Yes, AI can help, if clinicians are consulted during its creation
I don't know about you, but right now I'm worried that there is someone out there figuring out how to make AI make healthcare providers work harder -- not work better.
And most of all, I'm worried that that "someone" is not us.
I'm worried that there are many forces out there, some of them aligned, some of them working independently, that are taking a look at artificial intelligence and saying, "This is the answer! This is how we are finally going to fix the healthcare system." But I'm concerned that it's not us.
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The lab is now full but it's not too late to register for the 2-day symposium, June 9-10! |
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HOTEL
RESERVATIONS
WYNN AND ENCORE
LAS VEGAS
3131 Las Vegas Blvd. South
Las Vegas, NV 89109
Phone: (702) 770-7000 | Toll Free: 888-320-7123 | Fax: (702) 770-1500
If you have trouble reserving a room, contact Karen Avery at kavery@asipp.org with questions or concerns.
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A novel intervention that blends individualized care, mindfulness, and a tapering plan is more successful than usual care in helping patients discontinue opioids for chronic pain, new research shows.
As part of the multisite Improving the Wellbeing of People with Opioid Treated Chronic Pain (I-WOTCH) study, 30% of participants in the intervention group were able to discontinue opioids vs 7% of those in the usual care group.
Lead investigator Harbinder Sandhu, DHealthPsy, assistant professor of health psychology at Warwick Medical School in Coventry, UK, said the benefits of the intervention included tailoring the plan to each participant.
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OTC agents are not safe alternatives to prescription opioids, study suggests
Over-the-counter agents misused to curb opioid withdrawal or induce euphoria at high doses were linked to a disproportionate number of lethal arrhythmias reported to national pharmacovigilance systems, researchers found.
Antidiarrheal drug loperamide, a weak synthetic opioid, was significantly associated with ventricular arrhythmia (proportional reporting ratio [PRR] 3.2, 95% CI 3.0-3.4), with 37% of the 1,008 FDA Adverse Event Reporting System (FAERS) reports involving death.
The arrhythmic signal was worse -- an 8.9 PRR (95% CI 6.7-11.7) -- for mitragynine, the primary active ingredient in the herbal supplement kratom. Fully 91% of its 46 FAERS reports resulted in death.
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The ways in which artificial intelligence (AI) may transform the future of medicine is making headlines across the globe. But chances are, you're already using AI in your practice every day ― you may just not realize it.
And whether you recognize the presence of AI or not, the technology could be putting you in danger of a lawsuit, legal experts say.
The use of AI in your daily practice can come with hidden liabilities, say legal experts, and as hospitals and medical groups deploy AI into more areas of healthcare, new liability exposures may be on the horizon.
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Virtual
ABIPP Part I; ABIPP Path - Combined DCCPM/CSM virtual exam; ABIPP Competency Exam in IPM; ABIPP Competency Exam in Regenerative Medicine
Memphis, TN
ABIPP Part II - Practical Portion; ABIPP Competency Exam - Practical Portion; ABIPP Regenerative Medicine Competency Exam - Practical Portion
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Linda Bluestein remembers all the doctors who missed, ignored, or incompletely diagnosed her chronic illness.
There was the orthopedic surgeon who noted her hyperextended elbows but failed to check any of her other joints. The gastroenterologist who insisted on performing multiple scoping procedures but wouldn't discuss how to manage her symptoms. The other surgeon who, after performing arthroscopy on her injured knee, yelled at her, "There is nothing wrong with your knee! You're fine!" in a room full of people.
And then there was the rheumatologist who said, "Oh, you want something to be wrong with you?"
"No," Bluestein replied, "I want an explanation. I want to keep working. I just want to know why these things keep happening to me."
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In non-responsive patients, think polysubstance use, says addiction treatment expert Kelly Ramsey
There's confusion around how to use naloxone and also an under-recognition of polysubstance use and polysubstance overdose, and that is unfortunately conflated with the concept of certain substances being "naloxone resistant." We're in the era of very highly potent synthetic opioids, and whichever opioid we're talking about -- whether it's fentanyl and its analogs or any of the family of nitazene analogs -- all of those are responsive to naloxone. We have not seen in data that if someone, for example, is using heroin and needs to be revived with naloxone, or they're using a combination of heroin and fentanyl or just using fentanyl or its analogs, that they're actually requiring additional naloxone. We're not seeing higher-milligram dosages needed to reverse that overdose.
