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Narcotic prescribing

Minho Kang, Ryan A Mischel, Sukhada Bhave, Essie Komla, Alvin Cho, Charity Huang, William L Dewey, Hamid I Akbarali
There is growing appreciation for the importance of gastrointestinal microbiota in many physiological and pathophysiological processes. While morphine and other narcotics are the most widely prescribed therapy for moderate to severe pain clinically, they have been noted to alter microbial composition and promote bacterial translocation to other tissues. Here we examined the pharmacodynamic properties of chronic morphine in mice following bacterial depletion with oral gavage of an antibiotic cocktail (ABX). ABX significantly reduced gut bacteria and prevented chronic morphine induced increases in gut permeability, colonic mucosal destruction, and colonic IL-1β expression...
February 17, 2017: Scientific Reports
Alon D Altman, Gregg S Nelson
OBJECTIVE: To survey the current practice of Society of Gynecologic Oncology of Canada (GOC) members about preoperative, intraoperative, and postoperative phases of care. The survey was carried out prior to publication of the Enhanced Recovery After Surgery (ERAS) Society gynaecologic/oncology guidelines. METHODS: A survey was developed by the GOC and distributed to all surgical members between September and December 2015. RESULTS: The survey was completed by 77 of 92 practising gynaecologic oncologists (84%), representing 19 centres in 16 cities across Canada...
December 2016: Journal of Obstetrics and Gynaecology Canada: JOGC, Journal D'obstétrique et Gynécologie du Canada: JOGC
Kimberly Fernandes, Diana Martins, David Juurlink, Muhammad Mamdani, J Michael Paterson, Luke Spooner, Samantha Singh, Tara Gomes
AIMS: To examine the impact of national clinical practice guidelines and provincial drug policy interventions on prevalence of high-dose opioid prescribing and rates of hospitalization for opioid toxicity. DESIGN: Interventional time-series analysis. SETTING: Ontario, Canada, from 2003 to 2014. PARTICIPANTS: Ontario Drug Benefit (ODB) beneficiaries aged 15 to 64 years from 2003 to 2014. INTERVENTIONS: Publication of Canadian clinical practice guidelines for use of opioids in chronic non-cancer pain (May 2010) and implementation of Ontario's Narcotics Safety and Awareness Act (NSAA; November 2011)...
2016: PloS One
Tara Kelley-Baker, Geetha Waehrer, Robin A Pollini
OBJECTIVE: Drug-involved driving has become an increasing concern. Although the focus has been on illegal drugs, there is evidence that prescribed medications can impair driving ability. The purpose of this study was to determine the self-reported prevalence of prescription drug use, including medical and nonmedical use, among a nationally representative sample of drivers and to report related driver characteristics. METHOD: As part of the 2013-2014 National Roadside Survey, drivers from 60 sites were randomly recruited and asked to complete a survey on prescription drug use...
January 2017: Journal of Studies on Alcohol and Drugs
Parvin Sajedi, Ali Rahimian, Gholamreza Khalili
OBJECTIVE: This study aimed to compare two methods of controlled hypotension using labetalol and remifentanil in terms of capability to create controlled hypotension and to investigate the obtained complications, and satisfaction rate of surgeon and patient during functional endoscopic sinus surgery. METHODS: In this prospective clinical trial, 62 patients underwent endoscopic sinus surgery in Al-Zahra and Ayatollah Kashani Hospitals of Isfahan were divided into two groups: in the first group, 20 mg bolus dose of labetalol and then infusion of it, at a rate of 0...
October 2016: Journal of Research in Pharmacy Practice
Nathan J Gonik, Martin H Bluth
Concern for illicit and restricted drug use in otolaryngology is similar to other surgical specialties with a few notable exceptions. Many illicit drugs are consumed transnasally. Repeated nasal exposure to stimulants or narcotics can cause local tissue destruction that can present as chronic rhinosinusitis or nasoseptal perforation. Further, the Food and Drug Administration has taken a stance against codeine for pediatric patients undergoing adenotonsillectomy. They have identified an increased risk of death postoperatively with these medications...
