Contrary to popular belief, empathy can be learned, and it could improve the healthcare system
Even as the country creeps slowly toward a long-anticipated "new normal," I'm unable to shake off my concern about the pandemic's long-term toll on physicians, healthcare professionals, and others employed in the healthcare sector.
In the midst of these winter doldrums, I had an interesting and surprisingly upbeat conversation with Helen Riess, MD, a psychiatrist and medical educator at Massachusetts General Hospital and Harvard Medical School. Well before the arrival of COVID-19 and the socio-political polarization that intensified in its wake, Riess became concerned about the dearth of empathy in medical training and clinical practice. This led to a career-transforming focus the neuroscience and practical application of empathy.
Perhaps because it requires one individual to understand another's feelings, empathy is often assumed to be an innate ability -- "Some have it and others don't." Contrary to this conventional wisdom, Riess's research reveals a neurobiological basis for empathy and demonstrates that it can be learned and taught with the aid of evidence-based interventions.
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Call for Abstracts & Poster Presentations |
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The deadline has been extended to MARCH 18
Take advantage of this opportunity and submit your proposal today!
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Proposals accepted through
March 18th
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A $50 submission fee is required upon completion of the form. |
Questions can be directed to
Savannah Gold
at 270.554.9412 ext 4219 or
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- Top 3 will present during the general session on the final day.
- Top 10 will present during the abstract breakout session.
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Rapid review and publication in the Pain Physician journal will be extended to the Top 10 authors accepted for meeting presentations.
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Attack rates still highest among unvaccinated index cases
Risk of contracting COVID-19 during the Omicron surge was higher when the index case was unvaccinated, though this risk was still high among vaccinated cases, researchers found.
Among index cases who were unvaccinated, the attack rate in household contacts was 64% compared with 44% in contacts of index cases who completed their primary vaccination series within 5 months and 43% among those who were vaccinated and boosted, reported Julia Baker, PhD, of the CDC, and colleagues in the Morbidity and Mortality Weekly Report.
Not surprisingly, attack rates were lower when index cases isolated or wore a mask at home. Among household contacts of index patients who isolated, the attack rate was 41% versus 68% for those who did not isolate (P<0.01). These rates were 40% for contacts of index cases who reported "ever" wearing a mask at home "during their potentially infectious period" versus 69% for those who never wore a mask at home (P<0.01), they noted.
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New guidance to focus more on risk of severe disease versus cases alone
After much speculation, CDC unveiled its new criteria on Friday for masking throughout communities based on healthcare indicators, where only 30% of the country would currently be recommended to wear a mask.
These metrics are a combination of new hospital admissions, hospital bed utilization for COVID patients, as well as incidence of cases in a community, combined to indicate either a low risk (green), medium risk (yellow), or high risk (orange) of severe disease in a particular county.
By the most current CDC data, this means that only 28.2% of the population lives in a high-risk county, though 37.3% of U.S. counties would be classified as high-risk. About 40% of counties are classified as medium risk (containing 42% of the nation's population), while 23% are classified as low risk (29.5% of the population).
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NEXT EXAM DATE:
Saturday, April 2, 10am CST
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Experts say the U.S. does not have as high a vaccination rate as the U.K.
Since the beginning of the COVID-19 pandemic, the United States has closely followed what the United Kingdom had done to combat the virus from its early response to its vaccination rollout.
Outbreaks in Great Britain have been harbingers of what's to come in the U.S., and its policies have often helped shape America's COVID response.
Over the past several weeks, the U.K. has been lifting COVID restrictions and, on Monday, Prime Minister Boris Johnson announced he was dropping the remaining rules in England including the requirement to self-isolate after testing positive, contact tracing and free administration of rapid tests.
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As the COVID-19 pandemic enters its third year, the Omicron variant has been driving an uptick in cases in the United States primarily among people who are unvaccinated, and it is even causing infections in some vaccinated people. The good news is that COVID-19 vaccines are still expected to be effective at preventing severe disease, hospitalization, and death from COVID-19. And in the U.S., everyone ages 5 and older is eligible to be vaccinated.
As the SARS CoV-2 virus mutates and new variants emerge, it’s important to keep up with how well the vaccines are performing, but it’s also a daunting task, given the flood of information (and misinformation) coming at us from so many directions.
