 10-year risk was carried out according to Framingham risk scoring. Results: No significant differences were found between men and women with and without MS in the 3 categories of 10-year risk for CHD. In the group with MS, a greater percentage of women (p 80%). No significant differences were found between men and women with and without MS in different risk categories. However, certain studies have demonstrated that Framingham scoring and the ATP-III-NCEP underestimate risk in women, mainly in those with a history of premature CHD or MS. Therefore, other tools should be used to predict cardiovascular risk with greater reliability (AU)