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Background State-specific information about hospitalizations of children with birth defects can improve understanding of changes in occurrence, treatment practices, and health care financing policies. This study analyzed aggregated data on hospital charges and length of stay for a large, diverse population. Methods We extracted hospitalization data for children diagnosed with birth defects from the Texas Hospital Inpatient Discharge Public Use Data File (2001−2010). Analyses compared total charges and length of stay for children with and without a diagnosis code of any birth defect among 45 standard categories. We also examined trends for total charges by expected payer type. Results In Texas, 431,296 hospital stays were reported for children with birth defects, with total charges of $24.8 billion. Mean hospital stay for children with birth defects was more than twice that of those without, whereas mean of hospital total charges was approximately six times greater. Pyloric stenosis accounted for the largest number of hospitalizations, followed by certain cardiac defects. Pediatric hospitalizations for birth defects increased 273.7%, compared with a 214.7% increase overall. The percentage of charges with Medicaid as expected payer (2004-2010) ranged from 56.5 to 62.0%. Conclusion Charges associated with these conditions are far greater than those associated with pediatric hospitalizations for other causes, whether in the newborn period or beyond. However, these charges vary depending on specific diagnoses, expected payer source, and year of treatment. Birth Defects Research (Part A) 106:155-163, 2016. © 2015 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

In order to translate research findings into effective prevention strategies, it is important to understand people's beliefs about the causes of poor health outcomes. However, with the exception of knowledge and beliefs about folic acid supplementation, little is known regarding women's causal attributions women regarding birth defects. We employed Attribution Theory constructs to analyze open-text interview responses from 2,672 control mothers in the National Birth Defects Prevention Study who gave birth in 1997-2005. Common themes included use of alcohol, tobacco, illicit drugs, and medications during pregnancy. Stress and emotional upset were also suggested as possible causes of birth defects. Genetic- and heredity-related responses were more likely to be mentioned by Asian/Pacific Islander women compared to non-Hispanic Whites. Hispanic women were less likely to suggest several specific possible teratogens, such as paint, pesticides, or other chemicals, but were more likely to suggest events occurring during childbirth. Differences also emerged among ethnic groups for theoretical constructs, although most responses were categorized as controllable, changeable over time, and with an internal locus of causality. [ABSTRACT FROM AUTHOR]

BACKGROUND Although associations between maternal parity and birth defects have been observed previously, few studies have focused on the possibility that parity is an independent risk factor for birth defects. We investigated the relation between levels of parity and a range of birth defects, adjusting each defect group for the same covariates. METHODS We included infants who had an estimated delivery date between 1997 and 2007 and participated in the National Birth Defects Prevention Study, a multisite case-control study. Cases included infants or fetuses belonging to 38 phenotypes of birth defects (n = 17,908), and controls included infants who were unaffected by a major birth defect (n = 7173). Odds ratios (ORs) were adjusted for 12 covariates using logistic regression. RESULTS Compared with primiparous mothers, nulliparous mothers were more likely to have infants with amniotic band sequence, hydrocephaly, esophageal atresia, hypospadias, limb reduction deficiencies, diaphragmatic hernia, omphalocele, gastroschisis, tetralogy of Fallot, and septal cardiac defects, with significant ORs (1.2 to 2.3). Compared with primiparous mothers, multiparous mothers had a significantly increased risk of omphalocele, with an OR of 1.5, but had significantly decreased risk of hypospadias and limb reduction deficiencies, with ORs of 0.77 and 0.77. CONCLUSIONS Nulliparity was associated with an increased risk of specific phenotypes of birth defects. Most of the phenotypes associated with nulliparity in this study were consistent with those identified by previous studies. Research into biologic or environmental factors that are associated with nulliparity may be helpful in explaining some or all of these associations. Birth Defects Research (Part A), 2012. © 2012 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

1. Describe recent advances in opioid pharmacotherapy including conversion calculations, dosing of "unique" opioids, and prevention and detection of opioid toxicity. 2. Given a simulated patient, select an opioid for pain management in the current era of opioid misuse and abuse, including a patient/family history of substance use disorder. 3. Describe the appropriate use of co-analgesic therapy in conjunction with opioid therapy including duloxetine, gabapentinoids, ketamine, and cannabis. This fast-paced session is not for the faint of heart! This seminar delivers a solid half-day of opioid pharmacotherapy covers three primary themes. The first is results from an international consensus building process on best practices in opioid conversion calculations, and dosing of "unique" opioids (such as levorphanol, and strategies for dosing methadone and buprenorphine). This segment will also include a discussion on advanced in managing opioid adverse effects and drug interactions. The second section addresses the complex situation of opioid selection during an era of opioid misuse and abuse, and specific selection of an opioid for a patient with a past or current history of misuse of controlled or illicit substances. The final act of the afternoon will be the appropriate selection and use of co-analgesics along with opioid therapy including duloxetine gabapentinoids, ketamine and cannabis. There's no WAY anyone practicing in hospice or palliative care should miss this seminar! Buckle your seatbelts – this is going to be a FAST ride!! [ABSTRACT FROM AUTHOR]