So why are people thinking that we need more? A lot of it is anecdotal reports. I think there's probably a couple of different things going on. One is that probably EMS [emergency medical service personnel] and other first responders need more education around polysubstance overdose, because only the opioid component of an overdose will respond to naloxone.
If you give a dose of naloxone, you wait the full 2 minutes, and the person is not responding as expected, and also doesn't respond to a second dose -- and the response should be normalization of breathing; it should not be that someone wakes up and is walking and talking -- you really should be pivoting and thinking, "This is a polysubstance overdose and I need to do other maneuvers in order to reverse the overdose situation."
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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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While physicians are getting less of a Medicare pay cut than they thought this year (Congress voted to cut Medicare payments by 2%, which was less than the expected 8.5%), Medicare still pays physicians only 80% of what many third-party insurers pay.
Moreover, those reimbursements are often slow to arrive, and the paperwork is burdensome. In fact, about 65% of doctors won't accept new Medicare patients, down from 71% 5 years ago, according to the Medscape Physician Compensation Report 2023.
Worse, inflation makes continuous cuts feel even steeper and trickles down to physicians and their patients as more and more doctors become disenchanted and consider dropping Medicare.
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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 |
Neal Rakesh, MD, and Semih Gungor, MD
Abstract
BACKGROUND: Complex regional pain syndrome (CRPS) is a condition characterized by the development of spontaneous pain with features of allodynia; hyperalgesia; vasomotor, sudomotor, and trophic changes; as well as motor dysfunction. For lower extremity symptoms, the primary sympathetic intervention is the lumbar sympathetic block (LSB). There are several complications associated with the procedure including paraplegia, especially in the setting of neurolysis.
CASE REPORT: In this case, we describe a patient who underwent a successful LSB with local anesthetic resulting in 4 days of transient lower extremity paraplegia and subsequent complete resolution.
CONCLUSION: It is essential to understand that this is a potential complication of LSBs in patients with CRPS once all other explanations have been ruled out and that the symptoms will resolve with supportive care.
KEY WORDS: Complex regional pain syndrome, lumbar sympathetic block, sympathetic mediated pain, transient paraplegia, case report
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| RANDOMIZED CONTROL TRIAL |
Mengyao Qi, MSc, Wei Xiao, MD, Shuyi Yang, MD, Shijun Wang, MD, Liane Zhou, BS, Anxia Wan, BS, Shuai Feng, MSc, Dongxu Yao, MSc, Chunxiu Wang, MD, and Tianlong Wang, MD
Abstract
BACKGROUND: There has been limited research regarding the effect of preventive precise multimodal analgesia (PPMA) on the duration of acute postoperative pain after total laparoscopic hysterectomy (TLH). This randomized controlled trial aimed to evaluate how PPMA affects pain rehabilitation.
OBJECTIVES: Our primary objective was to reduce the duration of acute postoperative pain after TLH, including incisional and visceral pain.
STUDY DESIGN: A double blind randomized controlled clinical trial.
SETTING: Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing, People’s Republic of China.
METHODS: Seventy patients undergoing TLH were randomized to Group PPMA or Group Control (Group C) in a 1:1 ratio. Patients in Group PPMA were given PPMA through the pre-incisional administration of parecoxib sodium 40 mg (parecoxib is not approved for use in the US) and oxycodone 0.1 mg/kg as well as local anesthetic infiltration at the incision sites. In Group C, similar doses of parecoxib sodium and oxycodone were injected during uterine removal, and a local anesthetic infiltration procedure was performed immediately before skin closure. The index of consciousness 2 was utilized to titrate the remifentanil dosage in all patients to ensure sufficient analgesia.
