Understanding Clinician Knowledge, Attitudes, and Practices Relating to Nonpharmaceutical Fentanyl and Harm Reduction.

Background: Nonpharmaceutical fentanyl (NPF) is driving the national epidemic of opioid overdose deaths. Clinicians can play a role in fostering awareness of this growing risk and delivering interventions to reduce mortality. However, there is limited research assessing clinician knowledge, attitudes, and practices relating to NPF and harm reduction strategies.

Primary Care Continuity, Frequency, and Regularity Associated With Medicare Savings.

Importance: Reducing Medicare expenditures is a key objective of Medicare's transition to value-based reimbursement models. Improving access to primary care is an important way to reduce expenditures, yet less is known about how visits should be organized to maximize savings.

Objective: To examine the association between Medicare savings and primary care visit patterns.

Low dose IV buprenorphine inductions for patients with opioid use disorder and concurrent pain: a retrospective case series.

Background: Hospitalizations are a vital opportunity for the initiation of life-saving opioid agonist therapy (OAT) for patients with opioid use disorder. A novel approach to OAT initiation is the use of IV buprenorphine for low dose induction, which allows patients to immediately start buprenorphine at any point in a hospitalization without stopping full agonist opioids or experiencing significant withdrawal.

Methods: This is a retrospective case series of 33 patients with opioid use disorder concurrently treated with full agonist opioids for pain who voluntarily underwent low dose induction at a tertiary academic medical center.

Impact of an opioid use disorder consult service on hospitalized trauma patients with opioid use disorder.

Background: Opioid use disorder (OUD) is common in the hospitalized trauma population, being a comorbid diagnosis in approximately 1% of operative trauma cases. The impact of an addiction consult service in this population has been less well studied but may lead to increased provision of evidence-based OUD treatment and improved postdischarge outcomes.

Methods: One hundred thirteen patients with an International Classification of Diseases diagnosis of OUD who were admitted to the trauma service at a single academic hospital between January 2020 to December 2021 were included in a retrospective chart review.

A Model to Improve Care and Enhance the Physician-Patient Relationship for Hospitalized Patients With Opioid Use Disorder.

Problem: Opioid-related morbidity and mortality continues to accelerate, with increasing acute care events for opioid-related causes. Most patients do not receive evidence-based treatment for opioid use disorder (OUD) during acute hospitalizations despite this being an invaluable moment to initiate substance use treatment. Inpatient addiction consult services can bridge this gap and improve patient engagement and outcomes, but varying models and approaches are needed to match institutional resources.

Overcoming challenges in acute care hospitalizations for patients with opioid use disorder.

Background: Hospitalized patients with opioid use disorder (OUD) present unique challenges and opportunities for inpatient medical teams. Having the ability to initiate medications for opioid use disorder (MOUD) and linkage to outpatient treatment are key to improve inpatient care of patients with OUD.

Objective: This study aimed to describe the process taken by a multidisciplinary work group to improve the acute care management of patients with OUD.

Association of Time-Based Billing With Evaluation and Management Revenue for Outpatient Visits.

Importance: Time-based billing options for physicians have expanded, enabling many physicians to bill according to time spent instead of medical decision-making (MDM) level for fee-for-service outpatient visits. However, no study to date has estimated the revenue changes associated with time-based billing.

Objective: To compare evaluation and management (E/M) reimbursement for physicians using time-based billing vs MDM-based billing for outpatient visits of varying lengths.

Can Alternative Payment Models And Value-Based Insurance Design Alter The Course Of Diabetes In The United States?

Diabetes process and outcome measures are common quality measures in payment reform models, including Alternative Payment Models (APMs) and value-based insurance design (VBID). In this commentary we review evidence from selected research to examine whether these payment models can improve the value of diabetes care. We found that higher-risk APMs yielded greater improvements in diabetes process measures than lower-risk APMs, and that VBID models appeared to improve medication adherence but not other quality measures.

Clinician Perspectives on Telemedicine: Observational Cross-sectional Study.

Background: Since the COVID-19 pandemic onset, telemedicine has increased exponentially across numerous outpatient departments and specialties. Qualitative studies examining clinician telemedicine perspectives during the pandemic identified challenges with physical examination, workflow concerns, burnout, and reduced personal connection with patients. However, these studies only included a relatively small number of physicians or were limited to a single specialty, and few assessed perspectives on integrating trainees into workflows, an important area to address to support the clinical learning environment.

Teaching Telemedicine: The Next Frontier for Medical Educators.

The COVID-19 pandemic has pushed telemedicine to the forefront of health care delivery, and for many clinicians, virtual visits are the new normal. Although telemedicine has allowed clinicians to safely care for patients from a distance during the current pandemic, its rapid adoption has outpaced clinician training and development of best practices. Additionally, telemedicine has pulled trainees into a new virtual education environment that finds them oftentimes physically separated from their preceptors.

Atomic-scale study of the amorphous-to-crystalline phase transition mechanism in GeTe thin films.

The underlying mechanism driving the structural amorphous-to-crystalline transition in Group VI chalcogenides is still a matter of debate even in the simplest GeTe system. We exploit the extreme sensitivity of Fe emission Mössbauer spectroscopy, following dilute implantation of Mn (T½ = 1.5 min) at ISOLDE/CERN, to study the electronic charge distribution in the immediate vicinity of the Fe probe substituting Ge (Fe), and to interrogate the local environment of Fe over the amorphous-crystalline phase transition in GeTe thin films.

Hypertension Control in the University of Chicago Primary Care Group.

