Dylan Stephenson, Author at Southern Medical Association

All posts by Dylan Stephenson

Freedom from Addiction Coalition Community Breakfast
Friday, September 20, 2019
8:00 am – 9:00 am
(Breakfast served at 7:30 am)
Canterbury United Methodist Church – Canterbury Hall

For those in the Birmingham and surrounding areas, make plans to attend the Freedom from Addiction Coalition’s Community Breakfast on Friday, September 20, 2019. Guest speaker Susan Walley, MD, will discuss “Vaping-The New Gateway to Drug Addiction” to help raise awareness about the current reality of the addiction epidemic. Narcan training will take place immediately following the breakfast. 

This free event is taking place from 8:00 am - 9:00 am (breakfast served at 7:30 am)  in the Canterbury Hall of Canterbury United Methodist Church and is hosted by: 

Mayor Stewart Welch – Mountain Brook
Mayor Ashley Curry – Vestavia Hills
Mayor Scott McBrayer – Homewood
Mayor Frank Brocato – Hoover

Address: Canterbury United Methodist Church -- 350 Overbrook Road -- Mountain Brook, AL 35213

The BUSINESS of Medicine Simplified

The Business of Medicine Simplified is a CME conference designed to empower Physicians, Physicians Assistants, Nurse Practitioners, and Practice Managers with the tools they need to better manage the business side of healthcare.

blakley

Kala Blakely, DNP, CRNP, NP-C
State of Rural Health in the South

Kala Blakely, DNP, CRNP, NP-C is an Assistant Professor and the Coordinator for the Adult-Gero Primary Care NP specialty track at the UAB School of Nursing.  She has been an adult nurse practitioner since 2010. Dr. Blakely's faculty practice is in a NP led clinic outside of the metro Birmingham area. Her practice initiatives focus on providing women's health and primary care to those in rural Alabama. She desires to bring quality healthcare to those in underserved areas locally and globally. She is involved in ongoing AANP quality improvement initiatives at her rural clinic. Dr. Blakely serves as President of the UAB School of Nursing Alumni Board, a member of the Alabama Rural Health Association Board of Directors, and enjoys involvement in numerous other professional organizations. 

October 31 - November 2
Birmingham, AL

Assembly information
800-423-4992

Southern Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Southern Medical Association designates this live activity for a maximum of 13 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in this activity.

The Southern Medical Journal is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists, including medicine; surgery; women’s and children’s health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices.

Southern Medical Journal Vol. 112 • No. 09 • September 2019

Emergency Medicine & Disaster Preparedness

Patients Threatening Harm to Others Evaluated in the Emergency Department under the Florida Involuntary Hold Act (Baker Act)
Michael J. Maniaci, MD, M. Caroline Burton, MD, Christian Lachner, MD, Tyler F. Vadeboncoeur, MD, Nancy L. Dawson, MD, Archana Roy, MD, Adrian G. Dumitrascu, MD, Patricia C. Lewis, ARNP, and Teresa A. Rummans, MD

CME Article: Benefits of Using The Pause after Death in Emergency Departments: A Delphi Study
Tim Cunningham, DrPH, RN, and Dallas M. Ducar, MSN, RN

Commentary on “Benefits of Using The Pause after Death in Emergency Departments: A Delphi Study”
Brian James Daley, MD, FACS

Homelessness Among Patients in a Southeastern Safety Net Emergency Department
Toni S. Jackson, MD, Tim P. Moran, PhD, Jonathan Lin, BS, Jeremy Ackerman, MD, PhD, and Bisan A. Salhi, MD, PhD

Bioethics & Medical Education

Moral Injury or Burnout?
Thomas F. Heston, MD, and Joshuel A. Pahang, BS 

Women’s & Children’s Health

Comment on “Propofol Versus Dexmedetomidine for Procedural Sedation in a Pediatric Population”
Steven T. Baldwin, MD

A Simulation Course Focusing on Forensic Evidence Collection Improves Pediatric Knowledge and Standardizes Curriculum for Child Abuse
David W. Bernard, MD, Marjorie Lee White, MD, MPPM, Nancy M. Tofil, MD, Chris Jolliffe, RN, SANE-P, Amber Youngblood, BSN, RN, J. Lynn Zinkan, MPH, RN, Stacy L. Gaither, MSN, RN, Dawn Taylor Peterson, PhD, and Yih Ying Yuan, MD

