10 research outputs found
Public drug use in eight U.S. cities: Health risks and other factors associated with place of drug use.
No full textBACKGROUND: Drug overdose is the leading cause of accidental death in the United States (U.S.). Previous studies have found that place of drug use is associated with risks including overdose, sharing of drug use equipment, and arrest, but the research on this subject in the U.S. is limited.
METHODS: Our study describes the relationship between place of drug use and health outcomes through the analysis of associations between frequent public drug use and drug-related arrest, overdose, and reuse of injection equipment. We analysed data from a cross-sectional, observational study of individuals who utilize syringe exchange services in 8 U.S. cities. Using regression analysis, we assessed associations between public drug use, demographic characteristics, and health risks.
RESULTS: Half (48%) of the respondents (N = 575) reported that at least one of their top two most frequent places of drug use is a public place. Street homelessness (AOR = 17.44), unstable housing (AOR = 3.43) and being under age 30 (AOR = 1.85) were independently associated with increased odds of frequent public drug use. Frequent public drug use was associated with increased odds of past-year arrest for drug-related offenses (AOR = 1.87).
CONCLUSION: Public drug use is associated with negative health and social outcomes. Increased access to harm reduction services, housing, and supervised consumption sites (SCS) interventions and a shift away from punitive approaches to drug use may reduce the some of the harms associated with public drug use
Examining readmissions following outpatient microlaryngeal surgery.
No full textOBJECTIVE: The objective of this study was to examine readmissions following microlaryngeal surgery. It was hypothesized that airway surgical procedures would have higher rates of readmission.
DESIGN: Retrospective review.
METHODS: Outpatient microlaryngeal surgeries from May 1, 2018 to November 27, 2022 were reviewed. Readmissions related to the original surgery within a 30-day postoperative period were examined. Patient demographics, body mass index, American Society of Anesthesiologist class, comorbidities, type of surgery, ventilation techniques, and operative times were examined and compared.
RESULTS: Out of 480 procedures analyzed, 19 (4.0%) resulted in a readmission, 9 (1.9%) of which were for glottic stenosis management. Undergoing an airway procedure was significantly associated with a readmission (
CONCLUSION: Readmissions from microlaryngeal surgery are seldom reported but nonetheless occur. Identifying factors that may place a procedure at risk for readmission can help improve surgical quality of care.
LEVEL OF EVIDENCE: 4
Evaluating the Association of Preconception Blood Pressure Control and Adverse Pregnancy Outcomes
No full textExploration of the acceptability of HPV self-sampling for cervical cancer screening in Black and Hispanic populations
No full textSingle-Center Experience with Tixagevimab/Cilgavimab Pre-Exposure Prophylaxis against SARS-CoV-2 Infection in Kidney and Pancreas Transplant Recipients
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Advancing the Field of Deimplementation: Perspectives on Low-Value Clinical Preventive Services
No full textIntroduction: Clinical preventive services, such as screening tests, vaccinations, and health behavior counseling provided in primary care settings, aim to prevent future disease, detect early disease, or mitigate the impact of unhealthy behaviors on future health. However, research advances have shown that some clinical preventive services do not confer benefit and may even cause harm for some populations. Experts have increasingly emphasized discontinuing low-value health services, a process known as deimplementation. This project gathered expert input on the state of deimplementation of low-value clinical preventive services. Methods: The author conducted (1) an environmental scan of current work on deimplementation, (2) key informant interviews (n=4 individuals), and (3) a facilitated discussion with a technical expert panel (n=12 members) and synthesized the findings. The author used an iterative, inductive approach to identify themes from the discussions with experts. Results: The environmental scan and technical experts identified no frameworks and few empiric studies specific to the deimplementation of low-value clinical preventive services. The experts advised that terminology surrounding deimplementation efforts and low-value health services be revised to better resonate with patients and families. Experts suggested refining existing health services deimplementation frameworks and recommended future research to test deimplementation strategies specific to low-value clinical preventive services. Experts also described unintended consequences of deimplementation that could increase health inequities. Finally, experts emphasized the importance of engaging patients and families in deimplementation efforts. Conclusions: These findings offer guidance for future work, including advancing methods; testing strategies specific to low-value clinical preventive services; and engaging patients, families, and communities in deimplementation efforts
Use of Methylene Blue to Treat Hypotension in Poisoned Patients in the Toxicology Investigators Consortium (ToxIC) Core Registry: 2016-2023.
No full textOutcomes of a residential program after successful graduation: A pilot quality improvement study
No full textTrends in alcohol withdrawal management by medical toxicologists in the acute care setting: an analysis of the Toxicology Investigators Consortium (ToxIC) Core Registry, 2016-2022.
No full textAIMS: Alcohol withdrawal syndrome (AWS) requires urgent treatment to prevent morbidity and mortality. In the acute care setting, medical toxicologists play a critical role in AWS management, including the use of gamma-aminobutyric acid agonists and adjunctive medications. We aim to introduce the addiction medicine community to this role by describing clinical presentation and treatment of patients with AWS in the Toxicology Investigators Consortium Core Registry.
METHODS: Medical toxicologists from participating sites enter demographic, exposure, clinical presentation, and treatment data on all patients they evaluate into the Core Registry. This was a secondary analysis of registry patients evaluated for AWS from 2016 to 2022. Data were coded in a spreadsheet and analyzed using descriptive statistics.
RESULTS: We included 1093 cases. Agitation and delirium/toxic psychosis were documented in 373 (34.1%) and 227 (20.8%) patients, respectively. Benzodiazepines were the most common gamma-aminobutyric acid agonist treatment (n = 539, 49.3%). There was an overall decrease in the use of benzodiazepines alone and increases in the use of phenobarbital, ketamine, and dexmedetomidine. Intubation was performed in 115 (10.5%) patients. Naltrexone, used for alcohol use disorder, was given in 88 (8.1%) cases. The absolute number of AWS cases increased during this period.
CONCLUSIONS: Use of benzodiazepines alone to manage AWS decreased while phenobarbital, ketamine, and dexmedetomidine use increased. Many patients had severe withdrawal manifestations, and some received alcohol use disorder treatment, suggesting that medical toxicologists see more severe cases in the acute care setting and have an opportunity to address the underlying use disorder
