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4281. What does current Complex Regional Pain Syndrome (CRPS) rehabilitation look like?

to rehabilitation. We were interested in establishing what current rehabilitation practice for CRPS consists of, in order to use this information to inform the development of a “best practice” model of rehabilitation. The effectiveness of the “best practice” model would then be evaluated in a clinical trial. We also had a secondary aim: to establish which diagnostic criteria, if indeed any, are currently used for diagnosis. In our recent study (6), we developed an electronic survey aimed at clinicians involved (...) BodyInMind thinks they should think. Think about that! We aim to facilitate and disseminate good clinical science research. We love comments that engage with the research and are constructive and respectful. We do not prescribe treatments. Promotion of your particular therapy in the comments section is not appropriate here either - that is not the point of BiM. Finally, all the comments that are made reflect the views of the person who made them and are not endorsed by BiM or members of the BiM research

2018 Body in Mind blog

4282. 5 ways poorly thought out health IT can worsen patient safety

5 ways poorly thought out health IT can worsen patient safety 5 ways poorly thought out health IT can worsen patient safety 5 ways poorly thought out health IT can worsen patient safety | | January 19, 2018 122 Shares The frontlines of health care have been transformed over the last decade as electronic medical records have been rolled out across America. Unfortunately, information technology has yet to live up to its immense promise in health care­ — a topic that I frequently write about (...) concerning ways communication and patient safety can actually be impaired with ill-thought out computer systems: 1. Reviewing results. Electronic medical records present physicians with vast swathes of data, often redundant. Unfortunately, it’s become far too easy to mindlessly click on a box, import results into, for example, a progress note—without actually reading it and thoroughly reviewing what’s in front of you. In the days of the paper chart, doctors were forced to write down anything abnormal

2018 KevinMD blog

4283. The annals of “I’m not antivaccine,” part 26: “No, I’m not an ‘vaccine safety’ advocate”

pain? Give me a minimal amount – 1-2 days worth of dosing – so it’s not sitting around. But don’t forbid medication. (Yes, I know what the guidelines say . But I’ve already heard people talking about how doctors are refusing to prescribe adequate pain relief for their kids after surgery.) Apologies for the derail… JDK The vaccine safety gambit is depressingly effective, I find though that I can counter it equally effectively with ammunition from this blog. If you don’t know any better, the safety (...) acceptable. There is one additional factor for trans people: gender reassignment surgery was still a novelty forty years ago. The only case I knew about was Walter Carlos (creator of Switched-On Bach , which showcased the capabilities of the then recently invented Moog synthesizer in arrangements of Baroque-era music), who became Wendy Carlos and subsequently became famous as an electronic music pioneer. The only way trans people could exist before such surgeries were developed was to appear

2017 Respectful Insolence

4284. The annals of “I’m not antivaccine,” part 26: Hating on those who won’t let their antivax freak flag fly high

pain? Give me a minimal amount – 1-2 days worth of dosing – so it’s not sitting around. But don’t forbid medication. (Yes, I know what the guidelines say . But I’ve already heard people talking about how doctors are refusing to prescribe adequate pain relief for their kids after surgery.) Apologies for the derail… JDK The vaccine safety gambit is depressingly effective, I find though that I can counter it equally effectively with ammunition from this blog. If you don’t know any better, the safety (...) acceptable. There is one additional factor for trans people: gender reassignment surgery was still a novelty forty years ago. The only case I knew about was Walter Carlos (creator of Switched-On Bach , which showcased the capabilities of the then recently invented Moog synthesizer in arrangements of Baroque-era music), who became Wendy Carlos and subsequently became famous as an electronic music pioneer. The only way trans people could exist before such surgeries were developed was to appear

2017 Respectful Insolence

4285. Charlie Goldsmith: A new celebrity quack arises, enabled by TLC

by prescription drugs…these are those murdered by Charlatans. Doctors doing their master’s any cemetery and count the headstones…every one of them (just about) was a patient of a doctor once. The greater percentage of energy healing works… the agenda of the Pharma companies is to keep everyone foolish enough to believe their Doctor i a state of UNWELLNESS. Insiders tell us this truth all the time. what is is. In excess of three Pharma Co lobbyists for every USA congressman and they take 70 to 80 (...) cellular membranes as a given membrane depolarizes by letting ions flow through it –the electrical fields here are a side effect of the gradient, rather than the point of the gradient. And these currents are not of electrons. The resting 70 mV potential across a nerve membrane is due entirely to the difference in ion content on either side. The wave propagating along a nerve to send the signal are in measures of membrane polarization, which is not current at all and not really actually “transmitting

