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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 10 of 10 Research Studies Displayed
Khouja T, Zhou J, Gellad WF
Serious opioid-related adverse outcomes associated with opioids prescribed by dentists.
This study’s objective was to evaluate adverse outcomes and persistent opioid use (POU) after opioid prescriptions by dentists, based on whether opioids were overprescribed or within recommendations. A cross-sectional analysis of adults with dental visit and corresponding opioid prescription from 2011 to 2017 within a nationwide commercial claims database was conducted. As per CDC guidelines, opioid overprescribing was defined as >120 morphine milligram equivalents. Of 633,387 visits, 16.6% had POU and 2.6% experienced an adverse outcome. POU was higher when opioids were overprescribed with visits associated with mild pain and those with substance use disorders having the highest risk of both outcomes.
Citation: Khouja T, Zhou J, Gellad WF . Serious opioid-related adverse outcomes associated with opioids prescribed by dentists. Pain 2022 Aug 1;163(8):1571-80. doi: 10.1097/j.pain.0000000000002545..
Keywords: Opioids, Dental and Oral Health, Substance Abuse, Behavioral Health, Practice Patterns, Pain, Medication, Adverse Drug Events (ADE), Adverse Events
Wei YJ, Chen C, Lewis MO
Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study.
This study used a sample of older patients who are Medicare beneficiaries who were newly prescribed opioids to determine rates of 4 prescription opioid dose trajectories and the risk of opioid-related adverse events (ORAEs). A 5% random sample of Medicare beneficiaries from 2011 to 2018 was used to conduct a nested case-control study of patients age 65 and older who were newly diagnosed with chronic noncancer pain (CNCP). Among the cases and controls, 2,192 (70.6%) were women and mean age was 77.1 years. Four prescribed opioid trajectories before the incident ORAE diagnosis or matched date emerged: gradual dose discontinuation (from ≤3 to 0 daily morphine milligram equivalent (MME), 1,456 [23.5%]), gradual dose increase (from 0 to >3 daily MME, 1,878 [30.3%]), consistent low dose (between 3 and 5 daily MME, 1,510 [24.3%]), and consistent moderate dose (>20 daily MME, 1,362 [22.0%]). Less than 5% were prescribed a mean daily dose of ≥90 daily MME during 6 months before diagnosis or matched date. Patients with gradual dose discontinuation versus those with a consistent low or moderate dose, and increase dose were more likely to be 65 to 74 years, Midwest US residents, and receiving no low-income subsidy. Those with gradual dose increase and consistent moderate dose had a higher risk of ORAE, after adjustment for covariates.
Citation: Wei YJ, Chen C, Lewis MO . Trajectories of prescription opioid dose and risk of opioid-related adverse events among older Medicare beneficiaries in the United States: a nested case-control study. PLoS Med 2022 Mar;19(3):e1003947. doi: 10.1371/journal.pmed.1003947..
Keywords: Elderly, Opioids, Medication, Adverse Drug Events (ADE), Adverse Events, Risk, Chronic Conditions, Pain, Substance Abuse, Behavioral Health, Medication: Safety, Patient Safety
Ing C, Landau R, DeStephano D
Prenatal exposure to general anesthesia and childhood behavioral deficit.
This study looked at the association of prenatal exposure to general anesthesia and childhood behavioral deficits. The Raine Study was an observational cohort study of children born in Perth, Western Australia with 2 generations of participations. The first generation (Gen1) were mothers enrolled during pregnancy, and the second generation (Gen2) were the children born from 1989 to 1992 with neuropsychological and behavioral tests evaluated at age 10. Six neuropsychological and behavioral tests were used with the Child Behavior Checklist (CBCL) as the main test. Among 2024 children with available outcome scores, 22 were prenatally exposed to general anesthesia. These children had higher CBCL Externalizing behavioral scores than unexposed children. Of the six tests used, only CBCL Externalizing behavioral scores remained significant after multiple comparisons adjustment.
Citation: Ing C, Landau R, DeStephano D . Prenatal exposure to general anesthesia and childhood behavioral deficit. Anesth Analg 2021 Sep 1;133(3):595-605. doi: 10.1213/ane.0000000000005389..
