30: A Portrait of Morphine Use at Home After Pediatric Surgery
Bibliographic record
Abstract
Following case reports of deaths in children associated with codeine use came a shift in practice from codeine to other opioids for post-surgical pain management. This shift brings about concerns regarding morphine use and safety at home, which have not yet been addressed in this population. The aim of this study was to describe the actual at home use of morphine as a pain reliever after surgery in children 0 to 12 years of age. The safety of this usage was examined as well. This prospective observational study was conducted at a pediatric university health center. Patients younger than 12 years undergoing surgery and receiving a morphine prescription upon discharge were recruited. A telephone interview was conducted in order to describe the reality of morphine use at home. The primary outcome was compliance with the discharge prescription, although many other aspects of morphine use were analysed. A total of 243 subjects were included and 219 completed the study. The median age was 4.0 years and the most frequent surgery was an ear-nose-throat procedure (55.1% of cases). A prescription for morphine to be taken on a regular basis was handed to 47.5% of the subjects whereas 52.5% received a prescription for morphine to be taken as needed. In the “as needed” group, although 76% (95% CI, 68%-84%) of parents filled the morphine prescription after surgery, most administered less than two doses to their child. The most frequent reasons for non-compliance in the group with a regular basis prescription were the absence of pain and the relief of pain with morphine given as needed only. The medication was stored in a closed space, out of sight, in 56% of cases. The most reported specific storage locations were the closet (48%), the counter (24%) and the table (7%). For the disposal of morphine at the end of the treatment, 55% indicated that they were planning to return the remaining quantity to their pharmacy for safe destruction. Nine percent indicated that they would keep it at home. This study sheds light upon the necessity to question the change in practice from codeine to morphine. The results demonstrate a need to minimise the quantity of morphine prescribed and dispensed, while ensuring adequate yet safe use of this medication.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".