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American Journal of Obstetrics and... Apr 2024Although cesarean delivery is the most common surgery performed in the United States, prescribing practices for analgesia vary. Strategies to manage postpartum pain have...
BACKGROUND
Although cesarean delivery is the most common surgery performed in the United States, prescribing practices for analgesia vary. Strategies to manage postpartum pain have mostly focused on the immediate postpartum period when patients are still admitted to the hospital. At discharge, most providers prescribe a fixed number of opioid tablets. Most patients do not use all the opioids that they are prescribed at hospital discharge. This leads to an excess of opioids in the community, which can ultimately lead to misuse and diversion.
OBJECTIVE
This study aimed to determine whether a transition from universal opioid prescribing to a personalized, patient-specific protocol decreases morphine milligram equivalents prescribed at hospital discharge after cesarean delivery while adequately controlling pain.
STUDY DESIGN
This was a prospective cohort study of patients undergoing cesarean delivery before and after the implementation of a personalized opioid-prescribing practice at the time of hospital discharge. Each patient was prescribed scheduled ibuprofen and acetaminophen, with a prescription for oxycodone tablets equal to 5 times the morphine milligram equivalents used in the 24 hours before discharge, calculated via an electronic order set. The previous traditional cohorts were routinely prescribed 30 tablets of acetaminophen-codeine 300/30 mg. The primary outcome was morphine milligram equivalents prescribed at discharge. A hotline to address pain control issues after discharge was established, and calls, emergency department visits, and readmissions were examined. Statistical analyses was performed using chi-square and Wilcoxon rank-sum test, with a P value of <.05 considered statistically significant.
RESULTS
Overall, 412 patients underwent cesarean delivery in the 6 weeks after initiation of the personalized prescribing protocol and were compared with 367 patients before the change. The median morphine milligram equivalents prescribed at discharge was lower with personalized prescribing (37.5 [interquartile range, 0-75] vs 135 [interquartile range, 135-135]; P<.001). Moreover, 176 patients (43%) were not prescribed opioids at discharge, which was a substantial change as all 367 patients in the traditional cohort received opioids at discharge (P<.001). Of note, 9 hotline phone calls were received; none required additional opioids after a 24-hour trial of scheduled ibuprofen, which none had taken before the call. In addition, 11 patients (2.7%) presented to the emergency department for pain evaluation, of which none required readmission or an outpatient prescription of opioids.
CONCLUSION
A personalized protocol for opioid prescriptions after cesarean delivery decreased the total morphine milligram equivalents and the number of opioid tablets at discharge, without hospital readmissions or need for rescue opioid prescriptions after discharge. Opioids released into our community will be reduced by more than 90,000 tablets per year, without demonstrable adverse effect.
Topics: Pregnancy; Female; Humans; United States; Analgesics, Opioid; Acetaminophen; Ibuprofen; Prospective Studies; Outpatients; Electronic Health Records; Pain, Postoperative; Practice Patterns, Physicians'; Oxycodone; Prescriptions
PubMed: 37778679
DOI: 10.1016/j.ajog.2023.09.092 -
Science (New York, N.Y.) Jul 1982A pilot survey was made of the dietary calcium intake of normotensive and hypertensive individuals. Compared to 44 normotensive controls, 46 subjects with essential... (Comparative Study)
Comparative Study
A pilot survey was made of the dietary calcium intake of normotensive and hypertensive individuals. Compared to 44 normotensive controls, 46 subjects with essential hypertension reported significantly less daily calcium ingestion (668 +/- 55 milligrams compared to 886 +/- 89 milligrams). The intake of other nutrients, including sodium and potassium, was very similar in the two groups. The hypertensives differed from the controls primarily in their consumption of nonfluid dairy products. The data suggest that inadequate calcium intake may be a previously unrecognized factor in the development of hypertension.
Topics: Calcium, Dietary; Diet; Energy Intake; Humans; Hypertension; Potassium; Reference Values; Sodium
PubMed: 7089566
DOI: 10.1126/science.7089566 -
Science Robotics Nov 2022Tiny "gnat robots," weighing just a few milligrams, were first conjectured in the 1980s. How to stabilize one if it were to hover like a small insect has not been...
