Evaluation of Postoperative Pain Management Using an Opioid-Sparing Protocol in Pediatric Surgical Patients

Background Since the 1990s, the U.S. has faced increasing rates of opioid overuse, misuse, and overdose deaths. To combat the opioid epidemic, there have been national initiatives to limit prescribing of opioids. At our institution, we implemented an opioid-sparing protocol in pediatric surgical patients and sought to evaluate its impact on postoperative opioid prescribing patterns. Methods A retrospective chart review of the electronic medical record was performed for 9- to 18-year-old patients who underwent a laparoscopic appendectomy or cholecystectomy before and after the implementation of an opioid-sparing protocol. Data on postoperative opioids administered during the hospitalization and prescribed at discharge, postoperative pain control, use of non-opioid analgesics, and safety were collected. Results A total of 81 patient charts were analyzed. The median amount of opioids administered during hospitalization was 8 MMEs and 15 MMEs in the pre-implementation and post-implementation, respectively ( P = 0.310). The median amount of opioids prescribed at discharge was 150 MMEs and 60 MMEs in the pre-implementation and post-implementation, respectively ( P = 0.006). Patients reported mild pain scores throughout the hospitalization in both groups. Discussion Among young patients who underwent laparoscopic appendectomy or cholecystectomy, the administration of opioids during hospitalization for postoperative pain was minimal. The opioid sparing protocol did not reduce the amount of inpatient postoperative opioids administered but found a decrease in the amount of opioids prescribed at discharge. The study findings identified further areas of intervention and education to optimize postoperative opioid prescribing after these common pediatric surgical procedures.

Combined Impact of Prior SARS-CoV-2 Infection and Vaccination on Antibody Presence

As COVID-19 continues to spread rapidly and vaccine uptake stagnates, questions remain about the amount of SARS-CoV-2 antibodies present in the population induced by either SARS-CoV-2 infection, by a COVID-19 vaccine, or both.The TEXAS Coronavirus Antibody REsponse Survey (CARES) is a statewide seroprevalence program which utilizes the Roche S-test to detect antibodies to the SARS-CoV-2 spike protein and the Roche N-test to detect antibodies to the SARS-CoV-2 nucleocapsid protein, to monitor the combined impact of prior infection and the COVID-19 vaccine. The current sample size having both S- and N-test data and reported vaccination status is 8,846.Participants with prior infection (i.e. N+) and with either partial or full vaccination have the highest proportion of those showing the maximum value of the S-test (80.95% and 83.07%, respectively). Using a permutation test, there is no statistically significant difference between the median S-test value for those that have had prior infection and are partially vaccinated versus those that have had prior infection and are fully vaccinated. These groups both show significantly higher median amount compared to the other three groups: N+/not vaccinated, N-/partially vaccinated, and N-/fully vaccinated (all p-values < 0.0001).Unvaccinated individuals with prior infection have one of the lowest median S-test values. For participants with previous SARS-CoV-2 infection and a COVID-19 vaccine, the median S-test value is high and is not statistically different between those who are partially vaccinated and those who are fully vaccinated.

Association of Estimated Salt and Miso Intake with the Prevalence of Obesity in People with Type 2 Diabetes: A Cross-Sectional Study

Salt intake is often estimated by the amount of sodium excreted in urine, and miso has been reported to increase it. This cross-sectional study investigated the relationship between obesity and high estimated salt intake with and without habitual miso consumption. Estimates of salt intake (g/day) were calculated using urinary sodium excretion, and a high estimated intake was defined as greater than the median amount of 9.5 g/day. Participants were divided into four groups based on estimated salt intake and miso consumption. Among 300 people, the proportions of obesity were 77.8% (n = 14/18), 40.2% (n = 53/132), 26.0% (n = 33/127), and 34.8% (n = 8/23) in the (+/-), (+/+), (-/+), and (-/-) groups of high estimated salt intake/habitual miso consumption, respectively. Compared with the (+/-) group, the adjusted odds ratios for obesity were 0.07 (95% confidence interval (CI): 0.02–0.26, p < 0.001), 0.16 (95% CI: 0.03–0.76, p = 0.022), and 0.14 (95% CI: 0.04–0.51, p = 0.003) in the (-/+), (-/-), and (+/+) groups, respectively. The presence of obesity was not much higher in people with high estimated salt intake with habitual miso consumption than that in people without. Clinicians should be aware that miso consumption promotes salt excretion, which may lead to an apparently higher estimated salt intake than actual.

