The Language of Pain and Addiction (DRAFT)

2018 ◽  
Author(s):  
Michael M. Miller
Keyword(s):  
Substance Use ◽  
Treatment Plan ◽  
Improve Patient Care ◽  
Practice Research ◽  
Prescription Medications ◽  
Pain Medicine ◽  
Addiction Medicine ◽  
Research And Education ◽  
Monitoring Treatment ◽  
Improve Patient

The language employed in managing coexisting pain and addiction affects the management itself. Clinicians working with such patients may not realize that the two disorders share a terminology that can be confusing, imprecise, overlapping and/or stigmatizing. This chapter has two components:1. A description of Pain Medicine as a specialized area of practice, research, and education, whose leaders try to clarify concepts and terminology to improve patient care, professional standards, and public policy.2. The language of Addiction Medicine; arguably, even more complex than that of pain medicine because of the emotions, stigma, and discrimination attached to substance use disorders labels.All physicians’ concern must be that the patient adheres to the treatment plan by using prescription medications in only safe and healthy ways. This requires counseling, and monitoring treatment adherence and the safety of prescriptions, even in the absence of a diagnosable substance use disorder.

scholarly journals Buprenorphine: Not a silver bullet, and still controversial

2021 ◽  
Vol 17 (7) ◽  
pp. 9-10
Author(s):  
Sudheer Potru, DO, FASAM ◽  
Michael Sprintz, DO, DFASAM ◽  
Antje M. Barreveld, MD ◽  
Lynn Kohan, MD
Keyword(s):  
Substance Use ◽  
Substance Use Disorder ◽  
Working Group ◽  
Ad Hoc ◽  
Hospital Setting ◽  
Outpatient Setting ◽  
Pain Medicine ◽  
Appropriate Use ◽  
Addiction Medicine ◽  
Silver Bullet

We are practitioners of pain medicine and addiction medicine and also four of the seven members of the Multi-Society Ad Hoc Substance Use Disorder (SUD) Working Group comprised of representatives from anesthesia, pain, pharmacy, and addiction medicine societies. We are finalizing “tip sheets” and a consensus-based manuscript to provide guidance on the appropriate use and initiation of buprenorphine in the hospital setting by anesthesiologists, and in the outpatient setting by pain clinicians.

Recognition and Management of Iatrogenically Induced Opioid Dependence and Withdrawal in Children

2018 ◽  
pp. 109-112
Author(s):  
Jeffrey Galinkin ◽  
Jeffrey Lee Koh
Keyword(s):  
Substance Use ◽  
Pain Relief ◽  
Opioid Dependence ◽  
Pediatric Population ◽  
Single Source ◽  
Pain Medicine ◽  
Addiction Medicine ◽  
Or Management ◽  
Acute Injuries ◽  
American Society

Opioids are often prescribed to children for pain relief related to procedures, acute injuries, and chronic conditions. Round-the-clock dosing of opioids can produce opioid dependence within 5 days. According to a 2001 Consensus Paper from the American Academy of Pain Medicine, American Pain Society, and American Society of Addiction Medicine, dependence is defined as “a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.” Although the experience of many children undergoing iatrogenically induced withdrawal may be mild or goes unreported, there is currently no guidance for recognition or management of withdrawal for this population. Guidance on this subject is available only for adults and primarily for adults with substance use disorders. The guideline will summarize existing literature and provide readers with information currently not available in any single source specific for this vulnerable pediatric population.

scholarly journals Exploring Clinical Practice and Developing Clinician Self-Reflection Through Cross Self-Confrontation Methodology: An Application Within an Addiction Medicine Unit

2021 ◽  
Vol 8 ◽  
pp. 233339362110548
Author(s):  
Sophie Paroz ◽  
Jean-Bernard Daeppen ◽  
Martine Monnat ◽  
Michael Saraga ◽  
Francesco Panese
Keyword(s):  
Clinical Practice ◽  
University Hospital ◽  
Practice Research ◽  
Clinical Settings ◽  
Medical Doctors ◽  
Addiction Medicine ◽  
Self Reflection ◽  
Clinical Interviews ◽  
Research And Education ◽  
Phase Design