Tiny "gnat robots," weighing just a few milligrams, were first conjectured in the 1980s. How to stabilize one if it were to hover like a small insect has not been answered. Challenges include the requirement that sensors be both low mass and high bandwidth and that silicon-micromachined rate gyroscopes are too heavy. The smallest robot to perform controlled hovering uses a sensor suite weighing hundreds of milligrams. Here, we demonstrate that an accelerometer represents perhaps the most direct way to stabilize flight while satisfying the extreme size, speed, weight, and power constraints of a flying robot even as it scales down to just a few milligrams. As aircraft scale reduces, scaling physics dictates that the ratio of aerodynamic drag to mass increases. This results in reduced noise in an accelerometer's airspeed measurement. We show through simulation and experiment on a 30-gram robot that a 2-milligram off-the-shelf accelerometer is able in principle to stabilize a 10-milligram robot despite high noise in the sensor itself. Inspired by wind-vision sensory fusion in the flight controller of the fruit fly , we then added a tiny camera and efficient, fly-inspired autocorrelation-based visual processing to allow the robot to estimate and reject wind as well as control its attitude and flight velocity using a Kalman filter. Our biology-inspired approach, validated on a small flying helicopter, has a wind gust response comparable to the fruit fly and is small and efficient enough for a 10-milligram flying vehicle (weighing less than a grain of rice).
Topics: Animals; Wind; Flight, Animal; Wings, Animal; Robotics; Drosophila melanogaster; Drosophila
PubMed: 36417499
DOI: 10.1126/scirobotics.abq8184 -
Science Robotics Jun 2021Agility and trajectory control are two desirable features for robotics, but they become very challenging for soft robots without rigid structures to support rapid...
Agility and trajectory control are two desirable features for robotics, but they become very challenging for soft robots without rigid structures to support rapid manipulations. Here, a curved piezoelectric thin film driven at its structural resonant frequency is used as the main body of an insect-scale soft robot for its fast translational movements, and two electrostatic footpads are used for its swift rotational motions. These two schemes are simultaneously executed during operations through a simple two-wire connection arrangement. A high relative centripetal acceleration of 28 body length per square second compared with existing robots is realized on a 65-milligram tethered prototype, which is better than those of common insects, including the cockroach. The trajectory manipulation demonstration is accomplished by navigating the robot to pass through a 120-centimeter-long track in a maze within 5.6 seconds. One potential application is presented by carrying a 180-milligram on-board sensor to record a gas concentration route map and to identify the location of the leakage source. The radically simplified analog motion adjustment technique enables the scale-up construction of a 240-milligram untethered robot. Equipped with a payload of 1660 milligrams to include the control circuit, a battery, and photoresistors, the untethered prototype can follow a designated, 27.9-centimeter-long "S"-shaped path in 36.9 seconds. These results validate key performance attributes in achieving both high mobility and agility to emulate living agile insects for the advancements of soft robots.
PubMed: 34193563
DOI: 10.1126/scirobotics.abe7906 -
Methods in Molecular Biology (Clifton,... 2017C-di-GMP has emerged as a prevalent bacterial messenger that controls a multitude of bacterial behaviors. Having access to milligram or gram quantities of c-di-GMP is...
C-di-GMP has emerged as a prevalent bacterial messenger that controls a multitude of bacterial behaviors. Having access to milligram or gram quantities of c-di-GMP is essential for the biochemical and structural characterization of enzymes and effectors involved in c-di-GMP signaling. Although c-di-GMP can be synthesized using chemical methods, diguanylate cyclases (DGC)-based enzymatic synthesis is the most efficient method of preparing c-di-GMP today. Many DGCs are not suitable for c-di-GMP production because of poor protein stability and the presence of a c-di-GMP-binding inhibitory site (I-site) in most DGCs. We have identified and engineered a thermophilic DGC for efficient production of c-di-GMP for characterizing c-di-GMP signaling proteins and riboswitches. Importantly, residue replacement in the inhibitory I-site of the thermophilic DGC drastically relieved product inhibition to enable the production of hundreds of milligrams of c-di-GMP using 5-10 mg of this robust biocatalyst.
