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Facilitated telemedicine embedded into opioid treatment programs boosted HCV cure rates
Facilitated telemedicine integrated into an opioid treatment program led to better hepatitis C virus (HCV) cure rates compared with usual referral-based care, a randomized clinical trial showed.
In an intention-to-treat analysis, sustained virologic response (SVR) rates were substantially higher for those who had facilitated telemedicine compared with those referred for usual care (90.3% vs 39.4%), with a nearly threefold higher odds of achieving a cure (OR 2.9, 95% CI 2.0-3.5, P<0.001), Andrew Talal, MD, MPH, of the University at Buffalo, and colleagues reported in JAMA.
Notably, illicit drug use fell off significantly among cured participants in both the referral (P=0.001) and the facilitated telemedicine (P<0.001) groups, and few reinfections occurred, the researchers noted.
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Join the AMA or Renew your Membership Today!
As of now, ASIPP has two positions available in the House of Delegates and all of the other memberships where they are available, even for the other societies within AMA. The American Medical Association (AMA) requires all societies to requalify for membership in the AMA House of Delegates (HOD) every five years. To keep and hopefully increase ASIPP's membership in these committees, we have to keep at a minimum 20% AMA membership, otherwise, ASIPP will lose the AMA membership with all the available advantages.
We encourage you to join or renew your membership in the AMA. Joining the AMA will further strengthen our specialty’s representation at the national level through the AMA House of Delegates, the AMA’s policymaking body, and strengthen our ability to meet the challenges in health care today with thoughtful, well-organized responses.
As a member of the AMA, you become part of the organization that unites physicians nationwide to tackle the major issues we all face: 47 million uninsured Americans, looming Medicare payment cuts, and the need for medical liability reform. Membership also gives you access to a broad range of practice management resources and award-winning publications such as the Journal of the American Medical Association, AMNews, AMA Morning Rounds, and the Archives journals.
Please take this opportunity to support the critical activities of ASIPP by joining the AMA today. To join or renew the AMA, we encourage you to visit www.ama-assn.org or call (800) 262-3211.
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Physician shortages are affecting health care systems nationwide, which can have long-lasting effects on public health. And while the physician shortage in the U.S. has become a growing concern in recent years, Mid-Atlantic Permanente Medical Group has emerged with a notable increase in hiring.
Since the start of 2023, nearly 250 physicians have joined the medical group—more than they have ever hired in a single year. These doctors have experience and expertise from more than 45 physician specialties.
Mid-Atlantic Permanente Medical Group, which cares for Kaiser Permanente members in Maryland, Virginia and Washington, D.C., is a member of the AMA Health System Program. The program provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
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Virtual
April 27, May 25, June 29, & July 27
Click here for the complete list of upcoming exams.
ABIPP Part I; ABIPP Path - Combined DCCPM/CSM virtual exam;
ABIPP Competency Exam in IPM; ABIPP Competency Exam in Regenerative Medicine;
CSM Competency Exam; DCCPM Competency Exam
In Person
October 18, 2024
ABIPP Part II - Practical Examination
Lab Venue: MERI, 44 S. Cleveland Street, Memphis, TN 38104
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A dip in routine vaccinations and a rise in measles cases also are on the agency's radar
Although the risk to humans is very low, the case of the Texas farmworker apparently contracting pathogenic avian influenza A (H5N1) from a cow illustrates the importance of data collection, CDC Director Mandy Cohen, MD, MPH, said Tuesday.
"We need to continue to invest in data, in lab capacity, in our ability to respond to health threats, and we need a talented workforce," Cohen said here at the World Vaccine Congress. In the realm of modernizing data collection, she added, "We cannot solve problems we don't see."
Cohen's remarks about the "bird flu" came toward the end of a keynote speech about vaccines' role in preventing disease, in which she also discussed her concerns about "steps backward" in routine childhood vaccinations. She stressed that the CDC has been focused on and invested in ways to protect the nation and the world from avian flu for 20 years.
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Excellent opportunities for Residents & Fellows
at ASIPP's 2024 Annual Meeting:
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Abstract Session (April 4, 3:30–5:30pm) and Podium Presentation for Best Abstracts during General Session (April 5, 3:30–4:15pm)
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Half-Day Session dedicated to Young Physicians in Interventional Pain Management
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But fewer than one in five of this vulnerable group have received the updated shot
For adults who are immunocompromised, the updated 2023-2024 COVID-19 vaccine reduced risk of hospitalization compared with not getting the shot, according to CDC data.
Vaccine effectiveness against hospitalization was 38% in the first 7 to 59 days after receipt of the updated monovalent XBB.1.5 COVID vaccine, and 34% in the 60 to 119 days after receipt, reported Ruth Link-Gelles, PhD, of the CDC's National Center for Immunization and Respiratory Diseases, and colleagues in the Morbidity and Mortality Weekly Report.