Use of the methodology of cross self-confrontation (CSC) is limited in the field of healthcare and in the context of clinical practice. We applied this methodology within an addiction medicine unit of a university hospital, as part of an exploration of addiction-related clinical difficulties. Cross self-confrontation was used according to a 3-phase design based on video recorded clinical interviews with pairs of nurses and medical doctors. The article reports and discusses the application of CSC in a specific clinical context and illustrates the methodological process through one result. Findings suggest two major strengths of CSC in the context of clinical practice research and education: (1) the capacity to elicit tacit knowledge from daily clinical practice and (2) the ability to enhance self-reflection by questioning professionals both individually and collectively. Further use of CSC in nursing surroundings and clinical settings should be encouraged.

scholarly journals Monitoring patients on lithium – a good practice guideline

2002 ◽  
Vol 26 (9) ◽  
pp. 348-351 ◽  
Author(s):  
Joy Nicholson ◽  
Brian Fitzmaurice
Keyword(s):  
Systematic Approach ◽  
Lithium Treatment ◽  
Treatment Plan ◽  
Good Practice ◽  
Improve Patient Care ◽  
Patient Specific ◽  
Specific Information ◽  
Care Services ◽  
Good Practice Guideline ◽  
Improve Patient

Aims and MethodTo develop a guideline that would encourage a systematic approach for both psychiatrists and general practitioners in the provision of safe, effective and consistent management of patients who are prescribed lithium. A multi-disciplinary working group developed the guideline following literature review and consultation with lithium clinics and specialist centres nationally.ResultsThe Lothian lithium guidelines include three sections: (a) a lithium treatment plan; (b) advice for clinicians on managing lithium levels; and (c) pointers for counselling patients on lithium. The treatment plan is a key document in the guidelines which, once completed, ensures continuity of care with the transfer of patient-specific information.Clinical ImplicationsThis development has provided the opportunity for primary and secondary care services to work together in producing a guideline that will improve patient care and minimises risk.

Analytical Methods for the Determination of Sartans in Pharmaceutical Formulations and Biological Fluids: A Review

2020 ◽  
Vol 16 (3) ◽  
pp. 208-222
Author(s):  
Miglena Smerikarova ◽  
Stanislav Bozhanov ◽  
Vania Maslarska
Keyword(s):  
Biological Fluids ◽  
Pharmaceutical Preparations ◽  
Improve Patient Care ◽  
Pharmaceutical Formulations ◽  
Treatment Of Hypertension ◽  
Therapeutic Doses ◽  
Reliable Methods ◽  
Improve Patient

Background: Sartans are mostly used as a part of combination with additional medicines in the therapy of essencial hypertension. Preferred combinations are ARB and thiazide diuretics (Hydrochlorothiazide (HCT) and Chlorthalidone (CHL)) or ARB and calcium antagonists. The number of sartans mostly prescribed by specialists is only seven - Candesartan (CDS), Eprosartan (EPS), Irbesartan (IBS), Losartan (LOS), Olmesartan (OMS), Telmisartan (TMS) and Valsartan (VLS). Methods: The widespread use of sartans in the treatment of hypertension requires reliable methods of analysis. Bulk drugs and pharmaceutical preparations should be analyzed to ensure the quality of the medicinal products reaching patients. On the other hand, the analysis of drugs in biological fluids aims to trace and improve patient care by adjusting the therapeutic doses of drugs. According to our knowledge, a review devoted to the analysis of sartans was published in 2014. Results: Spectral methods are widely used in the analysis of bulk drugs and pharmaceutical dosage forms due to their relatively simple procedures, low reagent and sample consumption, speed, precision and accuracy combined with accessibility and comparatively low cost of common apparatus. Many papers for determination of sartans in bulk drugs and pharmaceutical preparations based on liquid chromatographic techniques were published in the available literature. Among these methods, HPLC takes the leading place but UPLC and HPTLC are also present. Conclusion: The widespread use of sartans in the treatment of hypertension requires reliable methods of analysis. Bulk drugs and pharmaceutical preparations should be analyzed to ensure the quality of the medicinal products reaching patients. On the other hand, the analysis of drugs in biological fluids aims to trace and improve patient care by adjusting the therapeutic doses of drugs. Since 2014, many articles have been published on the sartans analysis and this provoked our interest to summarize the latest applications in the analysis of sartans in pharmaceutical formulations and biological media. Articles published from 2014 to 2018 are covered.