Keywords: Children/Adolescents, Behavioral Health, Pregnancy, Adverse Drug Events (ADE), Adverse Events
Guglielminotti J, Li G
Exposure to general anesthesia for cesarean delivery and odds of severe postpartum depression requiring hospitalization.
This retrospective cohort study evaluated the risk of general anesthesia use in cesarean delivery versus neuraxial anesthesia on maternal mental health. Cesarean deliveries performed in New York State hospitals between 2006 and 2013 were included. Exclusion criteria included having more than 1 cesarean delivery during the study period, residing outside of New York State, and having a general anesthetic for other surgery or delivery in the year before or after the index case. The primary outcome looked at was severe postpartum depression (PPD), and secondary outcomes were suicidal ideation, anxiety disorders, and posttraumatic stress disorder (PTSD). The majority of cesareans used neuraxial anesthesia and only 8% (34,356) had general anesthesia. Severe PPD requiring hospitalization occurred in 1158 women with 60% identified during readmission. General anesthesia was found to be associated with a 54% increased odds of PPD, and a 91% increased odds of suicidal ideation or self-inflicted injury. There was insufficient evidence for increased risk of anxiety orders.
Citation: Guglielminotti J, Li G . Exposure to general anesthesia for cesarean delivery and odds of severe postpartum depression requiring hospitalization. Anesth Analg 2020 Nov;131(5):1421-29. doi: 10.1213/ane.0000000000004663..
Keywords: Labor and Delivery, Pregnancy, Women, Depression, Behavioral Health, Surgery, Risk, Hospitalization, Medication, Adverse Drug Events (ADE), Adverse Events
Ing C, Ma X, Sun M
Exposure to surgery and anesthesia in early childhood and subsequent use of attention deficit hyperactivity disorder medications.
This study examines the association between higher rates of attention deficit hyperactivity disorder (ADHD) diagnosis and exposure to surgery and anesthesia before the age of 5. Longitudinal pharmacy data for children enrolled in Texas and New York Medicaid from 1999 to 2010 were used. They examined the association between a single exposure to anesthesia before age 5 years for 1 of 4 common pediatric surgical procedures: pyloromytomy, inguinal hernia repair, circumcisions outside the perinatal period, and tonsillectomy and/or adenectomy; and persistent ADHD medication use. A total of 213,435 children were included in the study. Children with a single exposure to anesthesia were 37% more likely than unexposed children to persistently use ADHD medication.
Citation: Ing C, Ma X, Sun M . Exposure to surgery and anesthesia in early childhood and subsequent use of attention deficit hyperactivity disorder medications. Anesth Analg 2020 Sep;131(3):723-33. doi: 10.1213/ane.0000000000004619..
Keywords: Children/Adolescents, Behavioral Health, Medication, Surgery, Adverse Drug Events (ADE), Adverse Events
Chatterjee S, Bali V, Carnahan RM
Anticholinergic burden and risk of cognitive impairment in elderly nursing home residents with depression.
This study evaluated whether elderly nursing home residents with mild depression and intact cognition experienced cognitive impairment after using anticholinergic drugs. The study was a population-based nested case-control study using Minimum Data Set (MDS)-linked Medicare data where the base cohort were patients 65 years and older with depression who had intact cognition. Cumulative anticholinergic burden was measured within 30, 60, and 90 days preceding the event (cognitive measurement) date using the Anticholinergic Drug Scale (ADS). The end sample compared 3707 cases with mild-to-moderate cognition to 3707 matched controls with intact cognition. There was no association with cumulative anticholinergic exposure at 30 days with cognitive impairment, but the odds of cognitive impairment increased with exposure 60 and 90 days before the event date. This study concludes there should be concern in using anticholinergic drugs for longer than 30 days with elderly nursing home residents.
Citation: Chatterjee S, Bali V, Carnahan RM . Anticholinergic burden and risk of cognitive impairment in elderly nursing home residents with depression. Res Social Adm Pharm 2020 Mar;16(3):329-35. doi: 10.1016/j.sapharm.2019.05.020..
