Tag: Patient Safety

HIV patients can safely undergo hip replacement, study finds

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Newswise — DALLAS – July 26, 2023 – Hip replacement surgery is safe for patients living with human immunodeficiency virus (HIV), researchers at UT Southwestern Medical Center found.

Total hip arthroplasty (THA) is a common procedure performed primarily on older patients suffering from osteoarthritis or osteonecrosis, painful conditions that severely limit mobility and lifestyle choices. But some surgeons have been hesitant to perform THAs on patients with HIV or AIDS due to concerns about complications, including higher risk of infection, need for revision surgery, and increased length of hospital stay.

“Patients living with HIV are at a higher risk for orthopedic-related diseases such as osteoarthritis or osteonecrosis of the hip due to changes in their bone metabolism and effects from their medication regimen,” said Senthil Sambandam, M.D., Assistant Professor of Orthopaedic Surgery, who led the study. “With improvements in HIV treatment leading to increased life expectancies, we are seeing a rise in the need for THA procedures in this patient population. Our study demonstrates that HIV-positive patients can safely undergo THA without concern for increased risk of complications and adds to the growing amount of literature that encourages surgeons to deliver appropriate medical care to a marginalized patient population.”

Using data from the National Inpatient Sample covering 2016-2019, UTSW researchers identified 504 HIV-positive patients who underwent THAs and compared their postoperative complications to a cohort of 493 HIV-negative patients. Their findings, published in the Journal of Clinical Orthopaedics and Trauma, showed that postoperative complications such as pneumonia, periprosthetic infection, wound dehiscence (reopening), and superficial and deep surgical site infection were not significantly different between the HIV-positive and HIV-negative groups. Blood transfusion rates also were lower among the HIV-positive patients.

The study was part of a larger effort by the Department of Orthopaedic Surgery to analyze arthroplasty complications in various subpopulations in support of UTSW’s commitment to the care of marginalized patient populations and equal treatment for every patient.

“These are important findings because they can help alleviate worries among the medical community about treating a group of patients who are often overlooked,” Dr. Sambandam said. “It’s an important quality-of-life issue for many HIV-positive patients.”

Other UTSW researchers who contributed to this study are Varatharaj Mounasamy, M.D., Professor of Orthopaedic Surgery; Ashish R. Chowdary, B.S., medical student; and Jack Beale, M.D., and Jack Martinez, M.D., residents in Orthopaedic Surgery.

About UT Southwestern Medical Center
UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty has received six Nobel Prizes, and includes 26 members of the National Academy of Sciences, 19 members of the National Academy of Medicine, and 14 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 2,900 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 100,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 4 million outpatient visits a year.

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July 26, 2023
Keck Hospital of USC receives highest rating on national quality report
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Newswise — LOS ANGELES, CA — Keck Hospital of USC earned five stars, the highest rating possible, on the Centers for Medicare & Medicaid Services (CMS) 2023 quality star rating report.

Only approximately 16% of hospitals across the country, 483 out of 3,076, received five stars out of a one-to-five-star rating system.

“This prestigious designation demonstrates our continuing commitment to patient safety and to best patient outcomes, and is the result of the hard work of every physician, nurse and staff member at the hospital,” said Stephanie Hall, MD, MHA, chief medical officer of Keck Hospital and USC Norris Cancer Hospital.

A hospital’s star rating is based on how well it performs across five different areas of quality measures:
- Readmission — returns to the hospital following a hospitalization.
- Mortality — death rates of patients in the 30 days following a hospitalization.
- Safety of care — potentially preventable injury and complications due to care provided during a hospitalization.
- Timely and effective care.
- Patient experience — such as how effectively physicians and nurses communicate to the patient and if a patient would recommend the hospital to others.
“A five-star rating means that Keck Hospital outperforms the national average in readmission, mortality and complication rates as well as timely and effective care, which is a tremendous validation of our commitment to quality care,” said Marty Sargeant, MBA, CEO of Keck Hospital and USC Norris Cancer Hospital. “We’re also proud to have received five stars in the patient experience category, which reflects that more than 90% of our patients are likely to recommend our hospital to others.”

This quality designation is one of many recent national safety and quality recognitions the hospital has received, including earning a five-star ranking for excellence by Vizient, Inc., a leading health care performance improvement company. Keck Medicine of USC also recently underscored its commitment to safety by hiring a health system chief quality officer.

The CMS rating system was launched in 2016 to help patients and caregivers make informed decisions when selecting a hospital. Hospitals report quality data to the CMS through multiple reporting programs, and the data is then reviewed and standardized to calculate hospital star rankings.

For detailed information on how Keck Hospital scored on quality measures, please click here.

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For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.
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July 25, 2023
Oregon Patients Access to Quality Anesthesia Care Protected with Signing of HB 3425

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Newswise — ROSEMONT, Ill. The state of Oregon took a significant step towards streamlining anesthesia care for patients with the signing of House Bill 3425 by Governor Tina Kotek on July 18. This landmark legislation repeals redundant provisions and provides clear guidelines for Certified Registered Nurse Anesthetists (CRNAs) practicing in the state.

The bill reaffirms the Oregon State Board of Nursing’s authority to establish rules regarding CRNA scope of practice, ensuring safe and effective anesthesia care for patients.

“State nursing boards are uniquely qualified to oversee the practice of nursing,” Oregon Association of Nurse Anesthetists (ORANA) President Andrea Hargis, DNP, CRNA said. “Nursing boards understand the nurse-patient relationship and honor the expert care provided by nurses. We thank Gov. Kotek for preserving this important relationship.”

Oregon opted-out of federal physician supervision requirements for CRNAs in 2003, recognizing their expertise and capabilities. As of 2023, 24 states plus Guam have taken this action in acknowledgment of CRNAs as highly skilled healthcare professionals capable of providing safe and quality care independently.

CRNAs provide all aspects of superior anesthesia throughout Oregon. Nationally, CRNAs safely administer more than 50 million anesthetics to patients each year working in every setting in which anesthesia is delivered. CRNAs are the primary providers of anesthesia care in rural settings, enabling facilities in these medically underserved areas to offer obstetrical, surgical, pain management, and trauma stabilization services. CRNAs have full practice authority in the Army, Navy, and Air Force and are the predominant provider of anesthesia on forward surgical teams and in combat support hospitals.

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July 21, 2023
Maryland Patient Safety Center Awards B.I.R.T.H. Equity Maryland Designation to Mercy

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Newswise — (Elkridge, MD—June 2023) — The Maryland Patient Safety Center (MPSC) has awarded Mercy Medical Center in Baltimore, MD, with the B.I.R.T.H. Equity Maryland designation, signifying completion of the B.I.R.T.H. Equity Maryland: Breaking Inequality Reimagining Transformative Healthcare program. This state-wide improvement project was designed by MPSC in partnership with the Maryland Hospital Association (MHA), along with an advisory group of local experts in the fields of maternal health, emergency medicine, family practice, community health, and health equity, with the intent to engage non-obstetric providers on the critical need for knowledge of pregnancy-related complications and awareness of disparities in negative maternal outcomes.

According to the Centers for Disease Control (CDC), non-Hispanic Black women are three to four times more likely to die from pregnancy related complications as compared with non-Hispanic White women even when adjusting for sociodemographic and reproductive factors. Systemic racism, bias, and discrimination are key drivers of these disparities in outcomes.

Recent data from the CDC (2022) has shown that 80% of pregnancy related deaths are preventable, of which 53% occur in the postpartum period. Pregnant and postpartum are often seen in primary care offices, clinics, emergency departments, or other community health settings where their obstetric history and early symptoms may be underappreciated. Engaging non-obstetric providers to recognize and address early warning signs and identify and mitigate their biases will amplify the current implicit bias trainings and expansion of perinatal and post-partum resources across the state of Maryland.

“We applaud Mercy for completing the B.I.R.T.H. Equity Maryland training and taking the necessary steps to empower the patient voice at all levels of care,” said Dr. Blair Eig, President and CEO of the Maryland Patient Safety Center. “Aiding non-obstetric providers in identifying pregnancy-related complications that may otherwise go undetected will positively impact so many families in their community”.

“Mercy is committed to improving birth equity. This designation is indicative of our ongoing efforts to ensure equitable access to healthcare for all families in our community, and reaffirms Mercy’s dedication to eliminating disparities in maternal and infant health outcomes,” said Robert O. Atlas, M.D., Chair of Obstetrics and Gynecology at Mercy and a key leader within Mercy’s Family Childbirth and Children’s Center.

To earn the B.I.R.T.H. Equity Maryland designation, at least 80% of the Mercy team completed learning around warning signs of obstetric complications, leveraging teamwork and communication strategies, identifying and mitigating biases through training and reflection, and worked to create systems to support safe care for birthing people.

“We are thrilled to be leading this important initiative to increase awareness of disparities in maternal outcomes and the impact of racism and bias on maternal health. Our aim is to support the creation of systems of safer care” said Dr. Adriane Burgess, Director of Perinatal and Neonatal Quality and Patient Safety at MPSC. “The United States has the highest rate of maternal mortality of all industrialized countries we know it will take innovative approaches and a collective determination across the entire health care continuum to reverse this trend. Thank you to Mercy for their commitment to moving Maryland forward and keeping patients safe.”