Determinants of Willingness to Pay for COVID-19 Vaccines among Residents of Osun State, South-West Nigeria

Background: COVID-19 pandemic has affected virtually all spheres of society. As countries await the COVID-19 vaccine, it is imperative to plan for its financing to ensure high vaccine coverage. This study aimed to determine the willingness to pay for COVID-19 vaccine among adult residents of Osun State.Methods: A cross-sectional analytical study design was employed. Seven hundred and forty-four respondents were enrolled from three selected Local Government Areas using multistage sampling method. An interviewer-administered questionnaire in electronic format (Kobo Collect) was used for data collection while the data was analysed using SPSS version 25. Determinants of willingness to pay for COVID-19 vaccine were assessed using binary logistic regression. A p-value of < 0.05 was considered statistically significant.Results: About one-quarter, 181 (24.3%) were willing to pay for COVID-19 vaccine. The median amount respondents were willing to pay was ₦650 (IQR= ₦1563) [$1.71 (IQR = $3.96)]. Being a healthcare worker (Odds ratio = 2.0, 95% CI =1.085–3.712, p=0.026), perception of susceptibility (Odds ratio = 1.9, 95%CI = 1.232-2.973, p=0.029) and self-efficacy (Odds ratio = 2.5, 95% CI = 1.571 – 4.071, p<0.001) were significant positive determinants of willingness to pay for COVID-19 vaccine. Misconceptions or perceived barriers were not significant determinants of willingness to pay for the vaccine.Conclusion: These findings indicate that there is a need for health promotion interventions to correct misconceptions about COVID-19. Government and private donor interventions may be required to subsidize the vaccine to ensure high vaccine coverage.

COVID-19 vaccination intent and willingness to pay in Bangladesh: a cross-sectional study

Aim: This article reports the intent to receive a COVID-19 vaccine, its predictors and willingness to pay in Bangladesh. Subject and Methods: We did a cross-sectional survey of 697 adults in January 2021. A structured questionnaire was used to assess vaccination intent. Questionnaire included potential socio-demographic variables and health belief model constructs which may predict vaccination intent.Results: Among the participants, 25.5% demonstrated a definite intent, 43% probable intent, 24% probable negative, and 7.5% a definite negative intention. Multivariable logistic regression analyses suggest association between definite intent and previous COVID-19 infection (OR: 2.86; 95% CI: 1.71 – 4.78), perceiving COVID-19 as serious (OR: 1.93; 1.04 – 3.59), the belief that vaccination would make them feel less worried about COVID-19 (OR: 4.42; 2.25 – 8.68), and concerns about vaccine affordability (OR: 1.51; 1.01 – 2.25). Individuals afraid of the side effects (OR: 0.34; 0.21 – 0.53) and would take the vaccine if the vaccine were taken by many in public (OR: 0.44; 0.29 – 0.67) are less likely to have a definite intent. A definite negative intent is associated with the concern that the vaccine may not be halal (OR: 2.03; 1.04 – 3.96). 68.4% are willing to pay for vaccine. The median amount they are willing to pay is $7.08. Conclusion: Adequate monitoring to stop the spreading of misinformation, and further research work to understand challenges in making a new vaccine acceptable by the population are needed.

Cessation of Deliberate Self-Harm Behavior in Patients With Borderline Personality Traits Treated With Outpatient Dialectical Behavior Therapy

The first aim of the study was to identify when deliberate self-harm (DSH) behavior ceased in patients with borderline symptoms undergoing dialectical behavioral treatment (DBT). The second aim was to compare patients who ceased their self-harm behavior early or late in the course of treatment, with regard to demographics, comorbidity, and symptom severity. The study used a naturalistic design and included 75 treatment completers at an outpatient DBT clinic. Of these 75 patients, 46 presented with self-harming behavior at pre-treatment. These 46 participants where split into two groups, based on median amount of time before ceasing self-harm behavior, termed early (up to 8 weeks) and late (8+ weeks) responders. Treatment duration varied from 16 to 160 weeks. Patients were assessed pre- and post-treatment using measures of depression, hopelessness, personality traits, quality of life, and global assessment of symptoms and functioning. The majority (93.5%) ceased their self-harming within the first year, and the average number of weeks was 15.5 (SD = 17.8). Twenty-five percent of patients ceased their DSH behavior during the first week of treatment. For the remaining patients, the cessation of DSH continued gradually across a 1 year period. We found no differences between early and late responders with respect to demographics, comorbidity, symptom severity, or treatment outcome. None of the patients committed suicide. The findings indicate that self-harming behavior decreases gradually across the first year after starting DBT.

A new type of addiction: Emergency service abuse

Objective: Patients repeatedly applying to the emergency department have become a common problem for many hospitals. With this study, the demographic characteristics of the patients who applied to an emergency department in 12 or more times in a year, the patients' hospitalization status, and the rate of using ambulance service were retrospectively examined. Material and Methods: This study is a retrospective, descriptive, cross-sectional research article. The study was conducted in the 1300-bed Sakarya Training and Research Hospital (SEAH) adult emergency room (ER), the largest hospital in Sakarya Province, the study period was 2019. Adult patients with 12 or more emergency department applications per year were selected for the study. Results: In the SEAH adult emergency department, 220.296 patients have examined a total of 382.413 times (1.74 per person) during 2019. The applying patients' to the SEAH adult emergency room 12 times or more in a year was 808 in 2019. These patients' emergency examinations' total quantity was 14369, presenting 3.76% of all emergency examinations, 625 (77.4%) were never hospitalized. Of these patients 420 (52%) were male; the median age was 47. The emergency department examinations estimate was 17.78 (±10.98) times averagely, the median amount was 15 times, and was between 12-192. Of them, 305 (37.7%) had also applied to the psychiatry outpatient clinic at least once. A weak but notable correlation was perceived between the number of outpatient clinic admissions and emergency service admissions (p = 0.001, r = 0.245). Conclusion: Frequent users visit the ER and other polyclinics regularly. Limitations should be required on these patients using emergency services in non-emergency situations. It is essential to pay specific attention to frequent emergency room users and investigate the motivations for proceeding to the emergency room