scholarly journals How will artificial intelligence and bioinformatics change our understanding of IgA in the next decade?

2021 ◽  
Author(s):  
Roman David Bülow ◽  
Daniel Dimitrov ◽  
Peter Boor ◽  
Julio Saez-Rodriguez
Keyword(s):  
Artificial Intelligence ◽  
Multidisciplinary Approach ◽  
Immunoglobulin A ◽  
Improve Patient Care ◽  
Integrated Analysis ◽  
Clinical Expertise ◽  
End Stage ◽  
The Complement System ◽  
Improve Patient ◽  
Generation Sequencing

AbstractIgA nephropathy (IgAN) is the most common glomerulonephritis. It is characterized by the deposition of immune complexes containing immunoglobulin A (IgA) in the kidney’s glomeruli, triggering an inflammatory process. In many patients, the disease has a progressive course, eventually leading to end-stage kidney disease. The current understanding of IgAN’s pathophysiology is incomplete, with the involvement of several potential players, including the mucosal immune system, the complement system, and the microbiome. Dissecting this complex pathophysiology requires an integrated analysis across molecular, cellular, and organ scales. Such data can be obtained by employing emerging technologies, including single-cell sequencing, next-generation sequencing, proteomics, and complex imaging approaches. These techniques generate complex “big data,” requiring advanced computational methods for their analyses and interpretation. Here, we introduce such methods, focusing on the broad areas of bioinformatics and artificial intelligence and discuss how they can advance our understanding of IgAN and ultimately improve patient care. The close integration of advanced experimental and computational technologies with medical and clinical expertise is essential to improve our understanding of human diseases. We argue that IgAN is a paradigmatic disease to demonstrate the value of such a multidisciplinary approach.

scholarly journals Bargain Hunting for Buffered Lidocaine: A Collaborative Discovery of Cost-saving Strategies That Can Improve Patient Care

2020 ◽  
Author(s):  
Curtis L Simmons ◽  
Laura K Harper ◽  
Kathryn J Holst ◽  
Nathan J Brinkman ◽  
Christine U Lee
Keyword(s):  
Sodium Bicarbonate ◽  
Hospital Pharmacy ◽  
Cost Savings ◽  
Improve Patient Care ◽  
Medical Waste ◽  
Radiology Department ◽  
Access Pricing ◽  
Bundled Payments ◽  
Improve Patient ◽  
Procedure Room

Abstract Buffered lidocaine is a local anesthetic option during percutaneous needle-directed procedures in the breast. At our institution, sodium bicarbonate (the buffer) is dispensed in volumes that frequently lead to medical waste and shortages. In this study, we describe how moving the buffering of lidocaine from the procedure room to our clinical hospital pharmacy results in a reduction in costs and improves satisfaction across the breast radiology department. While cost savings are difficult to tease out in practices that opt for bundled payments, we were able to access pricing and supply data and coordinate with our pharmacy to change our practice. Making these changes saves our practice $26 000 a year and allows us to continue to offer buffered lidocaine even during sodium bicarbonate shortages. This manuscript describes how these changes came about and their economic impact.

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