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Background: The evolving conceptualization of the management of surgical pain was a major contributor to the supply of narcotics that led to the opioid crisis. We designed and implemented a breast surgery-specific Enhanced Recovery After Surgery (ERAS) protocol using opioid-sparing techniques to eliminate narcotic prescription at discharge without sacrificing perioperative pain control.Methods: A pilot observational study included patients with and without cancer undergoing lumpectomy. The convenience sample consisted of an ERAS group and a control usual care (UC) group who underwent surgery during the same time period. Discharge narcotic prescriptions were compared after converting to oral morphine milligram equivalents (MME’s). Postoperative day one and week one pain scores were also compared between the two groups.Results: Ninety ERAS and 67 UC patients were enrolled. Most lumpectomies were wire-localized, and half of the patients in each group had breast cancer. There were more obese patients in the ERAS group. UC lumpectomy patients were discharged with a median of 54.5 MMEs (range 0-120), while the ERAS lumpectomy patients were discharged with none (p < 0.001). Postoperative pain scores were not significantly different between groups, and there were few complications.Conclusion: A breast surgery-specific ERAS protocol employing opioid-sparing techniques successfully eliminated postoperative narcotic prescription without sacrificing perioperative pain control or increasing postoperative complications. By promoting the adoption of similar protocols, surgeons can continue to improve patient outcomes while decreasing the quantity of narcotics available for diversion within our patients’ communities. [ABSTRACT FROM AUTHOR]

Aims: To determine if measures of drug use risk, sexual risk, external norms and internalized norms developed for impoverished neighbourhoods of New York are usable in similar neighbourhoods of Buenos Aires and have similar associations with each other in the two cities despite the many cultural, social, economic and political differences between these localities. Methods: In 2003–2004, 240 current non-injection drug users (IDUs) and 63 current IDUs, aged 21–35 years, were interviewed in poor neighbourhoods of the Southern Metropolitan Area of Buenos Aires about their drug use, sexual behaviours, internalized norms and external norms (actual and perceived social pressures from others) using measures developed in New York (Flom, Friedman, Benny, & Curtis, 2001a, Flom, et al., 2001b; Flom, Friedman, Jose, Neaigus, & Curtis, 2001c). Analyses studied associations between a hierarchical scale of drug use risk and the other variables. Results: The hierarchical risk scale of drug use was associated with sexual risk behaviours; with external norms towards drug injection and sex with drug injectors, and internalized norms about social distance from drug injectors. Conclusions: The hierarchical drug use risk scale and the measures of external norms had relationships similar to those found in the earlier studies in New York City. This supports the ideas that these measures may have a degree of cross-cultural applicability. [ABSTRACT FROM AUTHOR]

Background: The incidence of new-onset diabetes after initiation of hemodialysis (NODAD) and its impact on survival is not known. Methods: We used data from the United States Renal Data System (USRDS) from January 2000 to December 2001, with at least 3 years of follow-up for this study. Patients aged 18–80 years were included. NODAD was defined as two Medicare institutional claims for diabetes in patients with no history of diabetes prior to starting hemodialysis (HD). Incidence (per 1,000 patient-years), prevalence (%) and hazard ratios for mortality in patients with NODAD were calculated. Results: There were 59,340 incident patients with no history of diabetes prior to starting HD, of which 3,853 met criteria for NODAD. The overall incidence and prevalence of NODAD were 20 per 1,000 patient-years and 7.6%, respectively. In a cohort of 444 patients without diabetes and documented glycosylated hemoglobin A1c, <6% prior to starting HD (from January 2005 and March 2006), at a mean follow-up of 4.7 ± 2.6 months, 6.8% developed NODAD defined by two Medicare claims for diabetes after initiation of HD. NODAD was associated with a significantly increased risk of death as compared to non-diabetes patients (hazard ratio 1.20, 95% confidence interval 1.14–1.25). Conclusion: The USRDS showed a high incidence of NODAD, associated with significantly higher mortality compared to those who did not develop NODAD. The mechanism of NODAD needs to be explored further in experimental and clinical studies. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective Divergent findings among prior studies on correlates of risk for postictal psychosis (PIP) suggest the value of a controlled study involving a relatively large number of patients. Methods The study population consisted of a consecutive series of 59 patients with partial epilepsy and a history of PIP, and 94 control patients with partial epilepsy and no history of PIP evaluated as inpatients with video-electroencephalography. The groups did not differ significantly regarding demographic features. Exact tests yielded a subset of variables and a tentative interpretation that were evaluated further utilizing principal components analysis and logistic regression. Results PIP was associated with extratemporal versus temporal ( p = 0.036) or undetermined ( p = 0.001) localization of seizure onset, bilateral interictal epileptiform activity ( p = 0.017), secondary generalization ( p = 0.049), and history of encephalitis ( p = 0.018). Interictal slow activity was more frequently absent in control patients ( p = 0.045). PIP was associated with family histories of psychiatric disorders ( p = 0.007) and epilepsy ( p = 0.042), which themselves were significantly intercorrelated ( r = 0.225; p = 0.006). Age of onset or duration of epilepsy and lateralized electroencephalographic or magnetic resonance imaging asymmetries did not differ significantly between control and PIP groups. The analysis indicated four underlying domains of risk for PIP: ambiguous/extratemporal localization, family neuropsychiatric history, abnormal interictal electroencephalographic activity, and encephalitis. Each unit increase on a simple additive scale composed of 9 dichotomous independent variables multiplied the odds ratio for PIP by 1.71 (95% confidence interval, 1.36-2.15; p < 0.0001). Interpretation PIP in partial epilepsy is associated with relatively broadly and bilaterally distributed epileptogenic networks, genetic determinants of psychiatric disorders and seizures, and encephalitis. Ann Neurol 2008;63:602-610 [ABSTRACT FROM AUTHOR]

