Increasing Naloxone Availability

Administration of naloxone is credited with the reversal of at least 10,000 opioid overdoses in the United States between 1996-2010 alone.[i] Moreover, intranasal naloxone has proven an equally effective route of drug administration when compared to IV dosing in emergent prehospital settings[ii], and retrospective studies have shown no significant difference in efficacy between doses delivered by healthcare professionals and non-healthcare professionals.[iii] Despite these facts, and broad protections provided to physicians prescribing naloxone and citizens administering naloxone outlined in Vermont Act 75, few if any Vermont physicians have incorporated prescribing naloxone into their practice. This project intended to find the barriers to prescribing and begin prophylactic distribution of naloxone to Stowe Family Practice patients. [i] Centers for Disease Control and Prevention (CDC).Community-based opioid overdose prevention programs providing naloxone - United States, 2010. MMWR Morb Mortal Wkly Rep. 2012 Feb 17;61(6):101-5. [ii] Barton ED, Colwell CB, et al. Efficacy of intranasal naloxone as a needleless alternative for treatment of opioid overdose in the prehospital setting. J Emerg Med. 2005 Oct;29(3):265-71. [iii] Doe-Simkins M, Quinn E, et al. Overdose rescues by trained and untrained participants and change in opioid use among substance-using participants in overdose education and naloxone distribution programs: a retrospective cohort study. BMC Public Health. 2014 Apr 1;14:297. doi: 10.1186/1471-2458-14-297.https://scholarworks.uvm.edu/fmclerk/1078/thumbnail.jp

Who is pirating medical literature? A bibliometric review of 28 million Sci-Hub downloads.

We aimed to define the proportion of downloads on Sci-Hub that are medical in nature and to consider these data at the national level, evaluating the relation between density of medical literature downloads and scientific output, national income classifications, and indicators of internet penetrance

Improving WIC Retention in Vermont: Beneficiary attitudes toward co-location in medical homes

Introduction: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a national program aimed at improving the nutrition and health of pregnant women and children. Those eligible for Vermont WIC include anyone pregnant or with children under 5 that has an income below 185% of federal poverty level or is enrolled in Vermont Medicaid. WIC has been shown to improve birth outcomes1, breast feeding rates2, infant growth and development, and consumption of important nutrients. Those enrolled in WIC report high levels of satisfaction Despite the benefits of WIC, retention rates of eligible families remain low. Studies have shown that mandatory bi-annual recertification appointments pose logistical problems. Rescheduling missed appointments and long waiting times at the WIC offices were also barriers. Other states have found that integration of WIC recertification appointments with the family’s primary care medical visits may improve retention. A limited scale co-localization of WIC and the medical home in Vermont showed some promise.https://scholarworks.uvm.edu/comphp_gallery/1213/thumbnail.jp

Kulturen des Kopierschutzes II

Seit den 1990er Jahren war viel die Rede von Kopie und Simulation, Re­produzier­barkeit und Serialität. Doch dass schon das eigene Portemon­naie Dinge wie Geld und Personalpapiere enthält, die nicht kopiert wer­den sollen und von Normal­bürgern auch nicht kopiert werden können, wird oft vergessen. Wir leben (auch) in einer "Kultur des Kopierschutzes", in der verschiedene technische, diskursive und juristische Verfahren zu­sammenwirken, um die gesteigerte "technische Repro­duzierbarkeit", um Benjamins berühmten Ausdruck zu bemühen, im Zaum zu halten. Besonders deutlich wird das auch in den manchmal aufgeregten Diskus­sionen um den Status des Urheberrechts im Feld der digitalen Medien. Die beiden Hefte der Navigationen des Jahres 2010 sind das Ergebnis einer von Prof. Dr. Jens Schröter (Medienwissenschaft,Theorie und Praxis multi­medialer Systeme) geleiteten Projektgruppe im Masterstudiengang "Medienkul­tur". Die Studierenden haben im Rahmen des gesetzten Themas selbstständig Problemstellungen formuliert und diskutiert, dieErgebnisse dieser Arbeit sind in den beiden Heften publiziert - zusammen miteiner Reihe eingeladener Beiträge, die Aspekte abdecken, die in der Projektgruppe nicht bearbeitet werden konn­te

From blockchain technology to global health equity: can cryptocurrencies finance universal health coverage?

Blockchain technology and cryptocurrencies could remake global health financing and usher in an era global health equity and universal health coverage. We outline and provide examples for at least four important ways in which this potential disruption of traditional global health funding mechanisms could occur: universal access to financing through direct transactions without third parties; novel new multilateral financing mechanisms; increased security and reduced fraud and corruption; and the opportunity for open markets for healthcare data that drive discovery and innovation. We see these issues as a paramount to the delivery of healthcare worldwide and relevant for payers and providers of healthcare at state, national and global levels; for government and non-governmental organisations; and for global aid organisations, including the WHO, International Monetary Fund and World Bank Group

Population and antenatal-based HIV prevalence estimates in a high contracepting female population in rural South Africa.

