Implementing Evidence-based Opioid Prescription Practices In a Primary Care Setting

The use and misuse of opioid pain medication has reached epidemic proportions in the United States. More than 16,000 people die each year due to the misuse or abuse of prescription opioid medications, which is more than from heroin, cocaine, and benzodiazepines combined. The purpose of this evidence-based practice project is to establish processes enabling a primary care clinic to implement and adhere to the 2016 Centers for Disease Control’s guidelines for opioid prescription practices in the primary care setting. A retrospective chart review conducted prior to implementation of the guidelines demonstrated that four of six of the CDC’s recommendations were in place. Following the Centers for Disease Control guidelines, a process was implemented to track evidence-based interventions including screening for potential abuse, urine drug screening, patient education, provider assessment of need, accessing the prescription drug monitoring program database, and the completion of a treatment agreement. Prior to implementation, a retrospective chart study revealed that none of the patients were screened for potential abuse, 80% had completed a treatment agreement, 90% had received education on opioid medication and potential abuse, 75% had undergone urine drug screening, 5% had the prescription drug monitoring program database accessed, and 95% had a documented provider assessment of need for treatment. At the completion of the project, 82% of patients were screened for potential abuse, 100% had completed a treatment agreement, 93% received education on opioid abuse, 93% underwent urine drug screening, 68% had the prescription drug monitoring program database accessed, and 96% had a documented provider assessment of need. The implementation of these guidelines has led to 11 (7%) patients being referred to a pain management specialist and a 10% reduction in the number of prescriptions written for opioid pain medications for patients seeking treatment for chronic pain

Media coverage of the environment

Master of ScienceResource Planning and ConservationUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/101678/1/39015003261842.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/101678/2/39015003261842.pd

An Investigation into Secondary Migration of Hydrocarbons in the San Joaquin Basin Near Fresno, California

Prolific amounts of oil and gas have been produced from the San Joaquin Basin in many different oil and gas fields. In many cases, the petroleum system is easily identifiable, and the path hydrocarbons take from source area to trap are known. This study aims to identify secondary migration pathways of hydrocarbons from the source to the trap in an oil field near Fresno, California, where the source is about 35 miles from the trap. To create an accurate subsurface interpretation of the study area, 3D seismic data and more than 300 well logs were used. From subsurface structure maps, net sand maps, an Allan profile, and regional research, it was found that there are two possible migration scenarios that reasonably describe the secondary migration of hydrocarbons into the study area. Six normal faults within the field play large roles as seals and/or migration pathways, and to better understand hydrocarbon migration in the study area, further work must be done on the sealing/leaking behavior of the faults within the field

Marker antibody expression stratifies Crohn's disease into immunologically homogeneous subgroups with distinct clinical characteristics

BACKGROUND—Perinuclear antineutrophil cytoplasmic antibodies (pANCA) have been detected in a clinically distinct Crohn's disease subpopulation. Antibodies to Saccharomyces cerevisiae (ASCA) have been demonstrated in the majority of patients with Crohn's disease.
AIMS—To examine the relationship between selective marker antibody expression in Crohn's disease and disease onset, location, and clinical behaviour patterns.
METHODS—Sera from 156 consecutive patients with established Crohn's disease were evaluated in a blinded fashion for the presence of ASCA and ANCA. Clinical profiles were generated by investigators blinded to immune marker status.
RESULTS—Using multiple regression analyses, higher ASCA levels were shown to be independently associated with early age of disease onset as well as both fibrostenosing and internal penetrating disease behaviours. Higher ANCA levels were associated with later age of onset and ulcerative colitis-like behaviour. Substratification of the Crohn's disease population using selective ANCA and ASCA expression (high levels of a single marker antibody): (1) distinguished homogeneous subgroups that manifested similar disease location and behaviours; and (2) identified patients with more aggressive small bowel disease.
CONCLUSIONS—The findings suggest that by taking into account the magnitude of the host immune response, Crohn's disease can now be stratified on an immunological basis into more homogeneous clinically distinct subgroups, characterised by greater uniformity among anatomical distribution of disease and disease behaviour.


Keywords: antineutrophil cytoplasmic antibody; anti-Saccharomyces cerevisiae antibody; Crohn's disease; inflammatory bowel disease; ulcerative coliti