Background: Sex risks and drug use are related. This relation in youth is described.Goal: To determine how stigmatized drug use is related to sexual risk behaviors and network characteristics among youth.Study Design: In-person interviews were conducted with both a probability household sample (n = 363) and a targeted, street-recruited sample of cocaine, heroin, crack, or injected drug users (n - 165) comprising 18- to 24-year-olds in an inner city neighborhood. Drug use in the preceding 12 months was scaled hierarchically, lowest to highest social stigma, as none, marijuana, noninjected cocaine, noninjected heroin, crack, and injected drugs.Results: Users of the more stigmatized drugs had more sex partners. They were more likely to report a history of concurrent sex partners, sex with someone who also had engaged in sex with a network member, commercial sex work, and unprotected sex. Findings showed crack use and drug injection to be associated more strongly with increased sex risk among women than among men.Conclusions: Young users of the more stigmatized drugs are at much greater network and behavior risk for sexually transmitted diseases. Drug use prevention, harm reduction interventions, or both may lower this risk. [ABSTRACT FROM AUTHOR]

Aims: To describe, illustrate, and assess the reliability and construct validity of a method for assessing peer norms regarding drug use and selling. Design and participants: Face-to-face interviews of young adults (age 18-24) selected through multi-stage probability sampling in a low-income, high drug use, urban environment. Measurements: Subjects reported what proportion of their close friends actually encouraged them to use specific drugs, or would have objected to such use, currently and at age 15. Findings: Self-reports of peer norms are highly reliable, and have considerable construct validity in predicting drug behaviors. There is little encouragement of drug use, and substantial objection to use of drugs other than marijuana. While few subjects had many friends who encouraged them to sell drugs, about a third of the subjects said few if any of their friends would object to their selling drugs. Objection to drug use is more common, and encouragement of drug use less common, among women's peers than among men's peers. Conclusions: These items can be used to reliably and validly assess young adults' peer norms regarding drug use. Men and women report different peer norms. [ABSTRACT FROM AUTHOR]

We investigated the relationship between the drug use norms of young adults' peers (recalled from age 15) and subject's drug use in the past 12 months. Subjects included two samples of 18-24 year olds from a low income, minority neighborhood in New York City: A probabilistically selected household sample, and a targeted sample of users of cocaine, heroin, crack or injected drugs. Norms varied by drug, and were least negative for marijuana, and increasingly negative for cocaine, heroin, crack, and injected drugs. We found a strong relationship between recalled norms and current use both for individual drugs and for a hierarchically defined level of drug use; this relationship remained significant after controlling for sociodemographics and parental and sibling drug use. Intervention programs for young teens that influence peer selection and norms of groups of adolescents should be developed and tested. Research is needed on the social, economic, political, and other determinants of norms in their neighborhood contexts. [ABSTRACT FROM AUTHOR]

Abstract: This systematic review examined the evidence on the prevalence of the Hepatitis C Virus (HCV) in non-injecting drug users (NIDUs) who sniff, smoke or snort drugs such as heroin, cocaine, crack or methamphetamine. The search included studies published from January 1989 to January 2006. Twenty-eight eligible studies were identified and the prevalence of HCV in these NIDU populations ranged from 2.3 to 35.3%. There was substantial variation in study focus and in the quality of the NIDU data presented in the studies. The results of our systematic review suggested that there are important gaps in the research of HCV in NIDUs. We identified a problem of study focus; much of the research did not aim to study HCV in users of non-injection drugs. Instead, NIDUs were typically included as a secondary research concern, with a principal focus on the problem of transmission of HCV in IDU populations. Despite methodological issues, HCV prevalence in this population is much higher than in a non-drug using population, even though some IDUs might have inadvertently been included in the NIDU samples. These studies point to a real problem of HCV in NIDU populations, but the causal pathway to infection remains unclear. [Copyright &y& Elsevier]