Founded in 1874 in downtown Baltimore City by the Sisters of Mercy, Mercy Medical Center is now home to The Family Childbirth & Children’s Center, a family-centered facility for expectant mothers, newborn babies, pediatric patients, families and visitors, located within Mercy’s award-winning Mary Catherine Bunting Center. Mercy Medical Center provides a team of obstetricians and certified nurse midwives as well as helpful amenities, programs and education for mothers, fathers and families as they prepare for pregnancy, birth and the transition to parenthood.

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July 19, 2023
Hospital Infection Control Experts Question Validity of Public Reporting Metrics, New Study Finds

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Newswise — Infections spread in hospitals and other healthcare settings cause over 680,000 infections and 72,000 patient deaths in the U.S. every year. Surveillance and reporting of these infections to government entities has become a key part of hospital infection control programs, yet infection control experts question the effectiveness of these measures at protecting public health. That is the finding of a new survey led by researchers at the University of Maryland School of Medicine. Results were recently published in the journal JAMA Network Open.

The UMSOM researchers analyzed results from survey respondents from 43 U.S. hospitals that are part of the Healthcare Epidemiology Research Network, a consortium focusing on research in infection control and antibiotic misuse. The respondents reported that many metrics, such as surgical site infections and antibiotic-resistant (MRSA) bloodstream infections, were important measures of infection control that should be reported to the federal government. The vast majority of respondents, however, said that two metrics — related to sepsis management and ventilator-associated infections — were not useful measures of infection control efforts.

“These infection control metrics are intended to reflect the quality of care at each institution, but some of the metrics don’t take into account the complex care provided by academic institutions as compared to community hospitals,” said study lead author Gregory Schrank, MD, Assistant Professor of Medicine at UMSOM. “Some have infections that can’t be prevented, while other metrics we are required to report aren’t indicative of an infection and don’t lead to an improvement in the quality of care that patients receive. Our survey found that tracking these metrics can detract from other important infection prevention work.”

Even more surprising, 84 percent of respondents said they believed hospitals and staff “intentionally manipulate” hospital-associated infection rates publicly reported on the government’s Centers for Medicare & Medicaid Services (CMS) Hospital Care Compare website. The federal government sets reimbursement rates for Medicare and Medicaid patients based on these metrics. The data are also used in hospital rankings published by US News & World Report and others. Survey respondents stated that they feel pressure to find ways to avoid reporting cases.

“We found that survey respondents did not believe the metrics reported on these websites were well understood by the public,” said study co-author Daniel Morgan, MD, Professor of Epidemiology & Public Health at UMSOM. “They also did not think reimbursements should be tied to these metrics, given all the caveats to collecting and reporting them.”

While the study researchers pointed out that reporting of hospital-acquired infections has led broadly to an improvement in care, they concluded that the survey highlighted the need for adjustments to these metrics to create less of an incentive for hospitals to game the system.

“While requirements to collect and report hospital metrics were implemented with the best of intentions, improvements clearly can be made to the system,” said UMSOM Dean, Mark T. Gladwin, MD, who is also Vice President for Medical Affairs, University of Maryland, Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor. “For example, there is a need for a more robust use of risk adjustment tools in these models to create national benchmarks for hospitals that treat the most complicated cases and sickest patients.”

Other co-authors on this study who were UMSOM Epidemiology & Public Health faculty members include Surbhi Leekha, MBBS, Jonathan Baghdadi, MD, Lisa Pineles MA, and Anthony Harris, MD. A researcher from VA Boston Healthcare System and Harvard Medical School was also a study co-author.

About the University of Maryland School of Medicine

Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world — with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.3 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic, and clinically based care for nearly 2 million patients each year. The School of Medicine has nearly $600 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The combined School of Medicine and Medical System (“University of Maryland Medicine”) has an annual budget of over $6 billion and an economic impact of nearly $20 billion on the state and local community. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2021, the UM School of Medicine is ranked #9 among the 92 public medical schools in the U.S., and in the top 15 percent (#27) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu

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June 6, 2023
Access To Quality Anesthesia Care Increased for Indiana Dental Patients

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Newswise — Rosemont, Ill. (AANA) – Indiana dental patients now have increased access to safe anesthesia care with the enacting of Indiana Senate Bill 273. The American Association of Nurse Anesthesiology (AANA) applauds the new law, as it expands the scope of practice for Certified Registered Nurse Anesthetists (CRNAs), allowing CRNAs to administer moderate sedation, deep sedation, or general anesthesia to a patient in a dental office, under the direction of and in the immediate presence of a physician.

Megan Engelman, DNP, CRNA, president of the Indiana Association of Nurse Anesthetists, applauded the legislation citing, “It is an important step in advancing patient safety and providing skilled anesthesia care throughout the state.”

“As an increasing number of patients of all ages and health comorbidities seek sedation and anesthesia for dental procedures in office-based settings, patient safety is the top priority in the delivery of these services,” said Engelman.

Sedation for any dental procedure increases the complexity of care and emphasizes the importance of having sedation and anesthesia provided by an anesthesia professional, such as a CRNA, who is focused only on patient safety, monitoring, and vigilance. “Each patient has a unique response to medications utilized for sedation and anesthesia. As anesthesia experts, CRNAs are available to continuously monitor the patient, and can focus on changes in the patient’s condition and intervene as necessary in emergent situations,” said Engelman. “Even for what would be considered routine dental care like cavity fillings, a discussion of the anesthesia delivery plan is important to address any concerns and help the patient and the patient’s caregivers move forward to treat the dental health issues.”

CRNAs are highly educated, trained, and qualified anesthesia experts. They provide 50 million anesthetics per year in the United States, working in every setting in which anesthesia is delivered. CRNAs are skilled to provide safe, high-quality, and cost-effective care as members of patient-centered dental care teams in all settings, including dental offices, in accordance with state law.

As trained anesthesiology professionals, CRNAs have the education and experience to react quickly to emergency situations in dental care settings, possess the expertise to administer the anesthesia and focus solely on the patient’s condition, and intervene as necessary if critical events occur during the procedure.

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May 26, 2023
Biomarkers may help ID treatment of acute kidney injury

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Newswise — Hospital inpatients who develop an acute kidney injury (AKI) generally fare poorly after being discharged, and have few options for effective treatment.

A UW Medicine-led study published recently in American Journal of Kidney Diseases suggests that new tests might improve this narrative.

In the study, “about 30% of the patients that came into the hospital developed AKI, which means in a matter of hours or days, their kidneys might be failing because of reaction to drugs or contracting sepsis,” said lead author Dr. Pavan Bhatraju, an assistant professor of pulmonary and critical care medicine at the University of Washington School of Medicine.

Causes of AKI vary. For instance, sepsis, medication and inadequate blood supply in someone who is undergoing cardiac bypass are all potential causes of kidney injury. It’s also the case that, within the kidneys, different cell types can be injured in the process of AKI, said Dr. Jonathan Himmelfarb, a professor of nephrology at the UW School of Medicine and the study’s senior author.

“The way that we diagnose acute kidney injury today relies on a simple blood test of kidney function or a change in urine output,” Himmelfarb said. “These relatively crude diagnostic tools don’t detect the specific cause of injury or predict which individuals will be more likely to respond to a treatment or recover kidney function.”

Unfortunately, effective medical therapies do not exist for this population of patients, Bhatraju said. In their paper, the investigators proposed a way to classify subpopulations of AKI patients with the aim of identifying therapies specific patient populations.

In much the same way that distinct biomarkers inform treatments of subgroups of patients with cancer or asthma, so, too, could blood- and urine-based biomarkers help identify subgroups of patients with AKI, leading to new ideas for treatments, the authors said.

In the study, the researchers retrospectively analyzed 769 patients with AKI and 769 without the condition, and followed them for five years after hospital discharge. The researchers found two molecularly distinct AKI subgroups, or sub-phenotypes, that were associated with differing risk profiles and long-term outcomes.

Patients in one group had higher rates of congestive heart failure, while another group had higher rates of chronic kidney disease and sepsis, Bhatraju said. The patients in the second group also had a 40% higher risk for major adverse kidney events five years later, compared with the first group, he said.

Interestingly, Bhatraju added, age, sex, diabetes rate or major surgical procedure as the cause of AKI was not different across AKI subgroups. This finding suggests that commonly measured clinical factors may not predict the AKI subgroups, and that identification requires measurement of blood and urine biomarkers, he said.

“We’re attempting to better understand the clinical factors and molecular drivers of acute kidney injury so that, in the long run, we can better treat the different ways that people experience this disease process,” Himmelfarb added. “We want to better understand the individual characteristics of people who get acute kidney injury so we can establish common characteristics of subgroup populations of these patients to know whose risk is relatively higher or lower, and work toward treatments specific to their needs.

“Our paper is one step on the path to tailoring clinical trials of new therapies to the people who are most likely to respond to those therapies,” Himmelfarb said.

This study was supported by the supplemental American Recovery and Reinvestment Act funds through the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health (grants U01DK082223, U01DK082185, U01DK082192, U01DK082183, U01DK084012 and R01DK098233) and by the NIH (K23DK116967, R01DK133177, U2CDK114886, UG3TR002158, and U01DK099923).

