This document summarizes harm reduction strategies for chronic pain patients prescribed opioids. It discusses the opioid overdose epidemic and risk factors for overdose death such as high opioid doses, methadone use, and co-prescribing benzodiazepines. The document also outlines risk factors for opioid use disorder and provides case studies demonstrating strategies like identifying at-risk patients, using prescription drug monitoring programs, prescribing nasal naloxone, obtaining a DATA 2000 waiver to prescribe buprenorphine, and considering non-opioid alternatives.
Drug and Alcohol use and misuse at work has significant safety threats to a company's employees, customers and reputation.
See More: https://www.flyingmedicine.uk/drug-alcohol-testing-occupational
Does galantamine hydrobromide supplement good for alzheimer diseasephcoker.com
Galantamine uses in treating the symptoms of dementia associated with Alzheimer’s disease occur due to its dual mode of action. it increases the level of acetylcholine, a key enzyme in cognitive enhancement. Galantamine acts as a reversible and competitive acetylcholinesterase inhibitor thus prevent the breakdown of acetylcholine. It also stimulates the nicotinic receptors to release more acetylcholine.
https://www.phcoker.com/galantamine-hydrobromide/
info@phcoker.com
Drug and Alcohol use and misuse at work has significant safety threats to a company's employees, customers and reputation.
See More: https://www.flyingmedicine.uk/drug-alcohol-testing-occupational
Does galantamine hydrobromide supplement good for alzheimer diseasephcoker.com
Galantamine uses in treating the symptoms of dementia associated with Alzheimer’s disease occur due to its dual mode of action. it increases the level of acetylcholine, a key enzyme in cognitive enhancement. Galantamine acts as a reversible and competitive acetylcholinesterase inhibitor thus prevent the breakdown of acetylcholine. It also stimulates the nicotinic receptors to release more acetylcholine.
https://www.phcoker.com/galantamine-hydrobromide/
info@phcoker.com
Introduction to the 2014 digital rural futures conference specialHelen Farley
In June, 2014, the Digital Rural Futures Conference, an initiative of the Regional Universities Network (RUN), was held at the University of Southern Queensland’s Toowoomba campus. RUN, a network of six universities with headquarters in regional Australia, was established in October 2011. The foundation members are CQUniversity, Southern Cross University, Federation University Australia, University of New England, University of Southern Queensland and University of the Sunshine Coast. The RUN member universities play an important and distinctive role in advancing Australia’s national prosperity, productivity and identity through their educational and research contributions to regional economic, social, cultural and environmental development.
Nasiol is the registered trade mark of Artekya Ltd. Co., which is the main and pioner manufacturer of protective Nano coating materials in Turkey and Europe
Чолак Тетяна Дмитрівна, АрПАЛ. Застосування сучасних інформаційних технологій...alem0077
Застосування сучасних інформаційних технологій у навчанні на прикладі бінарного уроку з інформатики та діловодства, на тему: «Поняття про шаблон документа; створення документа»
This Protocol is adapted from the World Health Organization recommendations and reflects the current expert opinion of staff from Montefiore’s Antimicrobial Stewardship Program, Infectious Diseases Division, and Pharmacy. Clinical efficacies of these agents are still under investigation at this time. Treatments of COVID-19 are evolving as we gain more clinical experiences along with more published data. Supportive care remains the mainstay of treatment. The availability of certain agents may be limited due to supply chain disruptions and backorders. For suspected or confirmed cases requiring treatments listed below, please consult Infectious Diseases and notify Infection Prevention and Control Departments immediately.
Introduction to the 2014 digital rural futures conference specialHelen Farley
In June, 2014, the Digital Rural Futures Conference, an initiative of the Regional Universities Network (RUN), was held at the University of Southern Queensland’s Toowoomba campus. RUN, a network of six universities with headquarters in regional Australia, was established in October 2011. The foundation members are CQUniversity, Southern Cross University, Federation University Australia, University of New England, University of Southern Queensland and University of the Sunshine Coast. The RUN member universities play an important and distinctive role in advancing Australia’s national prosperity, productivity and identity through their educational and research contributions to regional economic, social, cultural and environmental development.