Prescription opioids are used for managing pain in persons with cancer, however, there are socioeconomic and racial disparities in medication access. Cannabis is increasingly used for cancer symptom management and as an opioid alternative. Limited data are available about patterns of opioid and cannabis use among patients with cancer. We used survey data from 4 National Cancer Institute-designated cancer centers in 3 states (n = 1220) to assess perceptions, use of cannabis and opioids for pain, their substitution, and racial and ethnic differences in each outcome. Compared with White patients, Black patients were less likely to use opioids for pain (odds ratio [OR] = 0.66; P = .035) and more likely to report that cannabis was more effective than opioids (OR = 2.46; P = .03). Race effects were mitigated (P > .05) after controlling for socioeconomic factors. Further research is needed to understand cannabis and opioid use patterns and how overlapping social determinants of health create a disadvantage in cancer symptom management for Black patients., (© The Author(s) 2024. Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: The psychiatric needs of those with cancer and other advanced illnesses are becoming increasingly recognized. Ketamine is emerging as a promising treatment option for depressive disorders in psychiatric and palliative care. In the palliative care setting, its study has been hindered by lack of consistent administration routes and dosing. Intranasal (IN) esketamine (Spravato ® ) has recently received U.S. Food and Drug Administration (FDA) approval as an adjunctive agent for treatment-resistant depression (TRD) and major depressive disorder (MDD) with suicidal ideation (SI). Objective: We sought to offer IN esketamine to patients suffering from TRD and SI at a comprehensive cancer center. Methods: We designed and implemented a protocol to administer IN esketamine and describe three cases in which it was provided to patients with TRD and SI at a palliative care clinic in the United States. Results: Following treatment, all three patients had substantial reduction in depression severity and no further suicidalideation. These improvements were maintained for up to a year. No serious adverse events occurred. Conclusions: These cases illustrate the potential utility of IN esketamine in the palliative care setting.

Standardizing opioid management is challenging due to the absence of a ceiling dose, the unknown ideal therapeutic plasma level, and the lack of an clear relationship between dose and therapeutic response. Opioid rotation or conversion, which is switching from one opioid, route of administration, or both, to another, to improve therapeutic response and reduce toxicities, occurs in 20-40 percent of patients treated with opioids. Opioid conversion is often needed when there are adverse effects, toxicities, or inability to tolerate a certain opioid formulation. A majority of patients benefit from opioid conversion, leading to improved analgesia and less adverse effects. There are different published ways of converting opioids in the literature. This review of 20 years of literature is centered on opioid conversions and aims to discuss the complexity of converting opioids. We discuss study designs, outcomes and measures, pain phenotypes, patient characteristics, comparisons of equivalent doses between opioids, reconciling conversion ratios between opioids, routes, directional differences, half-lives and metabolites, interindividual variability, and comparison to package insert information. Palliative care specialists have not yet come to a consensus on the ideal opioid equianalgesic table; however, we discuss a recently updated table, based on retrospective evidence, that may serve as a gold standard for practical use in the palliative care population. More robust, well-designed studies are needed to validate and guide future opioid conversion data.

