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The Impact of Legislation and Implementation of an Emergency Department Medications for Opioid Use Disorder program on Buprenorphine Administration
Full text linkThe emergency department (ED) plays a critical role in addressing a wide range of healthcare needs and can be the first point of contact for individuals with opioid use disorder (OUD). Buprenorphine, a partial opioid agonist, is a medication that helps treat OUD. On January 12, 2023, federal changes removed a major barrier, allowing all clinicians to prescribe buprenorphine. Later in 2023, a Medications for Opioid Use Disorder (MOUD) program was implemented in a high-volume free-standing ED. We aimed to review the impact of these changes on buprenorphine administration.
We conducted a retrospective chart review of buprenorphine administration and ICD codes from October 2021 to October 2024 in a high-volume ED. We included cases where buprenorphine was administered or an OUD-related ICD-10 code was present, and excluded cases where neither condition was met.
During the 3-year period, 225,000 unique ED encounters were queried. From October 2021 to October 2022, 2 patients received buprenorphine and 46 OUD-related ICD-10 codes were noted (0.043 admin/OUD code). From October 2022 to October 2023, 18 patients received buprenorphine and 43 OUD-related ICD-10 codes appeared (0.419 admin/OUD code). From October 2023 to October 2024, 36 patients received buprenorphine and 36 OUD-related ICD-10 codes appeared (1.000 admin/OUD code). The increase in buprenorphine administration from 2022 to 2023 and 2023 to 2024 was statistically significant (p\u3c0.001).
In conclusion, both legislative changes and the ED MOUD program significantly increased buprenorphine administration, improving OUD treatment in the community ED
The Effect of Abdominal Insufflation on Transversus Abdominis Plane (TAP) Block Efficacy in Laparoscopic Gynecologic Surgery
Full text linkIntroduction:
Approximately 15 million laparoscopic procedures are performed annually worldwide, with 4.8 million (32%) occurring in the United States. Laparoscopy is widely used for procedures such as bilateral tubal sterilizations, hysterectomies, and treatments for endometriosis and adhesions. During gynecologic laparoscopic surgeries, the abdomen is inflated with pressurized carbon dioxide for surgical visualization. Pain management typically involves a transversus abdominis plane (TAP) block, which provides intermediate postoperative pain relief (lasting 12–24 hours). This study evaluates the efficacy of TAP blocks performed during insufflation to improve postoperative pain outcomes compared to the traditional technique.
Methods:
This patient-blinded study included female gynecologic patients aged 18–85 undergoing laparoscopic procedures at Harper University Hospital or Detroit Receiving Hospital. Patients using opioid medications or those allergic to local anesthetics were excluded. Participants were randomized into two groups: (1) TAP blocks performed intraoperatively with an insufflated abdomen (Insufflated OR) and (2) TAP blocks performed postoperatively with a non-insufflated abdomen in the PACU (Non-Insufflated PACU). Statistical analyses included Student’s t-test and repeated measures ANOVA for continuous variables and Fisher’s Exact test for categorical data, with significance set at p ≤ 0.05.
Results:
Contrary to the hypothesis, TAP blocks in the OR were not quicker and easier to perform compared to those in the PACU. While the OR group demonstrated better early postoperative pain control, the PACU group was more effective for later pain management, as reflected by reduced opioid consumption. Both groups achieved high patient satisfaction, with scores exceeding 85%.
Discussion:
Both approaches provided effective postoperative pain relief and high patient satisfaction. However, no operator advantage was observed for TAP blocks performed in an insufflated abdomen in the OR. Anecdotal observations suggest that OR TAP blocks may benefit nervous patients by providing superior early pain control. Conversely, PACU TAP blocks were more effective for managing later pain, as evidenced by lower opioid use at 24 hours
Decline in Hepatocellular Carcinoma and Evolving Age at Diagnosis in a Primarily African American Medical Center Population
Full text linkIntroduction: Hepatocellular carcinoma (HCC) remains a significant global health burden, particularly among vulnerable populations. This study investigates trends in HCC incidence and age at diagnosis within an urban medical center population, focusing on the impact of hepatitis C virus (HCV) treatment and racial disparities.
Methods: A retrospective cohort analysis was conducted using a merged dataset of 484 patients diagnosed with HCC between 2000 and 2023. Demographic, clinical, and laboratory data were collected and analyzed to assess trends in HCC incidence, age at diagnosis, and associated risk factors.
Results: A significant decline in HCC incidence was observed with a peak in incidences between 2015 and 2017 (p\u3c0.02). The increase and subsequent decline was primarily driven by a shift in HCV-related cases, particularly among the African American (AA) population. This trend was not seen for patients with other risk factors for HCC. There was an increase in age of AA patients at the time of diagnosis (62 years early vs 69 years recent p= 0.001) but not non-AA patients (66 years early vs 67 years recent p=0.16). Possibilities to account for this include variations in an aging population, changing risk factor profiles, and/or limitations in surveillance and early detection of HCC.