Nasiol is the registered trade mark of Artekya Ltd. Co., which is the main and pioner manufacturer of protective Nano coating materials in Turkey and Europe
Чолак Тетяна Дмитрівна, АрПАЛ. Застосування сучасних інформаційних технологій...alem0077
Застосування сучасних інформаційних технологій у навчанні на прикладі бінарного уроку з інформатики та діловодства, на тему: «Поняття про шаблон документа; створення документа»
This Protocol is adapted from the World Health Organization recommendations and reflects the current expert opinion of staff from Montefiore’s Antimicrobial Stewardship Program, Infectious Diseases Division, and Pharmacy. Clinical efficacies of these agents are still under investigation at this time. Treatments of COVID-19 are evolving as we gain more clinical experiences along with more published data. Supportive care remains the mainstay of treatment. The availability of certain agents may be limited due to supply chain disruptions and backorders. For suspected or confirmed cases requiring treatments listed below, please consult Infectious Diseases and notify Infection Prevention and Control Departments immediately.
Webinar Series on COVID-19: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research, NIH
Speaker: Dr Yasmin Gani, ID Physician, Hospital Sungai Buloh, MOH Malaysia.
More info about the speaker and this webinar available here: https://clinupcovid.mailerpage.com/resources/g7e5g8-medical-management-of-covid-19-an
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India Diagnostic Labs Market: Dynamics, Key Players, and Industry Projections...Kumar Satyam
According to the TechSci Research report titled “India Diagnostic Labs Market Industry Size, Share, Trends, Competition, Opportunity, and Forecast, 2019-2029,” the India Diagnostic Labs Market was valued at USD 16,471.21 million in 2023 and is projected to grow at an impressive compound annual growth rate (CAGR) of 11.55% through 2029. This significant growth can be attributed to various factors, including collaborations and partnerships among leading companies, the expansion of diagnostic chains, and increasing accessibility to diagnostic services across the country. This comprehensive report delves into the market dynamics, recent trends, drivers, competitive landscape, and benefits of the research report, providing a detailed analysis of the India Diagnostic Labs Market.
Collaborations and Partnerships
Collaborations and partnerships among leading companies play a pivotal role in driving the growth of the India Diagnostic Labs Market. These strategic alliances allow companies to merge their expertise, strengthen their market positions, and offer innovative solutions. By combining resources, companies can enhance their research and development capabilities, expand their product portfolios, and improve their distribution networks. These collaborations also facilitate the sharing of technological advancements and best practices, contributing to the overall growth of the market.
Expansion of Diagnostic Chains
The expansion of diagnostic chains is a driving force behind the growing demand for diagnostic lab services. Diagnostic chains often establish multiple laboratories and diagnostic centers in various cities and regions, including urban and rural areas. This expanded network makes diagnostic services more accessible to a larger portion of the population, addressing healthcare disparities and reaching underserved populations. The presence of diagnostic chain facilities in multiple locations within a city or region provides convenience for patients, reducing travel time and effort. A broader network of labs often leads to reduced waiting times for appointments and sample collection, ensuring that patients receive timely and efficient diagnostic services.
Rising Prevalence of Chronic Diseases
The increasing prevalence of chronic diseases is a significant driver for the demand for diagnostic lab services. Chronic conditions such as diabetes, cardiovascular diseases, and cancer require regular monitoring and diagnostic testing for effective management. The rise in chronic diseases necessitates the use of advanced diagnostic tools and technologies, driving the growth of the diagnostic labs market. Additionally, early diagnosis and timely intervention are crucial for managing chronic diseases, further boosting the demand for diagnostic lab services.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
For those battling kidney disease and exploring treatment options, understanding when to consider a kidney transplant is crucial. This guide aims to provide valuable insights into the circumstances under which a kidney transplant at the renowned Hiranandani Hospital may be the most appropriate course of action. By addressing the key indicators and factors involved, we hope to empower patients and their families to make informed decisions about their kidney care journey.
COVID-19 PCR tests remain a critical component of safe and responsible travel in 2024. They ensure compliance with international travel regulations, help detect and control the spread of new variants, protect vulnerable populations, and provide peace of mind. As we continue to navigate the complexities of global travel during the pandemic, PCR testing stands as a key measure to keep everyone safe and healthy. Whether you are planning a business trip, a family vacation, or an international adventure, incorporating PCR testing into your travel plans is a prudent and necessary step. Visit us at https://www.globaltravelclinics.com/
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Trauma Outpatient Center is a comprehensive facility dedicated to addressing mental health challenges and providing medication-assisted treatment. We offer a diverse range of services aimed at assisting individuals in overcoming addiction, mental health disorders, and related obstacles. Our team consists of seasoned professionals who are both experienced and compassionate, committed to delivering the highest standard of care to our clients. By utilizing evidence-based treatment methods, we strive to help our clients achieve their goals and lead healthier, more fulfilling lives.
