Bailey, Zachary

Boes, Emily A.

Kusin, David J.

Miller, Ryan E.

Mormino, Matthew

Putnam, Sara

Roessner, Colton

Samson, Kaeli K.

Sawatzke, Alexander

Siebler, Justin C.

Stockwell, Erin L.

English

University of Nebraska Medical Center Research: DigitalCommons@UNMC

Graduate Medical Education Research Journal Graduate Medical Education Research Journal Volume 3 Issue 1 Article 17 Patterns of Opiate Prescription Practices in Isolated Operative Ankle Fractures: Creating Guidelines David J. Kusin University of Nebraska Medical Center Ryan E. Miller Optum Orthopedics Zachary Bailey University of Nebraska Medical Center Erin L. Stockwell University of Nebraska Medical Center Emily A. Boes University of Utah See next page for additional authors Follow this and additional works at: https://digitalcommons.unmc.edu/gmerj Digital Commons Network Logo  Part of the Higher Education Commons, and the Medicine and Health Sciences Commons Recommended Citation Kusin, D. J., Miller, R. E., Bailey, Z., Stockwell, E. L., Boes, E. A., Roessner, C., Samson, K. K., Putnam, S., Sawatzke, A., Siebler, J. C., , Mormino, M. Patterns of Opiate Prescription Practices in Isolated Operative Ankle Fractures: Creating Guidelines. Graduate Medical Education Research Journal. 2021 Oct 04; 3(1). https://digitalcommons.unmc.edu/gmerj/vol3/iss1/17 This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. Patterns of Opiate Prescription Practices in Isolated Operative Ankle Fractures: Creating Guidelines Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. Authors David J. Kusin, Ryan E. Miller, Zachary Bailey, Erin L. Stockwell, Emily A. Boes, Colton Roessner, Kaeli K. Samson, Sara Putnam, Alexander Sawatzke, Justin C. Siebler, and Matthew Mormino This conference proceeding is available in Graduate Medical Education Research Journal: https://digitalcommons.unmc.edu/gmerj/vol3/iss1/17 Graduate Medical Education Research Journal34 Oral Presentations*Names in bold type indicate presenting author.Methods: We performed a retrospective cohort study, identifying patients with gout followed from the index date until death or censoring. Potential predictors of mortality Multivariable Cox regression models were constructed to identify independent predictors of all-cause mortality.Results: 4,250,477 patient-years of follow-up, there were 246,291 deaths. Multivariable adjusted associations with all-cause mortality are shown in Table 1. Risk factors associated with increased mortality risk included male sex, older age, Black non-Hispanic race, comorbidities, diuretic, opioid, ULT, colchicine, and steroid use. Factors associated with a lower risk of all-cause mortality included white Hispanic, black Hispanic, and Conclusion: multiple risk factors for mortality in veterans with gout with the strongest risk factors and cancer, as well as the use of steroids and opioids. Mechanisms underpinning associations between select medication use and survival will require additional study accounting for the effects of comorbid CKD severity.     Ming-yang Hung1, Nan Zhou1, Chi Zhang1 1University of Nebraska Medical Center, College of Medicine, Department of Radiation OncologyMentor: Chi ZhangProgram: Radiation OncologyType: Original ResearchBackground: Androgen receptor (AR) malignant gliomas, suggesting that AR plays an important role in tumor carcinogenesis. overexpression remains largely to be explored.Methods: AR gene expression at the levels of mRNA, protein expression, and clinical data were obtained from the Cancer Genome Atlas (TCGA) and Chinese Glioma Genome Atlas (CGGA) databases. AR expression levels were compared across gliomas of different histopathologic and molecular subtypes. Lastly, Kaplan-Meier survival analyses in patients with different AR expression levels were investigated for the potential prognostic values of AR.Results: Compared to normal brain tissue, higher AR mRNA expression (p < .01). Furthermore, AR mRNA expression was more prominent in higher grade disease, regardless of histopathologic and molecular subtypes (p < 0.01). Similarly, at the protein level, AR protein was more abundant in GBM than in (p <0.0001). This was corroborated by a linear association between AR mRNA and protein expression (r = 0.65, p < 0.001). Finally, in LGG, both high AR gene and protein worse overall survival. Five-year overall survival for patients with LGG with high AR Table 1.Patient characteristics associated with all-cause mortality in veterans with gout.CharacteristicAge, Years 1.06 (1.06, 1.06)Male (vs. Female) Sex 1.07 (1.02, 1.12)Race and EthnicityWhite HispanicWhite Non-HispanicBlack HispanicBlack Non-HispanicAsianOtherMissing0.81 (0.78, 0.83) Referent 0.78 (0.69, 0.89) 1.06 (1.04, 1.07) 0.62 (0.59, 0.66) 1.07 (1.04, 1.09) 1.95 (1.93, 1.97)Service Connected Condition 0.84 (0.83, 0.85)Urban Residence (vs. Rural) 1.02 (1.02, 1.03)VHA Enrollment Duration, Years 0.95 (0.95, 0.95)Health Factors & ComorbiditiesBody Mass Index<20 kg/m220 to <25 kg/m225 to <30 kg/m20.97 (0.93, 1.02)Referent0.74 (0.73, 0.75)0.68 (0.67, 0.69)ComorbiditiesMyocardial infarction or atherosclerosis, %Other cardiovascular disease, %Stroke, %Hypertension, %Lung disease, %Depression, %Diabetes mellitus, %Ulcer or stomach problem, %Cancer, %1.11 (1.09, 1.13)1.46 (1.45, 1.47)1.17 (1.15, 1.19)0.90 (0.89, 0.91)1.59 (1.57, 1.61)1.15 (1.14, 1.17)1.34 (1.32, 1.35)1.06 (1.04, 1.08)1.23 (1.21, 1.24)Diuretic Use 1.37 (1.36, 1.39)ULT Use (Allopurinol, Febuxostat, Probenecid, Pegloticase)1.04 (1.03, 1.05)NSAID Use 0.87 (0.86, 0.88)Steroid Use 1.15 (1.13, 1.16)Colchicine Use 1.08 (1.07, 1.09)Opioid Use 1.17 (1.16, 1.19)0.99 (0.98, 1.00)*All variables included in multivariable model are shown in the tableAbbreviations: VHA, Veterans Health Administration; ULT, urate lowering therapySept. 