Introduction: The 16-week randomised, placebo-controlled INCREASE trial (RCT) met its primary end-point by improving 6-min walk distance (6MWD) in patients receiving inhaled treprostinil for pulmonary hypertension due to interstitial lung disease (PH-ILD). The open-label extension (OLE) evaluated long-term effects of inhaled treprostinil in PH-ILD., Methods: Of 258 eligible patients, 242 enrolled in the INCREASE OLE and received inhaled treprostinil. Assessments included 6MWD, pulmonary function testing, N-terminal pro-brain natriuretic peptide (NT-proBNP), quality of life and adverse events. Hospitalisations, exacerbations of underlying lung disease and death were recorded., Results: At INCREASE OLE baseline, patients had a median age of 70 years and a mean 6MWD of 274.2 m; 52.1% were male. For the overall population, the mean 6MWD at week 52 was 279.1 m and the mean change from INCREASE RCT baseline was 3.5 m (22.1 m for the prior inhaled treprostinil arm and -19.5 m for the prior placebo arm); the median NT-proBNP decreased from 389 pg·mL -1 at RCT baseline to 359 pg·mL -1 at week 64; and the absolute (% predicted) mean forced vital capacity change from RCT baseline to week 64 was 51 mL (2.8%). Patients who received inhaled treprostinil versus placebo in the RCT had a 31% lower relative risk of exacerbation of underlying lung disease in the OLE (hazard ratio 0.69 (95% CI 0.49-0.97); p=0.03). Adverse events leading to drug discontinuation occurred in 54 (22.3%) patients., Conclusions: These results support the long-term safety and efficacy of inhaled treprostinil in patients with PH-ILD, and are consistent with the results observed in the INCREASE RCT., Competing Interests: Conflict of interest: A. Waxman reports that the present manuscript was funded by United Therapeutics; and reports grants or contracts with payments to his institution from United Therapeutics, Gossamer, Acceleron/Merck, ARIA CV and NIH/NHLBI, patents with Johnson & Johnson, and participation on a data safety monitoring board or advisory board for INSMED. R. Restrepo-Jaramillo reports research grants from Merck, United Therapeutics, Bayer and J&J Actelion, payment of honoraria for speakers bureaus from United Therapeutics, Bayer and J&J Actelion, and participation on advisory boards for Merck, United Therapeutics and Bayer. T. Thenappan reports grants for clinical research studies from United Therapeutics, Tenax Therapeutics, Aria CV and Merck, and consulting fees from United Therapeutics and Acceleron Pharma. P. Engel reports no disclosures. A. Bajwa reports a grant from United Therapeutics for study procedures, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from United Therapeutics, Bayer, Johnson & Johnson, Boehringer Ingelheim, and Intuitive. A. Ravichandran reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from United Therapeutics, Bayer, Abbott, Medtronic and Janssen. J. Feldman reports consulting fees from United Therapeutics, Aerovate, Altavant and Liquidia, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Janssen and United Therapeutics, and participation on a data safety monitoring board or advisory board for Liquidia, Altavant and Aerovate. A. Hajari Case reports that the present manuscript is funded by United Therapeutics; and reports clinical research contracts to institution from United Therapeutics, and serving as Senior Medical Advisor for the Pulmonary Fibrosis Foundation. R.G. Argula reports consulting fees from Liquidia Corporation, United Therapeutics, Merck Pharma Inc., Janssen Inc. and CVS Health, and payment or honoraria for lectures and educational events from United Therapeutics. V. Tapson reports research grants paid to institution from Boston Scientific Corporation, Bristol Myers Squibb and Genentech, speaker and consulting fees from Janssen, fees from Boston Scientific Corporation for participating in an executive committee for a clinical trial, that he serves as President for PE Response Team Consortium (unpaid), owns stock in Thrombolex and Inari Medical, and that he is employed as VP of Medical Affairs at Inari Medical. P. Smith reports that he is an employee of the study sponsor, United Therapeutics. C. Deng and E. Shen report that they are employees of and hold stock in United Therapeutics, the study sponsor. S.D. Nathan reports that the present manuscript is funded by United Therapeutics; and reports consulting fees from United Therapeutics, and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from United Therapeutics., (Copyright ©The authors 2023.)

Chronic obstructive pulmonary disease (COPD) is associated with a progressive course with a variable illness trajectory causing death either from respiratory failure or complications from its comorbities. Palliative care benefits patients throughout all stages of COPD, with a goal to manage patients' symptom burden which can reduce physical, psychological, and social complications. Dyspnea is the most common and distressing symptom patients with end stage COPD experience, which responds only partially to therapy and eventually becomes refractory to routine care. Palliative management goals aim at relieving refractory symptoms, improving function, and enhancing quality of life in patients with advanced illness and high symptom burden. Caregivers and informed patients can utilize palliative care resources to provide effective relief from refractory dyspnea and help patients maintain a dignified quality-of-life until the end of life. This review is focused on identifying current deficiencies in palliative care provided to patients with advanced COPD with attempts to overcome these. We hope to increase awareness of palliative care in advanced COPD to healthcare providers caring for this population of patients.

Background: Oral rapid HIV testing has been reported to have a lower sensitivity and specificity than rapid HIV testing with whole blood and has been associated with clusters of false-positive results. Patient preference for oral rapid HIV testing compared with more invasive whole blood fingerstick may influence the acceptance of rapid HIV testing., Objective: To compare HIV test acceptance rates among patients routinely offered fingerstick compared with those routinely offered oral fluid screening in an urban hospital emergency department., Methods: The Universal Screening for HIV Infection in the Emergency Room Phase II was a single-center, prospective, randomized controlled trial that randomized subjects to either fingerstick or oral rapid HIV screening in an urban academic emergency department. From May 5, 2009, to January 4, 2010, eligible patients aged 18-75 years were invited to participate in the trial. The primary outcome measure was HIV test acceptance rate., Results: : 2012 eligible patients were approached, of whom 1651 (82%) consented to trial participation and enrolled. Among those enrolled, 830 and 821 were randomized to the fingerstick and oral fluid arms, respectively. Acceptance of rapid HIV testing was similar in both arms; 67% (553 of 830) of subjects accepted fingerstick testing compared with 69% (565 of 821) who accepted oral (P = 0.34)., Conclusions: Although fingerstick rapid HIV testing is more invasive than oral fluid testing, test acceptance rates did not differ. Given the option, preference should therefore be given to fingerstick testing because of its slightly superior test characteristics. System factors such as ease of staff use, necessary Clinical Laboratory Improvement Amendments waivers, laboratory capacity, and HIV prevalence should also be considered.