ABSTRACT
OBJECTIVE: This study aims to determine if adoption of a user-friendly algorithm for individualized opioid prescribing at discharge would decrease the number of opioids prescribed after cesarean delivery. STUDY DESIGN: As part of a quality initiative, we developed and implemented an algorithm for opioid prescribing at discharge for patients after cesarean delivery. The intervention group comprised patients delivering by cesarean in the 6 months following initiation of the intervention. The intervention group was divided into three groups based on inpatient opioid needs 24 to 48 hours after delivery. Oxycodone tablets were prescribed at discharge based on inpatient group. The control group comprised patients delivering at the same institution in the 6 months prior to initiation of the intervention. The primary outcome was number of oxycodone tablets prescribed at discharge. The secondary outcome was the proportion of patients with a pain-related encounter or additional oxycodone prescription up to 6 weeks after delivery. RESULTS: From July to December 2020, a total of 382 subjects met criteria for the intervention. The comparison group consisted of 391 subjects discharged from January to June 30, 2020, after cesarean. Baseline characteristics and inpatient opioid use 24 to 48 hours after delivery did not differ between the groups. Compared with the control group, subjects in the intervention group had fewer oxycodone tablets prescribed at discharge (11.1 vs. 15.8, p < 0.001). The number of pain-related encounters within 6 weeks of delivery did not differ between the intervention and comparison groups (10.5 vs. 10.3%, p = 0.82). There was no increase in the additional number of oxycodone prescriptions after discharge (4.7% in the intervention group vs. 4.3% in the control group, p = 0.81). CONCLUSION: Discharge opioid prescribing based on inpatient use after cesarean reduces the number of opioids prescribed without increasing the number of pain-related encounters after discharge. A simple algorithm may ensure compliance from prescribers. KEY POINTS: · Previous research has shown that most opioids prescribed after cesarean delivery are unused after discharge. We implemented an algorithm for opioid discharge prescribing after cesarean delivery based on inpatient opioid consumption.. · Implementing an individualized approach to opioid prescribing reduced the number of tablets prescribed at discharge after cesarean delivery. The decrease in discharge prescribing did not correspond to an increase in pain-related encounters or additional narcotic prescriptions in the 6 weeks following delivery.. · The overprescription of opioids at discharge after cesarean delivery is well-established, and previous authors have found success in prescribing opioids at discharge based on inpatient use. Our study proposes a simple, reproducible algorithm for opioid prescribing at discharge after cesarean..
ABSTRACT
BACKGROUND: Ovarian cancer is one of the deadliest cancers in women. Improved preventative, diagnostic, and therapeutic strategies are needed. Certain dietary patterns and nutrients such as vitamin D and omega-3 fatty acids are associated with reduced cancer risk, but their effects on ovarian cancer remain to be fully elucidated, and their combined effects have not been explored. AIM: To determine the individual and combined effects of the active vitamin D metabolite, calcitriol, and the omega-3 fatty acid, docosahexaenoic acid, on cell growth, and the abundance of the vitamin D receptor (VDR), proteins that modulate cell cycle progression, and apoptotic markers. METHODS: OVCAR4 cells, a model of ovarian cancer, were treated with calcitriol, and docosahexaenoic acid, either alone or in combination. Effects on cell growth were determined by the sulforhodamine B assay. Changes in VDR, the cell cycle promotor c-Myc, the cell cycle inhibitor p27 and cleaved PARP, were determined by Western blotting. RESULTS: While OVCAR4 cell growth was inhibited by individual treatment with either calcitriol or docosahexaenoic acid, the combined treatment revealed enhanced growth inhibition as compared to either treatment alone. Furthermore, long-term treatment (12 days) yielded stronger growth inhibition at lower concentrations as compared to short-term treatments (3 days). Accompanying this growth inhibition was a decrease in c-Myc, and an increase in p27. CONCLUSIONS: The observed reduction in cell growth mediated by calcitriol and docosahexaenoic acid highlights the need for further research utilizing these nutrients, alone and especially in combination, to support ovarian cancer prevention and treatment.
ABSTRACT
Kershner, AL, Fry, AC, and Cabarkapa, D. Effect of internal vs. external focus of attention instructions on countermovement jump variables in NCAA Division I student-athletes. J Strength Cond Res XX(X): 000-000, 2019-The purpose of this study was compare the effect of internal and external focus of attention instructions on force-time characteristics of the countermovement jump (CMJ) in collegiate student-athletes. Forty-three resistance-trained men ((Equation is included in full-text article.)± SD; age = 20 ± 1.5 years) on an NCAA Division I baseball team volunteered to participate in this study. Each participant performed a total of 16 CMJs on a force platform while holding a wooden dowel on their shoulders to eliminate arm swing. Force and power parameters such as jump height (JH), peak velocity (PV), and mean concentric velocity (MCV) were calculated from force-time and position data. Paired-sample t-tests and Cohen's d effect sizes were used to examine differences between conditions. When subjects were instructed using an external focus, they demonstrated significantly (p < 0.05) greater JH, PV, and MCV compared with jumps performed with the internal focus (external JH = 48.0 ± 5.6 cm, internal JH = 46.4 ± 5.4 cm; external PV = 3.6 ± 0.3 m·s, internal PV = 3.5 ± 0.3 m·s; and external MCV = 2.31 ± 0.22 m·s, internal MCV = 2.25 ± 0.23 m·s). It is interesting to note that there was superior recall of the internal instructions during the manipulation checks that may suggest that the subjects consciously processed these instructions to a greater extent and reduced internal condition performance. These results indicate that instructions can alter the efficiency and performance of a skill. According to the literature and this study, if an optimum performance metric is desired, external focus of attention instructions should be used.