Surgery & Surgical Specialties

Anesthetic Errors During Procedures in the United States
Punit Singh, MD, Mostafa Maita, DO, John Lacci, BA, Brian Boies, MD, America S. Revere, BS, Eden T. Sirak, BS, and Ali Seifi, MD

Medicine & Medical Specialties

Transitions of Care for Healthy Young Adults: Promoting Primary Care and Preventive Health 
Laurie Graves, MD, Shannon Leung, MD, Prashant Raghavendran, DO, and Sarah Mennito, MD, MSCR

SMA Services, Inc.

Sponsored by SMA Services, Inc.

teddy

Teddy Gillen

Teddy Gillen is an insurance broker and healthcare consultant on a mission protect the independent physician practice model.  Teddy and his firm, Southern Protective Group, design group purchasing malpractice insurance programs for associations with pricing discounts and policy structures that would normally be reserved for larger healthcare systems. Teddy has 15 years of industry experience – He and SPG are endorsed by physician associations across the country.

G. Richard Holt, MD, MSE, MPH, MABE, DBE

Dr. Holt is Clinical Professor and Professor Emeritus in the Department of Otolaryngology-Head and Neck Surgery at the University of Texas Health Science Center at San Antonio, where he was the founding chair.  He holds advanced degrees in bioengineering, public health, health care policy, and bioethics.  Dr. Holt has published over 225 scientific articles in a wide range of medical journals and textbooks.  In addition to his term as Editor-in-Chief of the Southern Medical Journal, Dr. Holt is a past Editor-in-Chief of the journal Otolaryngology-Head and Neck Surgery, and past Editor-in-Chief of the journal Aviation, Space, and Environmental Medicine (official journal of the Aerospace Medical Association).  He is a past Co-Editor of The Yearbook of Otolaryngology-Head and Neck Surgery.  He has served on the Editorial Boards of the Journal of Long-Term Medical Effects of Implants, the Journal of CranioMaxillofacial Surgery, and Texas Medicine, and regularly reviews for the Journal of Trauma (now the Journal of Trauma and Acute Care Surgery), the American Journal of Transplantation, Military Medicine, Laryngoscope Investigative Otolaryngology, and the Laryngoscope.  Dr. Holt previously served as the Section Editor for Ethics and Public Policy for the AMA Archives of Facial Plastic Surgery.

The Southern Medical Journal is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists, including medicine; surgery; women’s and children’s health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices.

Southern Medical Journal Vol. 112 • No. 08 • August 2019

Medicine and Medical Specialties

Prevalence and Predictors of Pulmonary Embolism in Hospitalized Patients with Syncope
Hussam Ammar, MD, Chaand Ohri, MD, Said Hajouli, MD, Shaunak Kulkarni, MD, Eshetu Tefera, MS, Ragai Fouda, PhD, MD, Rukma Govindu, MD

Weight-Bearing Physical Activity Influences the Effect of Vitamin D on Bone Turnover Markers in Patients with Intellectual Disability
Philip B. May, MD, Stephen J. Winters, MD

Public Health & Environmental Medicine

Health Behaviors in Rural Appalachia
Aasha I. Hoogland, PhD, Charles E. Hoogland, PhD, Shoshana H. Bardach, PhD, Yelena N. Tarasenko, DrPH, Nancy E. Schoenberg, PhD

Bioethics & Medical Education

What Defines an Honors Student? Survey of Pediatric and Internal Medicine Faculty Perspectives
Erinn O. Schmit, MD, Chang L. Wu, MD, Ryan B. Khodadadi, MD, L. Nicholas Herrera, MD, Winter L. Williams, MD, Carlos A. Estrada, MD, MS

Commentary on “What Defines an Honors Student? Survey of Pediatric and Internal Medicine Faculty Perspectives”
Patricia G. McBurney, MD, MSCR

SMA Services, Inc.

Sponsored by SMA Services, Inc.