December 2016: Clinics in Laboratory Medicine
Rachel B Seymour, Daniel Leas, Meghan K Wally, Joseph R Hsu
No abstract text is available yet for this article.
2016: BMC Medical Informatics and Decision Making
Justin C Sowder, Craig M Gale, Jacob L Henrichsen, Kristy Veale, Katie B Liljestrand, Barbara C Ostlund, Aaron Sherwood, Austin Smith, Griffin H Olsen, Mark Ott, Jeremy D Meier
OBJECTIVES: To (1) review pain medications prescribed following pediatric adenotonsillectomy (T&A), (2) identify pain medications reported to be helpful, and (3) compare parent-reported outcomes among various combinations of pain medications. STUDY DESIGN: Case series with planned data collection. SETTING: Multihospital network. SUBJECTS AND METHODS: The primary caregivers of children aged 1 to 18 years who underwent isolated T&A from June to December 2014 were contacted 14 to 21 days after surgery...
November 2016: Otolaryngology—Head and Neck Surgery
N Krzyżaniak, I Pawłowska, B Bajorek
WHAT IS KNOWN AND OBJECTIVES: When considering acute care settings, such as the neonatal intensive care unit (NICU), the inappropriate use of medicines poses a great risk to vulnerable babies at the start of their lives. However, there is limited published literature that explores the current medication management practices in NICUs and where the main misuse issues lie. Therefore, the purpose of this review was to give an overview of medicine use in NICUs worldwide and identify therapeutic areas requiring more targeted pharmaceutical care...
December 2016: Journal of Clinical Pharmacy and Therapeutics
Rachel B Seymour, Daniel Leas, Meghan K Wally, Joseph R Hsu
BACKGROUND: Prescription narcotic overdoses and abuse have reached alarming numbers. To address this epidemic, integrated clinical decision support within the electronic medical record (EMR) to impact prescribing behavior was developed and tested. METHODS: A multidisciplinary Expert Panel identified risk factors for misuse, abuse, or diversion of opioids or benzodiazepines through literature reviews and consensus building for inclusion in a rule within the EMR. We ran the rule "silently" to test the rule and collect baseline data...
August 22, 2016: BMC Medical Informatics and Decision Making
Melissa M Butler, Randy A Sansone, Charles Opperman
No abstract text is available yet for this article.
2016: Primary Care Companion to CNS Disorders
O K Levchenko, E M Shulutko, V Yu Zorenko, G M Galstyan
AIM: to study the nature of pain in hemophilic arthropathy and its prevention ways used by patients with hemophilia. SUBJECTS AND METHODS: A prospective, multicenter, cross-sectional study was conducted to interview 136 patients with hemophilia A or B. The survey included 32 points, including questions about drug and nondrug pain treatment, as well as questionnaires to assess the severity of pain and its impact on daily life (Brief Pain Inventory) and those to identify a neuropathic pain component (PainDetect questionnaire)...
2016: Terapevticheskiĭ Arkhiv
Carolyn W Swenson, Angela S Kelley, Dee E Fenner, Mitchell B Berger
OBJECTIVES: To quantify outpatient narcotic use in the first 2 weeks after urogynecologic surgery. METHODS: Using a convenience sample, women who underwent minimally invasive urogynecologic surgery between May and October 2014 were contacted by telephone 2 weeks postoperatively and given a questionnaire regarding their postoperative pain experience. To quantify narcotic use, patients were asked to count the tablets remaining from their discharge narcotic prescription...
September 2016: Female Pelvic Medicine & Reconstructive Surgery
Susan Seago, Adam Hayek, Jessica Pruszynski, Megan Greene Newman
Nationally, health care providers wrote 259 million prescriptions for narcotic analgesics in 2012, or roughly one bottle of narcotics per US adult (1). In an effort to combat this ever-growing problem, the Drug Enforcement Administration changed the schedule of hydrocodone combination products from schedule III to schedule II on October 6, 2014. Fourteen Baylor Scott & White pharmacies encompassing a 200-mile radius in Central Texas were queried for prescription information on hydrocodone/acetaminophen, morphine, codeine/acetaminophen, and tramadol before and after the rescheduling to evaluate trends in prescription drug usage...
