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News Article | May 2, 2017
Site: hosted2.ap.org

Overcoming Opioids: When pills are a hospital's last resort (AP) — A car crash shattered Stuart Anders' thigh, leaving pieces of bone sticking through his skin. Yet Anders begged emergency room doctors not to give him powerful opioid painkillers — he'd been addicted once before and panicked at the thought of relapsing. "I can't lose what I worked for," he said. The nation's opioid crisis is forcing hospitals to begin rolling out non-addictive alternatives to treatments that have long been the mainstay for the severe pain of trauma and surgery, so they don't save patients' lives or limbs only to have them fall under the grip of addiction. Anders, 53, from Essex, Maryland, was lucky to land in a Baltimore emergency room offering an option that dramatically cut his need for opioids: An ultrasound-guided nerve block bathed a key nerve in local anesthetic, keeping his upper leg numb for several days. "It has really changed the dynamics of how we care for these patients," said trauma anesthesiologist Dr. Ron Samet, who treated Anders. An estimated 2 million people in the U.S. are addicted to prescription opioids, and an average of 91 Americans die every day from an overdose of those painkillers or their illicit cousin, heroin. This grim spiral often starts in the hospital. A Harvard study published in the New England Journal of Medicine in February raised the troubling prospect that for every 48 patients newly prescribed an opioid in the emergency room, one will use the pills for at least six months over the next year. And the longer they're used, the higher the risk for becoming dependent. Doctors and hospitals around the country are searching for ways to relieve extreme pain while at the same time sharply limiting what was long considered their most effective tool. It's a critical part of the effort to overcome the worst addiction crisis in U.S. history but, as Anders' experience shows, their options are neither simple nor perfect. Anders' excruciating injury eventually did require a low opioid dose when the nerve block wore off but, Samet said, far less than normal. "Provide them with good pain relief initially, for the first 24 to 48 hours after surgery, the pain that comes back after that isn't necessarily as hard and as strong," said Samet, an assistant anesthesiology professor at the University of Maryland School of Medicine. And some doctors are discovering an added benefit of cutting back or even eliminating opioids. At the University of Pittsburgh Medical Center, a program called "enhanced recovery after surgery" is getting some patients home two to four days faster following major abdominal operations, using non-opioid painkillers that are gentler on the digestive tract. "Our patients are very afraid of pain, especially the patients with a history of opioid addiction," said Dr. Jennifer Holder-Murray, a UPMC colorectal surgeon who helped start the program. "When they come back to me and tell me they didn't even fill their opioid prescription, that's a remarkable experience." In trauma centers and surgery suites, there are no one-size-fits-all replacements for prescription opioids — narcotic painkillers that range from intravenous morphine and Dilaudid to pills including Percocet, Vicodin and OxyContin. They so rapidly dull severe pain that they've become a default in hospital care, to the point where it's not uncommon for patients to have an opioid dripping through an IV before they wake from surgery, whether they'll really need it or not. Now, amid surging deaths from drug overdoses, some hospitals and emergency rooms are rethinking their own dependence on the painkillers, taking steps to make them a last resort rather than a starting reflex. The new approach: Mixing a variety of different medications, along with techniques like nerve blocks, spinal anesthesia and numbing lidocaine, to attack pain from multiple directions, rather than depending solely on opioids to dampen brain signals that scream "ouch." It's known by the wonky name "multimodal analgesia." Consider colorectal surgery, so painful that standard practice is to administer IV opioids in the operating room and switch to a patient-activated morphine pump right afterward. The University of Pittsburgh program ended that opioid-first mentality. Instead, doctors choose from a wide mix of options including IV acetaminophen and prescription-strength anti-inflammatory painkillers known as NSAIDs, anti-seizure medications such as gabapentin that calm nerve pain, muscle-relaxing drugs, and others. Without the opioid side effects of nausea, vomiting and constipation, patients may find it easier to start eating solid food and walking around hours after surgery. Some do still need a low opioid dose, Holder-Murray cautioned, but few require a morphine pump. And for those who go home earlier, the approach can save hundreds, even thousands, of dollars. "It's not just changing a medication or two. It's a whole culture change," she said. At MedStar Georgetown University Hospital, anesthesiologist Dr. Joseph Myers is adding to his non-opioid cocktail a long-acting version of the numbing agent bupivacaine that's squirted into wounds before they're stitched closed. Called Exparel, it's controversial because it costs more than standard painkillers. But Myers said it lasts so many hours longer that he recently used it for a cancer patient who had both breasts removed, without resorting to opioids. Hours after surgery, she was "eating crackers and drinking ginger ale and she says she's fine," he recalled. At Stanford University, pain psychologist Beth Darnall says it's not just about using different medications. Patients who are overly anxious about surgical pain wind up feeling worse, so doctors also need to address psychological factors if they're to succeed in cutting the opioids. In Baltimore, Anders remembers waking up in the University of Maryland's Shock Trauma Center and telling doctors and nurses, "I am a recovering addict." Years earlier, another car crash had led him to a pain clinic that prescribed Percocet "just like candy," Anders said. Before getting addiction treatment, he said, "I came close to losing my job, losing my wife." Samet, the anesthesiologist, estimates that Anders' nerve block cut by tenfold the amount of opioids he'd otherwise have received for his latest injury. Samet wheeled over a portable ultrasound machine, placed a probe over Anders' pelvis and searched the black-and-white screen for the dots that mark key nerves. He threaded a tiny tube directly to Anders' femoral nerve, allowing for repeated infusions of a non-addictive numbing medication for three days. "It's like a Godsend. If you can have something like this, why would you want to take anything else?," Anders said a day after surgeons implanted a rod in his femur to fix the break. "I can wiggle my toes, I can move my foot, there's feeling right above the ankle," but in that damaged thigh, "I can't feel anything." Patients need to ask about these kinds of alternatives, Samet said, but they're not available at all hospitals. Nerve blocks are becoming more common for elective bone surgery than in fast-paced trauma care, for example. What Samet calls a lingering weak link: Even if patients go home with only a small supply of an opioid for lingering post-surgical pain, too often they get a refill from another doctor who assumes that prescription must be OK if a hospital chose it. Not Anders. Sent home with some low-dose oxycodone, he discarded the last 20 pills. "I didn't want them," he said, "and I didn't want nobody else getting their hands on them."


