To compare the efficacy of single-dose anesthetic (SDA) erector spinae plane block (ESPB) versus continuous ESPB via thoracic catheters (CATs) in managing pain and reducing opioid use in cardiac surgery patients. Prospective, observational, longitudinal study. A tertiary-level hospital. A total of 70 patients aged 18 and above undergoing cardiovascular surgery involving sternotomy were included (35 per group). Patients received either a single-dose ESPB with bupivacaine or continuous ESPB via thoracic CATs with automatic intermittent boluses of bupivacaine for 72 hours. Opioid use (primary outcome) was measured in morphine milligram equivalents (MMEs), while pain intensity (secondary outcome) was assessed using the Numeric Rating Scale (NRS). The CAT group demonstrated significantly lower cumulative opioid use at 72 hours (median 12.0 MME [interquartile range {IQR} 9.0-20.0]) compared to the SDA group (median 17.0 MME [IQR 12.0-37.0], p = 0.029). Pain intensity scores on NRS showed no significant differences between groups. Post-operative nausea was less frequent in the CAT group (17.1 percent vs 40.0 percent, p = 0.034). No major complications were observed in either group. Continuous ESPB via thoracic CATs provides superior opioid-sparing effects compared to single-dose ESPB in cardiac surgery patients while maintaining comparable pain relief and safety. This technique may enhance recovery protocols by reducing opioid-associated side effects. Further research is warranted to explore adjuvants and optimize ESPB protocols in cardiac surgery.

Recreational therapists work in a broad field with numerous service settings for individuals with disabilities. Students' learning may be enhanced by providing opportunities during class time to implement services for more unfamiliar populations. Therefore, the purpose of this study was to investigate students' reflections from a class time fieldwork experience (CTFE) in a recreational therapy (RT) class with adolescents who engage in health-risk behaviors. A retrospective, qualitative content analysis of 111 RT students' perspectives was used for this study, and two main themes emerged: exposure to an unfamiliar community population and identifying personal biases and judgments. Implications are identified for RT educators and practitioners to apply these findings to future CTFEs, internships, and employment opportunities.

Opioid misuse has become a widespread public health issue, affecting diverse patient populations, including those with heart failure. Given that heart failure with preserved ejection fraction (HFpEF) constitutes nearly half of all heart failure cases, understanding its management and the influence of various factors on patient outcomes is essential. This study seeks to evaluate the outcomes of chronic opioid therapy in patients with HFpEF. Utilizing the National Inpatient Sample (2016-2020), adult HFpEF patients were identified using the appropriate International Classification of Diseases, Tenth Revision codes, excluding those with end-stage renal disease. Outcomes were compared between chronic opioid users and nonusers. Multivariate logistic and linear regression analyses were conducted, controlling for various patient and hospital confounders. The primary outcome measured was all-cause in-hospital mortality, with secondary outcomes including acute kidney injury/hemodialysis (AKI/HD), cardiogenic shock, cardiac arrest, mechanical ventilation, length of stay, and total hospital charges. Among 1,557,344 HFpEF patients, 21,655 (1.4 percent) were on chronic opioid therapy. No significant difference in inpatient mortality was found (adjusted odds ratio [aOR] 1.04, 95 percent confidence interval [CI]: 0.88-1.24, p = 0.58). A nonsignificant increase in cardiogenic shock (aOR 1.12, 95 percent CI: 0.85-1.48, p = 0.39) and cardiac arrest (aOR 1.06, 95 percent CI: 0.81-1.38, p = 0.65) was noted in chronic opioid users. However, chronic opioid use was associated with a higher risk of AKI/HD (aOR 1.15, 95 percent CI: 1.07-1.24, p < 0.001) and mechanical ventilation (aOR 1.27, 95 percent CI: 1.14-1.41, p < 0.001). Opioid use was also linked to longer hospital stays (adjusted mean difference [aMD] 1.15 days, 95 percent CI: 0.83-1.47, p < 0.001) and a nonsignificant increase in total charges (aMD USD 3,615, 95 percent CI: USD -1.014 to USD 8,245, p = 0.12). While chronic opioid use in hospitalized HFpEF patients did not significantly affect in-hospital mortality, it was associated with a higher risk of other adverse events and longer hospital stays.