July 2016: Proceedings of the Baylor University Medical Center
Steven J Waisbren
America is suffering from an epidemic of opioid misuse that has been attributed to the narcotic prescribing practices of physicians. This article focuses on the State of Minnesota and the role that its Board of Medical Practice (BMP) played in this crisis. It presents a review of guidelines issued by the BMP over the last 30 years, showing that it followed national trends in emphasizing increased prescribing of narcotics for pain up until last year, when a much more cautious and nuanced approach to opioid prescribing was advised...
May 2016: Minnesota Medicine
Ryan P Mulligan, Kevin J McCarthy, Benjamin J Grear, David R Richardson, Susan N Ishikawa, G Andrew Murphy
BACKGROUND: The purpose of this study was to examine factors associated with pain after elective ankle and hindfoot reconstruction. METHODS: Patients who underwent major ankle or hindfoot reconstruction over a 3-year period were identified. Retrospective chart review determined patient demographics, comorbidities, surgeries, tobacco, alcohol, and narcotic use, chronic pain, and mood disorders. Primary outcomes were cumulative amount of narcotic prescribed (morphine milligram equivalent dose) in the initial 90-day postoperative period, beyond 90 days, and visual analog pain score (VAS) at a minimum of 1-year follow-up...
October 2016: Foot & Ankle International
Norah Baker
Chronic pain and its associated syndrome have become increasingly prevalent in primary care. With the increase in narcotic use and subsequent adverse events, primary care physicians often seek safer alternatives to treating this condition. Prescribing narcotics necessitates using methods to screen for high abuse risk and protect against misuse. With the understanding of how chronic pain is related to mental illnesses such as depression and posttraumatic stress disorder, mindfulness techniques and behavioral therapy can be used to help decrease the dependence on dangerous opioid medications and help patients understand, accept, and cope with their chronic pain...
June 2016: Primary Care
Stephen F Kappa, Elizabeth A Green, Nicole L Miller, Stanley D Herrell, Christopher R Mitchell, Hassan R Mir, Matthew J Resnick
PURPOSE: We sought to determine perioperative patterns of narcotic use and the prevalence of postoperative doctor shopping among patients with nephrolithiasis requiring operative management. MATERIALS AND METHODS: We retrospectively reviewed the records of consecutive patients residing in Tennessee who required ureteroscopy with laser lithotripsy for nephrolithiasis at a single institution from January to December 2013. Using the Tennessee CSMD (Controlled Substances Medication Database) patients were categorized by the number of postoperative narcotic providers...
September 2016: Journal of Urology
Eija Kivekäs, Hannes Enlund, Elizabeth Borycki, Kaija Saranto
RATIONALE, AIMS AND OBJECTIVES: The purpose of this study was to assess general practitioners' (GP) experience of an electronic prescription (e-prescription) system and the use of a national prescription centre. METHODS: A web-based survey with 29 structured questions and 8 open-ended questions was used. The technology acceptance model was used to explain first users' use of e-prescribing technology. GPs (n = 269) in two different primary health care organizations, which implemented the e-prescribing module as the first of its kind in Finland...
October 2016: Journal of Evaluation in Clinical Practice
Xu Fang, Ling-Ling Zhu, Sheng-Dong Pan, Ping Xia, Meng Chen, Quan Zhou
Safe medication management and use of high-alert narcotics should arouse concern. Risk management experiences in this respect in a large-scale Joint Commission International (JCI)-accredited academic medical center hospital in the People's Republic of China during 2011-2015, focusing on organizational, educational, motivational, and information technological measures in storage, prescribing, preparing, dispensing, administration, and monitoring of medication are summarized. The intensity of use of meperidine in hospitalized patients in 2015 was one-fourth that in 2011...
2016: Therapeutics and Clinical Risk Management
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