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May 23, 2023
Hackensack Meridian Health Recognized for Excellence with ACC Chest Pain Center Accreditations

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Newswise — The American College of Cardiology has recognized all eligible Hackensack Meridian medical centers for their demonstrated expertise and commitment in treating patients with chest pain. They were recently awarded Chest Pain Center Accreditations based on rigorous onsite evaluation of the staffs’ ability to evaluate, diagnose and treat patients who may be experiencing a heart attack.

According to the Centers for Disease Control and Prevention, more than 730,000 Americans suffer a heart attack each year. The most common symptom of a heart attack for both men and women is chest pain or discomfort. However, women are more likely to have atypical symptoms. Other heart attack symptoms include, but are not limited to, tingling or discomfort in one or both arms, back, shoulder, neck or jaw, shortness of breath, cold sweat, unusual tiredness, heartburn-like feeling, nausea or vomiting, sudden dizziness and fainting.

Percutaneous coronary intervention (PCI) is also known as coronary angioplasty. It is a non-surgical procedure that opens narrowed or blocked coronary arteries with a balloon to relieve symptoms of heart disease or reduce heart damage during or after a heart attack.

Jersey Shore University Medical Center in Neptune, NJ and JFK University Medical Center in Edison, NJ, earned ACC Chest Pain Center with Primary PCI and Resuscitation Accreditation.

Hospitals that have received this accreditation have proven exceptional competency in treating patients with heart attack symptoms and have primary PCI available 24/7 every day of the year. As required to meet the criteria of the accreditation designation, they comply with standard Chest Pain Center protocols and are equipped with a robust hypothermia program for post-cardiac arrest treatment. These facilities also maintain a “No Diversion Policy” for out-of-hospital cardiac arrest patients.

Hackensack University Medical Center in Hackensack, NJ; Riverview Medical Center in Red Bank, NJ; Ocean University Medical Center in Brick, NJ; Bayshore Medical Center in Holmdel, NJ and Raritan Bay Medical Center in Perth Amboy, NJ, earned ACC Chest Pain Center with Primary PCI Accreditation. Hospitals that have received this accreditation have proven exceptional competency in treating patients with heart attack symptoms and have primary PCI available 24/7 every day of the year. As required to meet the criteria of the accreditation designation, they have streamlined their systems from admission to evaluation to diagnosis and treatment all the way through to appropriate post-discharge care and recommendations and assistance in patient lifestyle changes. In addition, they have formal agreements with other facilities that regularly refer heart attack patients to their facility for primary PCI.

Southern Ocean Medical Center in Manahawkin, NJ, earned ACC Chest Pain Center Accreditation. Hospitals with this accreditation have proven exceptional competency in treating patients with heart attack symptoms. They have streamlined their systems from admission to evaluation to diagnosis and treatment all the way through to appropriate post-discharge care and recommendations and assistance in patient lifestyle changes.

“Hackensack Meridian Health has demonstrated its commitment to providing New Jersey with excellent heart care,” said Deepak L. Bhatt, MD, MPH, FACC, chair of the ACC Accreditation Management Board. “ACC Accreditation Services is proud to award Hackensack Meridian medical centers with Chest Pain Center Accreditations.”

Hospitals receiving Chest Pain Center Accreditations from the ACC must take part in a multi-faceted clinical process that involves: completing a gap analysis; examining variances of care, developing an action plan; a rigorous onsite review; and monitoring for sustained success. Improved methods and strategies of caring for patients include streamlining processes, implementing guidelines and standards, and adopting best practices in the care of patients experiencing the signs and symptoms of a heart attack. Facilities that achieve accreditation meet or exceed an array of stringent criteria and have organized a team of doctors, nurses, clinicians, and other administrative staff that earnestly support the efforts leading to better patient education and improved patient outcomes.

“Depending on a variety of factors, patients experiencing a heart attack are treated with clot-dissolving drugs (thrombolysis), balloon angioplasty (PCI) and stenting, surgery or a combination of treatments,” said Elizabeth A. Maiorana, MBA, MSN, R.N., vice president, Cardiovascular Care Transformation Services, Hackensack Meridian Health. “I’m proud of our medical centers’ cardiac teams for achieving excellence in providing these treatments, done accordingly with their licensure.”

For information about Hackensack Meridian’s heart care services, visit

www.hackensackmeridianhealth.org/en/services/heart-care. For a free physician referral, call 844-HMH-WELL.

The ACC offers U.S. and international hospitals like Hackensack Meridian’s access to a comprehensive suite of cardiac accreditation services designed to optimize patient outcomes and improve hospital financial performance. These services are focused on all aspects of cardiac care, including emergency treatment of heart attacks.

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May 19, 2023
Immigration experts on Title 42, analysis of immigration policies, and other migrant news in the Immigration Channel

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Title 42, the United States pandemic rule that had been used to immediately deport hundreds of thousands of migrants who crossed the border illegally over the last three years, has expired. Those migrants will have the opportunity to apply for asylum. President Biden’s new rules to replace Title 42 are facing legal challenges. The US Homeland Security Department announced a rule to make it extremely difficult for anyone who travels through another country, like Mexico, to qualify for asylum. Border crossings have already risen sharply, as many migrants attempted to cross before the measure expired on Thursday night. Some have said they worry about tighter controls and uncertainty ahead. Immigration is once again a major focus of the media as we examine the humanitarian, political, and public health issues migrants must face.

Below are some of the latest headlines in the Immigration channel on Newswise.

Expert Commentary

Experts Available on Ending of Title 42

George Washington University Experts on End of Title 42

‘No one wins when immigrants cannot readily access healthcare’

URI professor discusses worsening child labor in the United States

Biden ‘between a rock and a hard place’ on immigration

University of Notre Dame Expert Available to Comment on House Bill Regarding Immigration Legislation, Border Safety and Security Act

American University Experts Available to Discuss President Biden’s Visit to U.S.-Mexico Border

Title 42 termination ‘overdue’, not ‘effective’ to manage migration

Research and Features

Study: Survey Methodology Should Be Calibrated to Account for Negative Attitudes About Immigrants and Asylum-Seekers

A study analyses racial discrimination in job recruitment in Europe

DACA has not had a negative impact on the U.S. job market

ASBMB cautions against drastic immigration fee increases

Study compares NGO communication around migration

Collaboration, support structures needed to address ‘polycrisis’ in the Americas

TTUHSC El Paso Faculty Teach Students While Caring for Migrants

Immigrants Report Declining Alcohol Use during First Two Years after Arriving in U.S.

How asylum seeker credibility is assessed by authorities

Speeding up and simplifying immigration claims urgently needed to help with dire situation for migrants experiencing homelessness

Training Individuals to Work in their Communities to Reduce Health Disparities

‘Regulation by reputation’: Rating program can help combat migrant abuse in the Gulf

Migration of academics: Economic development does not necessarily lead to brain drain

How has the COVID-19 pandemic affected immigration?

Immigrants with Darker Skin Tones Perceive More Discrimination

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May 12, 2023
Accelerated delivery of transcranial magnetic stimulation is safe and effective

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Newswise — May 12, 2023 — Accelerated schedules for repetitive transcranial magnetic stimulation (rTMS) can be offered to patients experiencing treatment-resistant major depressive disorder (MDD), a group of clinician–researchers and neuroscientists have concluded. The group cautions that such treatment should be proposed only after detailed discussion with patients about acceleration being an alternate form of rTMS scheduling, with documentation of informed consent.

The recommendations are published in a special issue of Harvard Review of Psychiatry (HRP), “Interventional Neuropsychiatry and Neuromodulation: An Emerging Subspecialty in Brain Medicine.” HRP is published in the Lippincott portfolio by Wolters Kluwer.

Repetitive TMS is a noninvasive therapy in which an electromagnet delivers repeated low-intensity pulses to stimulate the brain. It has been proven safe and effective in numerous clinical trials involving patients whose MDD does not respond to antidepressant medication. Conventionally, rTMS is given once daily 20 to 30 days over four to six weeks. That places great time demands on both patients and clinicians.

Theta burst stimulation treats MDD

The next step in development of rTMS is accelerated schedules in which patients undergo two or more sessions per day, each approximately 30 minutes long, separated by one hour or more. Although this change was just as effective in treating depression as once-daily rTMS, it created a different kind of impracticality and clinical inefficiency, according to Leo Chen, MBBS, MPsych, PhD, FRANZCP, of Monash University/Alfred Health in Melbourne, Australia, and colleagues. “These schedules required patients to attend treatment settings for long periods on each treatment day, limiting patient capacity at treatment clinics,” they note.

The time burden can be alleviated, at least in part, with a novel approach called theta-burst stimulation (TBS). The most commonly used conventional rTMS protocol delivers electromagnetic pulses at a frequency of 10 Hz, whereas TBS refers to three pulses applied at 50 Hz (gamma frequency), repeated at 5 Hz (theta frequency) intervals. Two or more TBS sessions can be delivered within an hour.

Dr. Chen and his colleagues recently published results from a multicenter randomized, controlled trial in which 10 days of TBS was compared head-to-head with a four week course of conventional rTMS. The two approaches were similar in antidepressant effect and safety. This was the largest study of accelerated TBS in depression to date.

