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It is estimated that nearly a third of people who abuse drugs started with prescription opioid medicines. Approximately, 11.5 million Americans used prescription drugs recreationally in 2016, and in 2018, 46,802 Americans died as the result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl (National Institutes on Drug Abuse (2020) Opioid Overdose Crisis. https://www.drugabuse.gov/drugs-abuse/opioids/opioid-overdose-crisis . Accessed 06 June 2020). Yet physicians will continue to prescribe oral opioids for moderate-to-severe pain in the absence of alternative therapeutics, underscoring the importance in understanding how drug choice can influence detrimental outcomes. One of the opioid prescription medications that led to this crisis is oxycodone, where misuse of this drug has been rampant. Being one of the most highly prescribed opioid medications for treating moderate-to-severe pain as reflected in the skyrocketed increase in retail sales of 866% between 1997 and 2007, oxycodone was initially suggested to be less addictive than morphine. The false-claimed non-addictive formulation of oxycodone, OxyContin, further contributed to the opioid crisis. Abuse was often carried out by crushing the pills for immediate burst release, typically by nasal insufflation, or by liquefying the pills for intravenous injection. Here, we review oxycodone pharmacology and abuse liability as well as present the hypothesis that oxycodone may exhibit a unique pharmacology that contributes to its high likability and abuse susceptibility. We will discuss various mechanisms that likely contribute to the high abuse rate of oxycodone including clinical drug likability, pharmacokinetics, pharmacodynamics, differences in its actions within mesolimbic reward circuity compared to other opioids, and the possibility of differential molecular and cellular receptor interactions that contribute to its selective effects. We will also discuss marketing strategies and drug difference that likely contributes to the oxycodone opioid use disorders and addiction.

Introduction: This study aims to evaluate program signaling in surgical specialties, analyze its influence on residency applications, and provide recommendations for enhancing its consistency and effectiveness. Methods: This cross-sectional study analyzed AAMC ERAS data from the 2021 to 2022 and 2023 residency match cycles, focusing on surgical specialties including general surgery, neurological surgery, obstetrics and gynecology, and orthopedic surgery. Results: A positive correlation existed between the number of signals received and the number of applicants to a program across 4 surgical specialties. 10% of programs in each specialty received between 17% and 28% of all signals. There was a negative correlation between the number of current DO residents at a program and the number of signals received. Amongst surgical specialties, those with more signals per applicant had a more equitable distribution of signals across competitive programs. University programs received the most signals, programs were less likely to receive signals if they had a higher percentage of DO residents, and IMG applicants were less likely to send signals. Conclusion: Specialties with more signals per applicant had a more equitable distribution of signals across competitive programs, and university programs received proportionally more signals than community programs. Further research is required to investigate the disparities in signaling and the impact of signaling on successful matching. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to compare the impact of early initiation of enteral feeding initiation on clinical outcomes in critically ill adult trauma patients with isolated traumatic brain injuries (TBI). Methods: A retrospective cohort analysis of the American College of Surgeons Trauma Quality Program Participant Use File 2017-2021 dataset of critically ill adult trauma patients with moderate to severe blunt isolated TBI. Outcomes included ICU length of stay (ICU-LOS), ventilation-free days (VFD), and complication rates. Timing cohorts were defined as very early (<6 hours), early (6-24 hours), intermediate (24-48 hours), and late (>48 hours). Results: 9210 patients were included in the analysis, of which 952 were in the very early enteral feeding initiation group, 652 in the early, 695 in intermediate, and 6938 in the late group. Earlier feeding was associated with significantly shorter ICU-LOS (very early: 7.82 days; early: 11.28; intermediate 12.25; late 17.55; P <.001) and more VFDs (very early: 21.72 days; early: 18.81; intermediate 18.81; late 14.51; P <.001). Patients with late EF had a significantly higher risk of VAP than very early (OR.21, CI 0.12-.38, P <.001) or early EF (OR.33, CI 0.17-.65, P =.001), and higher risk of ARDS than the intermediate group (OR.23, CI 0.05-.925, P =.039). Conclusion: Early enteral feeding in critically ill adult trauma patients with moderate to severe isolated TBI resulted in significantly fewer days in the ICU, more ventilation-free days, and lower odds of VAP and ARDS the sooner enteral feeding was initiated, with the most optimized outcomes within 6 hours. [ABSTRACT FROM AUTHOR]

