Maternal opioid use disorder at delivery hospitalization in a rural state: Maine, 2009-2018.

OBJECTIVES: A multistate analysis found Maine had the second highest average annual increase in maternal opioid use disorder (OUD) at delivery hospitalization during 1999-2012. The objective of our analysis was to estimate the prevalence, maternal characteristics, and geographic distribution of OUD at delivery hospitalization in Maine using recent state-level data. STUDY DESIGN: Serially collected cross-sectional population-based data. METHODS: We used diagnosis and procedure codes to identify deliveries among hospital discharges in Maine, 2009-2018 (n = 120,764), and to categorize deliveries according to the prevalence of maternal OUD and selected conditions. We assessed linear trends in OUD at delivery and calculated prevalence ratios (PR) for co-occurring maternal conditions. RESULTS: The prevalence of maternal OUD per 1000 deliveries in Maine increased from 22.7 in 2009 to 34.9 in 2018 (linear trend P value < 0.01), with a mean annual increase of 1.6 (95% confidence interval [CI]: 0.9 to 2.4). The following conditions were more prevalent among women with OUD at delivery: hepatitis C, PR = 45.8 (95% CI: 38.8 to 54.2); other drug abuse or dependence, PR = 16.8 (13.4 to 20.9); alcohol abuse and dependence, PR = 8.5 (5.8 to 12.5); nicotine use, PR = 6.0 (5.9 to 6.2); cannabis use, PR = 5.2 (4.6 to 5.9); anxiety, PR = 2.7 (2.5 to 3.2); and depression, PR = 2.7 (2.4 to 3.1). Women with OUD at delivery were also more likely to reside in small rural areas (27.3% vs 22.5%) and deliver in a hospital with a level III nursery (50.6% vs 34.9%). CONCLUSIONS: Maternal OUD now accounts for 1 in 29 deliveries in Maine and commonly occurs with other medical conditions. Prevention and treatment of OUD among reproductive age women in Maine remains needed.

Internal medicine fellowship directors' perspectives on the quality and utility of letters conforming to residency program director letter of recommendation guidelines.

Background: In May 2017, the Alliance for Academic Internal Medicine (AAIM) published guidelines intending to standardize and improve internal medicine residency program director (PD) letters of recommendation (LORs) for fellowship applicants. Objectives: This study aimed to examine fellowship PDs impressions of the new guidelines, letter writers' adherence to the guidelines, and the impact of LORs that conformed to guidelines compared to non-standardized letters. Methods: The authors anonymously surveyed fellowship PDs from January to March 2018 to gather input about LORs submitted to their programs during the 2017 fellowship application cycle. Results: A total of 78% of survey respondents were satisfied with letters that followed the AAIM guidelines, whereas 48% of respondents were satisfied with letters that did not. Fellowship PDs felt that letters that followed the AAIM guidelines were more helpful than letters that did not, especially for differentiating between applicants from the same institution and for understanding residents' performance across the six core competency domains. Fellowship PDs provided several suggestions for residency PDs to make the LORs even more helpful. Conclusion: Fellowship PD respondents indicated that LORs that followed the new AAIM guidelines were more helpful than letters that did not.

Sensory nerves only temporarily protect the unstable canine knee joint from osteoarthritis. Evidence that sensory nerves reprogram the central nervous system after cruciate ligament transection.

OBJECTIVE: The slow rate at which articular cartilage degrades in dogs after transection of the anterior cruciate ligament (ACLT) has been attributed to capsular thickening and buttressing by osteophytes. We investigated the roles of the peripheral and central nervous systems in protecting knee joints with chronic ACL deficiency from breakdown. METHODS: Five groups of dogs were studied; all were killed 72 weeks after left knee surgery. Group A had ACLT, group B had ACLT followed 52 weeks later by ipsilateral L4-S1 dorsal root ganglionectomy (DRG), group C had DRG followed 2 weeks later by ACLT, group D had sham DRG followed 2 weeks later by ACLT, and group E had DRG followed 2 weeks later by sham ACTL. RESULTS: Group E dogs did not develop knee pathology. All cruciate-deficient knees were lax at the end of the study. The osteoarthritis (OA) that developed in groups A, B, and D was comparable (P > 0.05), and was significantly greater than that in group E (P < 0.05). Group C developed much more severe OA than any of the other groups (P < 0.05). CONCLUSION: Ipsilateral sensory input is temporarily important in protecting the unstable joint from rapid breakdown. Over time, the central nervous system apparently acquires the ability to protect the unstable joint without continued ipsilateral sensory input.

Reasons nurses participate in continuing education.

The study was undertaken to identify dimensions, or motivational orientations that underlie reasons nurses participate in continuing education programs and to determine relationships between these orientations and the legal status of CE and selected demographic characteristics of participants. The sample included 843 nurses who participated in CE programs sponsored by colleges and universities with accredited baccalaureate schools of nursing. Two instruments were used for data collection: a 56-item checklist consisting of reasons for participation (Education Participation Scale) and a personal data sheet. Factor analysis of responses to the EPS indicated that seven motivational orientations underlay the nurses' reasons for participation: compliance with authority, improvement in social relations, improvement in social welfare skills, professional advancement, professional knowledge, relief from routine, and acquisition of credentials. Mean scores on each orientation for the entire sample ranged from 6.55 (professional knowledge) to 1.57 (improvement in social relations) on a 10-point scale. Analysis of variance to determine the relationship between motivational orientation scores and legal status of continuing nursing education revealed no differences among the three legal conditions studied---mandatory, proposed, and voluntary CE---except on the acquisition of credentials orientation. Scores on this orientation varied significantly (p less than .001), but only for respondents employed part-time; for these nurses mean scores were ranked mandatory, proposed, then voluntary. Study findings suggest that, for these nurses, the presence or threat of a mandatory CE law had little influence in motivating participation. Rather, these nurses participated in continuing nursing education programs for reasons related to maintaining professional currency and improving their ability to serve the public.