Tramadol and Opioid Prescription Rates in Chronic Kidney Disease Patients Before and After the 2016 Centers for Disease Control and Prevention Opioid Guideline.

Objectives. The objectives of this study were (1) to assess the impact of the 2016 Centers for Disease Control and Prevention (CDC) Guideline for Prescribing Opioids for Chronic Pain (GPOCP) on tramadol and opioid prescription rates in patients with chronic kidney disease (CKD), (2) to identify if tramadol was being properly dosed based on kidney function, and (3) to identify the number of clinically relevant drug-drug interactions related to tramadol. Design. Retrospective cohort study. Setting and Participants. Patients with a diagnosis of CKD stage IV or V or end-stage renal disease (ESRD) with a hospital discharge were identified. Participants were distributed into a pre-GPOCP cohort (January to December 2015) and post-GPOCP cohort (January 2017 to May 31, 2018) based on their hospital discharge date. Participants were then further divided into three categories: those who were discharged with a new prescription for tramadol, those who were discharged with a prescription for another opioid product, or those who were discharged with no new opioid or tramadol prescription. Outcome Measures. The primary outcome was incidence of new outpatient tramadol and opioid hospital discharge prescriptions. The secondary outcomes were the number of correctly dosed tramadol discharge prescriptions based on kidney function and incidence of clinically significant drug-drug interactions with tramadol. Results. New tramadol and opioid prescription rates upon hospital discharge for CKD stage IV and V and ESRD patients decreased from 76 (2.5%) to 54 (1.1%) and from 145 (4.7%) to 119 (2.5%), respectively (P < .001). Among the patients discharged with a new tramadol prescription, 113 (86.9%) patients did not have any clinically significant drug-drug interactions, and 94 (72.3%) patients were dosed correctly based on kidney function. Conclusion. The incidence of new outpatient tramadol and opioid prescriptions at discharge was significantly lower after the CDC GPOCP publication than before the publication.

The Einstellung effect in anagram problem solving: evidence from eye movements.

The Einstellung effect is the counterintuitive finding that prior experience or domain-specific knowledge can under some circumstances interfere with problem solving performance. This effect has been demonstrated in several domains of expertise including medicine and chess. In the present study we explored this effect in the context of a simplified anagram problem solving task. Participants solved anagram problems while their eye movements were monitored. Each problem consisted of six letters: a central three-letter string whose letters were part of the solution word, and three additional individual letters. Participants were informed that one of the individual letters was a distractor letter and were asked to find a five-letter solution word. In order to examine the impact of stimulus familiarity on problem solving performance and eye movements, the central letter string was presented either as a familiar three-letter word, or the letters were rearranged to form a three-letter nonword. Replicating the classic Einstellung effect, overall performance was better for nonword than word trials. However, participants' eye movements revealed a more complex pattern of both interference and facilitation as a function of the familiarity of the central letter string. Specifically, word trials resulted in shorter viewing times on the central letter string and longer viewing times on the individual letters than nonword trials. These findings suggest that while participants were better able to encode and maintain the meaningful word stimuli in working memory, they found it more challenging to integrate the individual letters into the central letter string when it was presented as a word.

Eye movements reveal solution knowledge prior to insight.

In two experiments, participants solved anagram problems while their eye movements were monitored. Each problem consisted of a circular array of five letters: a scrambled four-letter solution word containing three consonants and one vowel, and an additional randomly-placed distractor consonant. Viewing times on the distractor consonant compared to the solution consonants provided an online measure of knowledge of the solution. Viewing times on the distractor consonant and the solution consonants were indistinguishable early in the trial. In contrast, several seconds prior to the response, viewing times on the distractor consonant decreased in a gradual manner compared to viewing times on the solution consonants. Importantly, this pattern was obtained across both trials in which participants reported the subjective experience of insight and trials in which they did not. These findings are consistent with the availability of partial knowledge of the solution prior to such information being accessible to subjective phenomenal awareness.

Linezolid clearance during continuous venovenous hemodiafiltration: a case report.

OBJECTIVE: To determine the linezolid clearance and serum concentrations in a critically ill man receiving continuous venovenous hemodiafiltration (CVVHDF). METHODS: Intravenous linezolid 600 mg every 12 hours was administered to a critically ill, 85-year-old man with anuria who was receiving CVVHDF at a dialysate flow rate of 2000 ml/hour and a mean ultrafiltrate production rate of 775 ml/hour. Samples of blood and spent dialysate and ultrafiltrate were obtained at the time of linezolid peaks and troughs, and linezolid concentrations were determined. RESULTS: The CVVHDF yielded a mean linezolid clearance of 36.5 ml/minute and an elimination half-life of 7.5 hours. The linezolid saturation coefficient ranged from 0.77-0.81. Administration of intravenous linezolid 600 mg every 12 hours yielded suitable serum trough concentrations. CONCLUSION: Administration of intravenous linezolid 600 mg every 12 hours maintained therapeutic serum trough concentrations in this critically ill patient receiving CVVHDF.