2021  |  Vol. 3  |  Issue 1 Oral Presentations 35*Names in bold type indicate presenting author.gene expression and low AR gene expression were 59.1% and 73.3% respectively (p < 0.0001). Gender did not appear to be associated with either AR gene expression or prognosis.Conclusions: AR gene overexpression is frequent in malignant gliomas and correlates with increased protein expression. Higher AR expression levels are associated with higher grade disease and histopathologic features predicting poorer prognosis. Furthermore, high gene expression in LGG is correlated with poor prognosis but not within GBM, indicating saturated expression/functions of AR gene and protein status to properly interpret future clinical trials using AR inhibitors.  The Effect and Utility of Emergency Medicine Residency OrientationNicholas Jobeun1, Chad Branecki1, Elizabeth Lyden2, Aaron Barksdale11University of Nebraska Medical Center, College of Medicine, Department of Emergency Medicine 2University of Nebraska Medical Center, College of Public HealthMentor: Chad BraneckiProgram: Emergency Medicine Type: Original ResearchBackground: Most matriculating emergency medicine (EM) postgraduate year-ones (PGY-1s) receive a form of orientation to acclimate them to residency. With varying medical school education and clinical experiences, the orientation month is used to provide equal preparation for all PGY-1s. Educational universal curriculum despite the longstanding history of residency orientation. The objectives of this study were to determine identify areas of improvement for future curriculum development.Methods:underwent their EM orientation month, which included lectures, self-study, procedure skills labs, and simulation. Pre- and post-orientation surveys were administered and assessed for perceived comfort with common EM skills, preferred instructional methods, and the effect orientation had on their medical knowledge. For quantitative analysis, a 100-question EM board style exam was given at the beginning and end of the month. Data were summarized with descriptive statistics. Analysis was done the Wilcoxon signed-rank test, and the Mann-Whitney test. A P-value < 0.05 was Results: The pre- and post-survey and exam completion was 100% (12 of 12 PGY-1s). orientation month. Pharmacology (91.7%) and EMR documentation (66.7%) were prior to residency. Skills labs (91.7%) the most effective instructional methods. 0.05) improvement in perceived comfort performing ultrasounds, sutures, splints, punctures (LP), intubations, donning of personal protective equipment (PPE), and interpretation of electrocardiograms (EKG) and computed tomography (CT).Conclusion: The use of a residency orientation for EM PGY-1s improved the perceived comfort for beginning residency. and simulation) were perceived as more effective in learning, compared to lecture-based instruction.  Patterns of Opiate Prescription Practices in Isolated Operative Ankle Fractures: Creating Guidelines1, Ryan E. Miller2, Zachary Bailey1, Erin Stockwell1, Emily A. Boes3, Colton Roessner4, Kaeli K. Samson5, Sara M. Putnam1,  Alexander Sawatzke1, Justin C. Siebler1, Matthew A. Mormino11University of Nebraska Medical Center, College of Medicine, Department of Orthopedic Surgery 2Optum Orthopedics, Covina, California 3University of Utah, Department of Orthopedic Surgery 4Ohio University, Wexner Medical Center, Department of Anesthesiology 5University of Nebraska Medical Center, College of Public Health, Department of BiostatisticsMentor: Justin SieblerProgram: Orthopedic SurgeryType: Original ResearchBackground: Opioid use is associated with to pain control exist. The purpose of this study was to quantify our opioid prescribing practices for isolated, operative ankle fractures and to formulate guidelines for safe and effective opioid stewardship.Methods: The baseline average quantity of opioids prescribed (as Morphine Milligram Equivalents) at discharge and in the 90 days after surgery for adults with operatively treated, isolated ankle fractures were determined and prescribing guidelines were implemented. Opioid use was correlated to patient demographics, comorbidities, fracture characteristics, and patient reported pain control in each group. Results: The baseline and test groups had 37 (24 female, 13 male) and 34 (21 female, 13 male) patients, respectively. There was no years), comorbidities, or open fractures (1 vs 3). The mean MME prescribed was 444.86 This 18.8% reduction was not statistically postoperative visits (2.64 vs 2.84 and 1.56 vs 1.81). There was no correlation between patient demographics, comorbidities, or fracture characteristics and MME prescribed or pain scores. Patients with higher pain prescribed (p = 0.02 and 0.03).Conclusion: Postoperative opioid use in isolated, operative ankle fractures in adult difference in patient reported pain control,  but the decrease was not statistically 

Patterns of Opiate Prescription Practices in Isolated Operative Ankle Fractures: Creating Guidelines

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Patterns of Opiate Prescription Practices in Isolated Operative Ankle Fractures: Creating Guidelines

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