News Article | April 10, 2017
Site: www.techtimes.com

No amount of makeup can compete with the confidence a healthy and naturally glowing skin can bring. While there are treatments and procedures one can undergo to achieve a radiant complexion, nothing beats going au naturel. Check out these practical skincare tips, which are all backed by science and experts swear by, on how to get that glowing skin naturally. A lot of people underestimate the power of sleep on health, particularly on skin health. As part of its rest and rejuvenation process, sleep replenishes the body with collagen and elastin, the skin's connective tissue responsible for firmness, tone, and elasticity, Dr. Ava Shamban, dermatologist and founder of Ava MD Skincare, explains. Insufficient sleep triggers a surge in inflammatory cells in the body, leading to breakdown of collagen and hyaluronic acid, which give the skin a natural glow and clarity. Other than the sweet rosy color it gives the cheeks with every sip, research reveals other skin benefits one can get from red wine. A 2015 study published in the journal Dermatology and Therapy have made the amazing discovery that the resveratrol found in red wine (in combination with benzoyl peroxide, a topical acne medication) amazingly gets rid of Propionibacterium acnes (P. acnes), which is a type of pesky pimple-causing bacteria. Resveratrol, a potent antioxidant and polyphenol, has long been lauded for its boons on heart health. But recently, more experts are recognizing its positive effects on skincare too, including preventing wrinkles, fine lines, and sagging of the skin. There's no arguing that a hot, steamy shower or a soak in the tub can be super soothing, especially after a long day at work. While it's the best stress-buster and nasal relief one can get for free, experts say it can actually be bad for the skin. According to the University of Pittsburgh Medical Center (UPMC), frequent exposure to hot water can inflame the skin and cause redness, itching, and peeling as if it's sunburnt. It can also strip the skin of its innate moisture balance, which is key to a naturally glowing skin. A research published in the Journal of Applied Microbiology discovered that smartphones carry higher levels of disgusting germs and bacteria than a public toilet. Yes, we're talking about the same smartphones, whether Android or iPhone, that people can't let go of and put near their faces when answering a call. Because it's impossible to scrub smartphones clean without ruining them, the best thing that one can do is to wipe it down with an antibacterial wipe every now and then during the day to lessen the risks of getting in contact with potential skin-irritating contaminants. © 2017 Tech Times, All rights reserved. Do not reproduce without permission.


