Immunoassay Urine Drug Testing among Patients Receiving Opioids at a Safety-Net Palliative Medicine Clinic

BACKGROUND: Few studies have examined the use of immunoassay urine drug testing of cancer patients in palliative care clinics. OBJECTIVES: We examined the frequency of immunoassay urine drug test (UDT) abnormalities and the factors associated with aberrancy at a safety-net hospital palliative medicine clinic. METHODS: A retrospective review of the electronic medical records of consecutive eligible patients seen at the outpatient palliative medicine clinic in a resource-limited safety-net hospital system was conducted between 1 September 2015 and 31 December 2020. We collected longitudinal data on patient demographics, UDT findings, and potential predictors of aberrant results. RESULTS: Of the 913 patients in the study, 500 (55%) underwent UDT testing, with 455 (50%) having the testing within the first three visits. Among those tested within the first three visits, 125 (27%) had aberrant UDT results; 44 (35%) of these 125 patients were positive for cocaine. In a multivariable regression model analysis of predictors for aberrant UDT within the first three visits, non-Hispanic White race (odds ratio (OR) = 2.13; 95% confidence interval (CI): 1.03-4.38; CONCLUSION: Despite limitations of immunoassay UDT, it was able to detect aberrant drug-taking behaviors in a significant number of patients seen at a safety-net hospital palliative care clinic, including cocaine use. These findings support universal UDT monitoring and utility of immunoassay-based UDT in resource-limited settings

Adherence to Opioid Patient Prescriber Agreements at a Safety Net Hospital

Patient prescriber agreements, also known as opioid contracts or opioid treatment agreements, have been recommended as a strategy for mitigating non-medical opioid use (NMOU). The purpose of our study was to characterize the proportion of patients with PPAs, the rate of non-adherence, and clinical predictors for PPA completion and non-adherence. This retrospective study covered consecutive cancer patients seen at a palliative care clinic at a safety net hospital between 1 September 2015 and 31 December 2019. We included patients 18 years or older with cancer diagnoses who received opioids. We collected patient characteristics at consultation and information regarding PPA. The primary purpose was to determine the frequency and predictors of patients with a PPA and non-adherence to PPAs. Descriptive statistics and multivariable logistic regression models were used for the analysis. The survey covered 905 patients having a mean age of 55 (range 18-93), of whom 474 (52%) were female, 423 (47%) were Hispanic, 603 (67%) were single, and 814 (90%) had advanced cancer. Of patients surveyed, 484 (54%) had a PPA, and 50 (10%) of these did not adhere to their PPA. In multivariable analysis, PPAs were associated with younger age (odds ratio [OR] 1.44

Innovations in phacoemulsification technology

A working knowledge of the principles guiding recent technologic upgrades in phacoemulsification units will help the surgeon to maximize clinical benefits from the latest machines. Reduced thermal energy combined with more efficient emulsification resulting from microfractionation of ultrasound energy, and improved chamber stability from automatic fluidic adjustments are achievable with the recent technological advances. Improved safety and efficiency can be achieved with the most current advances in phacoemulsification technology

Epidemic expansion of HIV type 1 subtype C and recombinant genotypes in Tanzania

Human immunodeficiency virus type 1 (HIV-1) subtypes are distributed unevenly across African nations.1 In East and Central African countries such as Uganda, Rwanda, Kenya, and Tanzania, the HIV-1 epidemic has involved two HIV-1 subtypes, A and D. In contrast, HIV-1 subtype C has dominated the rapidly expanding epidemic in Malawi and South Africa.1-3 The relative roles played by virological, behavioral, and host determinants in the epidemic expansion of any particular HIV- 1 subtype are unclear. Characterization of the transmissibility and pathogenic potential of distinct HIV-1 genetic subtypes is currently under investigation in many regions of the world. Careful surveillance of genetic subtypes prevalent in a given population is one particularly important approach to better understand the biological properties of different HIV-1 subtypes. The presence of HIV-1 subtypes A and D in asymptomatic carriers and AIDS patients from several geographical locales in Tanzania has been previously described.4-7 An analysis of samples collected in 1988 showed that 10 of 15 (67%) envelope V3 sequences from Tanzanian samples were found to belong to subtype D. The remaining five samples (33%) belonged to HIV-1 subtype A.4 In Dar es Salaam, vpu and env sequences from 8 of 10 AIDS patients (80%) clustered with subtype D viruses and the remaining 2 (20%) with subtype A.5 A study in northern Tanzania reported that the env-encoded gp41 regions from 12 samples also clustered with HIV-1 subtypes A and D.6 In another report from northern Tanzania, four of eight (50%) envelope sequences sampled encompassing the C2V3 region belonged to subtype A and the other half to subtype D.7 Envelope sequences from HIV-1-infected individuals of Tanzanian origin, but living in Sweden, showed that three of four samples were HIV-1 subtype C and the remaining sample was HIV-1 subtype A.

Double Descemet's membranes after penetrating keratoplasty with anterior segment optical coherence tomography.

An 83-year-old man underwent penetrating keratoplasty for pseudophakic bullous keratopathy in the left eye. Postoperatively, a thin transparent membrane in the anterior chamber was noted. The differential diagnosis included vitreous prolapse, retained capsule, fibrinous anterior chamber membrane, and retained Descemet's membrane in the anterior chamber, but the diagnosis was uncertain due to corneal edema and Descemet's membrane folds. Anterior segment optical coherence tomography was used to determine the diagnosis of retained host Descemet's membrane. This case report demonstrates that anterior segment optical coherence tomography is a useful and noninvasive instrument for diagnosing and following complications from penetrating keratoplasty

Immunoassay Urine Drug Testing among Patients Receiving Opioids at a Safety-Net Palliative Medicine Clinic

Background: Few studies have examined the use of immunoassay urine drug testing of cancer patients in palliative care clinics. Objectives: We examined the frequency of immunoassay urine drug test (UDT) abnormalities and the factors associated with aberrancy at a safety-net hospital palliative medicine clinic. Methods: A retrospective review of the electronic medical records of consecutive eligible patients seen at the outpatient palliative medicine clinic in a resource-limited safety-net hospital system was conducted between 1 September 2015 and 31 December 2020. We collected longitudinal data on patient demographics, UDT findings, and potential predictors of aberrant results. Results: Of the 913 patients in the study, 500 (55%) underwent UDT testing, with 455 (50%) having the testing within the first three visits. Among those tested within the first three visits, 125 (27%) had aberrant UDT results; 44 (35%) of these 125 patients were positive for cocaine. In a multivariable regression model analysis of predictors for aberrant UDT within the first three visits, non-Hispanic White race (odds ratio (OR) = 2.13; 95% confidence interval (CI): 1.03–4.38; p = 0.04), history of illicit drug use (OR = 3.57; CI: 1.78–7.13; p p < 0.001) were independent predictors of an aberrant UDT finding. Conclusion: Despite limitations of immunoassay UDT, it was able to detect aberrant drug-taking behaviors in a significant number of patients seen at a safety-net hospital palliative care clinic, including cocaine use. These findings support universal UDT monitoring and utility of immunoassay-based UDT in resource-limited settings