Effect of the Prescription Drug Monitoring Program on Emergency Department Opioid Prescribing

Introduction: Our goal was to determine whether implementation of a prescription drug monitoring program (PDMP) altered emergency department (ED) opioid prescription rates overall and in patients of different pain severities.Methods: We conducted this single-center, retrospective review at an academic ED. The study examined patients discharged from the ED who received opioid prescriptions, before and after the state’s implementation of a PDMP (August 25, 2016). The monthly rate was a ratio of the patients given ≥ 1 opioid prescription to the ED patients with a numeric pain rating scale (NPRS) > 0. We performed an interrupted time series analysis on each demographic.Results: The overall ED opioid prescription rate decreased from 51.3% (95% confidence interval [Cl], 50.4%-52.2%) to 47.9% (95% Cl, 47.0%- 48.7%). For males, this decreased from 51.1% to 46.7% (P < 0.0001), while in females it did not significantly change (51.6% to 49.7% [P = 0.0529]). For those with mild pain, the rate increased from 27.5% to 34.3% (P < 0.0001), while for those with moderate pain, it did not significantly change (42.8% to 43.5% [P = 0.5924]). For those with severe pain, the rate decreased from 66.1% to 59.6% (P < 0.0001).Conclusion: We found that PDMP implementation was associated with an overall decrease in opioid prescription rates, and that patients with mild pain were prescribed opioids more often while severe pain patients were prescribed opioids less often

Effect of the Prescription Drug Monitoring Program on Emergency Department Opioid Prescribing

Introduction: Our goal was to determine whether implementation of a prescription drug monitoring program (PDMP) altered emergency department (ED) opioid prescription rates overall and in patients of different pain severities.Methods: We conducted this single-center, retrospective review at an academic ED. The study examined patients discharged from the ED who received opioid prescriptions, before and after the state’s implementation of a PDMP (August 25, 2016). The monthly rate was a ratio of the patients given ≥ 1 opioid prescription to the ED patients with a numeric pain rating scale (NPRS) > 0. We performed an interrupted time series analysis on each demographic.Results: The overall ED opioid prescription rate decreased from 51.3% (95% confidence interval [Cl], 50.4%-52.2%) to 47.9% (95% Cl, 47.0%- 48.7%). For males, this decreased from 51.1% to 46.7% (P < 0.0001), while in females it did not significantly change (51.6% to 49.7% [P = 0.0529]). For those with mild pain, the rate increased from 27.5% to 34.3% (P < 0.0001), while for those with moderate pain, it did not significantly change (42.8% to 43.5% [P = 0.5924]). For those with severe pain, the rate decreased from 66.1% to 59.6% (P < 0.0001).Conclusion: We found that PDMP implementation was associated with an overall decrease in opioid prescription rates, and that patients with mild pain were prescribed opioids more often while severe pain patients were prescribed opioids less often

Interruptions During Sign-out Between Emergency Medicine Residents Before and After Implementation of Group Sign-out Process

Introduction: Interruptions that occur during sign-out in the emergency department (ED) may affect workflow, quality of care, patient safety, errors in documentation, and resident education. Our objective in this study was to determine the frequency and classification (emergent vs non-emergent, in-person vs phone call) of interruptions that occur during emergency medicine (EM) resident sign-out before and after the institution of a group sign-out process involving residents and attending physicians.Methods: A convenience sample of sign-out observations between EM residents were observed and coded between April–December 2021. We excluded sign-out observations of pediatric patients (<18 years of age) and observations not conducted in the main ED. Collected data included number of patients signed out during each observation; total duration in minutes for each observation; total number of interruptions during each observation; and type of interruption (emergent vs non-emergent, in-person vs phone call). We further stratified data before and after the institution of a group sign-out process (July 2021).Results: We performed data analysis on 58 individual and 65 group sign-out observations, respectively. Although the total number of patients signed out, the total duration of sign-outs observed, mean number of patients signed out per minute, and mean duration of sign-out per observation were more for the group sign-out aggregate compared with the individual sign-out aggregate, the total number of interruptions (44 vs 73, P = 0.007), number of interruptions per minute (0.05 vs 0.16, P < 0.001), total number of non-emergent interruptions (38 vs. 67, P = 0.005), and total number of in-person interruptions (14 vs 44, P < 0.001) was less in the group sign-out compared with the individual sign-out totals.Conclusion: Based on our sample, although the total duration of group sign-out with both residents and an attending was longer than individual resident-to-resident sign-out, the total number of interruptions, number of interruptions per minute, total number of non-emergent interruptions, and total number of in-person interruptions was less in the group sign-out. Group sign-out may be an option to limit the negative effects of interruptions in the ED

Disclosing a cancer diagnosis to friends and family: a gendered analysis of young men's and women's experiences

Little is known about how young adults disclose their cancer diagnosis to family and friends, and whether there are similarities or differences between men and women. This article compares young adults' experiences of disclosing a cancer diagnosis, drawing on narrative interviews with 37 respondents aged 18 to 34 years. Most respondents were open about their diagnosis, and there were striking similarities in the difficulties that men and women described and in their desire to protect relatives. However, men made up most of the minority of respondents who were more secretive about their diagnosis. Men also made more explicit connections between their gendered identity and disclosure; worries about being perceived differently by peers resulted in some men hiding their diagnosis and others using humor to pre-empt sympathy. These findings are discussed in the context of gender stereotypes of “expressive” women and “stoical” men

Lck Activity Controls CD4/CD8 T Cell Lineage Commitment

Thymocytes carrying MHC class I–restricted TCRs differentiate into CD8 T cells, while those recognizing MHC class II become CD4 T cells. The mechanisms underlying how MHC class recognition, coreceptor expression, and effector function are coordinated are not well understood. Since the tyrosine kinase Lck binds with more affinity to CD4 than CD8, it has been proposed as a candidate to mediate this process. By using transgenic mice with altered Lck activity, we show that thymocytes carrying a class II–restricted TCR develop into functional CD8 T cells when Lck activity is reduced. Conversely, thymocytes carrying a class I–restricted TCR develop into functional CD4 T cells when Lck activity is increased. These results directly show that quantitative differences in the Lck signal control the CD4/CD8 lineage decision