Tetrahydrocannabinol - friend or foe? - Debate.

Tetrahydrocannabinol (THC) is a psychoactive cannabinoid that has been used to treat various conditions. However, due to various adverse effects, its widespread promotion and use has been controversial. It is this aspect (encouraged by various state legislatures) that forms the basis for an edited debate between an Integrative Family Medicine physician and a Medical Toxicologist.

The financial impact of the medical toxicology specialty code on a private practice.

We describe the financial impact following the implementation of this unique specialty taxonomy code after October 1, 2017 on an established private medical toxicology practice. Clinical financial data over a 1-year period (October 2016 through September 2017) prior to medical toxicology specialty CMS code implementation was compared to financial data (October 2017 through September, 2018) following implementation. The encounters were billed by current procedural terminology (CPT) codes through the same biller during these time periods.

Metal-on-Metal Hip Joint Prostheses: a Retrospective Case Series Investigating the Association of Systemic Toxicity with Serum Cobalt and Chromium Concentrations.

Introduction: There have been concerns about prosthesis failure and the potential for systemic toxicity due to release of cobalt and chromium from metal-on-metal hip joint prostheses (MoM-HP). There is conflicting evidence on whether there is a correlation between higher cobalt and chromium concentrations and systemic toxicity.

Methods: We undertook a retrospective review of consecutive patients with MoM-HP referred for outpatient review in toxicology clinics in London, UK, and in the USA recorded in the Toxicology Investigators Consortium (ToxIC) Registry from June 2011 to June 2015.

Adherence to Hydroxychloroquine Dosing Guidelines by Rheumatologists: An Electronic Medical Record-Based Study in an Integrated Health Care System.

Purpose: To study the adherence of rheumatologists to the hydroxychloroquine (HCQ) dosing guidelines established by the American Academy of Ophthalmology in 2011 and 2016.

Design: Retrospective review of electronic medical records (EMRs) in an integrated health care system.

Participants: All rheumatology patients started on HCQ who were seen by a NorthShore ophthalmologist between the years 2009 and 2016.

Pearls for Working with People Who Have Personality Disorder Diagnoses.

Personality disorders are a group of diagnostic categories applicable when people show personality traits that are so extreme they cause clear difficulties in their lives and relationships. More widespread agreement is found on sorting by three broad categories (odd/eccentric, dramatic/emotional/erratic, and anxious/fearful) than by more specific subtypes. Primary care physicians need to recognize when extreme personality traits are causing difficulties in their relationships with patients and to have a way to approach these difficulties when they arise.

Comparison of warfarin time in the therapeutic range at a pharmacist-run anticoagulation clinic and the RE-LY trial.

Purpose: An audit was conducted to determine if the benefits of dabigatran treatment, as demonstrated in the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial, are applicable to patients with nonvalvular atrial fibrillation managed by a pharmacist-run anticoagulation clinic (PAC).

Methods: The records of warfarin-treated patients managed by a PAC program over a three-year period were screened to identify patients with diagnosed nonvalvular atrial fibrillation and a goal International Normalized Ratio (INR) of 2-3; the case selection criteria were similar to those used in the RE-LY trial. Abstracted data included dates and results of INR monitoring and information needed to calculate CHADS2 (Congestive Heart Failure, Hypertension, Age, Diabetes, and Stroke [doubled]) scores.

Balancing the risk of complications in foot and ankle surgical patients taking antithrombotic medication.

Unlabelled: This review intends to provide guidance regarding perioperative management of anticoagulation and antiplatelet drug therapy as they relate to foot and ankle surgery. Venous and arterial thromboembolism are conditions in which the blood clots inappropriately, causing considerable morbidity and mortality. With an increase in awareness of thromboembolic risk factors and expansion of therapeutic options, more patients are routinely taking antithrombotic medication.

Glasgow coma scale: how to improve and enhance documentation.

The Glasgow Coma Scale (GCS) is an international tool used to measure the level of consciousness for traumatically injured patients. One Level I and 3 Level II Trauma Centers in our Health Care System perceived a deficiency in the documentation of the GCS. An audit was performed and insufficient documentation was confirmed.

Cholinergic symptoms with low serum cholinesterase from therapeutic cholinesterase inhibitor toxicity.

Although cholinesterase inhibitors have been frequently used in the treatment of Alzheimer disease, its effects on serum cholinesterase concentrations have been rarely described. We described significant depression of serum cholinesterase levels due to cholinesterase inhibitor toxicity from redundant use of donepezil and rivastigmine in a 78-year-old man. Recovery of serum cholinesterase level was noted upon drug discontinuation and cholinergic symptom resolution.

Current state of knowledge on oral anticoagulant reversal using procoagulant factors.

Objective: To discuss current trends and challenges in the use of procoagulants for treating bleeding caused by use of oral anticoagulants.

Data Sources: Literature searches of PubMed (MEDLINE), Google, and Medscape were conducted in February 2013. There were no date limitations.

Outpatient toxicology clinic experience of patients with hip implants.

Context: With regard to biological effects, the increasing number of early failure of metal-on-metal (MoM) hip arthroplasties and possible parenteral exposure to orthopedic metal alloys have caused concern for patients and providers alike.

Objective: We sought to characterize our outpatient clinical experience of patients with MoM and other forms of hip implants and associated serum/blood chromium and cobalt levels, with a focus on possible systemic sequelae.

Methods: This was an observational and retrospective chart review of consecutive patients presenting to two outpatient medical toxicology clinics from January 1, 2010-June 1, 2012 with history of hip implants.

Use of clonidine in the prevention and management of neonatal abstinence syndrome.

Introduction: Neonatal abstinence syndrome (NAS) is a complicated medical condition with treatment regimens that traditionally have included methadone and other opioids, barbiturates, and benzodiazepines. We describe a case series in which clonidine was used for the prevention and management of patients with NAS.

Patients And Methods: Medical records of infants treated with clonidine for NAS from January 2003 to March 2006 were reviewed for gestational age, birth weight, NAS score, dose of clonidine, duration of treatment, and additional medications required.

Status epilepticus due to tiagabine ingestion.

Tiagabine, in excess dosing scenarios, has been rarely documented to cause status epilepticus. We describe such a case that was not responsive to benzodiazepines, but only to propofol infusion.

Dapsone-induced methemoglobinemia: case report and literature review.

Dapsone is a potent cause for introgenic methemoglobinemia that is frequently unrecognized. We describe such a case with successful antidotal therapy.

Compliance with antithrombotic guidelines.

Venous thromboembolism (VTE) remains a significant threat to public health despite the availability of effective and safe prophylactic measures and treatments. Guidelines based on randomized clinical trials are available to improve the management of thromboembolic disease. However, gaps exist between recommendations and clinical practice, and many patients are unnecessarily exposed to the risk of a deep vein thrombosis or potentially fatal pulmonary embolism.

Reimbursement profile of a private toxicology practice.

This article presents two years of billing and collection data for a bedside toxicology consultation service. The collections rate was 34% or dollars 26.19 per hour of consultative time.

N-acetylcysteine use in ischemic hepatitis.

We describe a case of antidepressant-induced ischemic hepatitis that responded to intravenous administration of N-acetylcysteine. Cytoprotection in the setting of ischemic hepatitis may be a therapeutic effect of N-acetylcysteine.