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https://www.readbyqxmd.com/read/29121158/opioid-use-by-patients-after-rhinoplasty
#1
Sagar Patel, Angela Sturm, Michael Bobian, Peter F Svider, Giancarlo Zuliani, Russell Kridel
Importance: Given the increase in opioid addiction and overdose in the United States, reasoned opioid use after outpatient surgery may affect prescription medication abuse. Objectives: To examine patient use of opioids after rhinoplasty and establish an optimal postrhinoplasty pain management regimen. Design, Setting, and Participants: In this case series, opioid use was evaluated in 62 patients who underwent rhinoplasty performed by 3 fellowship-trained facial plastic surgeons, 2 in private practice in Texas and 1 in an academic setting in Michigan, from February 2016 to September 2016...
November 9, 2017: JAMA Facial Plastic Surgery
https://www.readbyqxmd.com/read/29084006/review-and-update-on-postoperative-opioid-use-after-nasal-and-sinus-surgery
#2
Sophia D Becker, Daniel G Becker
PURPOSE OF REVIEW: We examine the current literature on pain management after sinus and nasal surgery. The goal after surgery is to provide effective pain management without having too many 'leftovers', as leftover medications are an important source of opioids that are fueling the current prescription narcotic epidemic in the United States. There are more than 250 000 sinus operations and 260 000 septoplasties performed annually, and surgeons commonly prescribe a narcotic pain medication for postoperative pain management...
October 27, 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/29078056/pain-management-after-outpatient-foot-and-ankle-surgery
#3
Akash Gupta, Kanupriya Kumar, Matthew M Roberts, Austin E Sanders, Mackenzie T Jones, David S Levine, Martin J O'Malley, Mark C Drakos, Andrew J Elliott, Jonathan T Deland, Scott J Ellis
BACKGROUND: The number of opioids prescribed and used has increased precipitously over the past 2 decades for a number of reasons and has led to increases in long-term dependency, opioid-related deaths, and diversion. Most studies examining the role of prescribing habits have investigated nonoperative providers, although there is some literature describing perioperative opioid prescription and use. There are no studies looking at the number of pills consumed after outpatient foot and ankle surgeries, nor are there guidelines for how many pills providers should prescribe...
October 1, 2017: Foot & Ankle International
https://www.readbyqxmd.com/read/29065039/opioid-prescribing-practices-by-orthopaedic-trauma-surgeons-after-isolated-femur-fractures
#4
Basem Attum, Andres Buitrago Rodriguez, Nichelle Harrison, Adam Evans, William Obremskey, Manish Sethi, Alex Jahangir
OBJECTIVE: The purpose of this retrospective study was to identify opioid prescribing practices, determine the number of morphine milliequivalents (MMEs) prescribed by orthopaedic/non-orthopaedic members to narcotic naive and previously exposed patients and provide narcotic prescribing recommendations. METHODS: Patients over 18 years old with an isolated femur fracture sustained between 2013 and 2015 were identified using the CPT code 27506. Prescribing information was obtained from the State Controlled Substance Monitoring Database (CSMD)...
October 14, 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/29028641/postoperative-care-after-tonsillectomy-what-s-the-evidence
#5
Patrick Carpenter, Daniel Hall, Jeremy D Meier
PURPOSE OF REVIEW: The purpose of this review is to evaluate the current literature regarding postoperative management after tonsillectomy in children. RECENT FINDINGS: Controversy remains regarding the ideal medication regimen to manage pain after tonsillectomy. Acetaminophen and ibuprofen are routinely used, although concerns of more severe postoperative hemorrhage with ibuprofen remain. Narcotics are prescribed commonly, but with extreme caution in children with severe obstructive sleep apnea...
