***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To provide clinicians with a brief screening tool to predict accurately which individuals may develop aberrant behaviors when prescribed opioids for chronic pain . DESIGN One hundred and eighty-five consecutive new patients treated in one pain clinic took the self-administered Opioid Risk Tool ( ORT ) . The ORT measured the following risk factors associated in scientific literature with substance abuse : personal and family history of substance abuse ; age ; history of preadolescent sexual abuse ; and certain psychological diseases . Patients received scores of 0 - 3 ( low risk ) , 4 - 7 ( moderate risk ) , or > or= 8 ( high risk ) , indicating the probability of their displaying opioid-related aberrant behaviors . All patients were monitored for aberrant behaviors for 12 months after their initial visits . RESULTS For those patients with a risk category of low , 17 out of 18 ( 94.4 % ) did not display an aberrant behavior . For those patients with a risk category of high , 40 out of 44 ( 90.9 % ) did display an aberrant behavior . The authors used the c statistic to vali date the ORT , because it simultaneously assesses sensitivity and specificity . The ORT displayed excellent discrimination for both the male ( c = 0.82 ) and the female ( c = 0.85 ) prognostic models . CONCLUSION In a preliminary study , among patients prescribed opioids for chronic pain , the ORT exhibited a high degree of sensitivity and specificity for determining which individuals are at risk for opioid-related , aberrant behaviors . Further studies in a variety of pain and nonpain setting s are needed to determine the ORT 's universal applicability Assessing for the presence of addiction in the chronic pain patient receiving chronic opioid analgesia is a challenging clinical task . This paper presents a recently developed screening tool for addictive disease in chronic pain patients , and pilot efficacy data describing its ability to do so . In a small sample of patients ( n = 52 ) referred from a multidisciplinary pain center for " problematic " medication use , responses to the screening question naire were compared between patients who met combined diagnostic criteria for a substance use disorder and those who did not , as assessed by a trained addiction medicine specialist . Responses of addicted patients significantly differed from those of nonaddicted patients on multiple screening items , with the two groups easily differentiated by total question naire score . Further , three key screening indicators were identified as excellent predictors for the presence of addictive disease in this sample of chronic pain patients The Prescription Drug Use Question naire ( PDUQ ) is one of several published tools developed to help clinicians better identify the presence of opioid abuse or dependence in patients with chronic pain . This paper introduces a patient version of the PDUQ ( PDUQp ) , a 31-item question naire derived from the items of the original tool design ed for self-administration , and describes evidence for its validity and reliability in a sample of patients with chronic nonmalignant pain and on opioid therapy . Further , this study examines instances of discontinuation from opioid medication treatment related to violation of the medication agreement in this population , and the relationship of these with problematic opioid misuse behaviors , PDUQ and PDUQp scores . A sample of 135 consecutive patients with chronic nonmalignant pain was recruited from a multidisciplinary Veterans Affairs chronic pain clinic , and prospect ively followed over one year of opioid therapy . Using the PDUQ as a criterion measure , moderate to good concurrent and predictive validity data for the PDUQp are presented , as well as item-by-item comparison of the two formats . Reliability data indicate moderate test stability over time . Of those patients whose opioid treatment was discontinued due to medication agreement violation-related discontinuation ( MAVRD ) ( n=38 or 28 % of sample ) , 40 % of these ( n=11 ) were due to specific problematic opioid misuse behaviors . Based upon specificity and sensitivity analyses , a suggested cutoff PDUQp score for predicting MAVRD is provided . This study supports the PDUQp as a useful tool for assessing and predicting problematic opioid medication use in a chronic pain patient sample BACKGROUND : We recently described a method to identify drug diversion in the operating room ( OR ) from automated drug dispensing carts by anesthesia care providers , based on a retrospective outlier analysis of atypical transactions . Such transactions included those occurring on patients after their exit from the OR and on patients whose drugs were not dispensed at the location where the case was performed . In this report , we demonstrate prospect ively the utility of our methodology to detect diversion by unsuspected individuals . METHODS : Each month , all transactions involving scheduled drugs by anesthesia care providers are downloaded from the pharmacy data base and matched to case records from the anesthesia information management system . The frequency of atypical transactions is determined for each provider , normalized by the number of days they worked in the OR . For individuals who are > 2 SDs above the mean for the month for any of the screening queries , a manual examination of their drug transaction logs is performed . Anesthesia records for such providers are examined manually to help determine the likelihood that diversion is taking place , and evidence of escalating activity is considered . Actions taken depend on an assessment of the strength of the evidence that diversion has been occurring . RESULTS : Two unsuspected individuals were identified prospect ively as diverting drugs . Two individuals identified as abusing drugs recreationally outside the workplace showed no evidence of drug diversion through examination of the screening reports and transaction logs , and their rehabilitation treatment teams concurred that there was a very low probability of diversion . A final individual who demonstrated suspicious activity by the screening process was determined to have been careless in documentation practice s , rather than diverting . CONCLUSIONS : The drug diversion screening methodology previously developed is valid for the prospect i ve detection of unsuspected individuals diverting drugs from the OR . The system also provides material useful in the evaluation of possible diversion by anesthesia providers determined to be abusing drugs outside the workplace 
    Output:
    
Discussion Automated algorithms can facilitate population -level surveillance .
However , there is no true gold st and ard for determining nonmedical opioid use .
Few algorithms have been applied in real-world setting s. Conclusion Automated algorithms may facilitate identification of patients and /or providers most likely to need more intensive screening and /or intervention for nonmedical opioid use .