scholarly journals Nonconsensual Dose Reduction Mandates are Not Justified Clinically or Ethically: An Analysis

2020 ◽  
Vol 48 (2) ◽  
pp. 259-267 ◽  
Author(s):  
Stefan G. Kertesz ◽  
Ajay Manhapra ◽  
Adam J. Gordon

This manuscript describes the institutional and clinical considerations that apply to the question of whether to mandate opioid dose reduction in patients who have received opioids long-term. It describes how a calamitous rise in addiction and overdose involving opioids has both led to a clinical recalibration by healthcare providers, and to strong incentives favoring forcible opioid reduction by policy making agencies. Neither the 2016 Guideline issued by the Centers for Disease Control and Prevention nor clinical evidence can justify or promote such policies as safe or effective.

2019 ◽  
Vol 7 ◽  
pp. 205031211984198 ◽  
Author(s):  
Pallavi Srivastava ◽  
Ashish Verma ◽  
Christine Geronimo ◽  
Terry M Button

Introduction: Centers for Disease Control and Prevention Diabetes Prevention Program recognition requires successful program completion by a cohort of at least five people with prediabetes. Such programs have generally been “in-person” and provided by a qualified coach from a recognized program. A cohort of 10 patients with prediabetes was enrolled in a physician’s office to use the cloud-based Type II Diabetes Prevention Module in an effort to achieve recognition. Module use was supported by the physician and a qualified coach. The purpose of this article is to evaluate Module performance relative to behavior stages associated with long-term behavior modification. Methods: The Module employs a web application supporting diabetes prevention education and a mobile application that is an electronic diary and virtual coach. A dashboard allows an efficient review of user performance and the ability to send users notifications of support from the user’s coach or physician. The cohort of 10 patients with prediabetes was offered Module use upon diagnosis of prediabetes. Results: All 10 patients with prediabetes offered Module use agreed participation. Six have completed educational sessions, made diary entries, and have met the 5% Centers for Disease Control and Prevention Diabetes Prevention Program weight loss target prior to 6 months of Module use. This high success rate (60%) is contrary to behavior stages often associated with long-term behavior modification. Conclusion: The strength of the physician–patient relationship appears to allow patients with prediabetes to skip or advance rapidly through behavioral stages in the process of lifestyle modification.


2019 ◽  
Vol 28 (3) ◽  
pp. 1363-1370 ◽  
Author(s):  
Jessica Brown ◽  
Katy O'Brien ◽  
Kelly Knollman-Porter ◽  
Tracey Wallace

Purpose The Centers for Disease Control and Prevention (CDC) recently released guidelines for rehabilitation professionals regarding the care of children with mild traumatic brain injury (mTBI). Given that mTBI impacts millions of children each year and can be particularly detrimental to children in middle and high school age groups, access to universal recommendations for management of postinjury symptoms is ideal. Method This viewpoint article examines the CDC guidelines and applies these recommendations directly to speech-language pathology practices. In particular, education, assessment, treatment, team management, and ongoing monitoring are discussed. In addition, suggested timelines regarding implementation of services by speech-language pathologists (SLPs) are provided. Specific focus is placed on adolescents (i.e., middle and high school–age children). Results SLPs are critical members of the rehabilitation team working with children with mTBI and should be involved in education, symptom monitoring, and assessment early in the recovery process. SLPs can also provide unique insight into the cognitive and linguistic challenges of these students and can serve to bridge the gap among rehabilitation and school-based professionals, the adolescent with brain injury, and their parents. Conclusion The guidelines provided by the CDC, along with evidence from the field of speech pathology, can guide SLPs to advocate for involvement in the care of adolescents with mTBI. More research is needed to enhance the evidence base for direct assessment and treatment with this population; however, SLPs can use their extensive knowledge and experience working with individuals with traumatic brain injury as a starting point for post-mTBI care.


2016 ◽  
Vol 19 (1) ◽  
pp. 4-11
Author(s):  
Olivia Avriyanti Hanafiah ◽  
Gema Nazri Yanti ◽  
Chintya Faradilla ◽  
Dewi Wulandari

Prosedur kontrol infeksi yang umum dilakukan adalah dengan menerapkan standard precautions berdasarkan peraturan yang dikeluarkan oleh Centers for Disease Control and Prevention (CDC). Tujuan penelitian ini adalah untuk mengetahui tingkat pengetahuan mahasiswa kepaniteraan klinik tentang standard precautions operator sebelum dan setelah perawatan gigi. Penelitian ini merupakan penelitian survei deskriptif yang dilakukan dengan cara membagikan kuesioner pada mahasiswa kepaniteraan klinik yang terdiri atas 26 pertanyaan untuk sebelum dan 32 pertanyaan untuk setelah tindakan perawatan gigi. Data diolah secara manual dan dianalisis dengan analisis univariat. Hasil penelitian pengetahuan responden tentang standard precautions sebelum tindakan perawatan yang berpengetahuan kurang 69,8%, 29,3% cukup, 1% responden yang berpengetahuan baik. Setelah perawatan gigi didapat 54,5% responden memiliki pengetahuan cukup, 37,5% berpengetahuan baik, dan hanya 8% responden berpengetahuan kurang. Sebagai kesimpulan,  pengetahuan mahasiswa kepaniteraan klinik tentang standard precautions operator sebelum dan setelah perawatan gigi masih kurang.


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