Our mission is to provide a safe and supportive environment where our clients can receive the highest quality of care. We are dedicated to assisting our clients in reaching their objectives and improving their overall well-being. We prioritize our clients' needs and individualize treatment plans to ensure they receive tailored care. Our approach is rooted in evidence-based practices proven effective in treating addiction and mental health disorders.
1. Harm Reduction
Strategies for Chronic
Pain Patients
Paul C. Coelho, MD
Board Certified PM&R
Subspecialty Certified Pain Medicine
Disclosures
Paul Coelho,MD: No industry financial relationships to disclose.
I am a member of the OPG planning committee and on
the OPG speakers bureau.
Table Of Contents
1. Opioid Overdose Deaths
(ODD)
2. 2016 CDC Opioid Guidelines
3. Risk Factors for an ODD
4. Risk Factors for Opioid Use
Disorder (Addiction)
5. Harm Reduction Strategies
6. Sample Cases
4. Risk Factors for
Overdose Death
1. Opioid Dose
2. Methadone
3. Opioids + Benzodiazepines/Sedative
Dose as a Risk Factor For
ODD
https://www.aan.com/uploadedFiles/Website_Library_Assets/Documents/3.Practice_Management/2.Quality_Improvement/
2.Patient_Safety/2.Patient_Safety_Education/C171%20-%20Franklin.pdf
Methadone as a Risk
Factor for ODD
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6126a5.htm
1/3rd of all ODD
5. Co-Rx’d Benzos as a Risk
Factor for ODD
http://www.ncbi.nlm.nih.gov/pubmed/26890165
1/3rd of all ODD
Risk Factors for
Opioid Use Disorder
1. Age
2. Length of Exposure
3. Dose
4. Psychosocial Factors:
a. H/o drug/alcohol tobacco abuse
b. Family hx of drug/alcohol abuse
c. H/o childhood trauma/abuse
d. Intercurrent mental health ds
Prescribed Opioid
Addiction Tx By Age
http://www.samhsa.gov/data/sites/default/files/2013_Treatment_Episode_Data_Set_National/
2003_2013_Treatment_Episode_Data_Set_National_Body.html
2013
6. Opioid Use Disorder Dx By
Age
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032801/
0
10
20
30
40
18-30 31-40 41-50 51-64 >65
N = 570K
OR Medicaid Opioid Rx’s
By Age (86% 18-60yrs)
http://www.ncbi.nlm.nih.gov/pubmed/26766755
0
22.5
45
67.5
90
18-39 40-59 60-79 >80
Top 10% Prescribers Rx’d 80% All Opioids
Dose & Length of Exposure
As Risk Factors For OUD
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032801/
Low Dose 0-36MED
Med Dose 37-120MED
High Dose > 120MED
7. Harm Reduction
Strategies
Identify At Risk Patients
1. Morphine Equivalent Dose > 120mg/day
2. Methadone
3. Opioid and co-prescribed benzodiazepine
4. H/o aberrant behavior or addiction
Prescription Drug
Monitoring Program
http://www.orpdmp.com/health-care-provider/
8. Prescription Drug
Monitoring Program
http://www.orpdmp.com/health-care-provider/
PDMP Dashboard
https://orpdmp-ph.hidinc.com/orlogappl/bdorpdmqlog/pmqhome.html
6mo Look Back
Coelho’s PDMP Dashboard
https://orpdmp-ph.hidinc.com/orlogappl/bdorpdmqlog/pmqhome.html
Patient Name Dose >120
MED
Methadone Benzodiazepine >90 Days Use > 4
Pharmacies/
Prescribers
167 39 (23%) 4 (2%) 98 (59%) 79 (47%) 4 (2%)
9. Opioid Dose Calculator
http://www.agencymeddirectors.wa.gov/Calculator/DoseCalculator.htm
Examples of 120MED
Fentanyl 50ucg/hr
Buprenorphine 4mg
Methadone 30mg
Hydromorphone 30mg
Oxycodone 80mg
Oxymorphone 40mg
Morphine 120mg
Codeine 800mg
MED > 90
Prescribe Nasal Naloxone
1. SB 384 legalized for lay
administration in 2013.