Standardization needed

Accelerated delivery doesn’t necessarily mean accelerated response, the authors caution. Some retrospective studies have shown twice-daily rTMS induces antidepressant effects faster than once-daily administration, but the evidence is mixed. One barrier is that studies have varied widely in factors such as the stimulation target, frequency and intensity of stimulation, the duration of breaks between sessions, and the number of pulses applied per session and over a treatment course.

Importantly, though, “accelerated rTMS’s antidepressant efficacy appears comparable to conventional, once-daily rTMS protocols,” Dr. Chen’s group writes. In addition, “studies show that accelerated rTMS protocols are well-tolerated and not associated with serious adverse effects.”

“As with all therapies, the efficacy, safety, and tolerability of protocols that deviate from those investigated in clinical trials are unknown and should be cautioned against,” the researchers continue. “The durability and depression relapse patterns following accelerated rTMS remain a recognized knowledge gap.”

Read [Accelerated Repetitive Transcranial Magnetic Stimulation to Treat Major Depression: The Past, Present, and Future]

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students in effective decision-making and outcomes across healthcare. We support clinical effectiveness, learning and research, clinical surveillance and compliance, as well as data solutions. For more information about our solutions, visit https://www.wolterskluwer.com/en/health and follow us on LinkedIn and Twitter @WKHealth.

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About HRP

Harvard Review of Psychiatry is the authoritative source for scholarly reviews and perspectives on a diverse range of important topics in psychiatry. Founded by the Harvard Medical School Department of Psychiatry, the journal is peer-reviewed and not industry sponsored. It is the property of President and Fellows of Harvard College and is affiliated with all of the Departments of Psychiatry at the Harvard teaching hospitals.

Articles encompass all major issues in contemporary psychiatry, including (but not limited to) neuroscience, psychopharmacology, psychotherapy, history of psychiatry, and ethics. In addition to scholarly reviews, perspectives articles, and columns, the journal includes a Clinical Challenge section that presents a case followed by discussion and debate from a panel of experts.

About Wolters Kluwer

Wolters Kluwer (EURONEXT: WKL) is a global leader in professional information, software solutions, and services for the healthcare, tax and accounting, financial and corporate compliance, legal and regulatory, and corporate performance and ESG sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with specialized technology and services.

Wolters Kluwer reported 2022 annual revenues of €5.5 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 20,000 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

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Wolters Kluwer Health: Lippincott

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May 12, 2023
How to be a great physician, according to a UTHealth Houston expert

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Newswise — The first tip for physicians in a new paper authored by John Higgins, MD, is to have the mindset of a detective and dig deeper when something is not adding up with the care of a patient.

The article titled, “Ten Traits of Great Physicians,” was published recently in The American Journal of Medicine.

Higgins, professor of cardiovascular medicine in the Department of Internal Medicine with McGovern Medical School at UTHealth Houston, shares the story of a vision-impaired patient who was relying on his wife for proper heart medication dosages. As it turns out, her vision was deteriorating as well, leaving him to receive the wrong dose. After some “detective work,” Higgins and his team were able to identify the problem and reach a solution to offer the patient better care.

The paper is full of tips and stories gathered from experiences throughout his career in medicine that he said he hopes will enhance the ability to practice medicine and improve patient experiences while differentiate great doctors from good doctors.

“Although many good doctors are well trained in the basic and clinical sciences, many great doctors hold that other habits are equally, if not more crucial,” Higgins said.

Get Healthy and Relax The second tip in the paper is that in order to take care of other people, you have to also take care of yourself. This applies both physically and mentally for practicing physicians. Higgins not only encourages taking care of your body by completing physical exercise, but to also take time to “regroup, recharge, and recover, and don’t do things to the extreme.”

Be A Master Listener For his third tip, Higgins recommends devoting your full attention to a patient and not only focus on what they are saying, but how they are saying it, and any other nonverbal clues they may be giving. He mentions that if your attention is elsewhere, like typing on a computer while the patient is speaking, a physician may miss a nonverbal clue that could potentially lead to a change in care.

Find Your Passion Higgins’ recalls the moment that he fell in love with all things medical after suffering a minor injury when he was 9 years old. After accidentally running through a glass door, he was able to hear his heartbeat with a stethoscope for the first time as a distraction while his doctor sutured his knee.

“Meaningful work, especially that falls at the intersection of one’s values, passions, and strengths appear key for health care professionals to give their best,” Higgins said.

Treat the Whole Patient Quoting Sir William Osler for this tip, Higgins’ next piece of advice is that “A good physician treats the disease. The great physician treats the patient who has the disease.” Higgins then shares the story of Gillian Lynne, famous for choreographing Cats and Phantom of the Opera, and who had trouble focusing in school at a young age.

Eager to find out what may be ailing her daughter, who was underperforming, frequently late, and often fidgety, Lynne’s mother took her to see a doctor. However, after observing Lynne, the doctor and her mother left the room, but not before turning on some music, and observing Lynne dancing in the room. The doctor explained to Lynne’s mother that there was nothing wrong with her daughter, and instead encouraged the beginning of her career.

Have Empathy Higgins mentions that while empathy can be taught, oftentimes physicians are not good at practicing it, and that it can be difficult for a physician to put themselves in another person’s shoes, but by connecting verbally and nonverbally, speaking slowly, being curious, finding a common ground, listening actively, sharing, and always being supportive, one can affect a patient a great deal.

Three tips to having empathy that Higgins gives are asking yourself 1) “What would you think?” 2) “How would you feel?” and 3) “What would you like someone to do for you?”

Pay Attention to Detail While working in the emergency department one night, Higgins recalls a time when he was able to help an unresponsive patient simply by paying attention to details. While working on a separate patient, Higgins heard a call for help from another stall and was quickly able to assist because he and the team paid attention to details.

He points out three takeaways from the lesson which are 1) Attention to detail; 2) Always have a plan B in case a problem occurs; 3) Everything we do or say, or fail to do or say, has consequences; and 4) Not all patients behave or respond equally.

Develop Resistance Higgins quotes Charles Darwin for his eighth tip for being a great physician when the paper states that “It’s not the strongest of a species that survive, nor the most intelligent, but the ones most resilient and responsive to change.”

Higgins recalls the first time he encountered the death of a child while working in the emergency department and how hard it was for him emotionally. “Resilience is necessary to survive the frequent exposure to illness and death that doctors face,” he said. “You will need to take a step back and stay emotionally strong, knowing that you’ve done your best and need to move on to the next patient.”

Take Responsibility – The Buck Stops with You Higgins mentions that physicians will encounter critical moments where every moment counts. In those moments, he says you will need a “quick mind, extreme calmness, and most important of all, decisiveness.”

Higgins says that as a physician you will experience both a sense of accomplishment and fulfillment, as well as frustrations and disappointments, but that as John Rockefeller said, “the secret of success is to do the common things uncommonly well.”

Count Your Stars Higgins’ final tip is that you can’t spend your life chasing money, or you will miss out on “counting your stars.” His advice is that when you truly follow your passions, money and fame will be a by-product of your efforts, second to the lives you have improved and saved, and the thousands more you have yet to touch.

Higgins has already received positive feedback on the sentiments expressed in his paper from physicians worldwide and hopes his article will help future generations of medical students to become great doctors.

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University of Texas Health Science Center at Houston

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May 5, 2023
Hackensack Meridian Mountainside Medical Center Awarded Spring 2023 ‘A’ Hospital Grade from Leapfrog Group

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Newswise — Montclair, NJ – (May 3, 2023) – Hackensack Meridian Mountainside Medical Center received an “A” Hospital Safety Grade from The Leapfrog Group, a national nonprofit upholding the standard of patient safety in hospitals and ambulatory surgery centers. This national distinction celebrates Mountainside Medical Center’s achievements in prioritizing patient safety by protecting patients from preventable harm and errors. The new grades reflect performance primarily during the height of the pandemic.

“The past few years have been a challenge, but at Mountainside Medical Center never wavered in our commitment to providing safe patient care,” said Tim O’Brien, chief executive officer at Mountainside Medical Center. “I am proud of the Mountainside team, who understand and work hard to implement patient-first practices.

The Leapfrog Group, an independent national watchdog organization, assigns an “A,” “B,” “C,” “D” or “F” grade to general hospitals across the country based on over 30 national performance measures reflecting errors, accidents, injuries and infections, as well as systems hospitals have in place to prevent harm.

“This new update of Hospital Safety Grades shows that, at the national level, we saw deterioration in patient safety with the pandemic,” said Leah Binder, president and CEO of The Leapfrog Group. “But this hospital received an ‘A’ despite those challenges. I congratulate all the leaders, staff, volunteers, and clinicians who together made that possible.”

The Leapfrog Hospital Safety Grade is the only hospital ratings program based exclusively on hospital prevention of medical errors and harm to patients. The grading system is peer-reviewed, fully transparent and free to the public. Grades are updated twice annually, in the fall and spring.

