Escalation of Opioid Withdrawal Frequency and Subsequent AMA Rates in Hospitalized Patients From 2017 to 2020

Abstract

ObjectiveTo measure trends for the emergence of opioid withdrawal (OW) and leaving against medical advice (AMA) among hospitalized patients.MethodRetrospective time-series of hospitalized patients with OW, defined by a Clinical Opioid Withdrawal score >8, using electronic health record data at a tertiary health system and of patients with a discharge status of AMA from January 1, 2017 to December 31, 2020.ResultsThe average number of monthly hospitalizations with OW showed a year-to-year increment of 15% in 2018, 21% in 2019, and 34% from 2019 to 2020, whereas the total monthly hospitalizations remained stable. The segmented regression analysis showed that the upward trend in hospitalizations with OW became significant after January 2019 (slope: 1.14, 95% confidence interval [CI]: 0.70, 1.57). After August 2019, Fentanyl was added to the hospital urine drug testing panel and was identified in most OW patients. The monthly proportion of patients who left AMA was significantly higher among the OW patients than among all other admitted patients. There was a significant increase of 0.39 (95% CI: 0.29–0.49, P < 0.001) per month in %AMA among patients with OW. The estimated difference in %AMA among OW patients versus all other patients was 7.25 (95% CI: 5.12–9.38) in January 2017, and 16.92 (95% CI: 14.60–19.24) in December 2020.ConclusionsThe number of hospitalized patients either presenting with or developing OW increased between 2017 and 2020 with a significant rise occurring after January 2019. The percentage of patients who left AMA among those who developed OW steadily worsened during the entire study period.

Quinoa (Chenopodium quinoa Willd) Bran Saponins Alleviate Hyperuricemia and Inhibit Renal Injury by Regulating the PI3K/AKT/NFκB Signaling Pathway and Uric Acid Transport

“…Hyperuricemia (HUA) is one of the metabolic diseases caused by either insufficient excretion or excessive synthesis of UA and occurs when the level of UA in the blood exceeds 6.8 mg/dL. , Long-term exposure to elevated UA in the body can lead to serious complications, including gout, hypertension, diabetes, cardiovascular disease, and metabolic syndrome. , Modern lifestyles, including low exercise levels, alcohol consumption, and the excessive consumption of high-purine foods, have contributed to the increasing incidence of HUA worldwide. In 2020, the number of global HUA patients reached approximately 930 million, with a year-on-year increase of 5.68% . Consequently, HUA caused by abnormal UA metabolism has attracted attention as a global health concern.…”