Key Points Question What are the characteristics of patients with active cancer presenting to US emergency departments? Findings In this multicenter cohort study of 1075 adult patients with active cancer in the Comprehensive Oncologic Emergencies Research Network (CONCERN), patients commonly presented with symptoms such as pain (62.1%) and nausea (31.3%), were frequently treated for potential infection (26.5%), and were admitted (57.2%; 25.0% for <2 days) or placed in observation (7.6%). Meaning Opportunities for improving emergency department care for patients with cancer include establishing protocols and processes for prompt and appropriate symptom control, creating improved risk stratification tools, and improving outpatient management to prevent ED visits.

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Objective Opioid abuse and overdose constitute an ongoing health emergency. Many presume opioids have little potential for iatrogenic addiction when used as directed, particularly in short courses as is typical of the ED setting. We preliminarily explored the possibility that initial exposure to opioids by EDs could be related to subsequent opioid misuse. Methods This cross-sectional study surveyed a convenience sample of patients reporting heroin or non-medical opioid use at an urban, academic ED. We estimated the proportion whose initial exposure to opioids was a legitimate medical prescription and the proportion of those prescriptions that came from an ED. Secondary measurements included 1) the proportion using non-opioid substances before initial opioid exposure, 2) the source of opioids between initial exposure and onset of regular non-medical use, and 3) time from initial prescription to opioid use disorder. Results Of 59 subjects, 35 (59%; 95%CI: 47-71) reported they were first exposed to opioids by a legitimate medical prescription, and for 10/35 (29%; 95%CI: 16-45), the prescription came from an ED. Most medically exposed subjects (28/35, 80%; 95%CI: 65-91) reported non-opioid substance use or treatment for non-opioid substance use disorders preceding the initial opioid exposure. Emergency providers were a source of opioids between exposure and onset of regular non-medical use in 11/35 (31%, 95%CI: 18-48) cases. Thirty-one of the 35 medically exposed subjects reported the time of onset of non-medical use; median time from exposure to onset of non-medical use was: 6 months for use to get high (N=25; IQR 2-36), 12 months for regular use to get high (N=24, IQR: 2-36), 18 months for use to avoid withdrawal (N=26, IQR: 2-38), and 24 months for regular use to avoid withdrawal (N=27, IQR: 2-48). Eleven (36%, 95%CI: 21-53) began non-medical use within 2 months, and 9/11 (82%, 95%CI: 53-96) reported non-opioid substance use or treatment for alcohol abuse prior to initial opioid exposure. Conclusion Although short-term opioid administration by emergency providers is unlikely to cause addiction by itself, ED opioid prescriptions may contribute to the development of addiction in some patients. There is an urgent need for further research to estimate long-term risks of short-course opioid therapy, so that the risk of iatrogenic addiction can be appropriately balanced with the benefit of analgesia.

BackgroundAlthough thoracic vertebral malformations with kyphosis and scoliosis are often considered incidental findings on diagnostic imaging studies of screw-tailed brachycephalic breeds, they have been suggested to interfere with spinal biomechanics and intervertebral disc degeneration. It is however unknown if an abnormal spinal curvature also predisposes dogs to develop clinically relevant intervertebral disc herniations. The aim of this study was to evaluate if the occurrence of thoracic vertebral malformations, kyphosis or scoliosis would be associated with a higher prevalence of cervical or thoracolumbar intervertebral disc extrusion in French bulldogs.ResultsFrench bulldogs that underwent computed tomography for reasons unrelated to spinal disease (n = 101), and French bulldogs with thoracolumbar (n = 47) or cervical intervertebral disc extrusion (n = 30) that underwent magnetic resonance imaging were included. There was a significant association between the presence of kyphosis and the occurrence of intervertebral disc extrusion, particularly in the thoracolumbar region. Dogs with kyphosis were at nearly a two times increased odds of being affected by intervertebral disc extrusion than those without kyphosis [(OR = 1.98 (95% CI: 1.04–3.78)]. There was also an association between the presence of scoliosis and the anatomical distribution of intervertebral disc extrusions, with dogs with scoliosis more likely to have more caudal lumbar intervertebral disc extrusions. Presence of scoliosis was not associated with an increased odds of being affected by intervertebral disc extrusion.ConclusionsAlthough thoracic vertebral malformations with kyphosis only rarely cause spinal cord dysfunction in itself, French bulldogs with kyphosis appear to be at higher risk to develop thoracolumbar intervertebral disc extrusion.Electronic supplementary materialThe online version of this article (doi: 10.1186/s12917-017-1316-9) contains supplementary material, which is available to authorized users.