PITTSBURGH, May 3, 2017 - Researchers hoping for a single product that women could use to protect against both HIV and unintended pregnancy took an important step toward realizing their goal with the start of the first trial of a vaginal ring containing the antiretroviral (ARV) drug dapivirine and a hormonal contraceptive. A vaginal ring containing dapivirine alone that women use for a month at a time has already been found to be safe and to help prevent HIV in two large trials called ASPIRE and The Ring Study. The dual-purpose ring now being tested in a Phase I trial by the National Institutes of Health-funded Microbicide Trials Network (MTN) contains levonorgestrel, a synthetic progestin used in many contraceptives, along with dapivirine, in quantities large enough to feasibly provide protection from HIV and unintended pregnancy for up to three months. "Many of the women who have participated in our studies have told us that they want a single product that can provide both contraception and HIV prevention," said MTN Principal Investigator Sharon Hillier, Ph.D. "We are excited about the next-generation microbicide products that we hope will address that unmet need." Dr. Hillier is professor and vice chair, and director of reproductive infectious disease research, department of obstetrics, gynecology and reproductive sciences, at the University of Pittsburgh School of Medicine. The study, called MTN-030/IPM 041, is being conducted at Magee-Womens Hospital of UPMC in Pittsburgh and the University of Alabama at Birmingham (UAB), in close collaboration with the nonprofit International Partnership for Microbicides (IPM). IPM developed the monthly dapivirine ring and the three-month dual-purpose ring, as well as the three-month dapivirine-only ring that the MTN will be evaluating in a separate trial later this year. First developed for contraceptive use, vaginal rings are flexible products that are worn inside the vagina, where they release medication slowly over time. Investigators will enroll 24 women in MTN-030/IPM 041. Half will receive a ring containing 200 mg of dapivirine alone, and half will receive the dual-purpose ring containing 200 mg of dapivirine and 320 mg of levonorgestrel. Participants will be asked to wear their assigned ring for 14 days, during which time investigators will closely monitor safety and measure how dapivirine and levonorgestrel are each taken up by the body in the presence of the other. Results are expected by mid-2018. "What we learn from this small but very important study will set the course for the future of the dual-purpose dapivirine vaginal ring," said Sharon L. Achilles, M.D., Ph.D., who is MTN-030/IPM 041 protocol chair and also a lead investigator at the Magee-Womens Hospital clinical research site. "If all goes well, we would then proceed to studies involving more women who would use the ring longer, for up to three months, as it was intended. This study is a critical first step on a pathway that we hope will ultimately enable us to provide women with an easy-to-use product that can provide safe and effective, long-acting protection against both HIV and unintended pregnancy," added Dr. Achilles, who is also an assistant professor of obstetrics, gynecology and reproductive sciences at the University of Pittsburgh School of Medicine and director of the Magee-Womens Research Institute Center for Family Planning Research. Last year, research teams from the MTN and IPM reported results of two Phase III efficacy trials of the monthly 25 mg dapivirine vaginal ring - the first trials showing that a vaginal ring could deliver an ARV to prevent HIV infection. Across both studies, the overall risk of HIV infection was reduced by about 30 percent. Higher levels of protection were seen in women who used the ring most regularly, a later exploratory analysis found. The two trials - ASPIRE, conducted by MTN, and The Ring Study, led by IPM - together involved 4,588 women in four African countries where HIV rates for women continue to be among the highest globally, with heterosexual intercourse being the primary driver of HIV transmission. Based on these results - and those of several smaller supporting studies, including other MTN-led studies--IPM intends to seek licensure of the monthly dapivirine ring. If approved, the monthly dapivirine ring would be the first biomedical HIV prevention product developed specifically for women. Meanwhile, two open-label studies involving former Phase III trial participants - HOPE for former ASPIRE participants, and DREAM for former participants of The Ring Study - are collecting additional safety, adherence and efficacy data on the monthly dapivirine ring that will help inform its implementation, should it receive regulatory approval. MTN will also be conducting the REACH study, or MTN-034/IPM 045, evaluating safety and adherence of the monthly vaginal ring and daily use of Truvada as oral pre-exposure prophylaxis (PrEP) among adolescent girls and young women, and is also planning studies in pregnant and breastfeeding women. Researchers recognize that a ring that only needs to be replaced every three months may be easier for women to use than a monthly ring. And depending on individual and life circumstances, some women may find a product that can also double as their contraceptive method especially appealing. Both types of products could have important public health impact in regions like sub-Saharan Africa, where HIV is not the only risk women face. With little to no access to contraceptive and reproductive health services, women here and elsewhere in the developing world experience high rates of complications during pregnancy and childbirth, often resulting in maternal and newborn death. A second Phase I study, called MTN-036/IPM 047, plans to evaluate the safety of a 100 mg dapivirine ring and a 200 mg ring when used for 90 days compared to monthly use of the 25 mg dapivirine ring. Researchers will also look at levels of drug achieved within the body with each ring dosage. MTN-036/IPM 047, which is expected to start in the coming months, will be conducted at UAB and the Bridge HIV Clinical Research Site at the San Francisco Department of Public Health, where the study's protocol chair, Albert Liu, M.D., M.P.H., is director of clinical research. The Microbicide Trials Network (MTN) is an HIV/AIDS clinical trials network established in 2006 by the National Institute of Allergy and Infectious Diseases with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the U.S. National Institutes of Health. Based at Magee-Womens Research Institute and the University of Pittsburgh, the MTN brings together international investigators and community and industry partners whose work is focused on the rigorous evaluation of promising microbicides - products applied inside the vagina or rectum that are intended to prevent the sexual transmission of HIV - from the earliest phases of clinical study to large-scale trials that support potential licensure of these products for widespread use. More information about the MTN is available at http://www. . Dapivirine, also known as TMC-120, belongs to a class of ARVs called non-nucleoside reverse transcriptase inhibitors that bind to and disable HIV's reverse transcriptase enzyme, a key protein needed for HIV replication. IPM holds an exclusive worldwide license for dapivirine from Janssen Sciences Ireland UC, one of the Janssen Pharmaceutical Companies of Johnson & Johnson (Janssen), which is designed to ensure that women in low-resource settings have affordable access to any dapivirine-based microbicide. For more information about the dapivirine ring, go to http://www. .