ABIM Medical Knowledge MOC Points are now available for CME Courses!

Courses are available online 24/7/365

Addressing Hypertension and Diabetes in the Southern Region: The Role of Telemedicine
Presidential Keynote Speaker: Cardiovascular Disease: Now is the Time to Act Globally
An Introduction to Rheumatologic Diseases: Which Ones to Treat, Which Ones to Refer
The National Academy of Medicine Action Collaborative on Clinician Well-Being and Resilience
Pharmacological Therapeutic Advances: From New Pathways to Patient Care
The Risk Profile of the Southern Patient
Monitoring Blood Pressure & Disease Risks
Disease Risks Treatment and Control - Blood Pressure Management
Protocols, Strategies, and Programs for the Effective Treatment of Hypertension
New Payment Models
Clinically Integrated Networks
CIN Value-Based Contracting Strategies
Microhospitals and Free-Standing ERs
Health Insurance Exchanges
The Future is Now: Innovative Physician Organization Models
Telemedicine and Care Delivery Innovations
Substance Use Disorders in Women
Clinical Dilemmas: Vulvovaginitis and Vulvodynia
Endocrine Causes of Menstrual Dysfunction: More Common Than You Think
Management of Gestational Diabetes, Type 1 Diabetes, and Type 2 Diabetes in Pregnancy
Contraception Controversies Panel Discussion
Osteoporosis: What is Happening?
Sexually Transmitted Infections: I've Got an APP, What Else Do I Need?
Preconception Care - The Gateway to a Healthy Pregnancy
Cases in Diabetes & Thyroid Disease (New Thoughts)
Concussions and Gender Variations
Newer Orthopedic Modalities & Therapies 2019
Healthy Living: What's New? Guiding Your Patients in 2019
Challenging Case Presentations in Women's Health

SMA members get Online CME for FREE! Want to become a member? Check out our membership options here.

The BUSINESS of Medicine Simplified

The Business of Medicine Simplified is a CME conference designed to empower Physicians, Physicians Assistants, Nurse Practitioners, and Practice Managers with the tools they need to better manage the business side of healthcare.

martin

Robert Martin
Marketing and Promoting Your Medical Practice

Approximately 1 out of 5 of healthcare professionals do not have a website, making it harder for new patients to find them. SMA's Business of Medicine Simplified Conference will provide information to improve communication skills, develop relationships, and better engage patients through the use of tools and techniques available via internet marketing.

Robert began his career in the technology industry in 1995 as the VP for government sales for a technology supplier in Huntsville, Alabama. In 2002 Robert became one of the first certified HIPAA Privacy and Security officers through Network Edge in Memphis, Tennessee. He traveled throughout the southeast teaching "HIPAA in Daily Practice" based on the book of the same name, which he helped create.

October 31 - November 2
Birmingham, AL

Assembly information
800-423-4992

Southern Medical Association is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Southern Medical Association designates this live activity for a maximum of 13 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in this activity.

Joni Wyatt

With over 20 years of experience in the healthcare industry, Joni Wyatt, a senior healthcare advisor at Kassouf & Co. specializes in physician practice management, practice startups, physician contracting and compensation, health information systems, healthcare compliance, quality reporting and value-based reimbursement models.  Joni has been involved in several quality and value-based reimbursement initiatives in Alabama and was named a National Meaningful Use Vanguard for the State in 2012. She earned a Master’s Degree in Healthcare Administration and a Master’s degree in Health Information Administration from the Medical University of South Carolina in 2000. She is certified as a Professional in Health Information Management Systems (CPHIMS).  Joni is a member of the Medical Group Management Association (MGMA) and the Healthcare Financial Management Association (HFMA).  She has been an active member of the Health Information Management Systems Society (HIMSS) since 2001 and earned Fellow status in 2014. She has been an officer on the Board for the Alabama Chapter of HIMSS since 2012.

The Southern Medical Journal is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists, including medicine; surgery; women’s and children’s health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices.