However, despite the positive effect, only 18% of people in this high-risk population had received the updated COVID vaccine, "representing a missed opportunity to prevent severe COVID-19," the authors wrote.
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Does this explain why dementia incidence is falling?
Human brains appeared to be getting bigger, temporal trends showed.
From the 1930s to 1970s, brain volumes and cortical surface area of people who had neither dementia nor stroke became progressively larger, reported Charles DeCarli, MD, of the University of California Davis in Sacramento, and co-authors in JAMA Neurology.
When researchers compared people born in the 1930s with those born in the 1970s and adjusted for age and sex, they found (all P<0.001):
- Intracranial volume was 6.6% greater (1,234 vs 1,321 mL)
- White matter volume was 7.7% greater (441.9 vs 476.3 mL)
- Hippocampal volume had a 5.7% greater value (6.51 vs 6.89 mL)
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Cortical surface area had a 14.9% greater value (1,933 vs 2,222 cm2)
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ASIPP State Society Meetings | |
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Mounting hospital bills, crushing medical debt, ballooning insurance premiums… While we are wrestling with these widespread healthcare affordability problems, it’s helpful to keep in mind that they are often caused by public policies. The most recent example is the financing scheme of Medicaid expansion in North Carolina.
As in many other markets in the U.S., hospitals in North Carolina are highly consolidated and politically powerful. Medicaid expansion would not have become law in North Carolina without the support from hospitals. To win their support, the state and the Centers for Medicare and Medicaid Services (CMS) decided to reimburse hospitals for their Medicaid services at the commercial payment rates. Most of the funding comes from federal taxpayers. Healthcare policy expert Ann Kempski and I provided more details in a recent Health Affairs Forefront article. Similar schemes permeate in many other states.
This horse-trading scheme benefits hospitals, the state, and the Biden Administration, at the expense of North Carolina workers, employers, independent physicians, and federal taxpayers.
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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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Luke Lehman, MD, Daniel Ahn, MD, Jacqueline Curbelo, DO, and Matthew McClure, MD
Abstract
BACKGROUND: Limb loss is a debilitating condition affecting many Americans and approximately 80% go on to suffer phantom limb pain (PLP). Peripheral nerve stimulation (PNS) and perineural catheter (PC) placement are promising treatment options for PLP.
CASE REPORT: We present a 36-year-old man, who underwent right transhumeral and right transtibial amputations following a work-related accident. He developed significant PLP of both limbs. The right upper extremity PLP was treated first during the inpatient hospital course with a 5-day infusion of 0.5% ropivacaine via a PC. The right lower extremity PLP was later addressed in the outpatient setting with a diagnostic right sciatic/saphenous nerve block followed by a 60-day PNS lead placement, which provided > 50% pain relief from baseline. The patient continues to have > 50% pain relief in his RLE nearly 9 months after the initial procedure.
CONCLUSIONS: Our case adds to a growing body of evidence that supports the utility of PNS and PC. Future studies should explore whether early intervention with PNS could improve long-term outcomes. In addition, clinicians could consider the use of a PC for intractable PLP as an opioid-sparing strategy in the inpatient setting where close monitoring is feasible.
KEY WORDS: Phantom limb pain, traumatic amputation, peripheral nerve stimulation, perineural catheter
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Lu Qin, PhD, Xiaoqian Jiang, MM, Shishun Zhao, PhD, Wenlai Guo, MD, and Di You, MD.
Abstract
BACKGROUND: Lumbar disc herniation is a common spinal disease that causes low back pain; surgery is required when conservative treatment is ineffective. There is a growing demand for minimally invasive surgery in younger patient populations due to their fear of significant damage and a long recovery period following standard open discectomy. The development history of minimally invasive surgery is relatively short, and no gold standard has been established.
OBJECTIVES: We aimed to find, via a network meta-analysis, the best treatment for low back pain in younger patient populations.
STUDY DESIGN: Network meta-analysis.
METHODS: The PubMed, Embase, Cochrane Library, and Web of Science databases were searched. Data quality was evaluated using RevMan 5.3 (The Nordic Cochrane Centre for The Cochrane Collaboration), while STATA 14.0 (StataCorp LLC) was used for the network meta-analysis and to merge data on the Visual Analog Scale (VAS) score, Oswestry Disability Index (ODI) score, complication, blood loss, reoperation rate, and function score.