2017 Respectful Insolence

4286. Can Vaping Help Smokers Quit? The Real Story from a Real Story

, my son's coach approached me after practice and asked, “Can this thing really help me quit smoking?” He was holding a large, black box in his hand — a sort of stylized plastic straw jutted out from one side of the box and four green and red lighted buttons littered the other side. I recognized this as a “vape mod,” a more complicated and some would say, advanced version of the typical electronic cigarette or “vape pen.” In their modern form, electronic cigarettes were developed as an alternative (...) nicotine delivery device in 2003 and were introduced in the United States a few years later. The devices quickly grew into a multimillion-dollar industry and some business analysts even suggested that the sale of electronic cigarettes would by 2021. Rates of use certainly exploded in the last few years among both and , and many countries, including the United States, are still trying to come to regulatory grips with the new technology. The coach must have asked me because he knew I was involved

2017 The RAND blog

4287. Improving transparency and replicability of healthcare databases to increase credibility of “real world” evidence

Improving transparency and replicability of healthcare databases to increase credibility of “real world” evidence Improving transparency and replicability of healthcare databases to increase credibility of “real world” evidence - The BMJ ---> Evidence generated from “real world” data (e.g. administrative claims and electronic health record databases), alongside clinical trials, is highly valuable for regulatory, coverage, and clinical decisions. While randomized clinical trials (RCTs (...) for the risk-benefit profile of drugs and other medical products is reflected in recent policies such as Adaptive Pathways in the European Union, the 21 st Century Cures Act, and Prescription Drug User Fee Act (PDUFA) VI in the United States. Each of these policies has sections designed to advance use of “real world” evidence to support regulatory decisions. However, due to highly variable quality, decision makers are currently unsure how to use evidence from database studies. Equipping decision-makers

2017 The BMJ Blog

4288. Robert F. Kennedy, Jr. and his World Mercury Project: Antivaccine, NOT “fiercely pro-vaccine”

rare and serious adverse events following immunization. The VSD uses electronic health data from each participating site. This includes information on vaccines: the kind of vaccine given to each patient, date of vaccination, and other vaccinations given on the same day. The VSD also uses information on medical illnesses that have been diagnosed at doctors’ offices, urgent care visits, emergency department visits, and hospital stays. The VSD conducts vaccine safety studies based on questions (...) insurance claims data from four national healthcare plans: Aetna, HealthCore (Wellpoint), Humana, and OptumInsight (United Healthcare). And more: PRISM is one component of FDA’s Sentinel Initiative, which monitors the safety of a variety of FDA-regulated medical products by examining information in electronic healthcare databases. Sentinel performs what is called “active” surveillance, as opposed to “passive” surveillance. Passive FDA surveillance systems depend on industry, consumers, patients

2017 Respectful Insolence

4289. Hospitals and doctors: Is their role in soaring health care costs overlooked?

. “Covering the business of healthcare is so interesting,” Herman told me. “There should be more scrutiny and more criticism of it.” While drug manufacturers and insurance companies are “easy targets,” he said, hospitals and doctors often get overlooked. “I’ve never really understood that,” Herman said. “That’s where so much of the money is.” accounts for about one-third of the country’s health expenditures; physician services make up 20 percent, and contrary to public perception, prescription drugs (...) . “In theory value-based care means better care for less money,” Herman said. But does it? How would it affect premiums? How would it make care simpler and better? Proponents of value-based care want you to believe providers and insurers are on the same page, but . A hospital’s financials are the key to learning where a hospital or hospital system is headed financially. Herman recommends that reporters familiarize themselves with a database called (Electronic Municipal Market Access), a portal run

2017 HealthNewsReview

4290. Preparing Your Medicine Cabinet for an Emergency: A Checklist

of an emergency. Plan ahead . Make sure you know the shelf life and optimal storage temperature for your prescriptions, because some medications and supplies cannot be safely stored for long periods of time at room temperature. If you take a medication that needs to be refrigerated or requires electronic equipment plan ahead for temporary storage and administration in an emergency situation. Check before using . Before using the medication in your emergency kit, check to make sure the look or smell hasn’t (...) keep in your emergency kit – water, food, a flashlight, and a battery-powered radio. What you may not think about is personalizing your kit for your unique medical needs or the needs of your family. Particularly, including prescription medications and other medical supplies in your emergency kit and plans. As a pharmacist whose job is focused on emergency preparedness and response, I want to give you 10 pointers about how to prepare your medications for an emergency so you can decrease the risk

