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Introduction Older adults are more vulnerable to opioid-associated morbidity. The purpose of this study was to determine the frequency and timing of acetaminophen and opioid use in the postoperative period. Methods Older adult trauma patients (≥65 years) with hip fractures requiring femur or hip fixation were reviewed (Premier Database 2008-2014). We examined rates of acetaminophen use on the day of surgery and prior to receipt of oral opioids. Mixed-effects linear regression models were used to examine the effects of an acetaminophen-first approach on opioid use the day prior to and on the day of discharge. Results Of the 192 768 patients, 81.6% were Caucasian; 74.0% were female; and the mean age was 82.0 years [± 7.0]. Only 16.8% (32 291) of patients received acetaminophen prior to being prescribed opioids. 27.4% (52 779) received an acetaminophen-opioid combination, and 9.2% (17 730) received opioids without acetaminophen first. Acetaminophen first was associated with reduced opioid use on the day prior to and on the day of discharge (3.52 parenteral morphine equivalent doses (PMEs) less [95% CI: 3.33, 3.70]; P < .0001). A statistically but not clinically significant reduction in length of stay was observed in the acetaminophen-first group. Conclusion Nearly 37% of older adult patients did not receive acetaminophen as first-line analgesia after hip surgery. Multimodal analgesia, including non-opioid medications as first-line, should be encouraged.

Staphylococcus aureus is an opportunistic human pathogen and a primary cause of nosocomial infections. Its biofilm forming capability is an adaptation strategy utilized by many species of bacteria to overcome stressful environmental conditions and provides both resistance to antimicrobial treatments and protection from the host immune system. This paper addresses a growing demand for an objective, fully automated method of biofilm structure description with standardized parameters that are independent of user input. In this study, we used watershed segmentation to analyze and compare confocal laser scanning microscopy (CLSM) images of two S. aureus strains with different biofilm-forming capabilities. Results are compared with manual calculations as well as the commonly used COMSTAT software.