A Prospective Evaluation of Opioid Utilization After Upper-Extremity Surgical Procedures: Identifying Consumption Patterns and Determining Prescribing Guidelines.

BACKGROUND: Although adequate management of postoperative pain with oral analgesics is an important aspect of surgical procedures, inadvertent overprescribing can lead to excess availability of opioids in the community for potential diversion. The purpose of our study was to prospectively evaluate opioid consumption following outpatient upper-extremity surgical procedures to determine opioid utilization patterns and to develop prescribing guidelines. METHODS: All patients undergoing outpatient upper-extremity surgical procedures over a consecutive 6-month period had the following prospective data collected: patient demographic characteristics, surgical details, anesthesia type, and opioid prescription and consumption patterns. Analysis of variance and post hoc comparisons were performed using t tests, with the p value for multiple pairwise tests adjusted by the Bonferroni correction. RESULTS: A total of 1,416 patients with a mean age of 56 years (range, 18 to 93 years) were included in the study. Surgeons prescribed a mean total of 24 pills, and patients reported consuming a mean total of 8.1 pills, resulting in a utilization rate of 34%. Patients undergoing soft-tissue procedures reported requiring fewer opioids (5.1 pills for 2.2 days) compared with fracture surgical procedures (13.0 pills for 4.5 days) or joint procedures (14.5 pills for 5.0 days) (p \u3c 0.001). Patients who underwent wrist surgical procedures required a mean number of 7.5 pills for 3.1 days and those who underwent hand surgical procedures required a mean number of 7.7 pills for 2.9 days, compared with patients who underwent forearm or elbow surgical procedures (11.1 pills) and those who underwent upper arm or shoulder surgical procedures (22.0 pills) (p \u3c 0.01). Procedure type, anatomic location, anesthesia type, age, and type of insurance were also all significantly associated with reported opioid consumption (p \u3c 0.001). CONCLUSIONS: In this large, prospective evaluation of postoperative opioid consumption, we found that patients are being prescribed approximately 3 times greater opioid medications than needed following upper-extremity surgical procedures. We have provided general prescribing guidelines, and we recommend that surgeons carefully examine their patients\u27 opioid utilization and consider customizing their opioid prescriptions on the basis of anatomic location and procedure type to prescribe the optimal amount of opioids while avoiding dissemination of excess opioids

Predicting Elective Orthopaedic Sports Medicine Surgical Cancellations Based on Patient Demographics.

Purpose:To evaluate whether patient demographics are associated with cancellation of elective orthopaedic sports medicine surgical procedures. Methods:We retrospectively reviewed the electronic medical records of 761 patients who were scheduled to undergo an elective sports medicine orthopaedic operation from January 1, 2015, to December 31, 2017. The patients were divided into 2 groups: those who underwent the scheduled procedure (group A) and those in whom the operation was canceled for any reason prior to the surgical date and not rescheduled (group B). Univariate analysis assessed patient factors consisting of age, sex, race, language, marital status, occupation status, type of insurance (Medicaid or Medicare vs private), smoking history, employment status, and history of surgery to determine which demographic factors led to an increased risk of elective case cancellation. Results:Patients who canceled were significantly older (46.5 years vs 41.5 years, t = 2.432, P = .015) than those who do not. In addition, current smokers (22.5% vs 10.9%, χ2 = 10.85, P = .001), patients with Medicare or Medicaid versus private insurance (16.7% vs 10.0%, χ2 = 5.35, P = .021), non-English-speaking patients (29.5% vs 11.6%, χ2 = 11.43, P = .001), and patients without a history of surgery requiring anesthesia (18.8% vs 9.6%, χ2 = 9.96, P = .002) were all more likely to cancel. When all studied variables were examined in a logistic regression analysis, of the above demographic variables, only insurance status was no longer significant, given its correlation with age and language. Conclusions:Increased age (≥46.5 years), non-English speaking, smoking, lack of a history of surgery requiring anesthesia, and Medicaid or Medicare insurance were found to contribute to an increased risk of elective orthopaedic surgery cancellation. Level of Evidence:Level III, case-control study

1, 2, 3, 4: Infusing Quantitative Literacy into Introductory Biology

Biology of the twenty-first century is an increasingly quantitative science. Undergraduate biology education therefore needs to provide opportunities for students to develop fluency in the tools and language of quantitative disciplines. Quantitative literacy (QL) is important for future scientists as well as for citizens, who need to interpret numeric information and data-based claims regarding nearly every aspect of daily life. To address the need for QL in biology education, we incorporated quantitative concepts throughout a semester-long introductory biology course at a large research university. Early in the course, we assessed the quantitative skills that students bring to the introductory biology classroom and found that students had difficulties in performing simple calculations, representing data graphically, and articulating data-driven arguments. In response to students' learning needs, we infused the course with quantitative concepts aligned with the existing course content and learning objectives. The effectiveness of this approach is demonstrated by significant improvement in the quality of students' graphical representations of biological data. Infusing QL in introductory biology presents challenges. Our study, however, supports the conclusion that it is feasible in the context of an existing course, consistent with the goals of college biology education, and promotes students' development of important quantitative skills

Recruiting International Master\u27s-Level Students: Research and Good Practices

The presentation highlights new research on how international master’s-level students from different countries decide which schools to apply with a focus on how institutions can leverage this information to improve their outreach and recruitment efforts. This is followed by a panel discussion on good practices led by international recruitment experts

Correlation of the zinc level in the spermoplasm with the fertility characteristics of human ejaculate

Background: Zinc is essential for the normal functioning of the male reproductive system. The data on the diagnostic value of the zinc level in the human spermoplasm and its relationship with the main parameters of the sperm fertility are contradictory. Aim: study of the correlations between the zinc level in the spermoplasm and the spermogram characteristics. Methods: The sperm of men of the reproductive age (n=486, average age 33.073.03 years) was studied. In addition to the standard spermogram, MAR tests (IgA, IgG and IgM) were performed in the sperm samples, the degree of fragmentation of the sperm DNA, the sperm interaction with hyaluronic acid, the acrosine activity, and the neutral alpha-glucosidase activity were assessed, the citric acid, fructose and glycodelin levels were determined, and the level of reactive oxygen species was studied. The zinc level determination in the spermoplasm was carried out by a standard spectrophotometric method with 5-Br-PAPS chromogen. The Pearson's formula was used for the correlation analysis. The study was conducted from 2018 to May 2022, once. Results: A significant negative correlation of the zinc level in the spermoplasm with the age of men was revealed (r=-0.16; p 0.001). The level of zinc in the spermoplasm weakly negatively correlated with the dilution time and with the viscosity of the sperm. The positive correlation was found with the number of spermatozoa (r=0.13; p 0.01) and their mobility (r=0.38; p 0.00001). The level of zinc in the spermoplasm negatively correlated with the degree of the sperm DNA fragmentation and with the amount of reactive oxygen species, and positively correlated with the results of the test for binding to hyaluronic acid. Conclusions: The level of zinc in the spermoplasm significantly correlates with a number of physiological and biochemical characteristics of the sperm. The data obtained allow us to recommend determination of the zinc level in the sperm plasma to not only assess the functional activity of the prostate gland, but also to diagnose the fertility of the ejaculate, as well as to optimize the therapy with zinc-containing drugs and improve the control over the effectiveness of the treatment