Study Objectives: The United States is in the midst of an opioid epidemic. Of more than 42,000 opioid deaths in 2016, 40% were related to prescription medications. Emergency department (ED) visit prescriptions may provide the initial exposure for many patients who subsequently misuse or develop opioid use disorder (OUD). Physician prescribing patterns can vary extensively, however ED physicians are among the top 5 opioid prescribers in all medical specialties in almost all age groups. It is well documented that a larger quantity of tablets or prolonged prescription duration is associated with increased risk of chronic opioid use. Electronic health records (EHR) allow for implementation of active and passive interventions that may influence provider behavior, specifically the ability to set prescription preferences on the departmental level. We tested the hypothesis that decreasing the number of pills in our ED prescribing preference settings would decrease the duration of prescriptions and number of tablets for opioid medications prescribed by our providers.Methods: A pre-post study design was performed between 4/1/17 and 4/30/18 using all opioid prescriptions made through EPIC Corporation's 2015 ASAP EHR module in 2 EDs. Prior to the intervention, which occurred on 1/28/18, opioid prescriptions had the EHR default prescription settings, which varied in number of pills and durations. Using the CDC guidelines for opioid prescribing, all opioid entries were given defaults under 50 milligram morphine equivalents per day and supplies were only for 3-days. Opioid prescriptions, their dosages and total pills dispensed were abstracted using the institutional reporting software Qlik. Our outcome measures were rates of prescription attributes that were consistent with CDC guidelines. Chi-square and Mann Whitney test were used to determine statistical significance.Results: During the study period, there were 78,416 discharged patients, of whom 731 (0.093%) received opioid prescriptions. 503 (69%) of these prescriptions were for >3 days of therapy. Comparing the pre period to the post period there was a reduction in the median number of all opioid prescriptions per month (56 [IQR, 49.9-62.2] to 47 [IQR,[45][46][47][48][49], p ¼ 0.014). There was also a reduction in the proportion of prescriptions lasting >3 days (80% [95% CI, 76.5-83.1%] to 19.3% [95% CI, 13.2-27.1%], p<0.001), as well as a reduction in median number of pills dispensed (12 [IQR,[8][9][10][11][12][13][14][15][16] to 8 [IQR, 6-10], p<0.001).When isolating the 3 months pre and post intervention there was no difference in the median number of overall opioid prescriptions. However, there was a reduction in proportion of prescriptions lasting >3 days (70 .5% [95% CI, 62.6-77.4%] to 19.3% [95% CI, 13.2-27.1%], p<0.001), as well as the median number of pills dispensed (11 [IQR,.5] to 8 [IQR, 6-10] p<0.001).Conclusions: Modification of departmental EHR prescription preference settings can substantially alter prescribing patterns for opioid prescriptions in the ED. ...
A mutation in the gene encoding for the liver mitochondrial aldehyde dehydrogenase (ALDH2–2), present in some Asian populations, lowers or abolishes the activity of this enzyme and results in elevations in blood acetaldehyde upon ethanol consumption, a phenotype that greatly protects against alcohol abuse and alcoholism. We have determined whether the administration of antisense phosphorothioate oligonucleotides (ASOs) can mimic the low-activity ALDH2–2 Asian phenotype. Rat hepatoma cells incubated for 24 h with an antisense oligonucleotide (ASO-9) showed reductions in ALDH2 mRNA levels of 85% and ALDH2 (half-life of 22 h) activity of 55% equivalent to a >90% inhibition in ALDH2 synthesis. Glutamate dehydrogenase mRNA and activity remained unchanged. Base mismatches in the oligonucleotide rendered ASO-9 virtually inactive, confirming an antisense effect. Administration of ASO-9 (20 mg/kg/day for 4 d) to rats resulted in a 50% reduction in liver ALDH2 mRNA, a 40% inhibition in ALDH2 activity, and a fourfold (P < 0.001) increase in circulating plasma acetaldehyde levels after ethanol (1 g/kg) administration. Administration of ASO-9 to rats by osmotic pumps led to an aversion (−61%, P < 0.02) to ethanol. These studies provide a proof of principle that specific inhibition of gene expression can be used to mimic the protective effects afforded by the ALDH2–2 phenotype.
Background Telehealth has emerged as a crucial component of the SARS-CoV-2 pandemic emergency response. Simply stated, telehealth is a tool to provide health care from a distance. Jefferson Health has leveraged its acute care telehealth platform to screen, order testing, and manage patients with COVID-19–related concerns. Objective This study aims to describe the expansion and results of using a telehealth program to increase access to care while minimizing additional potential exposures during the early period of the COVID-19 pandemic. Methods Screening algorithms for patients with SARS-CoV-2–related complaints were created, and 150 new clinicians were trained within 72 hours to address increased patient demand. Simultaneously, Jefferson Health created mobile testing sites throughout eastern Pennsylvania and the southern New Jersey region. Visit volume, the number of SARS-CoV-2 tests ordered, and the number of positive tests were evaluated, and the volume was compared with preceding time periods. Results From March 8, 2020, to April 11, 2020, 4663 patients were screened using telehealth, representing a surge in visit volume. There were 1521 patients sent to mobile testing sites, and they received a telephone call from a centralized call center for results. Of the patients who were tested, nearly 20% (n=301) had a positive result. Conclusions Our model demonstrates how using telehealth for a referral to central testing sites can increase access to community-based care, decrease clinician exposure, and minimize the demand for personal protective equipment. The scaling of this innovation may allow health care systems to focus on preparing for and delivering hospital-based care needs.
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