2017 CDC Public Health Matters

4291. Amitava Banerjee: Is conflict of interest a concern in healthcare IT?

Amitava Banerjee: Is conflict of interest a concern in healthcare IT? Amitava Banerjee: Is conflict of interest a concern in healthcare IT? - The BMJ ---> In the UK, electronic health records (EHR) have been almost universal in general practice since the 1990s, and were deployed across hospitals in the early 2000s. The (PRSB) was set up in 2013 “to develop high quality, consistent care records and promote their use.” As I sat in the third annual general meeting of the PRSB recently, I wondered (...) ). Patient safety cannot play second fiddle to COI. has been problematic, particularly in the UK. However, renewed enthusiasm has come from high-level recommendations and national initiatives, such as the , , and the Faculty of Clinical Informatics. Moreover, the Wannacry cyber-attack in May 2017 showed that robust HIT infrastructure is a pre-requisite of data security. , including EHRs, telehealth, electronic ordering systems and clinical decision support systems, . Given the scale of investment

2017 The BMJ Blog

4292. A conversation with a Rigvir flack

existing registration, but unfortunately your analysis is used to doubt the registration. Which is off course strange, because nowhere in the world rules and regulations (in our case standards for clinical trials) are used with backward date. Yes for new registrations - we know the rules – we will provide proper RCT data, but as for now, please respect that the medicine is prescription medicine that is prescribed only in national clinics and by certified doctors for last 13 years. They have (...) trials and most of the evidences is not published. Doctors and clinics in Latvia use this medicine for majority of melanoma patients in Latvia for many years. In Latvia medicine is prescribed only in national clinics and by certified doctors and they have also other alternatives, so probably they know what they do. 2 years ago we started EMA (centralised EU) commercialisation process and even obtained EU commission support from Horizon2020 grant, we also obtained EMA regulatory advice

2017 Respectful Insolence

4293. Integrating Pharmacogenomics in Practice: One GIFT at a Time or a Package Deal?

a one at a time genomic testing platform for single applications seems highly inefficient. If warfarin pharmacogenomics data were readily available in the electronic health record (EHR) when individuals were prescribed warfarin, there seems little doubt that the data would be used routinely. But, if an entire system needs to be developed at the point of care for obtaining and using warfarin pharmacogenomics data at the time of a decision to treat, it may never become part of routine care. It is time (...) laid over the last decade by the groups such as the of the American Health Information Community, and a broad group of government and non-government interested in this topic. Developing electronic health records that can manage genomic data is crucial for the future U.S. health care system in order to ensure broad and equitable access to pharmacogenomics and other evidence-based genomic interventions. Posted on November 6, 2017 by W. Gregory Feero M.D., Ph.D. Faculty, Maine-Dartmouth Family

2017 CDC Genomics and Health Impact Blog

4294. A conversation with a Rigvir flack

and regulations (in our case standards for clinical trials) are used with backward date. Yes for new registrations – we know the rules – we will provide proper RCT data, but as for now, please respect that the medicine is prescription medicine that is prescribed only in national clinics and by certified doctors for last 13 years. They have alternatives and even reimbursed ones. So obviously these doctors have deeper knowledge about the therapy with RIGVIR, than just analysis of published data, since (...) and most of the evidences is not published. Doctors and clinics in Latvia use this medicine for majority of melanoma patients in Latvia for many years. In Latvia medicine is prescribed only in national clinics and by certified doctors and they have also other alternatives, so probably they know what they do. 2 years ago we started EMA (centralised EU) commercialisation process and even obtained EU commission support from Horizon2020 grant, we also obtained EMA regulatory advice. There is no doubts

2017 Respectful Insolence

4295. Love smart functions in your EMR? This doctor doesn’t.

Love smart functions in your EMR? This doctor doesn’t. Love smart functions in your EMR? This doctor doesn't. Love smart functions in your EMR? This doctor doesn’t. | | July 24, 2018 6 Shares How smart do we want our electronic health record to be? Somewhere between as dumb as a piece of paper and a pen, and too smart for our own good. Many, many years ago, before we spent the majority of our office visit staring at a flatscreen LED and typing away, our charts were simple manila folders (...) interested in doing a research project? Stacks of charts piled on your desk, incredibly labor-intensive work digging through all those pages trying to find what you’re looking for. Today, we have something more, something smarter, and yet we are still going through growing pains trying to figure out how to have the electronic health record work for us instead of the other way around. Those who designed it are convinced that it fills our needs, that it gives us everything we want. Now, it’s certainly