About Hackensack Meridian Mountainside Medical Center

Newswise — Hackensack Meridian Mountainside Medical Center has been serving Montclair and its surrounding New Jersey communities since 1891. The hospital provides patients access to innovative and effective treatment in specialized centers within the hospital focused on radiology, women’s health, oncology, surgery, bariatrics, neurosciences, stroke, and cardiovascular services. Mountainside is designated as a Primary Stroke Center by The Joint Commission and The NJ State Department of Health and Senior Services and is one of only a few community hospitals licensed by the State to perform emergency cardiac angioplasty and emergency neuroendovascular procedures. To learn more about Hackensack Meridian Health Mountainside Medical Center visit www.mountainsidehosp.com.

About The Leapfrog Group

Founded in 2000 by large employers and other purchasers, The Leapfrog Group is a national nonprofit organization driving a movement for giant leaps for patient safety. The flagship Leapfrog Hospital Survey and new Leapfrog Ambulatory Surgery Center (ASC) Survey collect and transparently report hospital and ASC performance, empowering purchasers to find the highest-value care and giving consumers the lifesaving information they need to make informed decisions. The Leapfrog Hospital Safety Grade, Leapfrog’s other main initiative, assigns letter grades to hospitals based on their record of patient safety, helping consumers protect themselves and their families from errors, injuries, accidents and infections. For more, follow us on Twitter and Facebook, and sign up for our newsletter.

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Hackensack Meridian Health (Mountainside Medical Center)

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May 2, 2023
USC Verdugo Hills Hospital nationally recognized with first ‘A’ hospital safety grade

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Newswise — LOS ANGELES — For the first time, USC Verdugo Hills Hospital (USC-VHH) earned an “A” Hospital Safety Grade from The Leapfrog Group, an independent national watchdog organization, for achieving the highest national standards in patient safety. This achievement places USC-VHH among top tier hospitals in the nation for safety and quality.

“Our entire staff is dedicated to improving and upholding the highest standards of patient care,” said Mary Virgallito, MSN, RN, chief quality officer at USC-VHH. “This score reinforces our ongoing efforts to implement the most current, evidence-based practices for patient safety and outcomes.”

The Leapfrog Group assigns letter grades to general hospitals throughout the U.S. based on a hospital’s ability to prevent medical errors and harm to patients. Hospital Safety Grade results are based on more than 30 national performance measures and are updated each fall and spring.

“We are proud of the unwavering commitment of our staff in ensuring safety and quality care for our patients and will continue striving to ensure that this is the first ‘A’ grade of many,” said Armand Dorian, MD, MMM, CEO of USC-VHH.

USC-VHH recently employed several initiatives to improve quality and patient safety. The hospital has maintained rigorous infection prevention programs and has dedicated staff providing specialized 24-hour care for inpatients, intensive care and labor and delivery through its hospitalist, intensivist and laborist programs.

The Leapfrog Group grading system is peer-reviewed, fully transparent and free to the public. To see USC-VHH’s full grade details and access hospital safety tips for patients, visit  hospitalsafetygrade.org.

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For more information about USC Verdugo Hills Hospital, please visit news.KeckMedicine.org.

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Keck Medicine of USC

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May 2, 2023
Achieving Prevention and Health, Rather Than More Healthcare

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Newswise — If more people have access to health insurance, we have to be sure the death rates of those with certain chronic conditions are decreasing.

This is one of the statements Gregory Peck, an acute care surgeon and associate professor at Rutgers Robert Wood Johnson Medical School, will be researching on behalf of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) at the National Institutes of Health.

Funded by NIH grants totaling more than $1 million through a recent two-year award from the New Jersey Alliance for Clinical and Translational Science (NJ ACTS), a Rutgers hub of the National Center for Advancing Translation Science, and now a four-year award from the NIDDK, Peck is on average one of just two critical care surgeons funded nationally annually creating new models of health for NIH consideration.

Peck recently published two studies investigating death rates for gallstone disease, a disease of the abdomen that causes right-sided belly pain after eating, which share risk factors with other deadly diseases. His study, published in Gastro Hep Advances, found that between 2009 and 2018 the number of deaths of people in New Jersey with diagnosed gallstone disease (1,580) remained steady and did not improve, and that deaths in Latinos ages 65 and older potentially increased.

His study in the Journal of Surgical Research found that after Medicaid expansion in 2014 as compared to before, the amount of emergency surgery to remove the gallbladders for gallstone disease decreased in the state overall, but increased in people with Medicaid. While fatality from gallbladder removal surgery decreased for those 65 or older, there was increased death from surgery in the younger population and a trend of more death in the population with Medicaid. Further, the relatively decreased amount of gallbladder removal surgery occurring in ambulatory outpatient care centers did not necessarily help this.

Peck discusses the implications of the findings on a new shift in healthcare to prevention model.

Why did you focus on gallstone disease?

As a metabolic disease, gallstone disease is also linked to heart disease, cancer, diabetes, obesity and a sedentary lifestyle. In fact, heart disease, which is the No. 1 killer in America, and gallstone disease, which is the No. 1 digestive disease requiring surgery in America, share the risk factors of high levels of bad cholesterol type and obesity.

How do these studies inform public policy?

The amount of people dying with gallstone disease – most of whom require surgery – over the past decade has not gotten better. That’s 160 people a year who still are dying from a preventable death such as gallstone disease. Making progress is what this type of epidemiologic study focuses on, and concerningly, we might not have made good progress.

If Medicaid expansion didn’t positively affect the death rate of people with gallstone disease and we see it increase specifically in older Latino populations, we need to be asking if we are helping people of color and those who live in communities with lower socioeconomic status improve health or treating them sooner to prevent emergency surgery and especially decreasing death from emergency surgery. Insurance expansion is certainly needed, but we have to ensure the action specific pieces of policy impact the population requiring surgery in a patient-centered way.

The real goal is preventing the disease from even occurring. When we pass public health policy, we need to advocate for preventive care that reaches people through their community. Right now, the findings show that we might just be providing people with insurance cards who find themselves still needing to use the emergency department. Instead, that insurance should help them visit their primary care doctor, who can help them make changes like decreasing their bad cholesterol levels, which contribute to gallstone disease, and help them access care in ambulatory surgery centers sooner.

We need to cultivate preventive healthcare rather than ballooning the investment in emergency healthcare, which does not solve current inequities.

What other steps to improve access to care should be taken?

We propose a novel population health approach that shifts from the reactive treatments of emergency disease to proactive prevention. One place to start is increasing access to appropriate outpatient elective healthcare for underrepresented groups with barriers to preventive care, such as by increasing health insurance that incentivizes the behaviors toward improved health. A first step for my research group is to focus on diseases that currently require as much emergency as elective care, such as gallstone disease, and understand this by understanding who presents to the hospital, as to dial this back into the community level, to decrease hospital care.

In addition, in primary care, laboratory, radiology or ambulatory care settings we need to improve communication with people with low English proficiency – especially how well prevention is explained in a patient’s primary language. Language barriers might also prevent them from understanding the importance of cholesterol or blood pressure control over the one, two and three decades of life, or how they find access to diagnostic tests or treatment needed earlier.

How is Rutgers working to increase primary care knowledge in underserved communities?

Shawna Hudson, the co-director of community engagement for NJ ACTS, and my research mentor, is researching how representatives rooted in the community can help healthcare providers and researchers better understand how we can use community engagement to involve people in a communities’ preventive care as to decrease risk factors for chronic disease before they need hospital-based care and, more importantly, emergency surgery.

One initiative is the Community Engagement Virtual Salons, which help researchers and health care providers at NJ ACTS engage with patients and community members about how biomedical and clinical research leads to action through understanding disease and then enacting policy. In these sessions, the public serves as experts to provide feedback from a community perspective. This allows the medical profession to build relationships with community partners and increase the culturally sensitive participation of hard-to-reach populations.

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Rutgers University-New Brunswick

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April 23, 2023
Mid-Calf Nerve Block May Enable Early Rehabilitation After Foot and Ankle Surgery, Preventing Pain While Allowing Foot Movement
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Newswise — A pilot study conducted at Hospital for Special Surgery (HSS) shows evidence that a mid-calf nerve block is a safe and effective regional anesthetic option for foot and ankle surgeries and may enable faster recovery of motor function of the ankle joint compared with a popliteal block. These findings were presented at the 2023 Spring American Society of Regional Anesthesia and Pain Medicine (ASRA) Annual Meeting.¹

“This new block provides excellent anesthesia and analgesia to foot and ankle surgeries and preserves motor function of the ankle joint. The results are very promising,” said Enrique A. Goytizolo, MD, an anesthesiologist at HSS and senior author of the study. “New protocols of early rehabilitation of foot surgeries can be instituted, since patients have no pain with movement of the foot.”

An ultrasound-guided popliteal block is the current standard anesthetic technique for foot and ankle surgeries, but the study findings show that using an ultrasound-guided mid-calf block could enable earlier rehabilitation protocols and an overall faster recovery from surgery.

A popliteal block numbs the sciatic nerve at the level of the popliteal fossa, which is a diamond-shaped space behind the knee joint. A mid-calf block is placed farther down the leg, between the popliteal fossa and the ankle, and numbs the posterior tibial nerve, superficial and deep peroneal nerves, sural, and saphenous nerves. A mid-calf block provides prolonged analgesia for any foot or ankle surgery while preserving motor function of the ankle joint.