Southern Medical Journal Vol. 112 • No. 07 • June 2019

Quality Care & Patient Safety

CME Article: Retrospective Analysis of the Effect of Postdischarge Telephone Calls by Hospitalists on Improvement of Patient Satisfaction and Readmission Rates
Mengli Xiao, MS, Catherine A. St. Hill, DVM, PhD, Marc Vacquier, MS, Love Patel, MD, Pamela Mink, PhD, Karl Fernstrom, MPH, Justin Kirven, MD, Jessica Jeruzal, BA, and David Beddow, MD

Outcomes of Patients Hospitalized for Severe Acute Alcoholic Hepatitis
Leonard Noronha, MD, Erin FitzGerald, DO, and J. Rush Pierce, Jr, MD, MPH

Public Health & Environmental Medicine

OPEN: Effect of Local Smoke-Free Ordinances on Smoking Prevalence in Kentucky, 2002–2009
W. Jay Christian, PhD, MPH, Courtney J. Walker, BA, Bin Huang, DrPH, MS, and Ellen J. Hahn, PhD, RN, FAAN

Bioethics & Medical Education

The Costs of Applying to Residency: One Institution’s Efforts to Increase Transparency
Andrew W. Kuhn, BA, Ryan T. Jarrett, BA, David R. Scudder, BS, Daniel E. Pereira, BS, Amy E. Fleming, MD, MHPE, and Brian C. Drolet, MD

Women’s & Children’s Health

Healthcare Access, Pregnancy Intention, and Contraceptive Practices Among Reproductive-Aged Women Receiving Opioid Agonist Therapy in Northeast Tennessee
Edward Leinaar, MPH, Leigh Johnson, MD, MPH, Ruby Yadav, DrPH, Abir Rahman, MPH, and Arsham Alamian, PhD, MSc

Medicine & Medical Specialties

Prevalence of Systemic Hypertension Among HIV-Infected and HIV-Uninfected Young Adults in Baltimore, Maryland
Patrick Ryscavage, MD, William Still, MS, Vimbai Nyemba, MD, and Kristen Stafford, PhD

An Updated Approach to Evaluation and Treatment of Helicobacter pylori Infection
Benjamin R. Lloyd, MD, and David A. Leiman, MD, MSHP

Commentary on “An Updated Approach to Evaluation and Treatment of Helicobacter pylori Infection”
Patrick G. Brady, MD

Choice of Intravenous Crystalloid Fluid and Mortality in Critically Ill Adult Patients.
Christopher D. Jackson, MD, Shawn B. Patel, MD, Matthew B. Haltom, MD, Praneet S. Iyer, MD, Marwan A. Odeesh, MD, Robert W. Bradsher, MD, Sehrish Kamal, MD, Ankur Seth, MD

Assessing the Availability of Pharmacotherapy Options for Tobacco Cessation in Tennessee’s Substance Use Facilities.
John Boatner, DSW, David Patterson, PhD, Freida Herron, DSW, William Nugent, PhD, Timothy Rice, MD

A Dose-Response Analysis of Crystalloid Administration during Esophageal Resection.
Morgan Smith, MBBS, Bobby Nossaman, MD

Commentary on “A Dose-Response Analysis of Crystalloid Administration during Esophageal Resection”.
Kyle J. Kalkwarf, MD

SMA Services, Inc.

Sponsored by SMA Services, Inc.

Thinking about attending the 2019 Southern Regional Assembly?

Here is a list of activities you and your family cane enjoy together in the city of Birmingham, The Magic City.

Birmingham Civil Rights Museum 

Richly detailed exhibits in the Civil Rights Institute reveal slices of black and white life in Alabama from the late 1800s to the present. A series of galleries tells the stories of daily life for African-Americans in the state and the nation and how dramatically different it was from the lives white people of that era took for granted.

Vulcan Park and Museum

Young and old. Modern and classic. It’s a fusion that makes Birmingham truly magical. At Vulcan Park and Museum, we’re a perfect blend of past and present, representing the spirit of our city. With breathtaking views of the city and a modern, yet timeless space for hosting, Vulcan Park and Museum holds distinction as a premier venue in Birmingham.

McWane Science Center

Four floors of hands-on exhibits and an IMAX Dome Theatre are all part of the fun of learning at McWane Science Center. Celebrating science and discovery, the exhibits include everything from dinosaurs to space travel. Play tunes with your feet on the Giant Piano, and learn about gravity with a daring ride on the High Cycle. Pet the sharks and stingrays in the Shark & Ray Touch Tank, and check out the Zoetrope for visual illusions of motion from still pictures.