News Article | May 1, 2017
Site: www.eurekalert.org

PITTSBURGH, May 1, 2017 - A novel gene therapy using CRISPR genome editing technology effectively targets cancer-causing "fusion genes" and improves survival in mouse models of aggressive liver and prostate cancers, University of Pittsburgh School of Medicine researchers report in a study published online today in Nature Biotechnology. "This is the first time that gene editing has been used to specifically target cancer fusion genes. It is really exciting because it lays the groundwork for what could become a totally new approach to treating cancer," explained lead study author Jian-Hua Luo, M.D., Ph.D., professor of pathology at Pitt's School of Medicine and director of its High Throughput Genome Center. Fusion genes, which often are associated with cancer, form when two previously separate genes become joined together and produce an abnormal protein that can cause or promote cancer. Luo and his team had previously identified a panel of fusion genes responsible for recurrent and aggressive prostate cancer. In a study published earlier this year in the journal Gastroenterology, the team reported that one of these fusion genes, known as MAN2A1-FER, also is found in several other types of cancer, including that of the liver, lungs and ovaries, and is responsible for rapid tumor growth and invasiveness. In the current study, the researchers employed the CRISPR-Cas9 genome editing technology to target unique DNA sequences formed because of the gene fusion. The team used viruses to deliver the gene editing tools that cut out the mutated DNA of the fusion gene and replaced it with a gene that leads to death of the cancer cells. Because the fusion gene is present only in cancer cells, not healthy ones, the gene therapy is highly specific. Such an approach could come with significantly fewer side effects when translated to the clinic, which is a major concern with other cancer treatments such as chemotherapy. To conduct the study, the researchers used mouse models that had received transplants of human prostate and liver cancer cells. Editing the cancer fusion gene resulted in up to 30 percent reduction in tumor size. None of the mice exhibited metastasis and all survived during the eight-week observation period. In contrast, in control mice treated with viruses designed to cut out another fusion gene not present in their tumors, the tumors increased nearly 40-fold in size, metastasis was observed in most animals, and all died before the end of the study. The new findings suggest a completely new way to combat cancer. "Other types of cancer treatments target the foot soldiers of the army. Our approach is to target the command center, so there is no chance for the enemy's soldiers to regroup in the battlefield for a comeback," said Luo. Another advantage over traditional cancer treatment is that the new approach is very adaptive. A common problem that renders standard chemotherapies ineffective is that the cancer cells evolve to generate new mutations. Using genome editing, the new mutations could be targeted to continue fighting the disease, Luo noted. In the future, the researchers plan to test whether this strategy could completely eradicate the disease rather than induce the partial remission observed in the current study. This work was supported by National Institutes of Health grant RO1 CA098249, Department of Defense grant W81XWH-16-1-0364 and a grant from the University of Pittsburgh Cancer Institute. Additional authors include: Zhang-Hui Chen, Ph.D., Yan Yu, M.D., Ph.D., Ze-Hua Zuo, Ph.D., Joel Nelson, M.D., George Michalopoulos, M.D., Ph.D., Satdatshan Monga, M.D., Silvia Liu, B.S., and George Tseng, Sc.D., all of Pitt. About the University of Pittsburgh School of Medicine As one of the nation's leading academic centers for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic science across a broad range of disciplines in a continuous quest to harness the power of new knowledge and improve the human condition. Driven mainly by the School of Medicine and its affiliates, Pitt has ranked among the top 10 recipients of funding from the National Institutes of Health since 1998. In rankings recently released by the National Science Foundation, Pitt ranked fifth among all American universities in total federal science and engineering research and development support. Likewise, the School of Medicine is equally committed to advancing the quality and strength of its medical and graduate education programs, for which it is recognized as an innovative leader, and to training highly skilled, compassionate clinicians and creative scientists well-equipped to engage in world-class research. The School of Medicine is the academic partner of UPMC, which has collaborated with the University to raise the standard of medical excellence in Pittsburgh and to position health care as a driving force behind the region's economy. For more information about the School of Medicine, see http://www. .


