Modifying emergency department electronic prescribing for outpatient opioid analgesia.

OBJECTIVES: The aim of this study was to examine how changing the electronic ordering sequences for opioid analgesics affected ED outpatient prescribing, and subsequent unused opioid tablets remaining in the community available for diversion. METHODS: A descriptive before and after study in adult patients prescribed an opioid analgesic by an ED prescriber for use in the outpatient setting. The hospital electronic prescribing system (FirstNet™) was modified to include smaller quantities of opioid analgesics for discharge. The change in quantity of opioid prescribed and change in quantity of opioid analgesic remaining in the community at follow up was measured pre- and post-intervention using a structured telephone interview. RESULTS: Pre- and post-intervention, 102 and 106 patients were interviewed, respectively. Percentage of prescriptions for oxycodone quantity five tablets increased from 3% to 32% and for quantity 20 tablets fell from 40% to 24% post-intervention. For paracetamol with codeine, prescriptions for quantity 10 tablets increased from 2% to 24% while for quantity 20 tablets fell from 98% to 76%. Mean number of tablets prescribed per patient fell from 13.8 (SD = 5.1) to 10.8 (SD = 5.6) for oxycodone and from 19.8 (SD = 1.5) to 17.6 (SD = 4.2) for paracetamol with codeine. Fifty-eight percent of patients in both pre- and post-intervention groups used half or less of the medication prescribed. CONCLUSION: Modification of an ED electronic prescribing system reduced overall quantities of opioid analgesics supplied and subsequently stored in the community but did not change the proportion of patients (>50%) who reported using half or less of their prescribed opioid medication.

High dietary taurine reduces apoptosis and atherosclerosis in the left main coronary artery: association with reduced CCAAT/enhancer binding protein homologous protein and total plasma homocysteine but not lipidemia.

We sought to determine whether taurine could specifically protect against coronary artery disease during an atherogenic diet and whether taurine affects the lipid profile, metabolites of methionine, and endothelial atherogenic systems. Rabbits were fed one of the following diets for 4 weeks: (1) control diet; (2) 0.5% cholesterol+1.0% methionine; or (3) 0.5% cholesterol+1.0% methionine+2.5% taurine. Endothelial function was examined, and the left main coronary artery atherosclerosis was quantified by stereology and semiquantitative immunohistochemistry to determine the endothelial expression of proteins related to the NO, renin-angiotensin, endoplasmic reticulum, and oxidative stress systems, as well as apoptosis. Taurine normalized hyperhomocysteinemia (P<0.05) and significantly reduced hypermethioninemia (P<0.05) but not lipidemia. The intima:media ratio was reduced by 28% (P=0.034), and atherosclerosis was reduced by 64% (P=0.012) and endothelial cell apoptosis by 30% (P<0.01). Endothelial cell CCAAT/enhancer binding protein homologous protein was normalized (P<0.05). Taurine failed to improve hyperlipidemia, endothelial function, or endothelial proteins related to the NO, renin-angiotensin, and oxidative stress systems. Taurine reduces left main coronary artery wall pathology associated with decreased plasma total homocysteine, methionine, apoptosis, and normalization of CCAAT/enhancer binding protein homologous protein. These results elucidate the antiapoptotic and antiatherogenic properties of taurine, possibly via normalization of endoplasmic reticulum stress.