The American journal of orthopedics
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Analgesic gaps--periods of inadequate pain control--commonly compromise the management of pain after joint arthroplasty. Such gaps can and should be prevented. ⋯ Multimodal analgesia should take into consideration not only the mechanisms of the individual medications, but also their timing of onset and duration of effect. And to avoid continual reestablishment of the pain pathways, it is also important to administer the medications on a scheduled basis rather than as needed.
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Reduced hospital staffing on weekends is a hypothesized risk factor for adverse health outcomes--commonly referred to as the weekend effect. We conducted a study on the effect of weekend admission on short-term outcomes among US hip fracture patients. We selected Nationwide Inpatient Sample (1998-2010) patients with a principal diagnosis of femoral neck fracture and grouped them by day of admission (weekend or weekday). ⋯ Compared with patients admitted on weekdays, patients admitted on weekends had lower mortality (OR, 0.94; 95% confidence interval [CI], 0.89-0.99) and shorter mean hospital stay (estimate, 3.74%; 95% CI, 3.40-4.08) but did not differ in risk of perioperative complications (OR, 1.00; 95% CI, 0.98-1.02). Weekend admission did not predict death, perioperative complications, longer hospital stay, or other adverse short-term outcomes. Our study data do not support a weekend effect among hip fracture admissions in the United States.
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There is growing concern about the emergence of an "opioid epidemic" in the United States, where the abuse of opioids has had a devastating impact on public health and safety. Around 250 million prescriptions for pain medication are now written each year in this country, and 46 people die from an overdose of a prescription pain medication every day. ⋯ A variety of government organizations and expert groups, such as the American Society of Anesthesiologists Task Force on Acute Pain Management, now recommend multimodal analgesia and weighing the benefits and risks of systemic opioids. The Joint Commission also has recommended that strategies for pain management include a patient-centered approach that takes into consideration the accompanying risks and benefits--including the potential risk of dependency, addiction, and abuse.