Alabama Theater

Built in 1927, the Alabama Theatre is one of the nation’s last operating movie palaces, featuring first-run and revival films, concerts and other special events. It is one of the grand architectural accomplishments saved from the wrecking-ball fate of many others of that era. The “Mighty Wurlitzer” organ still rises from the orchestra pit and is often played to accompany silent films.

This is just some of the many attractions that Birmingham has to offer.  Check out the links below for more options.

We hope you join us in the Magic City!

All images provided by CVB Birmingham and Bham Now

The Southern Medical Journal is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists, including medicine; surgery; women’s and children’s health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices.

Southern Medical Journal Vol. 112 • No. 06 • June 2019

Bioethics & Medical Education
Everyday Leadership: A Combined Resident and Faculty Workshop
Sherine Salib, MD, MRCP, FACP, and Victoria Valencia, MPH

OPEN: Practical Considerations for the Academic Physician Moving to a New State
Jeremy B. Richards, MD, MA, and Susan R. Wilcox, MD

CME Article: Workplace Violence: Experiences of Internal Medicine Trainees at an Academic Medical Center
Becky Lowry, MD, Leigh M. Eck, MD, Erica E. Howe, MD, JoHanna Peterson, MD, and Cheryl A. Gibson, PhD

Dealing With Surrogate Conflict: A Student’s Perspective
Derek Su, MD, and David A. Fleming, MD, MA

Commentary on “Dealing with Surrogate Conflict: A Student’s Perspective”
G. Richard Holt, MD, MSE, MPH, MABE, DBioethics

Predictors of Empathic Compassion: Do Spirituality, Religion, and Calling Matter?
Caroline L. Thomas, MD, Mariana Cuceu, MD, Hyo Jung Tak, PhD, Marija Nikolic, MD, Sakshi Jain, MD, Theodore Christou, MD, and John D. Yoon, MD

Women’s & Children’s Health
Increasing Prevalence of Chronic Hepatitis C Virus Infection in a Southern Academic Obstetrical Clinic
Gweneth B. Lazenby, MD, Cody Orr, BA, Constance Guille, MD, and Eric G. Meissner, MD, PhD

Quality Care & Patient Safety
Availability of Hospital Resources and Specialty Services for Stroke Care in North Carolina
Mehul D. Patel, PhD, Gilson Honvoh, MSPH, Antonio R. Fernandez, PhD, Rhonda Cadena, MD, Emma R. Kelly, BSPH, Philip McDaniel, MA, and Jane H. Brice, MD, MPH

Holiday Discharges Are Associated with Higher 30-Day General Internal Medicine Hospital Readmissions at an Academic Medical Center
Ajay Dharod, MD, Brian J. Wells, MD, PhD, Kristin Lenoir, MPH, Wesley G. Willeford, MD, Michael W. Milks, MD, and Hal H. Atkinson, MD, MS

Mental Health
Canine-Assisted Therapy in Hospitalized Patients Awaiting Heart Transplantation
David Snipelisky, MD, Jessica Smidt, BS, Shawn Gallup, RN, Jane Myrick, RN, Brent Bauer, MD, and M. Caroline Burton, MD

Medicine & Medical Specialties
Summary of Selected Healthcare Encounters among a Selection of Patients with Myotonic Muscular Dystrophy
Kevin J. Bennett, PhD, Joshua R. Mann, MD, MPH, and Lijing Ouyang, PhD

Emergency Medicine & Disaster Preparedness
On “Healthcare Professionals and In-Flight Medical Emergencies: Resources, Responsibilities, Goals, and Legalities as a Good Samaritan”
Jim Q. Ho, BA, and Ware G. Kuschner, MD

Authors’ Response
Pascal Joseph de Caprariis, MD Brooklyn, and Angela de Caprariis-Salerno, RPh, MS

SMA Services, Inc.

Sponsored by SMA Services, Inc.

