Preoperative and Postoperative Opioid Prescription Rates in the Total Hip Replacement Surgical Patient.

The United States is facing an opioid epidemic that has only worsened with the COVID-19 pandemic. There is little evidence regarding patterns of opioid use among patients with total hip replacement (THR). Although the Centers for Disease Control and Prevention has put forward guidelines for prescribing opioids, it does not include guidance specifically for THR patients suffering from presurgical and postsurgical pain. The purpose of this study was to (1) compare presurgical and postsurgical opioid rates, (2) compare presurgical and postsurgical morphine milligram equivalents (MME), and (3) determine whether having a presurgical opioid prescription predicts the receipt of postsurgical opioid prescriptions among patients undergoing THR surgery. Retrospective cohort analysis of 4,405 patients undergoing THR at a major academic medical center in the United States from April 30, 2015, to April 30, 2018, was done. Patient characteristics, opioid rates, and average MME/day/person were described. Logistic regression was used to determine whether presurgical opioid prescription and opioid risk level predicted postsurgical opioid prescribing. Median age was 64 years (range = 18-85 years); patients were primarily Caucasian/White (78.8%) and female (54.7%). Opioid prescription rates in this sample for the 12-month presurgical and postsurgical periods were 66.1% and 95.6%, respectively. Oxycodone was the most common opioid prescribed in both periods. Among those prescribed an opioid, moderate/high risk for overdose and/or death was 6.3% presurgery and 19.8% postsurgery. Patients with a comorbidity were two times more likely to receive an opioid prescription in the postsurgical period. The median average MME/day/person was 26.5 (range = 0.3-180.0) for patients with an opioid prescribed during the presurgery period and 40.4 (range = 1.5-270.0) during the postsurgery period. Opioid use, regardless of strength, in the presurgical period as well as having one or more comorbidities predicted opioid use in the postsurgical period.

The Anatomy Training Program: Mentoring the trainee through engagement in virtual curriculum and resource review

Introduction The Anatomy Training Program (ATP), co-sponsored by the Anatomical Society and American Association of Anatomy, is a program designed to train faculty and postdoctoral students in a structured, mentored experience with the goal of reaching proficiency to teach Gross Anatomy. The ATP has outlined specific training objectives;however, there is minimal guidance on the specific implementation of the objectives presumably to allow for differences in training environments. Mentorship requires a significant time investment, therefore designing an experience that is mutually beneficial for the mentor and trainee is critical to ensuring engagement and success. Additionally, in consideration of the unanticipated shift in education to a virtual format due to COVID-19, a critical review of virtual didactic content is essential to ensuring student learners are given the same, high-quality curricular content. Therefore, we suggest three areas of anatomy curriculum review, 1) appraisal of course design, 2) resource optimization, and 3) assessment development, that if appropriately aligned with ATP learning objectives, can enhance the experience of the trainee, align with quality improvement of anatomy pedagogy for the mentor, and result in an improved student engagement within a hybrid course model. Methods In consideration of the ATP objectives, we engaged in structured learning events performing an appraisal of course materials, critically assessing student learning resources and developing learning assessments, in a mentor-guided approach, that included the integration of Bloom's Taxonomy. Results Prior to starting the ATP, we created an intentional plan for curriculum review informed by the trainee's perspective and needs of the mentor in the following three areas: Appraisal of course design The trainee engaged in a critical review of pre-recorded didactic lectures and assessed for the saliency of information and resources. Resource optimization There has been an exponential increase in the availability of resources for learning and teaching anatomy, however, all resources are not equally suited for teaching anatomy for medical professionals. The mentor and trainee worked together to optimize the dissection guide for a 10-week Doctor of Physical Therapy program. This allowed for better alignment of dissection content and addition of virtual learning resources to improve the clinical context of dissection for students. Assessment The trainee created assessment questions, using Bloom's taxonomy, in order to ensure that the exam questions aligned with the rigor of the curriculum and expected outcomes. Conclusion & Significance The ATP does not state course design, resource optimization, and assessment development as the explicit goals of the program. However, in the context of the objectives, it does appear that a ?hidden curriculum? within the program can be mutually beneficial if the Mentor-Trainee partnership makes an intentional effort to align the goals of the ATP with mentor needs for course quality improvement.