Impact of an Australian/New Zealand organisational position statement on extended-release opioid prescribing among surgical inpatients: a dual centre before-and-after study.

Extended-release opioids are often prescribed to manage postoperative pain despite being difficult to titrate to analgesic requirements and their association with long-term opioid use. An Australian/New Zealand organisational position statement released in March 2018 recommended avoiding extended-release opioid prescribing for acute pain. This study aimed to evaluate the impact of this organisational position statement on extended-release opioid prescribing among surgical inpatients. Secondary objectives included predictors and clinical outcomes of prescribing extended-release opioids among surgical inpatients. We conducted a retrospective, dual centre, 11-month before-and-after study and time-series analysis by utilising electronic medical records from two teaching hospitals in Sydney, Australia. The primary outcome was the proportion of patients prescribed an extended-release opioid. For surgical patients prescribed any opioid (n = 16,284), extended-release opioid prescribing decreased after the release of the position statement (38.4% before vs. 26.6% after, p < 0.001), primarily driven by a reduction in extended-release oxycodone (31.1% before vs. 14.1% after, p < 0.001). There was a 23% immediate decline in extended-release opioid prescribing after the position statement release (p < 0.001), followed by an additional 0.2% decline per month in the following months. Multivariable regression showed that the release of the position statement was associated with a decrease in extended-release opioid prescribing (OR 0.54, 95%CI 0.50-0.58). Extended-release opioid prescribing was also associated with increased incidence of opioid-related adverse events (OR 1.52, 95%CI 1.35-1.71); length of stay (RR 1.44, 95%CI 1.39-1.51); and 28-day re-admission (OR 1.26, 95%CI 1.12-1.41). Overall, a reduction in extended-release opioid prescribing was observed in surgical inpatients following position statement release.

Clinical and parasitological aspects on human scabies in Qualyobia Governorate, Egypt.

In the last decade, human scabies caused by Sarcoptes scabiei and other non human strains is one of the most common contagious parasitic disease. Over a period of one year (June 1991--May 1992), a total of 200 scabietic patients were diagnosed in the outpatients' clinic of Dermatology and Venereology, Benha University Hospitals. They were 120 females and 80 males (sex ratio = 1.5:1). Their ages ranged between three months up to 70 years old. Most of the patients were parasitologically positive (160 or 80%). The most common signs and symptoms were itching, skin burrows, scratch markings, papules and pustules. Regional lymphadenitis was sometimes present as well as fever in patients with secondary bacterial infection. The most affected sites were the abdomen (100%), followed by the buttocks (81.3%), the thigh (50%), legs (50%) and the arms and web spaces (62.5%). The male external genitalia was infested in 60% and the female breast was infested in 72.7%. The sex and site distribution of the infestations were attributed to the risk factor of exposure to infestation. The patients were successfully treated with 5% sulfur precipitate and 2-5% permethrin. The whole results were discussed on the light of the previous work.