Inorganic Fiber Lung Burden in Subjects with Occupational and/or Anthropogenic Environmental Asbestos Exposure in Broni (Pavia, Northern Italy): An SEM-EDS Study on Autoptic Samples

Increased mortality due to malignant mesothelioma has been demonstrated by several epidemiologic studies in the area around Broni (a small town in Lombardy, northern Italy), where a factory producing asbestos cement was active between 1932 and 1993. Until now, the inorganic fiber burden in lungs has not been investigated in this population. The aim of this study is to assess the lung fiber burden in 72 individuals with previous occupational and/or anthropogenic environmental exposure to asbestos during the activity of an important asbestos cement factory. Inorganic fiber lung burden was assessed in autoptic samples taken from individuals deceased from asbestos-related diseases using a scanning electron microscope equipped with an energy-dispersive spectrometer. Significant differences in the detected amount of asbestos were pointed out among the three types of exposure. In most lung samples taken from patients who died of mesothelioma, very little asbestos (or, in some cases, no fibers) was found. Such subjects showed a significantly lower median amount of asbestos as compared to asbestosis. Almost no chrysotile was detected in the examined samples. Overall, crocidolite was the most represented asbestos, followed by amosite, tremolite/actinolite asbestos, and anthophyllite asbestos. There were significant differences in the amount of crocidolite and amosite fibers according to the kind of exposure. Overall, these findings provide novel insights into the link between asbestos exposure and mesothelioma, as well as the different impacts of the various types of asbestos on human health in relation to their different biopersistences in the lung microenvironment.

Cancer Impacts on Out-of-Pocket Expenses, Income Loss, and Informal (Unpaid) Care: A Cross-Sectional Study of Patient Perspective

A paper-based questionnaire was used to measure out-of-pocket expenses, income loss, and informal (unpaid) care from the cancer patient’s perspective. A total of 181 adult solid cancer patients on chemotherapy for at least 3 months were recruited from 1 teaching hospital in Riyadh, Saudi Arabia. The majority were female (66%) and 41% were 60 years of age or older. A total of 107 respondents used their own car for transport to and from the hospital to receive chemotherapy (median distance 42 km). Over the last 4 weeks, 21% purchased medications, 18% visited a physician, and 8% visited a physiotherapist, spending a median amount of $47, $220, and $793, respectively. A total of 47 participants were employed at the time of their cancer diagnoses, and 32% of them reported some loss of income. A total of 85% of respondents were escorted by a carer during chemotherapy sessions. Approximately 64%, 31%, 61%, 43%, and 28% reported getting help from a carer for housework, child care, shopping, medicine taking, and personal care, respectively. The carer spent on average 50 h per week looking after the patient.

Evaluation of new motorized articulating laparoscopic instruments by laparoscopic novices using a standardized laparoscopic skills curriculum

Background Motorized articulating laparoscopic instruments (ALI) offer more degrees of freedom than conventional laparoscopic instruments (CLI). However, a difficult learning curve and complex instrument handling are still a problem of ALI. We compared the performance of new prototypes of motorized ALI with CLI in a series of standardized laparoscopic tasks performed by laparoscopic novices. Further, usability of the new ALI was assessed. Methods A randomized cross-over study with 50 laparoscopic novices who either started with CLI and then changed to ALI (CA) or vice versa (AC) was conducted. All participants performed the European training in basic laparoscopic urological skills (E-BLUS) with each instrument in given order. Time and errors were measured for each exercise. Instrument usability was assessed. Results Overall, using CLI was significantly faster (CLI 4:27 min vs. ALI 4:50 min; p-value 0.005) and associated with fewer exercise failures in needle guidance (CLI 0 vs. ALI 12; p-value 0.0005) than ALI. Median amount of errors was similar for both instruments. Instrument sequence did not matter, as CA and AC showed comparable completion times. Regarding the learning effect, participants were significantly faster in the second attempt of exercises than in the first. In the needle guidance task, participants using CLI last demonstrated a significant speed improvement, whereas ALI were significantly slower in the second run. Regarding usability, CLI were preferred over ALI due to lighter weight and easier handling. Nevertheless, participants valued ALI’s additional degrees of freedom. Conclusion Using new motorized ALI in the E-BLUS examination by laparoscopic novices led to a worse performance compared to CLI. An explanation could be that participants felt overwhelmed by ALI and that ALI have an own distinct learning curve. As participants valued ALI’s additional degrees of freedom, however, a future application of ALI could be for training purposes, ideally in combination with CLI.