Opioids remain a central element of perioperative pain management despite increased utilization of multimodal adjuvant strategies intended to reduce their use. Contemporary use of methadone and buprenorphine, both conceived as opioid analgesics, is dominated by their essential roles in the treatment of opioid use disorder. Compared to usual care opioids, however, they provide improved post-operative pain control while reducing analgesic requirements. These findings argue for their expanded role within perioperative multimodal analgesia strategies.

Population-based screenings for substance use are highly recommended, but little is known about the screening status of substances in primary care settings (PCSs). This systematic review aims to understand what screening tools are used, the barriers that impact screenings, and the opportunities to improve screenings. Articles focusing on the utilization of screening tools for substance use disorders (SUDs) within PCSs were considered for inclusion. Searches on PubMed and Embase databases were conducted from April 25, 2022, to July 22, 2022, which yielded 487 results; only 32 articles meeting the inclusion and exclusion criteria were included. Among all substances, alcohol was the most frequently screened substance at PCSs, with 20 studies included in this article. This was followed by opioids (n = 11), other illicit drugs (n = 8), cannabis (n = 6), and nicotine (n = 2). The Alcohol Use Disorders Identification Test was the most commonly used screening tool. Most studies utilized different screening tools to screen for the same substances. Identified barriers include no referral to treatment upon positive screenings, lack of training in providing interventions, and no recognition of the effectiveness of intervention services. Our search resulted in only 32 studies focusing on substance screening at PCSs, indicating that substance screening may not be conducted as recommended or formally. Integrating patient-centered SUD screening in PCSs is challenging but could be feasible via implementation strategies to address barriers. Future studies focusing on the feasibility, acceptability, and effectiveness of screening tools in PCSs may increase the screening rates for early identification and intervention for SUDs.

To evaluate the percentage of family medicine providers in our institution on completing the 8-hour required training on opioid and substance use disorders 14 months after introduction of the Medication Access and Training Expansion (MATE) Act and to evaluate buprenorphine prescribing attitudes. An anonymized survey was electronically sent to all family medicine providers in a single institution in Minnesota, spanning five outpatient and two express care clinics. Survey was deployed for 2 weeks, August 26-September 8, 2024. Provider completion of MATE Act training and comfort level in prescribing buprenorphine for opioid use disorder (OUD). A total of 41 out of 127 providers completed the survey (31.5 percent). Although 76 percent respondents completed the training, only half felt comfortable seeing patients with OUD on buprenorphine, writing a bridge prescription, or initiating buprenorphine. Findings suggest that elimination of the x-waiver and enactment of required training are insufficient to positively affect buprenorphine prescribing comfort level.

Opioids are known to come with some relatively benign side effects, not including their addictive potential. This review will look at some of the side effects that occur when patients, especially chronic pain patients, take opioids chronically. These side effects include both hyperalgesia and allodynia caused by opioids. Overdose and factors, including hyperalgesia and allodynia, that make a patient more likely to overdose, is the other topic that will be covered. Not much research has been done with human subjects regarding treatment of opioid induced hyperalgesia or allodynia, but some of this research will also be briefly explored throughout this review.

This study aims to assess the application of opioids for pain control in patients following a cesarean section (CS) at a tertiary referral obstetric hospital. A retrospective cohort audit of CSs in September 2022 was conducted. Medical records were reviewed to capture patient demographics, opioid used, and discharge medications. Medical records of 46 patients were reviewed. Of those, 46 percent (n = 21) had a non-elective lower uterine CS (NELUSCS), 43 percent (n = 20) had an elective lower uterine CS (ELUSCS), and the remainder had a nonelective classical CS (NEClassicalCS). NEClassicalCS had higher total morphine equivalent opioid use with an average of 245.7 mg, compared with 92.4 mg and 60.1 mg for NELUSCS and ELUSCS, respectively. Tramadol was the most common opioid supplied on discharge (85 percent), followed by buprenorphine (17 percent) and oxycodone/naloxone (15 percent). An average discharge medication supply of 3 days was provided. NEClassicalCS procedures had higher use of opioid pain medications. All patients were initiated on opioids post-CS, with 93 percent (n = 43) discharged with at least one opioid.

Opioids pose significant risks of addiction due to the cyclical nature of serum opiate concentration associated with traditional dosing methods. Emerging technologies, including closed-loop feedback control systems, offer a promising solution by enabling dynamic, real-time microdosing that minimizes fluctuations in drug levels and reduces the risk of dependency. Drawing on advancements in biosensors and feedback systems used in other medical applications, these innovations could revolutionize pain management, potentially reducing opioid addiction rates by up to 87 percent compared to current oral administration methods.