MANAGING ABERRANT BEHAVIOR IN PATIENTS WITH DEMENTIA

We hope you will enjoy this program. View the program articles.

Alzheimer’s disease and most other dementias are not fatal diseases. Patients often survive many years after the diagnosis is made. During this time their mental functions deteriorate and their personality often changes. This is distressing and unnerving to caregivers and loved ones who often are at a loss: they simply do not know how to handle their loved one anymore.

Caregivers have to be constantly vigilant, twenty-four hours a day, seven days a week, fifty-two weeks a year. They become apprehensive, restless, sleep deprived, mentally and physically exhausted. Their loved ones with dementia appear to be so unpredictable and their behavior aberrant so much out of line with the person they knew, respected and loved before dementia set in.

Caregivers often state that they do not know when a catastrophic reaction will unexpectedly erupt. They find themselves sucked in, trapped, unable to change course and unable to avoid the catastrophic outcome. They feel powerless and sometimes guilty.

It is our contention that many of these aberrant and unpredictable behaviors are in fact predictable and often can be anticipated and defused.

In this series of cases, based on real patients, we explore how some “aberrant behaviors” develop and may have a catastrophic ending. The first part of each case study is a description of the scenario showing how the catastrophic situation arose, escalated and reached its climax. It is followed by a step by step examination of what went wrong in the caregiver/patient interaction and how that catastrophic outcome could have been avoided, averted or defused. Each case study concludes with a brief rationalization of the aberrant behavior in patients suffering from this particular type and stage of dementia and includes tangible advice to caregivers in order to avoid that particular behavior from developing, escalating and erupting.

We hope that clinicians and health care professionals will find this material useful advice to caregivers who might seek their help with similar problems.

Finally, as a result of the collaboration between Gerontology and Geriatric Medicine and the Southern Medical Association, interested clinicians may wish to test their knowledge and earn CME credits by answering a few multiple-choice questions1

1This accredited continuing medical education Journal-based CME series has been developed in cooperation with the Southern Medical Association, a regional, multi-specialty membership organization accredited by the ACCME (with a mission:  To improve quality of patient care through multidisciplinary, interprofessional education”), physicians from the Departments of Gerontology and Psychiatry at East Tennessee State University, the Gerontology and Geriatric Medicine, an on-line peer-reviewed open access medical journal, and SAGE Publications.

MANAGING ABERRANT BEHAVIOR IN PATIENTS WITH DEMENTIA

Too Many Choices Confuse Patients with Dementia
Click here to read the article Click here to access the CME

Patients with Dementia are Easy Victims to Predators
Click here to read the article Click here to access the CME

Hallucinations Are Real to Patients with Dementia
Click here to read the article Click here to access the CME

Patients with Dementia Are Easily Distracted
Click here to read the article Click here to access the CME

Repetitive Questioning Exasperates Caregivers
Click here to read the article Click here to access the CME

Repetitive Questioning II
Click here to read the article Click here to access the CME

Impulsive, Disinhibited Behavior—Dining in a Restaurant
Click here to read the article Click here to access the CME

Driving and Patients with Dementia
Click here to read the article Click here to access the CME

Agnosia Interferes with Daily Hygiene in Patients with Dementia
Click here to read the article Click here to access the CME

Insomnia and Mild Cognitive Impairment
Click here to read the article Click here to access the CME

Visual Hallucinations and Paranoid Delusions
Click here to read the article Click here to access the CME

Fronto-temporal Dementia, Diabetes Mellitus & Excessive Eating
Click here to read the article Click here to access the CME

The United States is facing an opioid use disorder epidemic with opioid overdoses killing 47,000 people in the U.S. in 2017. The past three decades have witnessed a significant increase in the prescribing of opioids for pain, based on the belief that patients were being undertreated for their pain, coupled with a widespread misunderstanding of the addictive properties of opioids. This increase in prescribing of opioids also saw a parallel increase in addiction and overdose. In an effort to address this ongoing epidemic of opioid misuse, policy and regulatory changes have been enacted that have served to limit the availability of prescription opioids for pain management.