Topics: Chromatography, High Pressure Liquid; Cyclic GMP; Escherichia coli Proteins; Gene Expression; Phosphorus-Oxygen Lyases; Recombinant Proteins; Structure-Activity Relationship; Temperature; Thermotoga maritima
PubMed: 28889282
DOI: 10.1007/978-1-4939-7240-1_2 -
Annals of the Royal College of Surgeons... Jan 1997The phenomenon of ischaemic preconditioning protects the myocardium by limiting infarct size in animal models of ischaemia and reperfusion. Ischaemic preconditioning may... (Clinical Trial)
Clinical Trial Randomized Controlled Trial
The phenomenon of ischaemic preconditioning protects the myocardium by limiting infarct size in animal models of ischaemia and reperfusion. Ischaemic preconditioning may be induced by short periods of ischaemia and reperfusion. We investigated whether the human heart can be ischaemically preconditioned during coronary artery bypass grafting (CABG). Patients were enrolled into two separate studies. In the first study myocardial adenosine triphosphate (ATP) was used as the measured endpoint, assayed from myocardial biopsies taken at onset of cardiopulmonary bypass (CPB), at the end of the preconditioning stimulus, and at the end of a 10 min sustained ischaemic insult. In the second study the release of myocardial troponin T was used as the endpoint; taken at pre-CPB, and at 1, 6, 24, and 72 h after CPB. In both studies, patients were randomised into either the preconditioning group or the control group. Preconditioning was induced, after the onset of CPB, with two 3 min periods of crossclamping and an intervening 2 min of reperfusion, followed by 10 min sustained ischaemia. The control group only received 10 min of sustained ischaemia. Ischaemic preconditioning resulted in a slower rate of ATP (mumol/g dry weight) depletion in the preconditioned hearts at the end of the 10 min of sustained ischaemia (preconditioned: 11.5 +/- 0.8 vs control: 7.2 +/- 0.3; P < 0.005). Also, preconditioning resulted in a slower rate of troponin T release which was significantly different at 72 h after CPB in the preconditioned group (0.3 milligram) when compared with the control group (1.4 milligrams; P < 0.05). In addition, more patients in the preconditioned group had troponin T levels lower than 0.5 milligram at 72 h than in the control group (10 vs 3 patients). Both groups of patients received the same number of grafts, and underwent the same length of ischaemia during the procedure. We conclude that in patients undergoing CABG surgery, ischaemic preconditioning may reduce myocardial injury as shown by the favourable changes in myocardial ATP, and serum troponin T levels.
Topics: Adenosine Triphosphate; Aged; Biomarkers; Coronary Artery Bypass; Creatine Kinase; Humans; Ischemic Preconditioning, Myocardial; Lactic Acid; Middle Aged; Myocardium; Phosphocreatine; Troponin; Troponin T
PubMed: 9038496
DOI: No ID Found -
Methods in Molecular Biology (Clifton,... 2022Because they are highly unsaturated, plant lipids are sensitive to oxidation and constitute a primary target of reactive oxygen species. Therefore, quantification of...
Because they are highly unsaturated, plant lipids are sensitive to oxidation and constitute a primary target of reactive oxygen species. Therefore, quantification of lipid peroxidation provides a pertinent approach to evaluating oxidative stress in plants. Here, we describe a simple method to measure upstream products of the peroxidation of the major polyunsaturated fatty acids in plants, namely, linolenic acid (C18:3) and linoleic acid (C18:2). The method uses conventional HPLC with UV detection to measure hydroxy C18:3 and C18:2 after reduction of their respective hydroperoxides. The described experimental approach requires low amounts of plant material (a few hundred milligrams), monitors oxidation of both membrane and free fatty acids, and can discriminate between enzymatic and non-enzymatic lipid peroxidation.
Topics: Chromatography, High Pressure Liquid; Fatty Acids; Fatty Acids, Unsaturated; Lipid Peroxidation; Oxidation-Reduction; Reactive Oxygen Species
PubMed: 35657520
DOI: 10.1007/978-1-0716-2469-2_13 -
Journal of Clinical Pathology Jun 1973Using the method of Chong and Owen (1967), the normal range of methaemalbumin in plasma was 0 to 0.6 mg/100 ml, expressed as milligrams of haematin per cent. Previous...
