Impact of an addiction medicine consult service on patients admitted to the hospital with injection drug use-associated infective endocarditis

Background: The addition of an addiction medicine consult service has been shown to improve mortality and decrease hospital costs but its impact on the proportion of patients discharged against medical advice (DAMA) and in-hospital initiation of medication for opioid use disorder (MOUD) has not been examined. Methods: A retrospective before-after cohort study was performed at an urban, academic medical center between January 1, 2015 and November 1, 2019. We included adult patients with infective endocarditis and injection drug use determined by admitting diagnosis ICD-9 or ICD-10 codes or documentation within the history section of electronic health recordEHR. Our institution implemented a formal addiction medicine consult service on July 1, 2018. We determined the proportion of patients DAMA and the proportion of patients started on MOUD among patients in the pre-intervention (i.e. hospitalized before July 1, 2018) and intervention (i.e. hospitalized July 1, 2018 or after) groups. Results: A total of 171 patients among hospitalized patients with injection drug use-associated infective endocarditis were included with 119 patients in the pre-intervention group and 52 patients in the intervention group. There was no statistically significant difference in patients DAMA [19% vs 15%, absolute risk difference 4.6% (95% confidence interval -8.6% to 17.7%)] between the intervention and pre-intervention groups. However, there was an increase in the proportion of inpatient MOUD initiation in the intervention group compared to the pre-intervention group [56% vs 21%, absolute risk difference 35% (95% confidence interval 19% to 50%)]. Conclusions: The initiation of an addiction medicine consult service was associated with a higher proportion of MOUD initiation but there was no statistically significant association with the proportion of patients DAMA

A Multifaceted Health System Initiative For Screening And Intervention For Substance Use Disorders

Drug overdose deaths and the proportion attributed to opioids have increased sharply from 2020 to 2021. Medication for Opioid Use Disorder (MOUD), including methadone and buprenorphine, decrease overdose-related deaths. Prior work has focused on implementation of screening and initiation of treatment in emergency departments or inpatient initiation of buprenorphine. The purpose of this study is to determine whether, in an acute care setting, the implementation of universal screening for substance use disorders and provision of clinical decision support tools to initiate treatment for Opioid Use Disorder (OUD) leads to an increase in the number of patients started on treatment and connected to outpatient follow-up. Methods include implementation of nurse-led screening for all admitted patients and triggers to recommend intervention and referral to treatment for those who screen positive. An order set was also implemented with clinical decision support to guide initiation or continuation of MOUD. During the development of this project, our organization began efforts to address screening and treatment for all substance use disorders in the outpatient and emergency department settings as part of a NJ state quality of care initiative. We integrated our project into the broader health system-wide effort. Pilot results demonstrate feasibility of implementing universal screening in the emergency department, though fewer patients screened positive than expected. Further training of the nurses may be needed to accurately capture all individuals at risk. Results post-implementation of the order set demonstrate that more patients were discharged to home on buprenorphine and that the volume of consults to Addiction Medicine did not increase. Full implementation of the interventions will require ongoing assessment for accuracy of the screening results. Future plans include quantification of patient outcomes and workload

On the use of multilayer Laue lenses with X-ray Free Electron Lasers

Multilayer Laue lenses were used for the first time to focus x-rays from an X-ray Free Electron Laser (XFEL). In an experiment, which was performed at the European XFEL, we demonstrated focusing to a spot size of a few tens of nanometers. A series of runs in which the number of pulses per train was increased from 1 to 2, 3, 4, 5, 6, 7, 10, 20 and 30 pulses per train, all with a pulse separation of 3.55 us, was done using the same set of lenses. The increase in the number of pulses per train was accompanied with an increase of x-ray intensity (transmission) from 9% to 92% at 5 pulses per train, and then the transmission was reduced to 23.5 % when the pulses were increased further. The final working condition was 30 pulses per train and 23.5% transmission. Only at this condition we saw that the diffraction efficiency of the MLLs changed over the course of a pulse train, and this variation was reproducible from train to train. We present the procedure to align and characterize these lenses and discuss challenges working with the pulse trains from this unique x-ray source

On the use of multilayer Laue lenses with X-ray free electron lasers

We report on the use of multilayer Laue lenses to focus the intense X-ray Free Electron Laser (XFEL) beam at the European XFEL to a spot size of a few tens of nanometers. We present the procedure to align and characterize these lenses and discuss challenges working with the pulse trains from this unique X-ray source