Overlooked amid the intense focus on efforts to end the opioid use disorder epidemic is the perspective of clinicians who are experiencing a significant amount of daily tension as opioid regulations and restrictions have limited their ability to treat the pain of their patients facing serious illness. Increased public and clinician scrutiny of opioid use has resulted in patients with serious illness facing stigma and other challenges when filling prescriptions for their pain medications or obtaining the prescription in the first place. Thus clinicians, patients, and their families are caught between the responses to the opioid use disorder epidemic and the need to manage pain related to serious illness.

The National Academies of Sciences, Engineering, and Medicine sponsored a workshop on November 29, 2018, to examine these unintended consequences of the responses to the opioid use disorder epidemic for patients, families, communities, and clinicians, and to consider potential policy opportunities to address them. This publication summarizes the presentations and discussions from the workshop.

Get the publication from The National Academies of Science, Engineering and Medicine .

A pregnancy can be one of the most joyous times for a family; the excitement of choosing a name, picking out colors for the nursery, selecting furniture. However, for many families this joy is short lived. According to the CDC, about 700 women die each year from complications of pregnancy with 60% of pregnancy related deaths preventable.

A pregnancy-related death can happen during pregnancy, at delivery, and even up to a year afterward (postpartum).

For 2011-2015:

  • About 1/3 of deaths (31%) happened during pregnancy;
  • About 1/3 (36%) happened at delivery or in the week after; and
  • About 1/3 (33%) happened 1 week to 1 year postpartum

Heart disease and stroke caused more than 1 in 3 deaths (34%). Other leading causes of death included infections and severe bleeding.

Every death reflects a web of missed opportunities. Factors playing a part include:

  • Access to care
  • Missed or delayed diagnoses
  • Not recognizing warning signs

Most deaths are preventable, no matter when they occur.

Join Drs. Nancy Phillip and Donald DiPette as they discuss Hypertension in Pregnancy and Diabetes in Pregnancy at the Focus on Women’s Health Conference.

Read more here.

According to the 2018 Physical Activity Guidelines for Americans, nearly 80% of adults are not meeting the recommended activity level. Women across all age groups are less likely to be physically active than men. The app, which was developed exclusively for the study and is not commercially available, had three main functions, including a pre-programed interactive daily message or video that reinforced what was learned during a beginning counseling session, and a daily activity diary to record progress. The app automatically increased the participants’ activity goals by 20 percent each week to 10,000 steps daily. To improve adherence, participants received an automated message if the app had not been used for three consecutive days. Read more.

The trial involved 210 physically inactive women, ages 25 and 65. They were equally divided into three groups--a control that had no intervention but used a tracking device for the nine months of the trial; a “regular” group that got counseling and used the tracker and the app for three months, then used only the tracker for the remaining six months; and a “plus” group that got counseling and used the tracker and the app for the entire nine months. Unlike most other studies, the researchers measured women’s activity every 60 seconds, every day for nine months, instead of relying on self-reported activity or intermittent activity measured by the tracker.

During the first three months, the tracker showed that, compared to the control group, the women in the regular and plus groups logged about 2,000 steps more per day, equivalent to approximately 1 mile or 20 minutes of walking. They also increased their moderate to vigorous physical activity by 18 minutes a day.

In the following six-month maintenance period, however, the regular and plus groups logged about 1,400 steps more than the control group and got in eight more minutes of moderate to vigorous physical activity. Researchers said these findings show that the women were able to sustain an impressive level of activity above their starting point. However, continued use of the app by the plus group did not add any extra benefit to help maintain this increased activity, compared to the regular group, which had stopped using the app after the first three months.

“Sustaining any behavior change is difficult in general, and in particular, sustaining the increased physical activity that resulted after the intervention,” Fukuoka said. “Still, it is encouraging to see that 97.6% of women in our trial completed a nine-month visit and kept up part of their increased activity.”

The researchers’ next goal is to refine maintenance strategies that can help maintain those increased levels of activity over a longer period.

CDC’s Guideline for Prescribing Opioids for Chronic Pain is intended to improve communication between providers and patients about the risks and benefits of opioid therapy for chronic pain, improve the safety and effectiveness of pain treatment, and reduce the risks associated with long-term opioid therapy, including opioid use disorder and overdose. The Guideline is not intended for patients who are in active cancer treatment, palliative care, or end-of-life care.