BACKGROUND: To present and compare population-based and antenatal-care (ANC) sentinel surveillance HIV prevalence estimates among women in a rural South African population where both provision of ANC services and family planning is prevalent and fertility is declining. With a need, in such settings, to understand how to appropriately adjust ANC sentinel surveillance estimates to represent HIV prevalence in general populations, and with evidence of possible biases inherent to both surveillance systems, we explore differences between the two systems. There is particular emphasis on unrepresentative selection of ANC clinics and unrepresentative testing in the population. METHODS: HIV sero-prevalence amongst blood samples collected from women consenting to test during the 2005 annual longitudinal population-based serological survey was compared to anonymous unlinked HIV sero-prevalence amongst women attending antenatal care (ANC) first visits in six clinics (January to May 2005). Both surveillance systems were conducted as part of the Africa Centre Demographic Information System. RESULTS: Population-based HIV prevalence estimates for all women (25.2%) and pregnant women (23.7%) were significantly lower than that for ANC attendees (37.7%). A large proportion of women attending urban or peri-urban clinics would be predicted to be resident within rural areas. Although overall estimates remained significantly different, presenting and standardising estimates by age and location (clinic for ANC-based estimates and individual-residence for population-based estimates) made some group-specific estimates from the two surveillance systems more predictive of one another. CONCLUSION: It is likely that where ANC coverage and contraceptive use is widespread and fertility is low, population-based surveillance under-estimates HIV prevalence due to unrepresentative testing by age, residence and also probably by HIV status, and that ANC sentinel surveillance over-estimates prevalence due to selection bias in terms of age of sexual debut and contraceptive use. The results presented highlight the importance of accounting for unrepresentative testing, particularly by individual residence and age, through system design and statistical analyses

Effect of remission status and induction chemotherapy regimen on outcome of autologous stem cell transplantation for mantle cell lymphoma.

We analysed the outcomes of autologous stem cell transplantation (ASCT) following high-dose therapy with respect to remission status at the time of transplantation and induction regimen used in 56 consecutive patients with mantle cell lymphoma (MCL). Twenty-one patients received induction chemotherapy with HyperCVAD with or without rituximab (+/-R) followed by ASCT in first complete or partial remission (CR1/PR1), 15 received CHOP (+/-R) followed by ASCT in CR1/PR1 and 20 received ASCT following disease progression. Estimates of overall and progression-free survival (PFS) at 3 years among patients transplanted in CR1/PR1 were 93% and 63% compared with 46% and 36% for patients transplanted with relapsed/refractory disease, respectively. The hazard of mortality among patients transplanted with relapsed/refractory disease was 6.09 times that of patients transplanted in CR1/PR1 (P = 0.006). Patients in the CHOP (+/-R) group had a higher risk of failure for PFS compared with patients in the HyperCVAD (+/-R) group, though the difference did not reach statistical significance (hazard ratio 3.67, P = 0.11). These results suggest that ASCT in CR1/PR1 leads to improved survival outcomes for patients with MCL compared to ASCT with relapsed/refractory disease, and a HyperCVAD (+/-R) induction regimen may be associated with an improved PFS among patients transplanted in CR1/PR1

Data Quality Barriers for Transparency in Public Procurement

Governments need to be accountable and transparent for their public spending decisions in order to prevent losses through fraud and corruption as well as to build healthy and sustainable economies. Open data act as a major instrument in this respect by enabling public administrations, service providers, data journalists, transparency activists, and regular citizens to identify fraud or uncompetitive markets through connecting related, heterogeneous, and originally unconnected data sources. To this end, in this article, we present our experience in the case of Slovenia, where we successfully applied a number of anomaly detection techniques over a set of open disparate data sets integrated into a Knowledge Graph, including procurement, company, and spending data, through a linked data-based platform called TheyBuyForYou. We then report a set of guidelines for publishing high quality procurement data for better procurement analytics, since our experience has shown us that there are significant shortcomings in the quality of data being published. This article contributes to enhanced policy making by guiding public administrations at local, regional, and national levels on how to improve the way they publish and use procurement-related data; developing technologies and solutions that buyers in the public and private sectors can use and adapt to become more transparent, make markets more competitive, and reduce waste and fraud; and providing a Knowledge Graph, which is a data resource that is designed to facilitate integration across multiple data silos by showing how it adds context and domain knowledge to machine-learning-based procurement analytics.publishedVersio

Using a Resident-Led Process Improvement Committee to Change Pain Medication Prescribing Habits: Early Results

The aims of this project were to: Streamline the ordering of IV and PO pain meds Encourage the appropriate ordering of Ofirmev

National trends in pectus excavatum repair: patient age, facility volume, and outcomes

Background: There is limited data on the adult repair of pectus excavatum (PE). Existing literature is largely limited to single institution experiences and suggests that adults undergoing modified Nuss repair may have worse outcomes than pediatric and adolescent patients. Using a representative national database, this analysis is the first to describe trends in demographics, outcomes, charges, and facility volume for adults undergoing modified Nuss procedure. Methods: Because of a coding change associated with ICD-10, a retrospective cohort analysis using the National Inpatient Sample (NIS) for patients 12 or older undergoing modified Nuss repair between 2016-2018 was possible. Pearson\u27s χ2 and Student\u27s t-tests were utilized to compare patient, clinical, and hospital characteristics. Complications were sub-classified into major and minor categories. Facilities performing greater than the mean number of operations were categorized as high-volume. Results: Of 360 patients, 79.2% were male. There was near gender parity for patients over 30 undergoing repair (55.2% male, 44.8% female). In all age cohorts, patients were predominantly Caucasian. Rates of any postoperative complication differed by age (12-17 years: 30.6%; 18-29 years: 45.2%; 30+ years: 62.1%; P\u3c0.01); older patients had higher rates of all but two subclasses of complication. Age over 30 was associated with higher charges (12-17 years: $57,312; 18-29 years:$57,001; 30+ years: $67,014; P\u3c0.01). High-volume centers operate on older patients, had shorter lengths of stay, and comparable charges to low-volume centers. Conclusions: Women comprise nearly half of patients undergoing modified Nuss repair after 30 years of age. There are significant differences in complication rates and charges when comparing patients by age. Patients undergoing repair at high-volume facilities benefitted from shorter lengths of stay