News Article | May 2, 2017
Site: hosted2.ap.org

Essential News from The Associated Press Overcoming Opioids: When pills are a hospital's last resort In this Jan. 19, 2017, handout photo from the University of Maryland Shock Trauma Center, nurse Amanda Fritsch checks the catheter delivering a drug that kept Stuart Anders’ injured leg numb for three days. Called a nerve block, the non-addictive numbing treatment substantially cut the amount of opioid painkillers that Anders otherwise would have been prescribed for his shattered femur. (University of Maryland Shock Trauma Center via AP) In this Jan. 19, 2017, handout photo from the University of Maryland Shock Trauma Center, nurse Amanda Fritsch checks the catheter delivering a drug that kept Stuart Anders’ injured leg numb for three days. Called a nerve block, the non-addictive numbing treatment substantially cut the amount of opioid painkillers that Anders otherwise would have been prescribed for his shattered femur. (University of Maryland Shock Trauma Center via AP) In this photo taken Feb. 15, 2017, anesthesiologist Dr. Ron Samet performs an ultrasound-guided nerve block at the University of Maryland Medical Center. Bathing the nerves responsible for certain types of pain in a numbing drug allows many patients to avoid or reduce use of potentially addictive painkillers after surgery, one way hospitals are reducing their own dependence on opioids. (AP Photo/Patrick Semansky) In this photo taken Feb. 15, 2017, anesthesiologist Dr. Ron Samet performs an ultrasound-guided nerve block at the University of Maryland Medical Center, preparing a catheter that will deliver a numbing drug to nerves responsible for a patient’s arm pain. Nerve blocks allow many patients to avoid or reduce use of potentially addictive painkillers after surgery, one way hospitals are reducing their own dependence on opioids. (AP Photo/Patrick Semansky) In this photo taken Feb. 15, 2017, anesthesiologist Dr. Ron Samet is seen at the University of Maryland Medical Center. Bathing the nerves responsible for certain types of pain in a numbing drug allows many patients to avoid or reduce use of potentially addictive painkillers after surgery, one way hospitals are reducing their own dependence on opioids.(AP Photo/Patrick Semansky) In this photo taken Feb. 15, 2017, anesthesiologist Dr. Ron Samet examines an ultrasound image while performing a nerve block at the University of Maryland Medical Center. Bathing specific nerves in a numbing drug allows many patients to avoid or reduce use of potentially addictive painkillers after surgery, one way hospitals are reducing their own dependence on opioids. (AP Photo/Patrick Semansky) BALTIMORE (AP) — A car crash shattered Stuart Anders' thigh, leaving pieces of bone sticking through his skin. Yet Anders begged emergency room doctors not to give him powerful opioid painkillers — he'd been addicted once before and panicked at the thought of relapsing. "I can't lose what I worked for," he said. The nation's opioid crisis is forcing hospitals to begin rolling out non-addictive alternatives to treatments that have long been the mainstay for the severe pain of trauma and surgery, so they don't save patients' lives or limbs only to have them fall under the grip of addiction. Anders, 53, from Essex, Maryland, was lucky to land in a Baltimore emergency room offering an option that dramatically cut his need for opioids: An ultrasound-guided nerve block bathed a key nerve in local anesthetic, keeping his upper leg numb for several days. "It has really changed the dynamics of how we care for these patients," said trauma anesthesiologist Dr. Ron Samet, who treated Anders. An estimated 2 million people in the U.S. are addicted to prescription opioids, and an average of 91 Americans die every day from an overdose of those painkillers or their illicit cousin, heroin. This grim spiral often starts in the hospital. A Harvard study published in the New England Journal of Medicine in February raised the troubling prospect that for every 48 patients newly prescribed an opioid in the emergency room, one will use the pills for at least six months over the next year. And the longer they're used, the higher the risk for becoming dependent. Doctors and hospitals around the country are searching for ways to relieve extreme pain while at the same time sharply limiting what was long considered their most effective tool. It's a critical part of the effort to overcome the worst addiction crisis in U.S. history but, as Anders' experience shows, their options are neither simple nor perfect. Anders' excruciating injury eventually did require a low opioid dose when the nerve block wore off but, Samet said, far less than normal. "Provide them with good pain relief initially, for the first 24 to 48 hours after surgery, the pain that comes back after that isn't necessarily as hard and as strong," said Samet, an assistant anesthesiology professor at the University of Maryland School of Medicine. And some doctors are discovering an added benefit of cutting back or even eliminating opioids. At the University of Pittsburgh Medical Center, a program called "enhanced recovery after surgery" is getting some patients home two to four days faster following major abdominal operations, using non-opioid painkillers that are gentler on the digestive tract. "Our patients are very afraid of pain, especially the patients with a history of opioid addiction," said Dr. Jennifer Holder-Murray, a UPMC colorectal surgeon who helped start the program. "When they come back to me and tell me they didn't even fill their opioid prescription, that's a remarkable experience." In trauma centers and surgery suites, there are no one-size-fits-all replacements for prescription opioids — narcotic painkillers that range from intravenous morphine and Dilaudid to pills including Percocet, Vicodin and OxyContin. They so rapidly dull severe pain that they've become a default in hospital care, to the point where it's not uncommon for patients to have an opioid dripping through an IV before they wake from surgery, whether they'll really need it or not. Now, amid surging deaths from drug overdoses, some hospitals and emergency rooms are rethinking their own dependence on the painkillers, taking steps to make them a last resort rather than a starting reflex. The new approach: Mixing a variety of different medications, along with techniques like nerve blocks, spinal anesthesia and numbing lidocaine, to attack pain from multiple directions, rather than depending solely on opioids to dampen brain signals that scream "ouch." It's known by the wonky name "multimodal analgesia." Consider colorectal surgery, so painful that standard practice is to administer IV opioids in the operating room and switch to a patient-activated morphine pump right afterward. The University of Pittsburgh program ended that opioid-first mentality. Instead, doctors choose from a wide mix of options including IV acetaminophen and prescription-strength anti-inflammatory painkillers known as NSAIDs, anti-seizure medications such as gabapentin that calm nerve pain, muscle-relaxing drugs, and others. Without the opioid side effects of nausea, vomiting and constipation, patients may find it easier to start eating solid food and walking around hours after surgery. Some do still need a low opioid dose, Holder-Murray cautioned, but few require a morphine pump. And for those who go home earlier, the approach can save hundreds, even thousands, of dollars. "It's not just changing a medication or two. It's a whole culture change," she said. At MedStar Georgetown University Hospital, anesthesiologist Dr. Joseph Myers is adding to his non-opioid cocktail a long-acting version of the numbing agent bupivacaine that's squirted into wounds before they're stitched closed. Called Exparel, it's controversial because it costs more than standard painkillers. But Myers said it lasts so many hours longer that he recently used it for a cancer patient who had both breasts removed, without resorting to opioids. Hours after surgery, she was "eating crackers and drinking ginger ale and she says she's fine," he recalled. At Stanford University, pain psychologist Beth Darnall says it's not just about using different medications. Patients who are overly anxious about surgical pain wind up feeling worse, so doctors also need to address psychological factors if they're to succeed in cutting the opioids. In Baltimore, Anders remembers waking up in the University of Maryland's Shock Trauma Center and telling doctors and nurses, "I am a recovering addict." Years earlier, another car crash had led him to a pain clinic that prescribed Percocet "just like candy," Anders said. Before getting addiction treatment, he said, "I came close to losing my job, losing my wife." Samet, the anesthesiologist, estimates that Anders' nerve block cut by tenfold the amount of opioids he'd otherwise have received for his latest injury. Samet wheeled over a portable ultrasound machine, placed a probe over Anders' pelvis and searched the black-and-white screen for the dots that mark key nerves. He threaded a tiny tube directly to Anders' femoral nerve, allowing for repeated infusions of a non-addictive numbing medication for three days. "It's like a godsend. If you can have something like this, why would you want to take anything else?," Anders said a day after surgeons implanted a rod in his femur to fix the break. "I can wiggle my toes, I can move my foot, there's feeling right above the ankle," but in that damaged thigh, "I can't feel anything." Patients need to ask about these kinds of alternatives, Samet said, but they're not available at all hospitals. Nerve blocks are becoming more common for elective bone surgery than in fast-paced trauma care, for example. What Samet calls a lingering weak link: Even if patients go home with only a small supply of an opioid for lingering post-surgical pain, too often they get a refill from another doctor who assumes that prescription must be OK if a hospital chose it. Not Anders. Sent home with some low-dose oxycodone, he discarded the last 20 pills. "I didn't want them," he said, "and I didn't want nobody else getting their hands on them." Copyright 2017 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.