December 2017: Current Opinion in Otolaryngology & Head and Neck Surgery
https://www.readbyqxmd.com/read/29023594/first-trimester-medication-abortion-practice-in-the-united-states-and-canada
#6
Heidi E Jones, Katharine O'Connell White, Wendy V Norman, Edith Guilbert, E Steve Lichtenberg, Maureen Paul
We conducted a cross-sectional survey of abortion facilities from professional networks in the United States (US, n = 703) and Canada (n = 94) to estimate the prevalence of medication abortion practices in these settings and to look at regional differences. Administrators responded to questions on gestational limits, while up to five clinicians per facility reported on 2012 medication abortion practice. At the time of fielding, mifepristone was not approved in Canada. 383 (54.5%) US and 78 (83.0%) Canadian facilities participated...
2017: PloS One
https://www.readbyqxmd.com/read/28990210/the-impact-of-practice-guidelines-on-opioid-utilization-for-injured-workers
#7
Christine Buttorff, Antonio J Trujillo, Renan Castillo, Andres I Vecino-Ortiz, Gerard F Anderson
BACKGROUND: Opioid use is rising in the US and may cause special problems in workers compensation cases, including addiction and preventing a return to work after an injury. OBJECTIVE: This study evaluates a physician-level intervention to curb opioid usage. An insurer identified patients with out-of-guideline opioid utilization and called the prescribing physician to discuss the patient's treatment protocol. RESEARCH DESIGN: This study uses a differences-in-differences study design with a propensity-score-matched control group...
October 9, 2017: American Journal of Industrial Medicine
https://www.readbyqxmd.com/read/28968623/responsible-opioid-prescribing-for-chronic-pain-interpreting-the-cdc-guideline-understanding-new-rhode-island-regulations
#8
Alan L Gordon, Amy F Snyder
New Rhode Island regulations require physicians and other licensed practitioners to make significant adjustments to comply with new requirements for prescribing narcotics for chronic pain. Responding to the opioid epidemic, the new rules are intended to improve patient safety by changing physicians' prescribing patterns. However, the new rules may overlook the importance of treatment-access problems and the importance of buprenorphine products for treating pain and opioid dependence. Empirical data have demonstrated the safety and efficacy of buprenorphine in treating opioid-dependent patients with chronic pain, including those with and without substance abuse histories, but access to buprenorphine treatment remains limited throughout the state...
October 2, 2017: Rhode Island Medical Journal
https://www.readbyqxmd.com/read/28955004/successful-treatment-of-mixed-mainly-cancer-pain-by-tramadol-preparations
#9
Shinji Kawahito, Tomohiro Soga, Naoji Mita, Shiho Satomi, Hiroyuki Kinoshita, Tomoko Arase, Akira Kondo, Hitoshi Miki, Kazumi Takaishi, Hiroshi Kitahata
The patient, a 70-year-old Japanese woman diagnosed with parotid gland cancer, underwent wide excision and reconstruction (facial nerve ablation, nerve transposition). At 1 month after the surgery, she was brought to our hospital's pain medicine department because her postoperative pain and cancer-related pain were poorly controlled. She had already been prescribed a tramadol (37.5 mg)/acetaminophen (325 mg) combination tablet (5 tablets/day). However, in addition to the continuous pain in her face and lower limbs, she was troubled by a trigeminal neuralgia-like prominence ache...
2017: Journal of Medical Investigation: JMI
https://www.readbyqxmd.com/read/28953194/guideline-recommended-vs-high-dose-long-term-opioid-therapy-for-chronic-noncancer-pain-is-associated-with-better-health-outcomes-data-from-a-representative-sample-of-the-german-population
#10
Winfried Häuser, Tino Schubert, Norbert Scherbaum, Thomas Tölle
Recent evidence-based guidelines for long-term opioid therapy (LTOT) for chronic noncancer pain (CNCP) have defined daily morphine equivalent doses (MEQ/d) that require particular caution. The recommendation for a threshold MEQ/d is based on North American studies that have demonstrated negative health outcomes associated with high-dose LTOT for CNCP. We have conducted a retrospective cross-sectional study using an anonymized German health claims database, including 4,028,618 persons insured by 69 German statutory health insurances, representative of age and sex for the German population in 2014...
