Effects of opioid prescribing laws on drug use in trauma patients

Background: On November 1st, 2018 Oklahoma Bill 1446 went into effect: limiting the total days of initial opioid prescriptions, follow up opioid prescriptions, chronic opioid prescriptions, mandating prescription monitoring program checking, prescribing opioids to minors, and the need to establish drug contracts and urine drug screening of your patients taking opioids. We believe that with the new rigid opioid prescribing laws in Oklahoma and difficult access to prescription pain medications, abandoned pain patients will turn to illicit drugs because of cheap cost and ease of access. We are assessing the illicit drug usage outcomes after a prescribing law going into effect in patients aged 18-65 reported in level II trauma registries.Methods: Data base search of all patients admitted to the trauma service at a level II trauma center from November 1st 2017 to November 1st 2019. We will assess de-identified patient data regarding injury severity score, mechanism of injury, urine drugs screen results, time spent in hospital and emergency department, prehospital prescriptions, emergency department medications, BMI, age, gender, mechanism of injury, surgical services, type and number of procedures performed, and disposition.Results: Currently we are building the search based on the above criteria of the trauma registry. We expect the results to demonstrate that illicit drug usage will rise in trauma patients after Bill 1446 went into effect due to decreased access of prescription opioids. Based on our current study design urine drug screen for opioids alone will not be enough information because many patients transferred into the trauma center may have received prescription opioids prior to arrival at the hospital via EMS or transferring facility. We expect a rise in urine drug screen's positive for illicit drugs. We also expect patients that did test positive for illicit drugs to have longer hospital admissions, higher injury severity scores, more surgeries/procedures required, and worse mechanism of injuries.Conclusions: We believe that with the new rigid opioid prescribing laws in Oklahoma and difficult access to prescription pain medications, many patients will turn to illicit drugs after Bill 1446 went into effect. Our study is aimed to determine how the Opioid Prescribing Laws in Oklahoma affected illicit drug use in trauma patients. The primary goal for implementing the Opioid Prescribing Laws was to combat the Opioid Epidemic across the United States, however we believe law makers may have been too stringent on the implementation of the Opioid Prescribing Laws. We believe our study will help guide politician and law makers in the future when assessing the possible secondary effects of these drugs laws

Statistical significance and sports medicine trials

Objectives: Lowering the threshold for statistical significance in medical research from a P value of .05 to .005 was recently proposed to reduce misinterpretation of study results. What effect this proposal would have on orthopaedic sports medicine literature is currently unclear.Research Question/Hypothesis: We seek to determine how the newly proposed threshold could affect the interpretation of previously published sports medicine RCTs.Methods: We searched PubMed from January 01, 2016 to December 31, 2017 for RCTs published in the American Journal of Sports Medicine, Arthroscopy, and Knee Surgery, Sports Traumatology, Arthroscopy. We extracted P value data for primary endpoints, since RCTs are most often powered for these endpoints. We used Google Forms for data extraction and STATA 13.1 for the data analysis.Results: Of the 159 studies, only 13 (8%) of the studies have endpoints in which all P values are below the new threshold of .005. 40 (25%) of the studies have endpoints in which some would meet the new P value threshold of .005, and some would not meet this new threshold. 106 (67%) of the studies have no endpoints in which the P value(s) was less than .005. Overall, 38% (59/157) of the previously statistically significant primary endpoints were less than .005, while 62% (98/157) would be reclassified as suggestive.Conclusions: Of statistically significant endpoints in our sample, only 17% (59/350) would maintain their statistical significance with a P value threshold of less than .005, and only 8% of studies would maintain their overall significance with all P values falling below the new threshold

COVID 19 and its effects on pediatric orthopaedic clinical trials

Background: Clinical trials for the treatment of pediatric orthopaedics are critical to enhance the quality of life of these children. In response to the COVID-19 pandemic, the FDA updated guidance on conducting clinical trials to prioritize patient safety; however the degree to which the pandemic disrupted pediatric orthopaedic-related clinical trials is unknown. Thus, our objective is to quantify the number of these trials disrupted due to the COVID-19 pandemic.Methods: We searched ClinicalTrials.gov for ongoing and discontinued trials between 01/01/2020 - 10/31/2021. Trials were screened for relevance to the study and the number of participants, trial location, funding source, and reason for discontinuation. Associations between reasons for termination, funding source, trial location, and the number of participants enrolled were evaluated using MannWhitney U tests or ANOVA, where appropriate.Results: Our search returned 544 trials, of which 128 were included with a total of 15,194 participants. Of the included Pediatric trials of orthopaedic conditions, 9 were discontinued with a total of 497 participants. Of the 9 discontinued trials, 1 of 3 stated COVID-19 as a reason. Mann-Whitney U tests and ANOVA showed no statistically significant difference in enrollment between trials discontinued due to COVID-19 compared to other discontinued trials, nor among funding or location.Conclusion: Our study shows 33% of discontinued pediatric orthopaedic-related clinical trials cited COVID-19 as a reason for discontinuation; however, only 12% of all children enrolled in discontinued trials. Findings from this study highlight the importance of developing strategies for safely continuing clinical research amid global emergencies that will almost certainly arise in the future

Post-clearcut dynamics of carbon, water and energy exchanges in a midlatitude temperate, deciduous broadleaf forest environment

Clearcutting and other forest disturbances perturb carbon, water, and energy balances in significant ways, with corresponding influences on Earth\u27s climate system through biogeochemical and biogeophysical effects. Observations are needed to quantify the precise changes in these balances as they vary across diverse disturbances of different types, severities, and in various climate and ecosystem type settings. This study combines eddy covariance and micrometeorological measurements of surface-atmosphere exchanges with vegetation inventories and chamber-based estimates of soil respiration to quantify how carbon, water, and energy fluxes changed during the first 3 years following forest clearing in a temperate forest environment of the northeastern US. We observed rapid recovery with sustained increases in gross ecosystem productivity (GEP) over the first three growing seasons post-clearing, coincident with large and relatively stable net emission of CO2 because of overwhelmingly large ecosystem respiration. The rise in GEP was attributed to vegetation changes not environmental conditions (e.g., weather), but attribution to the expansion of leaf area vs. changes in vegetation composition remains unclear. Soil respiration was estimated to contribute 44% of total ecosystem respiration during summer months and coarse woody debris accounted for another 18%. Evapotranspiration also recovered rapidly and continued to rise across years with a corresponding decrease in sensible heat flux. Gross short-wave and long-wave radiative fluxes were stable across years except for strong wintertime dependence on snow covered conditions and corresponding variation in albedo. Overall, these findings underscore the highly dynamic nature of carbon and water exchanges and vegetation composition during the regrowth following a severe forest disturbance, and sheds light on both the magnitude of such changes and the underlying mechanisms with a unique example from a temperate, deciduous broadleaf forest. © 2013 John Wiley & Sons Ltd