Click here for a mapped-out comparison of the most prominent COVID-19 vaccines.
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- ASIPP Members Only Site Information - |
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To log in for the first time you will need to click “forgot password” at the bottom of the login window.
- Check your email and then log in as directed.
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If you have problems logging into your account, click here.
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Pain Medicine Case Reports (PMCR) and Editor-in-Chief Alaa Abd-Elsayed, MD, PhD would like to invite you to submit case reports and case series to the PMCR journal. Your article will be published free of charge.
Open access journals are freely available online for immediate worldwide open access to the full text of published articles. There is no subscription fee for open access journals. Open access journals are no different from traditional subscription-based journals: they undergo the same peer-review and quality control as any other scholarly journal.
Interested in becoming a member of the PMCR Editorial Board?
Editorial board members are asked to review 2-6 manuscripts per year. Please submit your most up-to-date CV to sgold@asipp.org for consideration.
For more information or to submit your articles, click here.
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| CASE REPORT |
Daniel Lopez, MD, Oleg Desyatnikov, DO, Leon Anijar, MD, Jessica Reyes, MD, and Kristy Fisher, MD
Abstract
BACKGROUND: Failed back surgery syndrome (FBSS) continues to become more prevalent as surgical interventions for patients with chronic low back pain increase. Neuromodulation with spinal cord stimulation (SCS) is proven to benefit FBSS. A relative contraindication to SCS therapy is dementia.
CASE REPORT: An 81-year-old Hispanic woman with a medical history of dementia and persistent chronic low back pain despite L2-S1 lumbar fusion presented to an outpatient pain clinic with severe low back pain. The patient underwent a SCS trial and followed up with the clinic showing improvement of pain and ability to sit for longer periods of time and sleep longer. After 4 days, the patient underwent implantation of a recharge-free SCS using standard procedure and reported 80% to 90% improvement of pain, decreased dosing of opioid medication, and decrease in blood pressure.
CONCLUSION: We successfully implanted a SCS in a patient with dementia and chronic low back pain from FBSS.
PRESENTED AS A POSTER: American Society for Pain and Neuroscience Conference 2021; July 23 – 25, 2021
KEYWORDS: Case report, dementia, spinal cord stimulator
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| RETROSPECTIVE ANALYSIS |
Scott M. Fisher, DO, Ryan Jacobs, MD, Iulia Pirvulescu, MS, Kenneth D. Candido, MD, and Nebojsa Nick Knezevic, MD, PhD
Abstract
Background: It is well established that the experience of chronic pain significantly differs among ethnic-racial groups. There is mixed evidence to suggest that societal influences may contribute to pain prevalence among cultural groups and their treatment response. One possible explanation for differences in pain experience are the differences in socioeconomic status among patients with chronic pain.
Objective: To determine whether there is any difference in pain scores or treatment responses among patients with different socioeconomic status.
Study design: Retrospective analysis.
Setting: Outpatient pain clinic.
Methods: After approval from the Advocate Healthcare Institutional Review Board, we included 1,149 patients treated for different chronic pain conditions who were followed for at least 12 months. Patients were stratified into quartiles determined by median income according to ZIP code.
Results: Of the sampled patients, 207 patients lived in ZIP codes with median incomes > $51,294; 515 in ZIP codes with median incomes between $40,083 and $51,294; 332 in ZIP codes with median incomes between $30,625 and $40,083; and 95 in ZIP codes with median incomes < $30,625. Groups differed in age (P = 0.047), race (P < 0.001), body mass index (BMI) (P = 0.019), utilization of opioid medications (P = 0.011), morphine milligram equivalents (MME) on first visit (P = 0.036), and utilization of membrane stabilizers such as gabapentin (P = 0.019). There were no significant differences among groups in terms of gender (P = 0.531), type of pain experienced (P = 0.679), or time since pain onset (P = 0.174). Groups were treated similarly, with no statistically significant differences in the proportions of patients who had taken various nonopioid medications throughout their treatment course other than membrane stabilizers, the number of patients who received interventional pain management procedures, or MME at last visit. Average pretreatment numeric rating scale pain scores were not significantly different among quartiles (P = 0.079), posttreatment pain scores (P = 0.767), and subjective percent improvement (P = 0.434).
Limitations: This is a single center study and may have limitations in extrapolating to the general population.