Determining When to Initiate or Continue Opioids for Chronic Pain

  • Opioids are not first-line therapy

Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain. Clinicians should consider opioid therapy only if expected benefits for both pain and function are anticipated to outweigh risks to the patient. If opioids are used, they should be combined with non-pharmacologic therapy and non-opioid pharmacologic therapy, as appropriate.

  • Establish goals for pain and function

Before starting opioid therapy for chronic pain, clinicians should establish treatment goals with all patients, including realistic goals for pain and function, and should consider how opioid therapy will be discontinued if benefits do not outweigh risks. Clinicians should continue opioid therapy only if there is clinically meaningful improvement in pain and function that outweighs risks to patient safety. 

  • Discuss risks and benefits

Before starting and periodically during opioid therapy, clinicians should discuss with patients known risks and realistic benefits of opioid therapy and patient and clinician responsibilities for managing therapy.

Opioid Selection, dosage, Duration, Follow-Up, and Discontinuation

  • When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids
  • When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should use caution when prescribing opioids at any dosage, should carefully reassess evidence of individual benefits and risks when considering increasing dosage to ≥50 morphine milligram equivalents (MME)/day, and should avoid increasing dosage to ≥90 MME/day or carefully justify a decision to titrate dosage to ≥90 MME/day
  • Long-term opioid use often begins with treatment of acute pain. When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than seven days will rarely be needed
  • Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or of dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently. If benefits do not outweigh harms of continued opioid therapy, clinicians should optimize other therapies and work with patients to taper opioids to lower dosages or to taper and discontinue opioids

Assessing Risk and Addressing Harms of Opioid Use

  • Before starting and periodically during continuation of opioid therapy, clinicians should evaluate risk factors for opioid-related harms. Clinicians should incorporate into the management plan strategies to mitigate risk, including considering offering naloxone when factors that increase risk for opioid overdose, such as history of overdose, history of substance use disorder, higher opioid dosages (≥50 MME/day), or concurrent benzodiazepine use, are present
  • Clinicians should review the patient’s history of controlled substance prescriptions using state prescription drug monitoring program (PDMP) data to determine whether the patient is receiving opioid dosages or dangerous combinations that put him or her at high risk for overdose. Clinicians should review PDMP data when starting opioid therapy for chronic pain and periodically during opioid therapy for chronic pain, ranging from every prescription to every 3 months
  • When prescribing opioids for chronic pain, clinicians should use urine drug testing before starting opioid therapy and consider urine drug testing at least annually to assess for prescribed medications as well as other controlled prescription drugs and illicit drugs
  • Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible
  • Clinicians should offer or arrange evidence-based treatment (usually medication-assisted treatment with buprenorphine or methadone in combination with behavioral therapies) for patients with opioid use disorder.

On May 8, 2019, the Department of Health and Human Services (“HHS”) announced a final rule that will require direct-to-consumer television advertisements to include the list price for prescription pharmaceuticals that are covered by Medicare or Medicaid. The rule, which was promulgated through the Center for Medicare & Medicaid Services (“CMS”), requires the “the Wholesale Acquisition Cost” (i.e., the list price) of the drug to be included in the advertisement if the price is $35 or more for a one-month supply, or for the usual course of therapy.

“Patients have the right to know the prices of healthcare services, and CMS is serious about empowering patients with this information across-the-board,” said CMS Administrator Seema Verma.

This new CMS rule requires that advertisements for certain prescription drugs or biological products on television (including broadcast, cable, streaming and satellite) contain a “textual statement” indicating the Wholesale Acquisition Cost (referred to as “WAC” or the “list price”) for a “typical 30-day regimen or for a typical course of treatment, whichever is most appropriate, as determined on the first day of the quarter during which the advertisement is being aired or otherwise broadcast.” The statement is as follows: “The list price for a [30-day supply of] [typical course of treatment with] [name of prescription drug or biological product] is [insert list price]. If you have health insurance that covers drugs, your cost may be different.” It is important to note that the rule only applies to television advertisements, but not advertisements through other platforms, such as YouTube or Facebook.

Click here for a fact sheet about the final rule.

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