October 31, 2017: Pain
https://www.readbyqxmd.com/read/28887020/narcotic-use-and-total-knee-arthroplasty
#11
Jourdan M Cancienne, Kishan J Patel, James A Browne, Brian C Werner
BACKGROUND: Although the United States is in the midst of a narcotic epidemic, risk factors for use and the impact of perioperative narcotic use on total knee arthroplasty (TKA) outcomes is ill-defined. METHODS: A national database was queried for patients who underwent primary TKA from 2007 to 2015. Patients taking narcotics in the preoperative, and for a prolonged period of time postoperatively, were identified. The risk factors for prolonged narcotic use were analyzed with a regression analysis, in addition to evaluating preoperative and prolonged postoperative use as independent risk factors for short-term and long-term complications...
August 17, 2017: Journal of Arthroplasty
https://www.readbyqxmd.com/read/28862884/opioid-prescribing-patterns-by-obstetrics-and-gynecology-residents-in-the-united-states
#12
Adam D Baruch, Daniel McBurney Morgan, Vanessa K Dalton, Carolyn Swenson
BACKGROUND: Despite the opioid epidemic in the U.S., little data exist to guide postoperative opioid prescribing in Obstetrics & Gynecology (Ob/Gyn). OBJECTIVE: To describe Ob/Gyn resident opioid prescription patterns in the U.S. and assess influential factors. METHODS: An anonymous survey was emailed to Ob/Gyn residents in the U.S. between January-February 2015. Respondents reported the typical number of discharge narcotic tablets prescribed following six common procedures...
September 1, 2017: Substance Use & Misuse
https://www.readbyqxmd.com/read/28735156/adaptive-periodic-paralysis-allows-weaning-deep-sedation-overcoming-the-drowning-syndrome-in-ecmo-patients-bridged-for-lung-transplantation-a-case-series
#13
Irina Timofte, Michael Terrin, Erik Barr, June Kim, Joseph Rinaldi, Nicholas Ladikos, Jay Menaker, Ali Tabatabai, Zachary Kon, Bartley Griffith, Richard Pierson, Si Pham, Aldo Iacono, Daniel Herr
PURPOSE: Sedation in extracorporeal membrane oxygenation (ECMO) is challenging. Patients require deep sedation because of extremely high respiratory rates and increased work of breathing ("Drowning Syndrome") resulting in altered intra-thoracic pressure and reduced pump flow associated with hemodynamic compromise and decreased oxygenation. However, deep sedation impedes essential active rehabilitation with physical therapy. METHODS: We reviewed data on 3 ECMO patients for whom we used a novel approach to replace continuous drips with periodic sedation/paralysis...
July 17, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28705485/trainees-as-agents-of-change-in-the-opioid-epidemic-optimizing-the-opioid-prescription-practices-of-surgical-residents
#14
Alexander S Chiu, James M Healy, Michael P DeWane, Walter E Longo, Peter S Yoo
OBJECTIVE: Opioid abuse has become an epidemic in the United States, causing nearly 50,000 deaths a year. Postoperative pain is an unavoidable consequence of most surgery, and surgeons must balance the need for sufficient analgesia with the risks of overprescribing. Prescribing narcotics is often the responsibility of surgical residents, yet little is known about their opioid-prescribing habits, influences, and training experience. DESIGN: Anonymous online survey that assessed the amounts of postoperative opioid prescribed by residents, including type of analgesia, dosage, and number of pills, for a series of common general surgery procedures...
July 10, 2017: Journal of Surgical Education
https://www.readbyqxmd.com/read/28699380/addressing-the-barriers-related-with-opioid-therapy-for-management-of-chronic-pain-in-india
#15
Gur Prasad Dureja, Paramanand N Jain, Muralidhar Joshi, Ashok Saxena, Gautam Das, Jaishid Ahdal, Prashant Narang
India has a high prevalence of chronic disorders which may be associated with persistent pain. Despite the availability of multiple treatment options, chronic pain is largely untreated and contributes to disability and mortality. Medical consumption of opioids remains low due to various barriers that prevent access to opioids for patients and healthcare practitioners. Stringent regulatory provisions outlined in the Narcotic Drugs and Psychotropic Substances Act (1985) have been major deterrents to adequate opioid use...