Twenty patients who were scheduled to receive foot or ankle surgery at HSS were recruited for the study. The procedures included total ankle replacement, ankle arthroscopy, bunionectomy, cheilectomy, and Achilles tendon repair. Participants were assessed in the post-anesthesia care unit (PACU) and again before discharge to record the time when the mid-calf block ended, presence of paresthesia, and any other side effects. On postoperative days 1, 2, and 7, participants were asked about their pain on a numerical rating score (NRS), their medication use, and other symptoms.

The researchers found that the median duration of analgesia from the mid-calf block was 18.2 hours, with an interquartile range of 4.5-24.0 hours. All 20 patients were able to flex their toes in the PACU.

The average pain score in the PACU was 0.8 +/- 2.1 at rest, and 1.1 +/- 2.3 with movement. Three participants were excluded for sensitivity analysis because they received additional surgery in surgical areas not covered by the mid-calf block. Among the 17 patients in the sensitivity analysis group, these scores were both 0.3 +/- 1.2 at rest and with movement.

“The mid-calf block provides reliable, consistent, and excellent anesthesia and analgesia for foot and ankle surgeries,” said Dr. Goytizolo. “Follow-up research and patient treatments following this study should include a fast-track rehabilitation program for patients who have total ankle replacement surgeries with a mid-calf block.”

The findings of this study will also inform future randomized control trials on the mid-calf block.

References
1. Marko Popovic BS, Alex Illescas MPH, Pa Thor PhD, Jacques YaDeau MD PhD, Constantine Demetracopoulos MD, Scott Ellis MD, Vincent LaSala MD, Matthew Roberts MD, Anne H. Johnson MD, Mark Drakos MD, Enrique Goytizolo MD. “Mid-Calf Block for foot and ankle surgery: A pilot study.” Presented at: 48th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), April 20-22, 2023; Hollywood, FL.
About HSS

HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.
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Hospital for Special Surgery

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April 22, 2023
Peripheral Nerve Blocks in Total Joint Arthroplasty May Provide the Best Reduction in Complications in Older Patients With Fewer Comorbidities
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Newswise — Hollywood, Florida, April 22, 2023 — In a study conducted at Hospital for Special Surgery (HSS), researchers found that the use of peripheral nerve blocks in total knee and total hip arthroplasty were associated with a consistent reduction in risk for postoperative complications in patients with a lower comorbidity burden. In particular, the most consistent reduction in risk of complications and use of hospital resources was in older patients with no comorbidity burden. These findings were presented at the 2023 Spring American Society of Regional Anesthesia and Pain Medicine (ASRA) Annual Meeting and were acknowledged as one of the President’s Choice Abstracts.¹

“The utility of interventions in a general population of patients might be difficult to show, but might differ by subgroups, with certain patients deriving benefit when others do not,” said Stavros G. Memtsoudis, MD, PhD MBA FCCP, an anesthesiologist at HSS and lead author of the study. “In this study, we tried to identify which subgroups might benefit most from peripheral nerve blocks in terms of a reduction in complications after joint arthroplasty.”

These findings demonstrate that comorbidities may be a factor with a greater effect on complication risk than other factors, such as age, and that peripheral nerve blocks alone may not be sufficient to consistently influence outcomes in patients with comorbidities.

These findings may also demonstrate that there may be a specific optimal baseline patient population for whom peripheral nerve blocks have the greatest impact on improving surgical outcomes: patients who are older but do not have many comorbidities. This study could help clinicians determine which surgical patients may benefit most from peripheral nerve blocks and which candidates may need additional measures to improve their outcomes.

Many total joint arthroplasty (TJA) patients are at risk for poorly controlled pain and complications. The number of these surgeries performed increases each year, underscoring the importance of finding solutions. To find out how uniformly peripheral nerve blocks can improve perioperative outcomes and pain relief in TJA patients, the researchers conducted a population-based analysis using data from TJA surgeries in the United States from January 2006 to December 2019.

Patients were divided into nine groups based on age and number of comorbidities. Age was broken down as follows: Young (Y) = younger than 65 years; Middle (M) = 65 to 75 years; and Old (O) = older than 75 years. Comorbidities were categorized as: no pre-existing comorbidity (Group 1); 1 or 2 comorbidities (Group 2); and 3 or more comorbidities (Group 3). This led to a breakdown of nine groups total: Y1, Y2, Y3, M1, M2, M3, O1, O2, and O3.

The sample included more than 2.8 million TJA cases performed in 887 hospitals. Of those, 15.5% received a peripheral nerve block. The overall rate of peripheral nerve blocks increased from 9.5% in 2006 to 18.9% in 2019. Peripheral nerve blocks were used least often in young patients with more than 3 comorbidities (13.9%) and used most often in middle-aged patients with no comorbidities (16.3%). Peripheral nerve blocks were associated with a significant reduction in the odds of respiratory complication, acute renal failure, delirium, ICU admission, high opioid consumption during hospitalization, and prolonged length of stay.

The results showed reduced odds of respiratory complications for the O1 and Y2 groups, reduced odds of acute renal failure in the Y1, O1, and M2 groups, and reduced odds of delirium in O1. The risk for ICU admission was reduced in those who received peripheral nerve blocks in all ages with no comorbidities, as well as in the Y2 and O2 groups, compared with those who did not receive a peripheral nerve block. Peripheral nerve blocks also reduced the odds of a prolonged length of stay in the Y1, M1, Y2, M2, and Y3 groups. Odds of high opioid use in patients who received a peripheral nerve block versus no peripheral nerve block were significantly reduced in all groups except for Y3 and O3.

“While peripheral nerve blocks might have the advantage of providing superior pain control versus systemic modalities as well as reducing opioid consumption, a reduction in complications might be expected in those without comorbidities,” Dr. Memtsoudis said. “However, given that peripheral nerve blocks still provide better pain control and reduce opioid use, all patients should be considered for peripheral nerve blocks.”

“Older patients without major comorbidities might represent a subgroup in which the beneficial effects of peripheral nerve blocks are most likely to be expected,” he noted. “This might be the case because major comorbidities are a bigger determinant of complications, with peripheral nerve blocks being less likely to be able to exert a substantial effect.”

Future research should include further examination of the benefits of peripheral nerve blocks. “Many questions remain unanswered, including quantification of attributable risk reduction of peripheral nerve blocks and which peripheral nerve blocks provide the biggest effect,” Dr. Memtsoudis concluded.

References
1. Haoyan Zhong MPA, Marko Popovic BS, Jashvant Poeran MD PhD, Crispiana Cozowicz MD, Alex Illescas MPH, Jiabin Liu MD PhD, Stavros G Memtsoudis MD PhD MBA FCCP. “Does the impact of peripheral nerve blocks vary by age and comorbidity subgroups? A nationwide population based study.” Presented at: 48th Annual Regional Anesthesiology and Acute Pain Medicine Meeting of the American Society of Regional Anesthesia and Pain Medicine (ASRA), April 20-22, 2023; Hollywood, FL.
About HSS

HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 13th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2022-2023), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2022-2023). In a survey of medical professionals in more than 20 countries by Newsweek, HSS is ranked world #1 in orthopedics for a third consecutive year (2023). Founded in 1863, the Hospital has the lowest complication and readmission rates in the nation for orthopedics, and among the lowest infection rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 145 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.
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Hospital for Special Surgery

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April 22, 2023
Cleveland Clinic-Led Study Suggests More Patients with Community-Acquired Pneumonia Could Be Switched from IV to Oral Antibiotics Earlier

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Newswise — Friday, April 21, 2023, CLEVELAND: Findings from a Cleveland Clinic-led study showed for patients with community-acquired pneumonia treated with intravenous (IV) antibiotics, earlier switching to oral antibiotics in clinically stable patients was associated with shorter duration of antibiotics and hospital stay.

The results from this retrospective study, led by Abhishek Deshpande, M.D., Ph.D., a staff physician investigator in the Center for Value-Based Care Research and Michael B. Rothberg, M.D., vice chair of research, Cleveland Clinic Community Care, were recently published in Clinical Infectious Diseases.

Current clinical practice guidelines from the American Thoracic Society/Infectious Diseases Society of America recommend switching from IV to oral antibiotics once patients are clinically stable, which is typically after three days of IV therapy. Early switching in stable patients appears safe but data showed it occurred infrequently in patients with community-acquired pneumonia.

For the study, researchers analyzed data from a national cohort of 378,041 adult patients from 642 hospitals in the U.S. from 2010 to 2015 who were admitted to the hospital with community-acquired pneumonia and initially treated with IV antibiotics.

Of this patient group, approximately six percent were switched early from IV antibiotics to oral antibiotics on or before hospital day three, and 30% were switched before discharge. Early switching to oral antibiotics was associated with shorter length of stay and shorter duration of antibiotic treatment and was not associated with worse outcomes.

Despite the evidence for safety of early switching in stable patients, the study found most patients received IV therapy throughout their hospital stay. The data highlights the opportunity for hospitals to reduce the burden of antibiotics by encouraging clinicians to follow evidence-based recommendations to switch therapy in clinically stable patients with community-acquired pneumonia.

“Community-acquired pneumonia is a leading cause of hospitalizations and antibiotic use,” said Dr. Deshpande. “Optimizing the delivery of antibiotics is crucial, as prolonged exposure can lead to increased antibiotic resistance and healthcare-associated infections. Our research suggests many more patients could be switched earlier without compromising outcomes.”

