Comparison of Narcotic Prescribing Habits Between Trainee and Attending Orthopaedic Surgeons

Background: Orthopaedic surgeons are among the highest prescribing physicians of narcotics to opioidnaïve patients. Despite the current opioid epidemic, few studies have specifically quantified the appropriate amount of opioids necessary for postoperative pain control. We hypothesized a significant variability in the quantity of postoperative opioids prescribed among trainee (ie, residents and fellows) and attending surgeons at a single institution. Methods: Postoperative narcotic prescribing habits were assessed using an anonymous survey. Ultimately, 28 trainee physicians and 17 attending physicians responded to the survey (86.5%). The survey recorded the amount of 5-mg oxycodone tablets that were commonly prescribed to manage pain after various typical orthopaedic procedures (eg, total knee arthroplasty). Non-narcotic analgesic use was also measured. Mean, standard deviation, and variance values were calculated, with significance set at α = 0.05. Results: After the following procedures, the respondents reported prescribing the following quantities of 5-mg oxycodone tablets: total knee arthroplasty, 56 (SD, 16); total hip arthroplasty, 53 (SD, 13); anterior cruciate ligament reconstruction, 38 (SD, 16); partial meniscectomy, 23 (SD, 14); arthroscopic rotator cuff repair, 39 (SD, 16); carpal tunnel release, 10 (SD, 10); A1 pulley release for treating trigger finger, 9 (SD, 9); open reduction and internal fixation (ORIF) for treating distal radius fractures, 32 (SD, 16); and ORIF for treating ankle fractures, 39 (SD, 15). Statistically significant variation existed between trainee and attending physicians for total hip arthroplasty and A1 pulley release. There was no difference for acetaminophen or nonsteroidal anti-inflammatory drugs, with about 70% of patients receiving at least one of these adjuncts. Conclusions: Variability exists in postoperative opioid prescribing habits between trainee and attending physicians at the academic training institution we accessed. In light of the ongoing opioid epidemic, institutions may benefit from standardized postoperative pain protocols

Severe gynaecomastia associated with spironolactone treatment in a patient with decompensated alcoholic liver cirrhosis - case report

Gynaecomastia is uni- or bilateral breast enlargement in males associated with benign hyperplasia of the glandular, fibrous and adipose tissue resulting from oestrogen-androgen imbalance. Asymptomatic gynaecomastia is a common finding in healthy male adults and does not have to be treated, while symptomatic gynaecomastia might be the symptoma of many pathological conditions and requires meticulous diagnosis and therapeutic management. The commonest causes of gynaecomastia in the Polish population include liver cirrhosis and drugs used to treat its complications. The current study presents the case of severe painless gynaecomastia in a patient with decompensated alcoholic liver cirrhosis, treated with spironolactone because of ascites. Breast enlargement assessed a IIb according to the Simon’s Scale or III according to the Cordova-Moschella classification, developed slowly over the two-year period of low-dose spironolactone therapy The course and dynamics of disease are described and the main mechanisms leading to its development discussed. The importance of effective treatment of patients with severe gynecomastia is emphasized as the disease may result in significant psychosocial problems

Molecular genetic programming

The paper addresses a new implementation of genetic programming by using molecular approach. Our method is based on dataflow techniques in DNA computing. After description of fundamental operations on DNA molecules and construction of logical functions the genetic programming method is introduced. We propose a way to handle these graph encoding molecules and which can be considered a genetic programming algorithm; a short discussion about experiments in implementing parts of this procedure is added

Anti-neoplastic properties of plants – can nature help to cure cancer?

Nowadays cancers are predominant cause of morbidity and mortality all over the world. Therefore, the greatest challenge for clinical oncology is to reduce the prevalence of these diseases. What gains rising interest are natural substances derived from plants, which have both chemopreventive and chemotherapeutic properties. The task is demanding since the mechanisms underlying antitumor activity of plants-derived natural substances are complex and diverse. Several natural substances are already the components of international protocols of multi-drug chemotherapy. Nevertheless, cooperation between botanists, pharmacologists and clinical oncologists is essential to achieve further improvement in this field

The assessment of the level of knowledge and the use of plant-derived preparations among people reporting to the Rehabilitation Clinic in Lublin

The use of plant-derived compounds in medicine arouses more and more interest. Most plants contain numerous active ingredients that may have therapeutic effects on the human body. For many years, herbs have been used as medicinal agents. However, it is necessary to learn about the chemical content of the plant as well as how they work on the human body. The aim of this study was to evaluate the use of preparations containing plant extracts and the assessment of respondents’ knowledge about plant resources with medicinal properties. The study group consisted of people who visited the Rehabilitation Department in Lublin. Respondents voluntarily filled out the questionnaire consisting of 21 questions. 33 persons were examined in total. More than 77% of those who participated in the study have ever applied preparations of plant origin. More than half rated their level of knowledge about medicinal plants as small. Respondents gained knowledge about data on herbs and herbal supplements from several sources. None of the respondents considers preparations containing plant extracts as fully safe for the body and no one would use it without consulting a doctor first. The majority of respondents (over 63%) rated the effectiveness of the plant-derived compounds as good. Over 90% of respondents noticed positive effects of the use of plant supplements. Most respondents did not use compounds of plant origin which might slow down the body’s aging process or improve memory and concentration. However, more than half of the respondents applied preparations containing sedative plant extracts. As seen in the studies and the discussion above, the prevalence of the use of plant-derived compounds among respondents is relatively large. Respondents do not have sufficient knowledge of these substances. Almost all respondents notice the positive impact of plant compounds on the body. There is a need for educational campaigns among society to enrich the knowledge on the use of herbal medicine and its side effects in details