Descriptive Study of Prescriptions for Opioids from a Suburban Academic Emergency Department before New York\u27s I-STOP Act.

Introduction: Controlled prescription opioid use is perceived as a national problem attributed to all specialties. Our objective was to provide a descriptive analysis of prescriptions written for controlled opioids from a database of emergency department (ED) visits prior to the enactment of the I-STOP law, which requires New York prescribers to consult the Prescription Monitoring Program (PMP) prior to prescribing Schedule II, III, and IV controlled substances for prescriptions of greater than five days duration. Methods: We conducted a retrospective medical record review of patients 21 years of age and older, who presented to the ED between July 1, 2011 – June 30, 2012 and were given a prescription for a controlled opioid. Our primary purpose was to characterize each prescription as to the type of controlled substance, the quantity dispensed, and the duration of the prescription. We also looked at outliers, those patients who received prescriptions for longer than five days. Results: A total of 9,502 prescriptions were written for opioids out of a total 63,143 prescriptions for 69,500 adult patients. Twenty-six (0.27%) of the prescriptions for controlled opioids were written for greater than five days. Most prescriptions were for five days or less (99.7%, 95% CI [99.6 to 99.8%]). Conclusion: The vast majority of opioid prescriptions in our ED prior to the I-STOP legislature were limited to a five-day or less supply. These new regulations were meant to reduce the ED’s contribution to the rise of opioid related morbidity. This study suggests that the emergency physicians’ usual prescribing practices were negligibly limited by the new restrictive regulations. The ED may not be primarily contributing to the increase in opioid-related overdoses and death. The effect of the I-STOP regulation on future prescribing patterns in the ED remains to be determined

A research primer: Basic guidelines for the novice researcher

Research can achieve many objectives, primarily by establishing a supportable, verifiable basis for clinical decisions. An evidence-based practice can streamline patient care, improving safety through consistency of care and making health care more affordable for patients. By cultivating research skills, osteopathic physicians and trainees can begin to forge a reciprocal relationship with medical literature and current findings, approaching research as active contributors as well as consumers. Many challenges, however, potentially hinder osteopathic physicians, residents, or medical students who wish to develop research skills. In the present article, the authors summarize research concepts and terminology that will enable novice researchers to interact effectively with more experienced researchers, statisticians, and methodologists. © 2013 American Osteopathic Association

A Research Primer, Part 2: Guidelines for Developing a Research Project

In this article, the second in a series on the basic concepts of research, the authors review aspects of research design including participant considerations, randomization, reliability and validity of measurements, and data collection and management. The authors also discuss considerations for research using questionnaires and tests. The goal of this article is to assist the novice researcher in identifying potential problems that must be addressed during the design of a research project

In hospital cardiac arrest: a role for automatic defibrillation.

INTRODUCTION: Sudden cardiac death (SCD) survival decreases by 10% for each minute of delay in defibrillation, however, survival rates of 98% can be achieved when defibrillation is accomplished within 30s of collapse. Recently, a fully automated external cardioverter-defibrillator (AECD) was approved by the FDA for in-hospital use. The AECD can be programmed to automatically defibrillate when a life threatening ventricular arrhythmia occurs. The purpose of this study was to assess the potential impact of in-hospital AECDs on the critical time to defibrillation in monitored hospital units. METHODS: Mock emergency (n = 18) were conducted using simulated ventricular fibrillation in various monitored units. Observers were stationed to record the time staff responded to the arrhythmia, and the time to shock. These times were compared to an AECD protocol that defibrillates automatically in an average of 38.3 s from onset of arrhythmia (n = 18). RESULTS: Staff versus AECD response time to arrhythmia (s) was 76.3 +/- 113.7 (CI 19.8-132.8) versus 7.6 +/- 0.6 (CI 7.3-7.9). Staff versus AECD time to shock was 169.2 +/- 103.1 (CI 117.9-220.4) versus 38.3 +/- 0.7 (CI 37.9-38.6). P-values are CONCLUSION: The use of AECDs on monitored units would significantly reduce the critical time to defibrillation in patients with SCA. We anticipate this would translate to improved survival rates, and better neurologic outcomes