July 2017: Pain Management
https://www.readbyqxmd.com/read/28697049/wide-variation-and-overprescription-of-opioids-after-elective-surgery
#16
MULTICENTER STUDY
Cornelius A Thiels, Stephanie S Anderson, Daniel S Ubl, Kristine T Hanson, Whitney J Bergquist, Richard J Gray, Halena M Gazelka, Robert R Cima, Elizabeth B Habermann
OBJECTIVE: We aimed to identify opioid prescribing practices across surgical specialties and institutions. BACKGROUND: In an effort to minimize the contribution of prescription narcotics to the nationwide opioid epidemic, reductions in postoperative opioid prescribing have been proposed. It has been suggested that a maximum of 7 days, or 200 mg oral morphine equivalents (OME), should be prescribed at discharge in opioid-naïve patients. METHODS: Adults undergoing 25 common elective procedures from 2013 to 2015 were identified from American College of Surgeons National Surgical Quality Improvement Program data from 3 academic centers in Minnesota, Arizona, and Florida...
October 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28665561/-the-travelling-sports-physician
#17
Peter Jenoure
Travelling around your own country or even further abroad with a sports team or individual athletes as a sports physician is to be considered as a fundamental part of the various activities of a sports medicine practitioner.However, in our modern and quickly changing world, it is imperative to understand the different aspects of caring for athletes, also the legal ones. These may include licensing issues, malpractice coverage, access to care at outside institutions and prescribing and transporting medication of all sorts, including narcotics and substances of the list of prohibited ones (doping)...
July 13, 2016: Revue Médicale Suisse
https://www.readbyqxmd.com/read/28636707/incidence-and-predictors-of-opioid-prescription-at-discharge-after-traumatic-injury
#18
Muhammad Ali Chaudhary, Andrew J Schoenfeld, Alyssa F Harlow, Anju Ranjit, Rebecca Scully, Ritam Chowdhury, Meesha Sharma, Stephanie Nitzschke, Tracey Koehlmoos, Adil H Haider
Importance: In the current health care environment with increased scrutiny and growing concern regarding opioid use and abuse, there has been a push toward greater regulation over prescriptions of opioids. Trauma patients represent a population that may be affected by this regulation, as the incidence of pain at hospital discharge is greater than 95%, and opioids are considered the first line of treatment for pain management. However, the use of opioid prescriptions in trauma patients at hospital discharge has not been explored...
October 1, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28571723/opioid-consumption-after-rotator-cuff-repair
#19
Robert W Westermann, Chris A Anthony, Nic Bedard, Natalie Glass, Matt Bollier, Carolyn M Hettrich, Brian R Wolf
PURPOSE: Rising perioperative opioid use in the United States is of increasing concern. The purposes of this study were (1) to define opioid consumption after rotator cuff repair (RCR) in the United States and (2) to evaluate patient factors that may be associated with prolonged opioid use after arthroscopic RCR. METHODS: All arthroscopic RCRs performed between 2007 and 2014 were identified by use of Current Procedural Terminology code (29,827). Patients who filled opioid prescriptions preoperatively were divided into those who filled prescriptions at 1 to 3 months preceding RCR and those who filled opioid prescriptions only in the 1 month preceding RCR...
August 2017: Arthroscopy: the Journal of Arthroscopic & related Surgery
https://www.readbyqxmd.com/read/28554207/provider-type-and-management-of-common-visits-in-primary-care
#20
Douglas W Roblin, Hangsheng Liu, Lee F Cromwell, Michael Robbins, Brandi E Robinson, David Auerbach, Ateev Mehrotra
OBJECTIVES: Debate continues on whether nurse practitioners (NPs) and physician assistants (PAs) are more likely to order ancillary services, or order more costly services among alternatives, than primary care physicians (PCPs). We compared prescription medication and diagnostic service orders associated with NP/PA versus PCP visits for management of neck or back (N/B) pain or acute respiratory infection (ARI). STUDY DESIGN: Retrospective, observational study of visits from January 2006 through March 2008 in the adult primary care practice of Kaiser Permanente in Atlanta, Georgia...
April 2017: American Journal of Managed Care
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