OBJECTIVE: Post-operative patients are at increased risk of becoming chronic users of opioids, and overprescribing can lead to abuse and diversion. Though data have shown a decrease in opioid prescriptions nationally, limited studies have specifically evaluated the influence of state legislation on this trend. This study aimed to assess the impact of legislation in the state of Tennessee on opioid prescribing amongst orthopedic surgeons. DESIGN: This retrospective cohort analysis evaluated patients who received opioids post-orthopedic surgery before and after the state legislation was passed. SETTING: A community teaching hospital. PATIENTS AND PARTICIPANTS: Two hundred and three post-orthopedic surgery patients were included, with 101 in the preleg-islation and 102 in the post-legislation groups. INTERVENTIONS: State legislation in Tennessee limiting amounts of prescribed opioids went into effect in July 2018. MAIN OUTCOME MEASURE(S): The primary outcome was total morphine milligram equivalents (MMEs) prescribed, with secondary outcomes of days' supply, dosage units, and MME per day. RESULTS: Orthopedic surgery patients in the post-legislation arm were prescribed significantly fewer MME than those in the prelegislation arm (median MME 375 vs. 562.5; p < 0.001). Prescription days' supply, number of dosage units, and MME per day were also significant lower in the post-legislation group. CONCLUSIONS: After orthopedic surgery, patients in the post-legislation arm were prescribed a median 187.5 MME less than those in the prelegislation arm. Our findings suggest that state opioid legislation is associated with a reduction in the amount of opioids prescribed in certain orthopedic surgery patients, though further studies evaluating adequacy of pain control are warranted.

BACKGROUND: Numerous studies have suggested that Helicobacter pylori infection in asymptomatic subjects is transmitted from person to person. Its prevalence is higher in the institutionalized setting. If that is the case, persons involved in patient care should have a higher prevalence of the infection. METHODS: We estimated the prevalence of H pylori antibodies among groups of asymptomatic medical and nursing staff and compared them with volunteer blood donors of similar age and sex. RESULTS: One hundred fifty-eight nurses and aides, 59 residents, 46 senior medical students, and 22 senior nursing students were enrolled in this study. Serum samples were tested for IgG antibodies against H pylori by enzyme-linked immunosorbent assay. Sixty-two (39%) of 158 nurses were found to be positive for antibodies to H pylori compared with 114 (26%) of 441 specimens from the blood donor group. Within the youngest age group (20 to 34 years), 13 (25%) of 51 nurses were positive for H pylori antibodies compared with 19 (13%) of 143 age-matched serum samples from the blood donor group. Within the middle age group (35 to 49 years), 32 (39%) of 83 nurses were positive for H pylori antibodies vs 43 (26%) of 167 age-matched blood donors. In the oldest age group (> 50 years), 17 (71%) of 24 nurses were positive for H pylori antibodies compared with 52 (40%) of 131 age-matched blood donors. Twenty-three (27%) of 86 nurses with 1 to 15 years of occupational exposure were positive for H pylori antibodies compared with 40 (56%) of 72 nurses with more than 15 years of occupational exposure. CONCLUSIONS: Nurses have an increased prevalence of H pylori antibodies that is significantly higher than the comparable prevalence of volunteer blood donors and is evident in the youngest age group. In addition, the increased prevalence is related to a longer duration of patient exposure in the nursing group.

Sparse information is available concerning use of emergency departments (EDs) by the elderly in rural areas. We reviewed records of all patients seeking care at EDs of three rural hospitals during 7 days in October 1991. We found that elderly people did not use EDs in proportion to their numbers in the community (15.2% versus 19.3%). Compared with younger ED patients, more elderly patients required an ambulance (40.8% versus 10.7%), more needed hospitalization (38.4% versus 11.9%), and their ED stays were longer (140 minutes versus 89 minutes). Falls/injuries (18.7%) and cardiac illness (18.1%) were the most frequent reasons for ED visits by the elderly, and relatively few (2.8%) had confusion. More elderly patients arrived during daytime hours than during the night, and more on weekends than weekdays. Also, we found no difference between patients in the 65- to 74-year-old age group and those aged 75 years and older.