Predictors and Characteristics of Opioid Utilization >15 Days Following Total Knee Arthroplasty.

Background: America is amid an opioid epidemic, best characterized by liberal prescribing practices; widespread opioid misuse, abuse, and diversion; and rising rates of prescription-related opioid overdose. While many contributors to opioid overprescribing exist, orthopedic surgery is identified as a key driver. The purpose of this study is to determine predictors of ongoing opioid use >15 days post-total knee arthroplasty (TKA) and those patients prescribed >1350 morphine milligram equivalents (MMEs) in the 15 days following surgery.

Bilateral Total Knee Arthroplasty: Predictors of Discharge Disposition.

Background: Total knee arthroplasty is on the rise. Some patients choose to undergo simultaneous bilateral total knee arthroplasty (simultaneous BTKA). No studies were found that examined which patients may be better candidates to successfully undergo this procedure.

Depression Outcomes From a Fully Integrated Obstetric Mental Health Clinic: A 10-Year Examination.

A fully integrated Obstetric Mental Health Clinic (OBMHC) was established in 2007 in the rural northwest United States to address perinatal depression. The purpose of this mixed methods study was to examine depression outcomes in women receiving outpatient psychiatric services between 2007 and 2017 at a fully integrated OBMHC and to explore patient and obstetric team perceptions of OBMHC experiences. A retrospective database study was employed; depression was measured at baseline and follow-up visits using the Edinburgh Postnatal Depression Scale.

The Stepped-Wedge Trial Design: Paving the Way for Cancer Care Delivery Research.

Cancer care delivery research (CCDR) is an emerging field that investigates ways to optimally provide care for patients within complex health-care systems. Novel research designs are essential to efficiently study CCDR research questions. A stepped-wedge trial (SWT) is one such pragmatic design and is similar to a parallel randomized controlled trial (RCT).

Predictors of oversedation in hospitalized patients.

Purpose: Results of a study to determine demographic and clinical characteristics predictive of oversedation and potential opioid-induced respiratory depression (OIRD) in hospitalized patients are reported.

Methods: In a retrospective case-controlled study, an incident reporting database was searched to identify cases of in-hospital oversedation; to form the control group, patients who did not experience an oversedation event while hospitalized were sampled in reverse chronological order until the desired total sample size ( = 225) was obtained. An allocation ratio of 2:1 was specified to adjust for case variability.

Intent-to-treat analysis of a simultaneous multisite telehealth diabetes prevention program.

Objective: Determine the effectiveness of a 16-week modified diabetes prevention program (DPP) administered simultaneously to multiple rural communities from a single urban site, as compared with a similar face-to-face intervention. A 12-week intervention was evaluated to consider minimization of staff costs in communities where resources are limited.

Research Design And Methods: A prospective cohort study compared DPP interventions implemented in rural (via telehealth technology) and urban (face-to-face) communities using an intent-to-treat analysis.

Improving Blood Pressure Control Using Smart Technology.

Background: The authors sought to determine if wireless oscillometric home blood pressure monitoring (HBPM) that integrates with smartphone technology improves blood pressure (BP) control among patients with new or existing uncontrolled hypertension (HTN).

Methods: A prospective observational cohort study monitored BP control before and after an educational intervention and introduction to HBPM. Patients in the intervention group were instructed to track their BP using a smartphone device three to seven times per week.

Why the Interdisciplinary Team Approach Works: Insights from Complexity Science.

Background: Although an interdisciplinary approach is considered best practice for caring for patients at the end of life, or in need of palliative care (PC) services, there is growing tension between healthcare organizations' need to contain costs and the provision of this beneficial, yet resource-intensive service.

Objective: To support the interdisciplinary team (IDT) approach by recognizing organizations, teams, patients, and families as complex adaptive systems, illustrated by a qualitative study of the experiences, roles, and attributes of healthcare professionals (HCPs) who work with patients in need of PC services.

Design: In-depth, semi-structured interviews of PC health professionals were conducted, transcribed, and independently reviewed using grounded theory methodology and preliminary interpretations.

A qualitative analysis of patient and family perspectives of palliative care.

Background: To provide truly patient-centered palliative care services, there is a need to better understand the perspectives and experiences of patients and families. Increased understanding will provide insight into the development of health care team competencies and organizational changes necessary to improve patient care.

Objective: Our aim was to explore patient and family perceptions of palliative care services at the end of life or during serious illness and to identify facilitators and barriers to receipt of palliative care services.