RESULTS: Compared with the Control, PPMA shortened the durations of incisional and visceral pain at rest (median, interquartile range [IQR]: 0, 0.0– 2.5) vs 2.0, 0.0–48.0 hours, P = 0.045; 24.0, 6.0–24.0 vs 48.0, 24.0–48.0 hours, P < 0.001; and during coughing 1.0, 0.0–3.0 vs 24.0, 0.3–48.0 hours, P = 0.001; 24.0, 24.0–48.0] vs 48.0, 48.0–72.0] hours, P < 0.001). The Visual Analog Scale (VAS) scores for incisional pain within 24 hours and visceral pain within 48 hours in Group PPMA were lower than those in Group C (P < 0.05). PPMA evidently decreased the VAS scores for incisional pain during coughing at 48 hours (P < 0.05). Pre-incisional PPMA significantly reduced postoperative opioid consumption (median, IQR: 3.0 [0.0–3.0] vs 3.0 [0.8–6.0] mg, P = 0.041) and the incidence of postoperative nausea and vomiting (25.0% vs 50.0%, P = 0.039). Postoperative recovery and hospital stay were similar between the 2 groups.
LIMITATIONS: This research had some limitations, including that it was a single-center research with a limited sample size. Our study cohort did not represent the overall patient population in the People’s Republic of China; therefore, the external validity of our findings remains limited. Furthermore, the prevalence of chronic pain was not tracked.
CONCLUSION: Pre-incisional PPMA may enhance the rehabilitation process of acute postoperative pain after TLH.
KEY WORDS: Total laparoscopic hysterectomy, preventive precise multimodal analgesia, incisional pain, visceral pain, rehabilitation process
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| RANDOMIZED CONTROLLED TRIAL |
Ahmed Hassanein, MD, Mohamed Abdel-Haleem, MSc, and Shadwa R. Mohamed, MD
Abstract
BACKGROUND: Postoperative pain increases the incidence of venous thrombosis and respiratory complications, prevents early postoperative ambulation, and prolongs hospital stay. Fascial plane injections such as erector spinae plane (ESP) block and quadratus lumborum (QL) blocks are popular methods for postoperative pain control and reducing opioid consumption.
OBJECTIVES: We aimed to evaluate the analgesic effects of ultrasound-guided ESP versus QL block during laparoscopic cholecystectomy for the reduction of pain and analgesic consumption.
STUDY DESIGN: Prospective, double-blind, single-center, randomized controlled clinical trial.
SETTING: Minia University Hospital, Minia Governorate, Egypt.
METHODS: Patients scheduled for laparoscopic cholecystectomy from April 2019 through December 2019 were randomly allocated into 3 groups. After induction of general anesthesia, Group A received an ESP block, group B received a QL block, and group C didn’t receive any block (control). The main outcome was the time to the first analgesic request. Secondary outcomes were the pain intensity measured by the Visual Analog Scale at one, 2, 4, 6, 8, 12, 16, 20, and 24 hours postoperatively at rest and cough. The total analgesic requirement during the first 24 postoperative hours, hemodynamics, and any complications were recorded.
RESULTS: Sixty patients scheduled for elective laparoscopic cholecystectomy were enrolled; the clinical and demographic data were similar in the 3 groups. Groups A and B had lower VAS scores at cough than Group C in the first postoperative 2 hours. Compared to Group C, a higher score was reported at 8, 12, and 16 hours in Group A, and at 8 and 16 hours in Group B. Group B had a higher score at 4 hours than Group A. At rest, Group C showed higher scores than Groups A and B in the first 2 hours, while higher scores were noted at 16 hours in Group A and 12 hours in Group B. Time to first request of analgesia was significantly prolonged in Group A than in Groups B and C (P < 0.001). Our study showed that Groups A and B had lower postoperative analgesic requirements than Group C (P < 0.05).
LIMITATIONS: This study had a small number of patients enrolled.
CONCLUSIONS: Both ESP and QL blocks effectively reduced VAS scores at both cough and rest. There was a decreased total consumption of analgesics in the first postoperative 24 hours with a longer duration of analgesia, which lasted 16 hours in the ESP group and 12 hours in the QL group.
KEY WORDS: Plane nerve block, cholecystectomy, postoperative pain, regional analgesia
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ASIPP is now in collaboration with Curi Medical Liability Program
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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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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