Introduction: This narrative review aims to evaluate the impact of current spinal immobilization practices on clinical outcomes in adult trauma patients with suspected or confirmed spinal injury to direct the creation of improved practice management guidelines. Methods: PubMed, ProQuest, Embase, Google Scholar, and Cochrane were searched for studies that evaluated the impact of spine immobilization practices during resuscitation in adult trauma patients and reported associated clinical outcomes. Outcomes included neurological deficits, in-hospital mortality, hospital length of stay (HLOS), ICU length of stay (ICU-LOS), discharge disposition, long-term functional status (modified Rankin scale), vascular injury rate, and respiratory injury rate. Results: Nine studies were included in this review, divided into two groups based on patient immobilization status. Patients compared with and without cervical immobilization had higher mortality, longer ICU-LOS, and a higher incidence of neurological deficits if immobilized. Immobilization only was associated with a higher incidence of indirect neurological injury and poor functional outcomes. Conclusion: Spinal immobilization during resuscitation in adult trauma patients is associated with a higher risk of neurological injury, in-hospital mortality, and longer ICU-LOS. Further research is needed to provide strong evidence for spinal immobilization guidelines and identify the optimal method and timing for immobilization practices in trauma patients. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to examine the trends across the entire NRMP application cycles from 2007-2008 to 2022-2023, specifically exploring trends across competitive surgical specialties to assess the efficacy of the existing NRMP business model and provide evidence-based recommendations to better address the current needs of both applicants and programs. Methods: A cross-sectional study exploring the trends in the mean number of applicants and mean number of total ranked positions per applicant across surgical, the top 5 most competitive surgical specialties, and non-surgical specialties from 2007-2008 to the 2022-2023 match cycles utilizing data from the NRMP database. Results: Over the studied 16 match cycles, the mean number of applicants to surgical specialties has increased by 47.99% and the mean number of total ranked positions per applicant has increased by 88.07%. For the top 5 most competitive specialties, the mean number of applicants has increased by 57.66% and the mean number of total ranked positions per applicant has increased by 83.33%. Conclusion: Trends across the 16 most recent NRMP cycles show evidence of increased congestion in the match system, the burden of which is primarily placed on applicants. Our findings support the need for drastic reform in the NRMP to relieve this burden, and we discuss practical solutions to allow the NRMP to better meet the needs of applicants and residency programs alike. [ABSTRACT FROM AUTHOR]

This project aims to review and compare the professional identity formation (PIF) of medical, dental, nursing, and pharmacy students while analyzing the role of interprofessional education (IPE) in this journey. Our medical research librarian conducted a literature review. Papers were selected based on the inclusion criteria developed by authors for PIF and IPE topics, which were then stratified for each health program of interest: medicine, dentistry, nursing, and pharmacy. The IPE core competencies were analyzed to understand the effect of IPE on each respective group of health professional students. Among all four major health professions, trust, collaboration, responsibility, accountability, communication, and empathy are key values within PIF. Trust, collaboration, and empathy were also regarded as core values in developing professionalism. Medical and dental students placed greater emphasis on responsibility and accountability regarding PIF. IPE played a crucial role in PIF for all students as values, teamwork, roles, and responsibilities were emphasized among each healthcare discipline of interest. This review provides significant information regarding which characteristics are emphasized for professional development across healthcare training programs. Future research to explore how certain characteristics and values influence healthcare as a whole is crucial. Investigating various influences on PIF outcomes is warranted for enhancing professional training programs and promoting interprofessional collaboration for better healthcare delivery., Competing Interests: Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rachakonda et al.)