Conclusion: The results of our study show that there are no differences in pain perception or treatment responses in patients from different socioeconomic statuses despite differences among groups in age, BMI, race, utilization of opioid medications, and MME at first visit. Patients at this pain practice appear to have been treated with similar modalities regardless of socioeconomic status.
Keywords: ethnicity; income; opioid utilization; pain perception; race; socioeconomic status; treatment response; Pain experience.
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| OBSERVATIONAL STUDY |
Zheng Liu, PhD, Zhihai Su, MD, Min Wang, MD, Tao Chen, PhD, Zhifei Cui, MD, Xiaojun Chen, MD, Shaolin Li, MD, Qianjin Feng, PhD, Shumao Pang, PhD, and Hai Lu, PhD
Abstract
Background: Segmentation of spinal structures is important in medical imaging analysis, which facilitates surgeons to plan a preoperative trajectory for the transforaminal approach. However, manual segmentation of spinal structures is time-consuming, and studies have not explored automatic segmentation of spinal structures at the L5/S1 level.
Objectives: This study sought to develop a new method based on a deep learning algorithm for automatic segmentation of spinal structures. The resulting algorithm may be used to rapidly generate a precise 3D lumbosacral intervertebral foramen model to assist physicians in planning an ideal trajectory in L5/S1 lumbar transforaminal radiofrequency ablation (LTRFA).
Study design: This was an observational study for developing a new technique on spinal structures segmentation.
Study site: The study was carried out at the department of radiology and spine surgery at our hospital.
Methods: A total of 100 L5/S1 level data samples from 100 study patients were used in this study. Masks of vertebral bone structures (VBSs) and intervertebral discs (IVDs) for all data samples were segmented manually by a skilled surgeon and served as the "ground truth." After data preprocessing, a 3D-UNet model based on deep learning was used for automated segmentation of lumbar spine structures at L5/S1 level magnetic resonance imaging (MRI). Segmentation performances and morphometric measurement were used for 3D lumbosacral intervertebral foramen (LIVF) reconstruction generated by either manual segmentation and automatic segmentation.
Results: The 3D-UNet model showed high performance in automatic segmentation of lumbar spinal structures (VBSs and IVDs). The corresponding mean Dice similarity coefficient (DSC) of 5-fold cross-validation scores for L5 vertebrae, IVDs, S1 vertebrae, and all L5/S1 level spinal structures were 93.46 ± 2.93%, 90.39 ± 6.22%, 93.32 ± 1.51%, and 92.39 ± 2.82%, respectively. Notably, the analysis showed no associated difference in morphometric measurements between the manual and automatic segmentation at the L5/S1 level.
Limitations: Semantic segmentation of multiple spinal structures (such as VBSs, IVDs, blood vessels, muscles, and ligaments) was simultaneously not integrated into the deep-learning method in this study. In addition, large clinical experiments are needed to evaluate the clinical efficacy of the model.
Conclusion: The 3D-UNet model developed in this study based on deep learning can effectively and simultaneously segment VBSs and IVDs at L5/S1 level formMR images, thereby enabling rapid and accurate 3D reconstruction of LIVF models. The method can be used to segment VBSs and IVDs of spinal structures on MR images within near-human expert performance; therefore, it is reliable for reconstructing LIVF for L5/S1 LTRFA.
Keywords: 3D reconstruction; 3D-UNet model; MRI; automatic segmentation; intervertebral discs; lumbosacral intervertebral foramen; manual segmentation; vertebral bone structures; Deep learning.
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Since this malpractice insurance program officially launched in November 2018, ASIPP has signed up hundreds of providers with an average savings of 30%. This is professional liability insurance tailored to our specialty and will stand up for us and defend our practices.
Norcal Mutual is A-Rated by AM best and is licensed in all 50 states. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary award-winning risk management CME activities, click here.
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ASIPP® has formed a partnership with Henry Schein and PedsPal, a national GPO that has a successful history of negotiating better prices on medical supplies and creating value-added services for independent physicians. Working with MedAssets, PedsPal provides excellent pricing on products like contrast media that alleviate some of the financial pressures you experience today.
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ASIPP® is now offering our members the benefit of a unique revenue cycle management/ billing service.
We have received a tremendous amount of interest in the ASIPP® billing and coding program.
Click here to learn more about the negotiated rate for practices and more!
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