Over 1 million adults in the United States are hospitalized each year for pneumonia and 50,000 of those die from the disease. The best way to prevent pneumonia is to get vaccinated against bacteria and viruses that commonly cause it.

About Cleveland Clinic

Cleveland Clinic is a nonprofit multispecialty academic medical center that integrates clinical and hospital care with research and education. Located in Cleveland, Ohio, it was founded in 1921 by four renowned physicians with a vision of providing outstanding patient care based upon the principles of cooperation, compassion and innovation. Cleveland Clinic has pioneered many medical breakthroughs, including coronary artery bypass surgery and the first face transplant in the United States. U.S. News & World Report consistently names Cleveland Clinic as one of the nation’s best hospitals in its annual “America’s Best Hospitals” survey. Among Cleveland Clinic’s 77,000 employees worldwide are more than 5,658 salaried physicians and researchers, and 19,000 registered nurses and advanced practice providers, representing 140 medical specialties and subspecialties. Cleveland Clinic is a 6,665-bed health system that includes a 173-acre main campus near downtown Cleveland, 22 hospitals, more than 275 outpatient facilities, including locations in northeast Ohio; southeast Florida; Las Vegas, Nevada; Toronto, Canada; Abu Dhabi, UAE; and London, England. In 2022, there were 12.8 million outpatient encounters, 303,000 hospital admissions and observations, and 270,000 surgeries and procedures throughout Cleveland Clinic’s health system. Patients came for treatment from every state and 185 countries. Visit us at clevelandclinic.org. Follow us at twitter.com/ClevelandClinic. News and resources available at newsroom.clevelandclinic.org.

Editor’s Note: Cleveland Clinic News Service is available to provide broadcast-quality interviews and B-roll upon request.

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Cleveland Clinic

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April 21, 2023
Hackensack Meridian Hackensack University Medical Center Performs 1,000th Single-Port Robotic Procedure – More Than Any Other Hospital in the Country

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Newswise — Surgeons at Hackensack Meridian Hackensack University Medical Center performed their 1,000th Single-Port Robotic surgery with the da Vinci single port (SP) system on March 23.

Hackensack University Medical Center, a center for excellence in advanced robotic surgery, was the first and only hospital in New Jersey to have access to this groundbreaking technology in 2018 and is now the first hospital in the country to perform the most procedures with it.

“Performing 1,000 Single-Port Robotic procedures is a tremendous accomplishment for our entire team and for our patients,” says Michael D. Stifleman, MD, director of Robotic Surgery at Hackensack Meridian Health Network. “The more procedures we perform with this state-of-the-art technology, the greater the benefit for our patients as it further minimizes the trauma associated with surgery while enhancing precision and control compared to traditional techniques.”

The da Vinci SP technology’s revolutionary design involves a single arm that delivers three multi-jointed instruments and camera, making it an innovative, dynamic instrument for narrow, deep spaces. A single, one inch incision helps surgeons perform complex procedures in the most minimally invasive way, resulting in less pain and fewer complications, especially with urologic procedures, including prostate cancer; kidney cancer; head and neck cancers; and advanced urinary tract reconstruction surgery. Click here to learn more about the future of single-port surgery in an episode of “Operation: Reimagine Surgery,” a Freethink original series produced in partnership with Intuitive, which created the world’s first commercially available robotic surgery system in the 1990s.

“Surgeons at Hackensack University Medical Center performed New Jersey’s first robotic surgery more than 20 years ago,” says Mark D. Sparta, FACHE, President & Chief Hospital Executive of Hackensack University Medical Center and President, North Region, Hackensack Meridian Health. “Our academic medical center now has the largest and most experienced robotic surgery program in the state and one of the busiest in the nation.”

Experience matters as close to 25% of the nation’s single-port robotic procedures are completed at Hackensack University Medical Center by renowned surgeons including Chan W. Park, M.D., head and neck oncology surgeon; Brian E. Benson, M.D., interim chair of Otolaryngology; and Mutahar Ahmed, M.D., director of the Urologic Bladder Cancer Program; and Dr. Michael Stifelman, who is also professor and chair of Urology at Hackensack Meridian School of Medicine.

“Single-port robotic surgery places Hackensack University Medical Center’s urology program on the world stage with surgeons visiting us from the most prestigious medical centers nationally and internationally to see how we do it here in Hackensack,” says Dr. Ahmed. “Hackensack University Medical Center is focused on bringing the most advanced technologies and the most experienced surgeons together to constantly improve patient outcomes. The single-port technology is transformative and enables our surgeons to perform the most complex surgeries in the hardest to reach places, through just one small incision.”

Mutahar Ahmed, M.D., director of the Urologic Bladder Cancer Program using the Single-Port Robot

ABOUT HACKENSACK UNIVERSITY MEDICAL CENTER

Hackensack University Medical Center, a 803-bed nonprofit teaching and research hospital, was Bergen County’s first hospital founded in 1888. It was also the first hospital in New Jersey and second in the nation to become a Magnet®-recognized hospital for nursing excellence, receiving its sixth consecutive designation from the American Nurses Credentialing Center. The academic flagship of the Hackensack Meridian Health network, Hackensack University Medical Center is Nationally-Ranked by U.S. News & World Report 2022-2023 in four specialties, more than any other hospital in New Jersey. The hospital is home to the state’s only nationally-ranked Urology and Neurology & Neurosurgery programs, as well as the best Cardiology & Heart Surgery program. It also offers patients nationally-ranked Orthopedic care and one of the state’s premier Cancer Centers (John Theurer Cancer Center at Hackensack University Medical Center). Hackensack University Medical Center also ranked as High-Performing in conditions such as Acute Kidney Failure, Heart Attack (AMI), Heart Failure, Pneumonia, chronic obstructive pulmonary disease (COPD), Diabetes and Stroke. As well as High Performing in procedures like Aortic Valve Surgery, Heart Bypass Surgery (CABG), Colon Cancer Surgery, Lung Cancer Surgery, Prostate Cancer Surgery, Hip Replacement and Knee Replacement. This award-winning care is provided on a campus that is home to facilities such as the Heart & Vascular Hospital; and the Sarkis and Siran Gabrellian Women’s and Children’s Pavilion, which houses the Donna A. Sanzari Women’s Hospital and the Joseph M. Sanzari Children’s Hospital, ranked #1 in the state and top 20 in the Mid-Atlantic Region in the U.S. News & World Report’s 2022-23 Best Children’s Hospital Report. Additionally, the children’s nephrology program ranks in the top 50 in the United States. Hackensack University Medical Center is also home to the Deirdre Imus Environmental Health Center and is listed on the Green Guide’s list of Top 10 Green Hospitals in the U.S. Our comprehensive clinical research portfolio includes studies focused on precision medicine, translational medicine, immunotherapy, cell therapy, and vaccine development. The hospital has embarked on the largest healthcare expansion project ever approved by the state: Construction of the Helena Theurer Pavilion, a 530,000-sq.-ft., nine-story building, which began in 2019. A $714.2 million endeavor, the pavilion is one the largest healthcare capital projects in New Jersey and will house 24 state-of-the-art operating rooms with intraoperative MRI capability, 50 ICU beds, and 175 medical/surgical beds including a 50 room Musculoskeletal Institute.

ABOUT HACKENSACK MERIDIAN HEALTH

Hackensack Meridian Health is a leading not-for-profit health care organization that is the largest, most comprehensive and truly integrated health care network in New Jersey, offering a complete range of medical services, innovative research and life-enhancing care. The network has 18 hospitals and more than 500 patient care locations, which include ambulatory care centers, surgery centers, home health services, long-term care and assisted living communities, ambulance services, lifesaving air medical transportation, rehabilitation centers, urgent care centers, physician practice locations, and a fitness and wellness center. With more than 35,000 team members and 7,000 physicians, Hackensack Meridian Health is a distinguished leader in health care philanthropy and committed to the health and well-being of communities throughout New Jersey. The network’s notable distinctions include having more U.S. News-ranked hospitals than any other health system in New Jersey, as ranked by U.S. News & World Report, 2022-23. Hackensack University Medical Center is nationally-ranked by U.S. News & World Report in four specialties, more than any other hospital in New Jersey. Joseph M. Sanzari Children’s Hospital at Hackensack University Medical Center, and K. Hovnanian Children’s Hospital at Jersey Shore University Medical Center, are ranked #1 in the state and top 20 in the Mid-Atlantic Region by U.S. News & World Report’s 2022-23 Best Children’s Hospital Report. Additionally, their combined nephrology program ranks in the top 50 in the United States. To learn more, visit www.hackensackmeridianhealth.org.

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Hackensack Meridian Health

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April 3, 2023
A healthy microbiome may prevent deadly infections in critically ill people

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Newswise — Twenty to 50 per cent of all critically ill patients contract potentially deadly infections during their stay in the intensive care unit or in hospital after being in the ICU – markedly increasing the risk of death.

“Despite the use of antibiotics, hospital-acquired infections are a major clinical problem that persists to be a huge issue for which we don’t have good solutions,” says Dr. Braedon McDonald, MD, PhD, an intensive care physician at the Foothills Medical Centre (FMC) and assistant professor at the Cumming School of Medicine (CSM). “We tackled this issue from a different angle. We looked at the body’s natural defense to infection to better understand why some people are more susceptible to these deadly infections.”