2. Stock in your pharmacies.
3. Some patients must pay out of
pocket ($35.00 -$75.00)
http://www.amphastar.com/assets/naloxone.pdf
10. Consider a Data 2000
Waiver: Buprenorphine
http://projects.huffingtonpost.com/dying-to-be-free-heroin-treatment/opioid-abuse-outpace-treatment-capacity
17K MD/DO in OR, 400 with Waiver [2%]
Buprenorphine
1. Schedule III drug, partial mu agonist
2. FDA approved for both pain - Butrans/Belbuca -
and addiction - Suboxone/Subutex.
3. Ceiling effect for respiratory suppression (RS).
Buprenorphine’s Ceiling
Effect for R.S.
12. Random Urine Or Saliva
Drug Screening
https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm
Sample Cases
Case 1: Teresa
75y/o retiree with diffuse OA.
Lives alone in Prineville. Uses
Oxycodone-APAP 10/325, five
perday (MED 70). No h/o
aberrant behavior or addiction.
13. Case 1: Teresa
Teresa reports that the medications
give her comfort. She was started on
her current dose years ago.
Recommendations:
Continue as prescribed.
Case 2: Cleatus
68y/o retired logger with failed back
surgery syndrome. Lives with spouse Rx’d
Methadone 10mg po QID (MED 320).
No h/o addiction or aberrant behaviors.
Case 2: Cleatus
Recommendations:
Call Cleatus & his spouse in.
Explain that his dose and medication
are both unsafe and will need to change.
a. Prescribe nasal naloxone & train spouse
in assembly and use.
b. Offer a conversion to Morphine Sulfate
ER 75mg QD (30,15,30) at his next refill.
http://www.prescribetoprevent.org/wp-content/uploads/2012/11/naloxone-one-pager-in-nov-2012.pdf
14. Case 3: Jane
55y/o woman with FMS.
Lives alone in Redmond. Uses
OxyContin 30mg PO BID (MED
80), and alprazolam 0.5mg po
QID. No h/o aberrant behavior
or addiction.
Case 3: Jane
Recommendations:
Call Jane in to clinic.
Explain that the combination of
alprazolam and Oxycodone is
unsafe.
a. Offer a conversion to
clonazapam 2mg BID.
b. Taper clonazepam by .5 -1mg/
mo over 4-8mo.
c. Offer non-benzodiazepine
alternatives for anxiety/sleep/
panic attacks.
http://www.slideshare.net/101N/alternatives-to-benzodiazepines-60678319
Case 4: Luc
49y/o married restaurant owner with
chronic migraine. Prescribed
Oxycodone 5mg BID, 30/mo over
many years. No h/o addiction or
aberrant behavior. Recent review of
the PDMP with at a f/u visit reveals
visits to 6 other prescribers over the
past 3mo for opioids. Patient
acknowledges that he is overusing
pain medication and wants your help
in getting off opioids entirely.
15. Case 4: Luc
Recommendations:
Use your data-2000 waiver to offer Luc
treatment of opioid use disorder. Stop
opioids.
a. Offer conversion to buprenorphine
(Suboxone/Subutex) with a planned
6mo taper off. (8mg QD x 2mo,
4mgQD x 2mo, 4mg QOD x 2mo)
b. Offer an addiction counseling
referral.
c. Continue to see frequently for
followups with both urine or saliva
drug screens and frequent checks
of the PDMP to ensure adherence.
Help with Tough Cases
Resources
Alternatives to Benzodiazepines:
http://www.slideshare.net/101N/alternatives-to-benzodiazepines-60701295
Oregon Prescription Drug Monitoring Signup:
http://www.orpdmp.com/health-care-provider/
Opioid Withdrawal Attenuation Cocktail:
http://www.slideshare.net/101N/opioid-withdrawal-attenuation-coctail
Nasal Naloxone:
http://www.amphastar.com/assets/naloxone.pdf
http://www.narcannasalspray.com/nns-4-mg-dose/how-to-use-nns/
Oregon Drug & Alcohol Services by County:
https://www.oregon.gov/oha/amh/publications/provider-directory.pdf