"Before medically advised" hospital discharge and the risk of subsequent drug overdose: A case-crossover analysis.

Background: Patient-initiated or "before medically advised" (BMA) hospital discharge is more common among people who use drugs. Transitions of care can be destabilizing and might increase the risk of subsequent illicit drug overdose.

Objectives: This study sought to evaluate whether BMA discharge is associated with an increased risk of subsequent drug overdose (primary objective) and whether physician-advised discharge is associated with an increased risk of subsequent drug overdose (secondary objective).

Patient-Physician Sex Discordance and "Before Medically Advised" Discharge from Hospital: A Population-Based Retrospective Cohort Study.

Background: Patient-physician sex discordance (when patient sex does not match physician sex) has been associated with reduced clinical rapport and adverse outcomes including post-operative mortality and unplanned hospital readmission. It remains unknown whether patient-physician sex discordance is associated with "before medically advised" hospital discharge (BMA discharge; commonly known as discharge "against medical advice").

Objective: To evaluate whether patient-physician sex discordance is associated with BMA discharge.

Characterizing safer drinking strategies among hospitalized adults with severe alcohol use disorder; a cross-sectional secondary analysis.

Background: Safer drinking strategies (SDS) reduce alcohol-related harms in outpatient settings. Little is known about SDS among hospitalized patients.

Objective: Evaluate SDS among hospitalized patients with alcohol use disorder (AUD) and assess for association with past-year acute-care utilization.

Opioid Overdose Risk Following Hospital Discharge Among Individuals Prescribed Long-Term Opioid Therapy: a Risk Interval Analysis.

Background: Individuals prescribed long-term opioid therapy (LTOT) have increased risk of readmission and death after hospital discharge. The risk of opioid overdose during the immediate post-discharge time period is unknown.

Objective: To examine the association between time since hospital discharge and opioid overdose among individuals prescribed LTOT.

The Association between Opioid Discontinuation and Heroin Use: A Nested Case-Control Study.

Background: Opioid prescribing guidelines recommend reducing or discontinuing opioids for chronic pain if harms of opioid treatment outweigh benefits. As opioid discontinuation becomes more prevalent, it is important to understand whether opioid discontinuation is associated with heroin use. In this study, we sought to assess the association between opioid discontinuation and heroin use documented in the medical record.

The United States opioid epidemic.

The United States opioid epidemic is a nationwide public health crisis. Initially driven by increased consumption and availability of pharmaceutical opioids, an increasing number of opioid overdoses are now related to heroin and illicitly manufactured fentanyl and fentanyl analogs. Addressing this epidemic requires addressing the stigma associated with opioid use disorders and its treatment, improving access to efficacious treatment options, specifically methadone and buprenorphine, and reducing opioid overdose fatalities with distribution of the opioid antagonist and overdose reversal agent naloxone.

Barriers to Early Hospital Discharge: A Cross-Sectional Study at Five Academic Hospitals.

Background: Understanding the issues delaying hospital discharges may inform efforts to improve hospital throughput.

Objective: This study was conducted to identify and determine the frequency of barriers contributing to delays in placing discharge orders.

Design: This was a prospective, cross-sectional study.

A personal health information toolkit for health intervention research.

With the emergence of mobile health (mHealth) apps, there is a growing demand for better tools for developing and evaluating mobile health interventions. Recently we developed the Personal Health Intervention Toolkit (PHIT), a software framework which eases app implementation and facilitates scientific evaluation. PHIT integrates self-report and physiological sensor instruments, evidence-based advisor logic, and self-help interventions such as meditation, health education, and cognitive behavior change.

Implementing health information technology in a patient-centered manner: patient experiences with an online evidence-based lifestyle intervention.

The patient-centered care (PCC) model and the use of health information technology (HIT) are major initiatives for improving U.S. healthcare quality and delivery.

PHIT for duty, a mobile approach for psychological health intervention.

The goal of this effort is to support prevention of psychological health problems through innovation in mobile personal health assessment and self-help intervention (SHI). For the U.S.

Using formative research to design an epidemiologic survey: the north Carolina study of home care and hospice nurses.

Objectives: Formative research can serve as a means of obtaining important information for designing an epidemiologic study, but descriptions of this approach in the epidemiologic literature are lacking. The objective of this paper is to describe the use of three formative research techniques in designing a survey of home care and hospice nurses.

Methods: We conducted two focus groups, seven key informant interviews, and approximately fifteen hours of direct observation among home care and hospice nurses recruited by word of mouth in North Carolina in 2006.

The national study to prevent blood exposure in paramedics: rates of exposure to blood.

Objective: The purpose of this analysis is to present incidence rates of exposure to blood among paramedics in the United States by selected variables and to compare all percutaneous exposure rates among different types of healthcare workers.

Methods: A survey on blood exposure was mailed in 2002-2003 to a national sample of paramedics. Results for California paramedics were analyzed with the national sample and also separately.

Evaluation of institutional practices for prevention of phlebotomy-associated percutaneous injuries in hospital settings.

Background: To reduce the incidence of phlebotomy-related percutaneous injuries (PIs), factors that contribute to these injuries must be identified. This study examined institutional phlebotomy practices, policies, perceptions, and culture to identify facilitators and barriers that appear to have the greatest impact in preventing injuries.

Methods: During site visits at study hospitals, observational data were collected during the performance of phlebotomy.

Blood exposure incidence rates from the North Carolina study of home care and hospice nurses.

Background: Home care/hospice nurses may be at elevated risk of blood exposure because of the nature of their work and work environment. However, little is known about the incidence of blood exposure in this population.

Methods: A mail survey (n = 1,473) was conducted among home care/hospice nurses in North Carolina in 2006.

Provision and use of personal protective equipment and safety devices in the National Study to Prevent Blood Exposure in Paramedics.

Background: Paramedics are at risk for human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection from occupational blood exposure. This study examined how often paramedics are provided with personal protective equipment (PPE), sharps containers, and selected safety devices by their employers; the frequency with which paramedics use sharps containers and these safety devices; and paramedics' attitudes regarding this equipment.

Methods: We conducted a mail survey among a nationally representative sample of certified paramedics.

The national study to prevent blood exposure in paramedics: exposure reporting.

Background: This survey was conducted to provide national incidence rates and risk factors for exposure to blood among paramedics. The present analysis assesses reporting of exposures to employers.

Methods: A questionnaire was mailed in 2002-2003 to a national sample of paramedics selected using a two-stage design.

Blood exposure among paramedics: incidence rates from the national study to prevent blood exposure in paramedics.

Purpose: The aim of the study is to estimate incidence rates of occupational blood exposure by route of exposure (needlesticks; cuts from sharp objects; mucous membrane exposures to the eyes, nose, or mouth; bites; and blood contact with nonintact skin) in US and California paramedics.

Methods: A mail survey was conducted in a national probability sample of certified paramedics.

Results: Proportions of paramedics who reported an exposure in the previous year were 21.