Conclusion: This study highlights the critical role of HCV treatment in reducing HCC incidence, particularly within the AA population. These findings emphasize the need for sustained efforts in surveillance, early detection, and targeted prevention strategies to address the evolving epidemiology of HCC and improve outcomes across all populations
Narratives of COVID-19 in China and the US: An Introduction
No full textThis special issue examines diverse stories, struggles, resiliencies, and actions of individuals and communities in China and the US as they navigated the “twin pandemics” of COVID-19 and racisms. Responding to the absence of voices from scholars in China in many English-language publications about COVID-19, this issue brings together a rich tapestry of COVID-19 narratives that includes the perspectives of Chinese scholars and scholars in the pan-Asian community. Exploring diverse narratives of COVID-19 in China and the US, the authors engage in processes of knowledge production and social advocacy, recognizing the significance of narratives as research subjects, methodology, practices, and strategies
Politicized Pandemic Narratives: A Case Study of Hong Kong
No full textThe COVID-19 pandemic, superimposed upon the preceding pro-democracy movements in Hong Kong, has created a complex environment for grappling with questions surrounding the implementation and implications of the “one country, two systems” principle. Drawing upon twenty-seven in-depth interviews, this paper presents the blurred, contradictory, and intricate political narratives of Hong Kong citizens as they pertain to issues of self-identity, governance rights, and central-local relations. This research calls for a multidimensional understanding of the complexity and ambiguity inherent in the evolving social dynamics to rethink the paradoxical relationship between cooperation and confrontation among Hongkongers and their counterparts in mainland China
Executive Function Improvements Across a Mindfulness-Based Preschool Curriculum Intervention: Preschooler Performance and Teacher Perceptions of Performance
No full textResearch suggests that improving executive function (EF) skills using mindfulness-based interventions is promising, though few studies investigate mindfulness-based interventions for young children. The current study evaluated preliminary data examining EF over the course of a 12-week mindfulness-based curriculum implemented within preschool classrooms. Study 1 suggested that 4-year-olds’ performance on the Head-to-Toes EF task improved over the curriculum. However, behavior in the Gift Delay EF task appeared to decline from early intervention to post-intervention. In Study 2, the teachers’ retrospective reflections on performance suggested that they anticipated children would improve on EF across the intervention, potentially more on the Head-to-Toes task. The teachers suggested that children peeked earlier on the Gift Delay because of testing conditions (e.g., time of year, differences between measures) and learning experience (e.g., earlier peeking without consequence). This study demonstrated mixed results for mindfulness-based interventions related to EF performance in preschoolers and the need for future research incorporating several practical considerations for understanding how behavioral testing may inform classroom interventions
Fairy Tales Forever After: Expanding the Canon, Creative Disruption, and Unconscious Upcycling
No full textThis essay juxtaposes the self-conscious iconoclasm of writers like Angela Carter and Margaret Atwood with the unconscious upcycling of fairy tales in films like Alex Garland’s Ex Machina and Jordan Peele’s Get Out. In the vast recycling project that provides new ways of making meaning out of the old, there is no sense in turning proprietary and insisting on acknowledging source material drawn from collective cultural capital. Still, it is important to acknowledge that a storytelling craft once deployed by women for the sake of passing on wisdom in the service of survival continues to flourish and to find its way into a culture that also continues to dismiss fairy tales as entertainment for the young
TikTok Skincare Trends and Their Clinical Evidence
Full text linkBackground: TikTok is a popular social media platform with bite-sized videos. Many educational skincare videos are shared by healthcare professionals, with 13% being board-certified dermatologists.1 Only 2.5% of the most viewed skincare videos are created by board-certified dermatologists.1 The majority of videos are posted by non-experts sharing personal anecdotes or advertising products. This raises concern as around 40% of people use social media for information on dermatologic conditions.2 The misinformation shared by non-medical professionals can be potentially harmful. Recent TikTok skincare trends include slugging, skin cycling, glycolic acid as a deodorant, collagen supplementation, gua sha, and face tape. Given TikTok’s impact on health decisions, the information shared should be evaluated to ensure skincare decisions are based on evidence-based guidance.
Methods: The authors utilized a content analysis approach to review the top skincare trends on TikTok and their clinical evidence and effectiveness. We reviewed research papers that focused on the benefits and risks of the relevant skincare ingredients and techniques.
Results: The paper evaluates the effectiveness of skincare trends on TikTok including slugging, glycolic acid as deodorant, skin cycling, gua sha, collagen supplementation, and face tape. Many of these products focus on achieving hydrated, ageless skin. Glycolic acid aims at reducing axillary hyperpigmentation. While skin cycling and slugging can be beneficial, they are not ideal for every skin type. The evidence for oral collagen supplements as an individual ingredient is minimal. Gua sha and face tape are potentially harmful to the skin.
Conclusion: Skincare trends on TikTok can be either beneficial or potentially harmful to the skin. Since content creators who differ in expertise and profession share videos on TikTok, there is a potential for the spread of misinformation about the effects of each skincare trend. In addition, many of these skincare trends are not supported by scientific evidence and research. TikTok can be used as a platform to educate on skincare products, including proper use and adverse effects. By sharing reliable information, social media can play a role in combating misinformation and swaying the information readily available