Keywords: Elderly, Nursing Homes, Long-Term Care, Depression, Behavioral Health, Medication, Neurological Disorders, Adverse Drug Events (ADE), Adverse Events, Patient Safety
Fung VC, Overhage LN, Sylvia LG
Complex polypharmacy in bipolar disorder: side effect burden, adherence, and response predictors.
Investigators assessed the associations between complex polypharmacy (CP), adherence, and side effect burden, and patient traits associated with clinical improvement in relationship to CP in patients with bipolar disorder. They found that bipolar disorder patients with CP were less likely to adhere to therapy, and those with worse adherence to CP were less likely to clinically respond. They recommended that clinicians assess medication adherence prior to adding another agent to medication regimens.
Citation: Fung VC, Overhage LN, Sylvia LG . Complex polypharmacy in bipolar disorder: side effect burden, adherence, and response predictors. J Affect Disord 2019 Oct 1;257:17-22. doi: 10.1016/j.jad.2019.06.050..
Keywords: Adverse Drug Events (ADE), Adverse Events, Medication, Behavioral Health, Chronic Conditions, Patient Adherence/Compliance
Sobieraj DM, Martinez BK, Hernandez AV
Adverse effects of pharmacologic treatments of major depression in older adults.
The objective of this study was to assess adverse effects of pharmacologic antidepressants for treatment of major depressive disorder (MDD) in adults 65 years of age or older. The investigators found, among other conclusions, that in patients 65 years of age or older with MDD, treatment of the acute phase of MDD with serotonin norepinephrine reuptake inhibitors (SNRIs), but not selective serotonin reuptake inhibitors (SSRIs), was associated with a statistically greater number of overall adverse events vs placebo.
Citation: Sobieraj DM, Martinez BK, Hernandez AV . Adverse effects of pharmacologic treatments of major depression in older adults. J Am Geriatr Soc 2019 Aug;67(8):1571-81. doi: 10.1111/jgs.15966..
Keywords: Depression, Behavioral Health, Medication: Safety, Medication, Adverse Drug Events (ADE), Adverse Events, Patient Safety, Elderly
Brunsberg KA, Landrigan CP, Garcia BM
Association of pediatric resident physician depression and burnout with harmful medical errors on inpatient services.
The objective of this paper was to determine whether higher rates of medical errors were associated with positive screenings for depression or burnout among resident physicians. Results of this prospective cohort study showed that resident physicians with a positive depression screen were three times more likely than those who screened negative to make harmful errors, indicating the importance of determining what interventions might mitigate the patient safety risk.
Citation: Brunsberg KA, Landrigan CP, Garcia BM . Association of pediatric resident physician depression and burnout with harmful medical errors on inpatient services. Acad Med 2019 Aug;94(8):1150-56. doi: 10.1097/acm.0000000000002778..
Keywords: Children/Adolescents, Provider: Physician, Provider, Medical Errors, Adverse Events, Burnout, Patient Safety, Depression, Behavioral Health
Blumenthal KG, Li Y, Acker WW
Multiple drug intolerance syndrome and multiple drug allergy syndrome: epidemiology and associations with anxiety and depression.
In this study, the authors used electronic health record (EHR) data to describe prevalences of MDIS and MDAS and to examine associations with anxiety and depression. The investigators concluded that: 1.) while 6% of patients had MDIS, only 1% had MDAS; 2.) MDIS was associated with both anxiety and depression; 3.) patients with both anxiety and depression had an almost twofold increased odds of MDIS; 4.) MDAS was associated with a 40% increased odds of depression, but there was no significant association with anxiety.
Citation: Blumenthal KG, Li Y, Acker WW . Multiple drug intolerance syndrome and multiple drug allergy syndrome: epidemiology and associations with anxiety and depression. Allergy 2018 Oct;73(10):2012-23. doi: 10.1111/all.13440..
Keywords: Adverse Drug Events (ADE), Adverse Events, Anxiety, Depression, Electronic Health Records (EHRs), Health Information Technology (HIT), Medication, Behavioral Health, Patient Safety