Male with Altered Mental Status.

CASE PRESENTATION: A 62-year-old male presented to the emergency department with altered mental status and fever. Computed tomography of the head showed enlargement of the left lateral ventricle. Magnetic resonance imaging demonstrated debris and purulence in the ventricle along with edema and transependymal flow of cerebrospinal fluid surrounding both ventricles. DISCUSSION: The patient was diagnosed with ventriculitis. Ventriculitis is an uncommon but serious disease. Early recognition and treatment are essential.

Effect of New York State Electronic Prescribing Mandate on Opioid Prescribing Patterns.

BACKGROUND: Drug overdose was the leading cause of injury and death in 2013, with drug misuse and abuse causing approximately 2.5 million emergency department (ED) visits in 2011. The Electronic Prescriptions for Controlled Substances (EPCS) program was created with the goal of decreasing rates of prescription opioid addiction, abuse, diversion, and death by making it more difficult to "doctor-shop" and alter prescriptions. OBJECTIVE: In this study, we describe the opioid-prescribing patterns of emergency physicians after the introduction of the New York State EPCS mandate. METHODS: We conducted a retrospective, single-center, descriptive study with a pre-/post-test design. The pre-implementation period used for comparison was April 1-July 31, 2015 and the post-implementation period was April 1-July 31, 2016. All ED discharge prescriptions for opioid medications prior to and after the initiation of New York State EPCS were identified. RESULTS: During the pre-implementation study period, 22,221 patient visits were identified with 1366 patients receiving an opioid prescription. During the post-implementation study period, 22,405 patient visits were identified with 642 patients receiving an opioid prescription. This represented an absolute decrease of 724 (53%) opioid prescriptions (p < 0.0001), which is an absolute difference of 2.3% (95% confidence interval 2.0-2.6%). CONCLUSIONS: There was a significant decline in the overall number of opioid prescriptions after implementation of the New York EPCS mandate.