Strategies to Deimplement Opioid Prescribing in Primary Care: A Cluster Randomized Clinical Trial.

Importance: Centers for Disease Control and Prevention guidelines advocate reduced opioid prescribing for chronic pain, yet research on their implementation remains limited.

Objective: To compare 4 deimplementation strategies to promote guideline-concordant opioid prescribing.

Design, Setting, And Participants: This cluster randomized clinical trial was performed at 32 primary care clinics from 2 US health care systems from February 2020 to March 2022, using a hybrid type 3 sequential multiple-assignment design focused on patient outcomes.

Pediatric Acute Q Fever in Rural Wisconsin: A Case Report.

Introduction: Q fever is a zoonotic disease with a variable clinical presentation and potentially fatal complications. While rare, it is more common in rural areas due to its transmission from animals, including cattle.

Case Presentation: A 3-year-old boy presented in December 2020 with intermittent fevers, headache, rash, and lymphadenopathy.

The Balanced Opioid Initiative: protocol for a clustered, sequential, multiple-assignment randomized trial to construct an adaptive implementation strategy to improve guideline-concordant opioid prescribing in primary care.

Background: Rates of opioid prescribing tripled in the USA between 1999 and 2015 and were associated with significant increases in opioid misuse and overdose death. Roughly half of all opioids are prescribed in primary care. Although clinical guidelines describe recommended opioid prescribing practices, implementing these guidelines in a way that balances safety and effectiveness vs.

Osmotic demyelination syndrome.

Formerly known as central pontine myelinolysis, osmotic demyelination syndrome (ODS) is defined by a symmetrical destruction of myelin sheaths involving mainly the central portion of the basis pontis without evidence of vascular involvement. We report the case of a 60-year-old man who presented to the emergency department with a 2-week history of progressive confusion, memory loss, and lower extremity weakness with limited ambulation. A computed tomography scan of the head revealed areas of low attenuation within the pons, and brain magnetic resonance imaging (MRI) confirmed the changes as compatible with ODS.