An apparatus includes a container and a content identification device providing an audible identification of the contents of the container. The container can be included in an automatic dispensing system. A method is also provided. The method includes providing a container, and producing an audible identification of contents of the container in response to one of: opening the container, a request to access the contents of the container, or actual access of the contents of the container by a user.


A system and method for improved viewing and navigation of large digital images, such as whole slide images used in microscopy. The system and method displays the digital image along with movable navigation and field of view boxes that enable a viewer to pan the digital image in an accurate manner, and also performs automatic absolute reorientation of the digital image and automatic relative reorientation of subsequent digital images in relation to the first digital image.


A system for processing healthcare information includes: a patient clinical context module including a patient-user relationship model, a medical knowledge database, and an applied workflow execution model; the patient clinical context module being configured to retrieve information from a plurality of data sources and to use the patient-user relationship model, the medical knowledge database, and the applied workflow execution model to produce output information relevant to a patient; and a user display configured to display the output information in a longitudinal view of health data for the patient aggregated from the plurality of data sources. A method for processing healthcare information that can be implemented by the system is also disclosed.


An apparatus includes a computer system programmed to retrieve information from a plurality of data sources; the computer system including a plurality of vault query services; an adapter for each of the data sources, each adapter translating an interface for one of the data sources to a vault query service interface; and a cross-vault query service providing an interface for data communication between an application program and the plurality of vault query services; and a user display for displaying the information retrieved from the data sources in response to a query from the application program.


A method for processing healthcare information includes: receiving information related to a patient and a plurality of providers involved with caring for the patient; using the information to generate patient centered provider graphs that describe relationships among the patient and the plurality of providers and include an indication of provider availability within a clinical situation; and presenting the graphs to a plurality of uses. An apparatus that is used to practice the method is also provided.

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