Treating Chronic Pain with Buprenorphine-The Practical Guide.

OPINION STATEMENT: Buprenorphine has unique and favorable pharmacological properties that make it useful in a variety of clinical scenarios. It has been recommended to consider buprenorphine first-line opioid for chronic pain, especially in the elderly as it may be associated with less cognitive impairment, falls, sexual dysfunction, and sarcopenia when compared with schedule II opioids. It may be useful in patients with comorbid substance use disorder or non-medical opioid use, as there is less risk of misuse, euphoria and it may improve mood. When used to treat opioid use disorder, the training and waiver was recently waived for licensed practitioners with a DEA and any provider may prescribe buprenorphine. For many reasons outlined in this article, the popularity of using buprenorphine for analgesia continues to grow and a practitioner should consider this as an excellent and safe option for chronic pain.

Association of Physician Orders for Life-Sustaining Treatment Form Use With End-of-Life Care Quality Metrics in Patients With Cancer.

PURPOSE: Many patients with advanced cancer receive aggressive treatment near the end of life. The Physician Orders for Life-Sustaining Treatment (POLST) form is an innovation that converts patient preferences into medical orders. We compared the end-of-life care of patients with advanced cancer who had completed POLST forms with that of patients who had advance directives (ADs). METHODS: We studied 2,159 West Virginians with ADs and/or POLST forms in the West Virginia e-Directive Registry who died as a result of cancer between January 2011 and February 2016. Data from the Vital Registration Office (date, site, and cause of death) were merged with those from the registry (form type, completion date, and hospice admission). The primary outcome variables were out-of-hospital death (OHD) and hospice admission. RESULTS: The percentage of patients with OHD was 85.7% for patients with POLST forms compared with 72.0% for those with ADs ( P < .001). The odds of OHD for patients with POLST forms were 2.33 times those of patients with ADs. The percentage of patients admitted to hospice was 49.9% for those with POLST forms compared with 27.0% for those with ADs ( P < .001). The odds of being admitted to hospice for patients with POLST forms were 2.69 times those of patients with ADs. CONCLUSION: Advance care planning with completion of POLST forms compared with ADs in patients with advanced cancer was associated with two quality end-of-life care metrics: OHD and hospice admission. Our study suggests that goals-of-care discussions including POLST form completion may improve end-of-life care for patients with advanced cancer.

POST Forms More Than Advance Directives Associated With Out-of-Hospital Death: Insights From a State Registry.

CONTEXT: Patients' end-of-life care outcomes often do not reflect their preferences. Ninety-two percent of West Virginians prefer to die outside the hospital, yet only 58.8% do. OBJECTIVES: To compare out-of-hospital death (OHD) between those with completed advance directive (AD) and Physician Orders for Scope of Treatment (POST) forms. METHODS: This was a retrospective cohort study of 2027 West Virginians who submitted AD and/or POST forms to the West Virginia e-Directive Registry and died between October 1, 2010 and December 31, 2013. A multivariable logistic regression model examined the relationship between OHD by form type while adjusting for age and enrollment in hospice. RESULTS: Patients who completed an AD were significantly less likely to have an OHD (56.9%) than those who completed a POST form with comfort measures orders or a POST form with limited/full intervention orders (88.4% and 75.9%, respectively, P < 0.001). The odds of OHD were significantly higher for patients with POST forms with comfort measures orders than for those with ADs (OR 4.239, P < 0.001). CONCLUSION: A prospective study is needed to validate that a statewide POST program and registry provide a more effective way than ADs to express, document, and honor patients' preferences for an OHD.

Sleep quality and sleep problems in Mexican Americans aged 75 and older.

BACKGROUND AND AIMS: Sleep complaints and poor sleep quality are common in the elderly population. The aim of this study was to determine factors associated with sleep complaints and poor sleep quality among older Mexican Americans over a 3-year period. METHODS: One thousand eighty-five non-institutionalized Mexican American aged 75 years and older. Sociodemographic characteristics, medical conditions, depressive symptoms, disability cognitive impairment, body mass index, sleep problems (trouble falling asleep, waking up several times per night, trouble staying asleep and awaking not rested) and overall sleep quality were obtained. RESULTS: Of 1085 participants, 12.6% reported trouble falling asleep, 30% waking up several times per night, 11.4 % trouble staying asleep, 9.4% awaking not rested and 16.6% poor sleep quality. Depressive symptoms and heart attack predicted trouble falling asleep; diabetes, cancer and obesity predicted waking up several times per night; diabetes, hypertension, cancer and depressive symptoms predicted both trouble staying asleep and awaking not rested. Being female, married, heart attack and depressive symptoms were associated with poor quality sleep. CONCLUSIONS: Different risk factors were associated with different aspects of sleep complaints. Since poor sleep has been linked to poor outcomes, a good understanding of these factors may help in designing interventions to improve sleep quality in this population.