Bedda Rosario-Rivera

Background: Buprenorphine use in the intensive care unit (ICU) remains not well studied despite growing perioperative guidance supporting its continuation and initiation for patients with opioid use disorder (OUD). Trauma ICU admissions represent a critical opportunity to address untreated OUD, as well as continuation of an already established treatment plan for OUD, yet barriers limit its adoption in this setting. Methods: This single-center quality improvement study evaluated for inpatient buprenorphine prescribing patterns following provider education at a tertiary academic trauma center. Adult trauma ICU patients with OUD admitted between 2016–2024 were identified through the institutional trauma registry. Patients with pre-admission buprenorphine were excluded, yielding a cohort of 95 patients: 24 buprenorphine-exposed (initiated in the hospital) and 71 controls. Primary outcomes included pain scores and opioid requirements (morphine milligram equivalents, MME) during the first 48 hours. Secondary outcomes included hospital length of stay (LOS), discharge disposition, and 90-day readmission. Results: Baseline characteristics were similar between groups. No statistically significant differences were observed in first recorded pain scores (median 8 vs. 10; p=0.35), mean 48-hour pain scores (7.40 vs. 7.76; p=0.44), or total opioid consumption (232 vs. 119 mg MME; p=0.45). Median hospital LOS (16 vs. 19 days; p=0.48) and 90-day readmission rates (42.3% vs. 33.3%; p=0.40) were also comparable. Conclusion: Inpatient buprenorphine initiation in trauma ICU patients with OUD was not associated with worse pain control, increased opioid requirements, or adverse clinical outcomes. These findings support the integration of buprenorphine into critical care pathways as a safe strategy to address OUD during hospitalization and improve long-term recovery continuity.

Purpose: This study examined whether chronic opioid use reduces the effectiveness of brachial plexus block in patients undergoing upper extremity surgery. Patients and Methods: Patients undergoing surgery with brachial plexus blocks were divided into two groups: opioid-dependent (daily opioid use for ≥ 1 month) and control (no opioid use for ≥ 3 months). Pain scores and opioid use were recorded over 72 hours postoperatively. Results: Forty-six patients were included (23 opioid-dependent and 23 control). The median (IQR) NRS scores upon PACU arrival were 0 (0– 0) in the control group and 0 (0– 5) in the opioid group (p=0.0101). The duration of the nerve block was shorter in opioid-dependent patients (14 versus 22 hours; p=0.0035). Conclusion: Chronic opioid users experienced shorter brachial plexus block duration and more postoperative pain after being discharged home.

Background: Extended foster care programs help prepare transitional-aged youth (TAY) to step into adulthood and live independent lives. Aspiranet, one of California’s largest social service organizations, used a social care management solution (SCMS) to meet TAY’s needs. Objective: We aimed to investigate the impact of an SCMS, IBM Watson Care Manager (WCM), in transforming foster program service delivery and improving TAY outcomes. Methods: We used a mixed methods study design by collecting primary data from stakeholders through semistructured interviews in 2021 and by pulling secondary data from annual reports, system use logs, and data repositories from 2014 to 2021. Thematic analysis based on grounded theory was used to analyze qualitative data using NVivo software. Descriptive analysis of aggregated outcome metrics in the quantitative data was performed and compared across 2 periods: pre-SCMS implementation (before October 31, 2016) and post-SCMS implementation (November 1, 2016, and March 31, 2021). Results: In total, 6 Aspiranet employees (4 leaders and 2 life coaches) were interviewed, with a median time of 56 (IQR 53-67) minutes. The majority (5/6, 83%) were female, over 30 years of age (median 37, IQR 32-39) with a median of 6 (IQR 5-10) years of experience at Aspiranet and overall field experience of 10 (IQR 7-14) years. Most (4/6, 67%) participants rated their technological skills as expert. Thematic analysis of participants’ interview transcripts yielded 24 subthemes that were grouped into 6 superordinate themes: study context, the impact of the new tool, key strengths, commonly used features, expectations with WCM, and limitations and recommendations. The tool met users’ initial expectations of streamlining tasks and adopting essential functionalities. Median satisfaction scores around pre- and post-WCM workflow processes remained constant between 2 life coaches (3.25, IQR 2.5-4); however, among leaders, post-WCM scores (median 4, IQR 4-5) were higher than pre-WCM scores (median 3, IQR 3-3). Across the 2 study phases, Aspiranet served 1641 TAY having consistent population demographics (median age of 18, IQR 18-19 years; female: 903/1641, 55.03%; race and ethnicity: Hispanic or Latino: 621/1641, 37.84%; Black: 470/1641, 28.64%; White: 397/1641, 24.19%; Other: 153/1641, 9.32%). Between the pre- and post-WCM period, there was an increase in full-time school enrollment (359/531, 67.6% to 833/1110, 75.04%) and a reduction in part-time school enrollment (61/531, 11.5% to 91/1110, 8.2%). The median number of days spent in the foster care program remained the same (247, IQR 125-468 years); however, the number of incidents reported monthly per hundred youth showed a steady decline, even with an exponentially increasing number of enrolled youth and incidents. Conclusions: The SCMS for coordinating care and delivering tailored services to TAY streamlined Aspiranet’s workflows and processes and positively impacted youth outcomes. Further enhancements are needed to better align with user and youth needs.

Background: COVID-19 has been observed to be associated with venous and arterial thrombosis. The inflammatory disease prolongs hospitalization, and preexisting comorbidities can intensity the thrombotic burden in patients with COVID-19. However, venous thromboembolism, arterial thrombosis, and other vascular complications may go unnoticed in critical care settings. Early risk stratification is paramount in the COVID-19 patient population for proactive monitoring of thrombotic complications. Objective: The aim of this exploratory research was to characterize thrombotic complication risk factors associated with COVID-19 using information from electronic health record (EHR) and insurance claims databases. The goal is to develop an approach for analysis using real-world data evidence that can be generalized to characterize thrombotic complications and additional conditions in other clinical settings as well, such as pneumonia or acute respiratory distress syndrome in COVID-19 patients or in the intensive care unit. Methods: We extracted deidentified patient data from the insurance claims database IBM MarketScan, and formulated hypotheses on thrombotic complications in patients with COVID-19 with respect to patient demographic and clinical factors using logistic regression. The hypotheses were then verified with analysis of deidentified patient data from the Research Patient Data Registry (RPDR) Mass General Brigham (MGB) patient EHR database. Data were analyzed according to odds ratios, 95% CIs, and P values. Results: The analysis identified significant predictors (P<.001) for thrombotic complications in 184,831 COVID-19 patients out of the millions of records from IBM MarketScan and the MGB RPDR. With respect to age groups, patients 60 years and older had higher odds (4.866 in MarketScan and 6.357 in RPDR) to have thrombotic complications than those under 60 years old. In terms of gender, men were more likely (odds ratio of 1.245 in MarketScan and 1.693 in RPDR) to have thrombotic complications than women. Among the preexisting comorbidities, patients with heart disease, cerebrovascular diseases, hypertension, and personal history of thrombosis all had significantly higher odds of developing a thrombotic complication. Cancer and obesity were also associated with odds>1. The results from RPDR validated the IBM MarketScan findings, as they were largely consistent and afford mutual enrichment. Conclusions: The analysis approach adopted in this study can work across heterogeneous databases from diverse organizations and thus facilitates collaboration. Searching through millions of patient records, the analysis helped to identify factors influencing a phenotype. Use of thrombotic complications in COVID-19 patients represents only a case study; however, the same design can be used across other disease areas by extracting corresponding disease-specific patient data from available databases.