2018 KevinMD blog

4296. Making progress in curbing opioid use in hospitals

part of the solution. That means partnering with patients and families on pain management expectations; education on safe use, storage and disposal of opioids; and prevention of misuse and abuse after discharge. Clinicians throughout a patient’s full continuum of care also need to increase their awareness to ensure that prescriptions are being written only when absolutely necessary. Effective, safe pain management requires making time for patient-centric care, so when opioids are prescribed (...) Making progress in curbing opioid use in hospitals Making progress in curbing opioid use in hospitals Making progress in curbing opioid use in hospitals | | May 30, 2018 131 Shares A guest column by the , exclusive to KevinMD.com. The opioid epidemic has reached a tipping point. Overdose deaths involving prescription opioids have quadrupled since 1999, as safer pain management practices must be a national priority. Everyone in health care needs to be aware of the potential dangers and become

2018 KevinMD blog

4297. Too many things need physicians’ signatures

equipment are illegal? How come I can quickly and easily electronically prescribe every medication under the sun, but to give someone incontinence supplies, urinary catheters, wheelchair repair, or wound care supplies, I have to dig out my prescription paper, print a hard copy, then hand-write on the ICD-10 code and fax this off to the equipment supplier? I want my patient to get physical therapy — I suggested it; I put in a referral to a physical therapist — but once they decided what they wanted (...) was asked to hand-write the date on a prescription and then initial that I had dated the prescription, despite the fact that it already had the date stamped electronically as well as my own signature in ink. I understand there are lots of regulations out there, things that have been put in place to prevent non-medical mischief, and we would all be fools if we thought fraud and waste wasn’t happening, if we all just went on faith that everyone in the healthcare system was really only looking out

2018 KevinMD blog

4298. Think you have an iodine allergy? You may want to reconsider.

, it was almost certainly an older ionic contrast agent. If symptoms consisted of nausea, vomiting, or a brief warm sensation, it may not have been pleasant for the patient, but those are considered physiologic effects of IV contrast, not actual allergic reactions. If the reaction to an older ionic contrast agent was mild, such as hives with no trouble breathing, a newer nonionic agent (those commonly used today) will usually be tolerated. Oral steroid premedication may also be prescribed. If the former (...) be done whenever information is inaccurate. A few questions in the history taking, and confirmation of agents used for prior injections, are usually all that is required to clear a patient for a study they may need. Better to clarify now, than to wait until there is an immediate situation with less time to act, like a possible pulmonary embolism, stroke, or trauma. And for anyone in the electronic medical records business, it would be best if “iodine” were not allowed as an allergy choice option

2018 KevinMD blog

4299. Pronouns matter: How we can do better in LGBTQ patient care

Pronouns matter: How we can do better in LGBTQ patient care Pronouns matter: How we can do better in LGBTQ patient care Pronouns matter: How we can do better in LGBTQ patient care | | July 13, 2018 30 Shares In the wake of Pride Month, I have been reflecting on how our health care system impacts the lives of individuals with identities across the gender spectrum. Sometimes, when sending a prescription to a pharmacy for any given patient, we will get a phone call that the date of birth on file (...) (WPATH) has made recommendations that electronic medical record systems include fields for not only assigned sex at birth and legal name, but also affirmed gender pronouns used and what name a person goes by if not their legal name. The final rules issued by the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare and Medicaid Services (CMS) in October 2015 require EMR software certified for meaningful use to include fields for gender identity

2018 KevinMD blog

4300. Come see for yourself why medicine rarely runs on time

to talk to you about a mammogram report,” she says. I get into my multitask mode and answer the phone while electronically sending in the prescription. Now, back to the patients in exam rooms. I walk into the next exam room where the patient is scheduled for an annual exam. She is a young college student and is excited to tell me she is dating someone. After we talk a little about how they met and what he is like, I ask “Are you using condoms?” “Ah, no,” she answers. So I take some time to talk about (...) and electronically sent several prescriptions. I still need to call some patients about their lab results. That will have to wait for the moment, I have more patients to see and surgery after leaving the office. I think you get the idea of how a doctor’s office flows, well, at least, at my office. We try to accommodate our patients’ needs and sometimes it takes a little longer than anticipated or a patient is scheduled for one thing and “oh, while I’m here, can’t you just also do …” Sometimes people have

2018 KevinMD blog

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