The study involved 51 patients newly admitted to the intensive care unit (ICU) at FMC. Patients were studied over the first week of acute critical illness. The research showed that the gut microbiota and systemic immunity work together as a dynamic “metasystem,” in which problems with gut microbes and immune system dysfunction are associated with significantly increased rates of hospital-acquired infections.

“The signal that we’ve seen in our research is that a family of bacteria, that naturally live in the gut, seems to be important for directing the immune system,” says Jared Schlechte, PhD candidate in McDonald’s lab and first author of the study. “However, during critical illness the microbiome becomes injured allowing these bacteria to start taking over.”

The study published in Nature Medicine found that patients who experienced an abnormal increase in the growth of this common bacteria, called a bloom, were at the highest risk of severe infections.

“This information is important because it gives us a whole new avenue to start thinking about not just ways to treat infections, but a potential treatment to prevent them,” says McDonald. “The findings suggest that if we want to fight infection, we can’t just target these bad bacteria in isolation and the immune system in isolation. We really need to have a more holistic view of how things are functioning.” McDonald says the study’s findings

As a next step, McDonald and the team plan to launch a randomized, controlled clinical trial – based on a precision medicine approach that borrows from probiotics therapy, and utilizes multiple different bacteria engineered to specifically target the bacteria identified in the study. People who agree to participate will be given engineered microbiomes.

“What we’re trying to do is restore the normal mechanism that work when we’re healthy, and take advantage of that to help protect people from infections,” McDonald says.

UCalgary faculty co-authors included Drs. Christopher Doig, MD, Kathy McCoy, PhD, and Mary Dunbar, MD. PhD candidate Amanda Zucoloto, along with research technician and laboratory manager Ian-Ling Yu, also co-authored the study. The study was supported by the Canadian Institutes of Health Research and the Alberta Health Services Critical Care Strategic Clinical Network.

Braedon McDonald is an assistant professor in the Department of Critical Care Medicine at the Cumming School of Medicine (CSM), an intensive care physician at the Foothills Medical Centre, and a member of the Snyder Institute for Chronic Diseases at CSM.

The Snyder Institute for Chronic Diseases is a team of more than 480 clinician-scientists and basic scientists dedicated to uncovering new knowledge leading to disease prevention, tailored medical applications and ultimately cures for those with chronic and infectious disease. Visit snyder.ucalgary.ca and follow @SnyderInstitute to learn more.

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University of Calgary

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March 31, 2023
How one state beat national surgery opioid trends

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Newswise — A statewide effort to treat the pain of surgery patients without increasing their risk of long-term dependence on opioids has paid off in Michigan, a study shows.

In less than two years, the effort led to a 56% reduction in the amount of opioids patients received after having six different common operations, and a 26% drop in the chance that they would still be filling opioid prescriptions months after their surgical pain should have eased.

Both of those drops beat national trends for similar patients, according to the new study published in Annals of Surgery by a team from Michigan Medicine, the University of Michigan’s academic medical center.

Michigan patients having certain operations – for instance, to remove part of their colon – saw the biggest drops over the study period in how many opioids they received after their operations. They also had the biggest drop in risk of developing persistent opioid use, which the researchers define as filling opioid prescriptions for months or years after surgery, when their initial surgery-related prescription was intended for short-term use.

The Michigan effort used prescribing guidelines based on real-world evidence about how many opioid doses surgery patients actually need to ease their pain, compared with what they were prescribed.

Importantly, the guidelines don’t leave patients in pain. In fact, past research showed that surgery patients receiving smaller opioid prescriptions had similar pain outcomes and were just as satisfied with their pain care.

“Tens of millions of people have operations in the U.S. every year, and most of them go home with a prescription for an opioid painkiller. Although they are meant for short-term use during recovery from surgery, unfortunately, some patients keep filling opioid prescriptions for months or years after surgery, which raises their risk of opioid use disorder, overdose, and death,” said Ryan Howard, M.D., M.S., the resident in the U-M Department of Surgery who led the new analysis. “Reducing those trends is a key part of addressing our national opioid problems.”

A statewide team effort

The achievement was driven by the Opioid Prescribing Engagement Network and the Michigan Surgical Quality Collaborative – both based at U-M – and by surgical team leaders at 70 hospitals across the state that take part in MSQC and have implemented OPEN guidelines.

“Our study shows how voluntary prescribing guidelines, and involvement of surgical teams in choosing evidence-based pain care options, can really make a difference,” said senior author Chad Brummett, M.D., co-director of OPEN and director of pain research at Michigan Medicine’s Department of Anesthesiology. “Fewer opioids prescribed and dispensed means lower risk not only of persistent use, but also of risks to others in the household from unused opioid medication.”

Helping patients get leftover opioids out of their homes and disposed of safely is another key goal of the opioid prescribing engagement network. They offer several free programs to Michigan organizations including free medication disposal pouches, permanent disposal boxes and medication take back event planning materials.

Making Michigan the safest place for surgery

The team showed that declines in Michigan – where these guidelines were implemented – outpaced the nation, and other Midwest states, by comparing records from tens of thousands of patients who had the six types of operations in Michigan and those who had them in other states.

Their analysis spans almost four years before the prescribing guidelines were deployed statewide, and nearly two years afterward, from 2013 to mid-2019.

They focused on patients covered by traditional Medicare, who had not filled an opioid prescription for a year before their operation, and who had not had a second operation in the six months after their index operation.

The study focuses on nearly 25,000 Michigan patients and more than 118,600 non-Michigan patients who had minimally invasive gallbladder removal or appendix removal, minor or major hernia repairs, removal of part of the colon (colectomy), or hysterectomy.

Those six types of operations were the first ones that focused on when developing and implementing prescribing guidelines based on opioid prescription fills and surveys of patients undergoing surgery. They were first published in October 2017, and have been added to ever since with guidelines for other types of surgical and dental procedures. The opioid prescribing engagement network recently published its first pediatric surgery prescribing guidelines.

The 70 hospitals across Michigan where the guidelines were deployed account for the majority of surgical care in the state. The non-Michigan patients were a 20% sample of all traditional Medicare patients who had the same operations in the same timeframe.

The researchers looked for signs of new persistent use of opioids, which means a patient filled an opioid prescription immediately after surgery, and then also filled at least one more opioid prescription in the three months after surgery, and another up to six months after surgery. They also looked at the total amount of opioids that patients received in the six months after their operation.

Because opioid prescribing in general was trending downward in the mid-2010s, the researchers looked at differences between Michigan and national trends to see if there was any difference.

Michigan outperforms the nation

Michigan patients had a larger decrease in the rate of new persistent opioid use than their non-Michigan counterparts, with the two drops differing by about half a percentage point.

This was driven especially by a 2.76 percentage-point reduction among those having colon surgery, and smaller but significant reductions among those having gallbladder and minor hernia operations. Patients having other operations had either no difference between Michigan and the rest of the nation, or a slight increase in Michigan for appendectomy.

On the whole, Michigan surgical patients saw a faster drop in the size of the opioid prescriptions they filled, compared with those in other states having the same operations in the same time period.

The difference was nearly 56 mg of opioids by the end of the study period, with significant drops in all types of surgery except laparoscopic appendectomy. Michigan patients started at about 200 mg morphine equivalents, and dropped to 89 mg morphine on average, while non-Michigan patients started at 218 mg morphine and dropped to 154 mg morphine.

The size of dispensed opioid prescriptions to Michigan surgical patients was actually already lower than national surgical opioid prescribing before the guidelines, though persistent opioid use after surgery was higher in Michigan at 3.4% compared with 2.7%.

When the researchers excluded cancer patients, or patients with substance issues, Michigan still outperformed the rest of the country in decreasing persistent use and reducing the size of prescriptions dispensed to patients.

Michigan’s colon surgery patients had the biggest drop in both the amount of opioids they received and their chance of developing persistent use.

The researchers also did additional comparisons of Michigan with a group of Midwestern states, and with Indiana and Wisconsin, as well as doing analyses that excluded cancer patients and patients who had previously been diagnosed with a substance use disorder. In all these cases, Michigan performed better than the nation.

Both MSQC and OPEN receive funding from Blue Cross Blue Shield of Michigan. The opioid prescribing engagement network also has received funding from the Michigan Department of Health and Human Services and National Institutes of Health, as well as support from the U-M Institute for Healthcare Policy and Innovation.

In addition to Howard and Brummett, the study’s authors are Andrew Ryan, Ph.D., formerly of the U-M School of Public Health, Hsou Mei Hu, Ph.D., M.B.A., of OPEN; Craig S. Brown, M.D., M.S., of Surgery; and OPEN co-directors Jennifer Waljee, M.D., M.P.H., M.S., Mark Bicket, M.D., Ph.D. and Michael Englesbe, M.D. Many of the authors are members of IHPI and the Center for Healthcare Outcomes and Policy.

Paper cited: “Evidence-Based Opioid Prescribing Guidelines and New Persistent Opioid Use After Surgery,” Annals of Surgery. DOI: 10.1097/SLA.0000000000005792

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Michigan Medicine – University of Michigan

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March 24, 2023