RESULTS: We included 50 randomized controlled trials, involving 7 interventions; heterogeneity and inconsistency were acceptable. Comparatively, microendoscopic discectomy and percutaneous endoscopic lumbar discectomy were the best surgical procedures from the aspects of VAS score and ODI score, while standard open discectomy was the worst one from the aspect of ODI score. Regarding complications, tubular discectomy was preferred with the fewest complications. Additionally, microendoscopic discectomy outperformed other surgical procedures in reducing blood loss and reoperation rate.
LIMITATIONS: First, follow-up data were not reported in all included studies, and the follow-up time varied from several months to 8 years, which affected the results accuracy of our study to some extent. Second, there were some nonsurgical factors that also affected the self-reported outcomes, such as rehabilitation and pain management, which also brought a certain bias in our study results.
CONCLUSIONS: Compared to standard open discectomy, minimally invasive surgical procedures not only achieve satisfactory efficacy, but also microendoscopic discectomy and percutaneous endoscopic lumbar discectomy can obtain a more satisfactory short-term VAS score and ODI score. Microendoscopic discectomy has significant advantages in blood loss and reoperation rate, and tubular discectomy has fewer postoperative complications.
KEY WORDS: Lumbar disc herniation, minimally invasive surgery, standard open discectomy, Visual Analog Scale, Oswestry Disability Index, complication, blood loss, reoperation rate, function score, network meta-analysis
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Yanmei Bi, MD, Min Diao, MD, Yunkai Tao, MD, Hao Li, PhD, and Xuemei Lin, PhD
Abstract
BACKGROUND: Reducing postoperative pain is still a tremendous challenge for perioperative clinicians. Lidocaine is a local anesthetic that belongs to the amide class and has anti-inflammatory, anti-hyperalgesic, and analgesic effects. Extensive research has been conducted to determine the optimal route for its administration.
OBJECTIVE: To compare the efficacy of perioperative intravenous lidocaine with that of intraperitoneal lidocaine on postoperative analgesia in patients undergoing abdominal surgery.
STUDY DESIGN: EMBASE, PubMed, and The Cochrane Library were searched for randomized controlled trials published through December 2022 that compared patients receiving perioperative intravenous lidocaine with those receiving intraperitoneal lidocaine. The primary outcome measures included the pain score, as evaluated by the Visual Analog Scale, and opioid analgesia requirements. The secondary outcome measures were hospitalization length, gastrointestinal function recovery, etc. The data were acquired and recorded in electronic spreadsheets that had been designed for this purpose.
METHODS: This systematic review’s design was based on the Cochrane Handbook for Systematic Reviews of Interventions and was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) method was used to examine the certainty of the evidence. Furthermore, we examined the dependability of the calculated (favorable) treatment effects through considerations of information size and modified significance thresholds (trial sequential analysis).
RESULTS: Seven trials including 478 patients were included. Our meta-analysis demonstrates that compared with intravenous lidocaine, patients who received intraperitoneal lidocaine had lower pain scores at 4 hours (mean difference [MD] 1.40; 95% CI, 0.22 to 2.59); 12 hours (MD 0.18; 95% CI, 0.06 to 0.30); and 24 hours (MD -0.12; 95% CI -0.40 to 0.17) postsurgery. However, no obvious difference in opioid consumption (P > 0.05) was found. In addition, the intraperitoneal lidocaine group had a longer postsurgery hospital stay than the intravenous lidocaine group (95%CI, -0.17 to -0.00; I2 = 0%). Intravenous lidocaine was more beneficial for achieving gastrointestinal return than intraperitoneal lidocaine (95% CI, -0.26 to -0.10; I2 = 2%).
LIMITATIONS: The sample size of enrolled RCTs was small, which could potentially result in an overestimation or underestimation of the treatment effect in the collected data. There was high heterogeneity among the studies.
CONCLUSION: This meta-analysis suggests that post-abdominal surgery intraperitoneal lidocaine administration has a better analgesic effect than intravenous lidocaine, with a lower pain score. However, intravenous lidocaine is more beneficial for gastrointestinal recovery after abdominal surgery.
KEY WORDS: Lidocaine, abdominal surgery, intravenous, intraperitoneal, postoperative pain, opioid consumption, meta-analysis, trial sequential analysis
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ASIPP is now in collaboration with Curi Medical Liability Program
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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.
Curi is a full-service advisory firm that serves physicians and their practices. Their valued advice is grounded in your priorities and elevated in your outcomes. They are driven by a deep understanding of your specific circumstances in medicine, business, and life. To read a few important points to keep in mind about the program, including discounts, administrative defense, cyber coverage, aggressive claims handling, and complimentary risk management CME activities, visit our website.
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Group Purchasing Organization Offer Better Pricing and Creates Added Value
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, Fedora Billing,
and Revenue Cycle Management Partnership
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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up-to-date news related to you, your practice, and your patients!
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