Using the method of Chong and Owen (1967), the normal range of methaemalbumin in plasma was 0 to 0.6 mg/100 ml, expressed as milligrams of haematin per cent. Previous results, using the method of Shinowara and Walters (1963), reported a normal range of 0 to 8.0 mg/100 ml, but it was expressed as milligrams of haemoglobin percent. The conversion factor from the Shinowara method is as follows: mg haematin % = mg haemoglobin % x 0.04.
Topics: Heme; Hemeproteins; Hemoglobins; Humans; Methods; Serum Albumin
PubMed: 4718969
DOI: 10.1136/jcp.26.6.446 -
Current Protocols in Neuroscience May 2001The protocols in this unit describe methods for preparing bacterial plasmid DNA free from chromosomal DNA. The first is an alkaline lysis miniprep suitable for screening...
The protocols in this unit describe methods for preparing bacterial plasmid DNA free from chromosomal DNA. The first is an alkaline lysis miniprep suitable for screening a moderate number of bacterial colonies by restriction endonuclease cleavage and agarose gel electrophoresis. The second is the first step to producing large amounts (milligrams) of plasmid DNA and is also based on alkaline lysis of the bacterial cells. The crude lysate generated in this protocol can be further purified by centrifugation using CsCl/ethidium bromide (CsCl/EtBr) equilibrium density gradients. Three support protocols provide information on how to grow overnight and larger cultures of bacteria, and how to monitor bacterial growth with a spectrophotometer. Other methods, some relying on commercially available ion-exchange columns, are discussed in the commentary.
Topics: Bacteria; Bacteriological Techniques; Bacteriolysis; Centrifugation, Density Gradient; DNA, Bacterial; DNA, Recombinant; Indicators and Reagents; Plasmids; Spectrophotometry
PubMed: 18428441
DOI: 10.1002/0471142301.nsa01js10 -
International Journal of Pharmaceutics May 2007In this article, we present a parallel experimentation approach to rapidly identify a solubility-enhancing formulation that improved the bioavailability of a poorly...
Parallel screening approach to identify solubility-enhancing formulations for improved bioavailability of a poorly water-soluble compound using milligram quantities of material.
In this article, we present a parallel experimentation approach to rapidly identify a solubility-enhancing formulation that improved the bioavailability of a poorly water-soluble compound using milligrams of material. The lead compound and a panel of excipients were dissolved in n-propanol and dispensed into the wells of a 96-well microtiter plate by a TECAN robot. Following solvent evaporation, the neat formulations were diluted with an aqueous buffer, and incubated for 24h. The solubilization capacity of the excipients for the compound at 24h (SC(24h)), was determined by HPLC, and compared with its solubility in the corresponding neat formulations determined by a bench-scale method. The ranking order of solubilization capacity of the five tested formulations for this compound by this microscreening assay is same as the ranking order of the compound solubility in the neat formulations. Several formulations that achieved the target aqueous solubility were identified using the screening method. One of the top formulations, an aqueous solution of the compound containing 20% Tween 80 by weight, increased the compound solubility from less than 2 microg/mL to at least 10mg/mL. In a rat pharmacokinetic (PK) study, the Tween 80 formulation achieved 26.6% of bioavailability, a significant improvement over 3.4% of bioavailability for the aqueous Methocel formulation (p<0.01). The results in the study suggest that this parallel screening assay can be potentially used to rapidly identify solubility-enhancing formulations for an improved bioavailability of poorly water-soluble compounds using milligram quantities of material.
Topics: Animals; Area Under Curve; Biological Availability; Chemistry, Pharmaceutical; Excipients; Female; Hydrogen-Ion Concentration; Indans; Male; Molecular Weight; Permeability; Pharmaceutical Solutions; Pyrazoles; Rats; Rats, Sprague-Dawley; Receptors, Platelet-Derived Growth Factor; Solubility; Surface-Active Agents; Transition Temperature; Water
PubMed: 17178444
DOI: 10.1016/j.ijpharm.2006.11.034