"Quality Improvement Success Stories" are published by the American Diabetes Association in collaboration with the American College of Physicians, Inc., and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions.

Pulmonary Hypertension: Diagnosis and Treatment.

Pulmonary hypertension is a common, complex group of disorders that result from different pathophysiologic mechanisms but are all defined by a mean pulmonary arterial pressure of 25 mm Hg or greater. Patients often initially present to family physicians; however, because the symptoms are typically nonspecific or easily attributable to comorbid conditions, diagnosis can be challenging and requires a stepwise evaluation. There is limited evidence to support screening of asymptomatic individuals.

BAIT DEVELOPMENT FOR ORAL DELIVERY OF PHARMACEUTICALS TO RACCOONS (PROCYON LOTOR) AND STRIPED SKUNKS (MEPHITIS MEPHITIS).

Oral vaccination is one tool used to control wildlife diseases. A challenge to oral vaccination is identifying baits specific to target species. The US has been conducting oral vaccination against rabies since the 1990s.

Hypertension in Women: Evaluation and Management.

Hypertension is the most commonly encountered chronic medical condition in primary care and one of the most significant modifiable cardiovascular risk factors for women and men. Timely diagnosis and evidence-based management offer an important opportunity to reduce the risk of hypertension-related morbidity and mortality, including cardiovascular events, end-stage renal disease, and heart failure. Clinical trials have shown significant improvements in patient-oriented outcomes when hypertension is well-controlled, yet many hypertensive patients remain undiagnosed, uncontrolled, or managed with inappropriate pharmacotherapy.

Fauna europaea: Diptera - brachycera.

Fauna Europaea provides a public web-service with an index of scientific names (including important synonyms) of all extant multicellular European terrestrial and freshwater animals and their geographical distribution at the level of countries and major islands (east of the Urals and excluding the Caucasus region). The Fauna Europaea project comprises about 230,000 taxonomic names, including 130,000 accepted species and 14,000 accepted subspecies, which is much more than the originally projected number of 100,000 species. Fauna Europaea represents a huge effort by more than 400 contributing taxonomic specialists throughout Europe and is a unique (standard) reference suitable for many user communities in science, government, industry, nature conservation and education.

Fe charge state adjustment in ZnO upon ion implantation.

The influence of the ion implantation process on the charge state of dilute (57)Fe impurities implanted as radioactive (57)Mn in ZnO is investigated by (57)Fe emission Mössbauer spectroscopy. One sample is additionally implanted with stable (23)Na impurities. Both Fe(2+) and Fe(3+) charge states are observed, and the Fe(3+)/Fe(2+) ratio is found to increase with the fluence of both (57)Mn/(57)Fe and (23)Na ions, demonstrating that the build-up of Fe(3+) is not related to the chemical nature of the implanted ions.

An fMRI study on the acute effects of exercise on pain processing in trained athletes.

Endurance exercise is known to promote sustained antinociceptive effects, and there is evidence that the reduction of pain perception mediated by exercise is driven by central opioidergic neurotransmission. To directly investigate the involved brain areas and the underlying neural mechanisms in humans, thermal heat-pain challenges were applied to 20 athletes during 4 separate functional magnetic resonance imaging (fMRI) scans, i.e.

Endovascular management of complex renal artery aneurysms using the multilayer stent.

Since its approval as an innovative stent system for peripheral aneurysm management in May 2009, the Cardiatis Multilayer Stent (Cardiatis, Isnes, Belgium) has been applied in several clinical cases. The unique design of this multilayer stent decreases mean velocity and vorticity within the aneurysm sac immediate and causes thrombus to form, resulting in physiological exclusion of the aneurysm from the circulation, whereas branches and collaterals sprouting from the aneurysm remain patent. Here we present a case of a complex renal artery aneurysm successfully treated with a 6×30-mm Cardiatis Multilayer Stent.

Endometrial effects of exemestane compared to tamoxifen within the Tamoxifen Exemestane Adjuvant Multicenter (TEAM) trial: results of a prospective gynecological ultrasound substudy.

Objectives: This study prospectively assessed the effects of exemestane and tamoxifen on the endometrium in patients receiving adjuvant treatment for postmenopausal hormone receptor-positive breast cancer within the Tamoxifen Exemestane Adjuvant Multicenter (TEAM) trial.

Methods: Patients were randomized to receive tamoxifen or exemestane. In a prespecified trial subprotocol, patients underwent transvaginal ultrasound to assess endometrial thickness at baseline and during a 1- to 3-year treatment period.

Magnetism at single isolated iron atoms implanted in graphite.

Mössbauer spectra obtained after implantation of 57Fe into highly oriented pyrolytic graphite (HOPG) show a combined magnetic and quadrupole interaction with a magnetic hyperfine field Bhf = 32.6 T at 14 K. Though magnetic effects in nominally diamagnetic HOPG have been reported recently, no experiment has previously shown the existence of magnetism at the atomic scale.

Temporal profile of potassium channel dysfunction in cerebrovascular smooth muscle after experimental subarachnoid haemorrhage.

The pathogenesis of cerebral vasospasm after subarachnoid haemorrhage (SAH) involves sustained contraction of arterial smooth muscle cells that is maximal 6-8 days after SAH. We reported that function of voltage-gated K+ (KV) channels was significantly decreased during vasospasm 7 days after SAH in dogs. Since arterial constriction is regulated by membrane potential that in turn is determined predominately by K+ conductance, the compromised K+ channel dysfunction may cause vasospasm.