Category: Daily News

Not prescribing opioids first or as a long-term therapy for chronic, non-cancer pain and avoiding MRIs, CTs and X-rays for low-back pain are among the tests and treatments identified by American Society of Anesthesiologists (ASA) that are commonly ordered but not always necessary. As part of the ABIM Foundation’s Choosing Wisely campaign, ASA today released its second list of five targeted, evidence-based recommendations that can support conversations between patients and physician anesthesiologists about what care is really necessary.

ASA’s list identified the following recommendations:

1. Don’t prescribe opioid analgesics as first-line therapy to treat chronic non-cancer pain. Physicians should consider multimodal therapy, including non-drug treatments such as behavioral and physical therapies prior to pharmacological intervention. If drug therapy appears indicated, non-opioid medication (e.g., NSAIDs, anticonvulsants, etc.) should be trialed prior to commencing opioids.

2. Don’t prescribe opioid analgesics as long-term therapy to treat chronic non-cancer pain until the risks are considered and discussed with the patient. Patients should be informed of the risks of such treatment, including the potential for addiction. Physicians and patients should review and sign a written agreement that identifies the responsibilities of each party (e.g., urine drug testing) and the consequences of non-compliance with the agreement. Physicians should be cautious in co-prescribing opioids and benzodiazepines. Physicians should proactively evaluate and treat, if indicated, the nearly universal side effects of constipation and low testosterone or estrogen.

3. Avoid imaging studies (MRI, CT or X-rays) for acute low-back pain without specific indications. Imaging for low-back pain in the first six weeks after pain begins should be avoided in the absence of specific clinical indications (e.g., history of cancer with potential metastases, known aortic aneurysm, progressive neurologic deficit, etc.). Most low back pain does not need imaging and doing so may reveal incidental findings that divert attention and increase the risk of having unhelpful surgery.

4. Don’t use intravenous sedation for diagnostic and therapeutic nerve blocks, or joint injections as a default practice. * Intravenous sedation, such as with propofol, midazolam, or ultrashort-acting opioid infusions for diagnostic and therapeutic nerve blocks, or joint injections, should not be used as the default practice. Ideally, diagnostic procedures should be performed with local anesthetic alone. Intravenous sedation can be used after evaluation and discussion of risks, including interference with assessing the acute pain-relieving effects of the procedure and the potential for false positive responses ASA Standards for Basic Anesthetic Monitoring should be followed in cases where moderate or deep sedation is provided or anticipated.

5. Avoid irreversible interventions for non-cancer pain that carry significant costs and/or risks. Irreversible interventions for non-cancer pain, such as peripheral chemical neurolytic blocks or peripheral radiofrequency ablation, should be avoided because they may carry significant long-term risks of weakness, numbness or increased pain.

The ASA Committee on Pain Medicine was charged with developing the Choosing Wisely list on pain medicine. Committee members submitted recommendations for the campaign, and from this list voted on which should be included in the Choosing Wisely list. The literature was then searched to provide supporting evidence. Once approved by the committee, the Choosing Wisely list was reviewed by ASA’s Chair of the Section on Subspecialties, Vice President for Scientific Affairs, Executive Committee, and Administrative Council. The American Pain Society (APS) has endorsed ASA’s Choosing Wisely list on pain medicine.

To learn more about Choosing Wisely and to view the complete lists and additional detail about the recommendations and evidence supporting them, visit ChoosingWisely.org.

Acting on complaints from residents, police carried out compliance checks at six Azusa massage parlors issuing several citations but making no arrests, officials said. The San Gabriel Valley Tribune reports that police joined with officials from Azusa code enforcement, the California Employment Development Department, the California Department of Industrial Relations, and the Los Angeles County Sheriff’s Department’s Major Crimes Bureau’s licensing unit during the operation, Azusa police Lt. Mike Bertelsen said in a written statement.

“Azusa PD has received complaints that some massage parlors within the city may be offering sexual services to customers in addition to massages,” Bertelsen said. “After learning of the complaints, Azusa PD detectives solicited the help of outside agencies with specific expertise in massage parlor operations to develop and execute this administrative compliance detail.” In addition to verifying that all local, county and state laws and regulations were being followed, police said officials were also seeking to determine whether any victims of human trafficking were associated with any of the massage parlors.

“No victims of human trafficking were located, however numerous citations were issued for violations of various Azusa municipal codes, along with workers compensation insurance or minimum wage violations,” Bertelsen said. “Some of the businesses involved face fines of several thousand dollars each. These investigations are ongoing, so none of the businesses are being identified.” Bertelsen said similar “administrative inspections” are likely to be held again in the future.

3D printing is a process of making a three-dimensional solid object of virtually any shape from a digital model. 3D printable models may be created with a 3D scanner. To perform a print, the machine reads the design from 3D printable file and lays down successive layers of liquid, powder, paper or sheet material to build the model from a series of cross sections. These layers, which correspond to the virtual cross sections from the model, are joined or automatically fused to create the final shape. The primary advantage of this technique is its ability to create almost any shape or geometric feature.The 3D printing technology is used for both prototyping and distributed manufacturing with applications in architecture, construction, industrial design, automotive, aerospace, military, engineering, dental and medical industries, biotech (human tissue replacement), fashion, footwear, jewelry, eyewear, education, geographic information systems, food, and many other fields. Several projects and companies are develop affordable 3D printers for home desktop use.

NBC News reports that doctors in the Netherlands have for the first time successfully replaced most of a human’s skull with a 3-D printed plastic one – and likely saved a woman’s life in the process.The 23-hour surgery took place three months ago at University Medical Center Utrecht. The hospital announced details of the groundbreaking operation this week and said the patient, a 22-year-old woman, is doing just fine.

The woman, whose name wasn’t released, suffered from severe headaches due to a thickening of her skull. She slowly lost her vision, her motor coordination was suffering and it was only a matter of time before other essential brain functions would have atrophied, Dr. Verweij said in a press release issued by UMC Utrecht. Verweij noted that in some brain operations it’s common for part of the skull to be temporarily removed to reduce pressure on the brain, then put back later or replaced by an artificial implant. In this case, doctors inserted nearly an entire plastic skull that was manufactured with the help of Anatomics, an Australian medical device company that specializes in 3-D printing,

“We used to create an implant by hand in the operating theater using a kind of cement, but those implants did not have a very good fit,” Dr. Verweij said. “Now we can use 3-D printing to ensure that these components are an exact fit. This has major advantages, not only cosmetically but also because patients often have better brain function compared with the old method.”

Three months after surgery, the woman’s pain is gone and she can see again. “The patient has fully regained her vision, she has no more complaints, she’s gone back to work and there are almost no traces that she had any surgery at all,” said Dr. Verweij.

In another success story, Business Insider reports that a British surgeon successfully implanted a 3-D printed pelvis for a man who lost half his pelvis to bone cancer. It was the first transplant of its kind. The patient, who is in his sixties and has remained unnamed, suffered from a rare type of bone cancer called chondrosarcoma. It affected the entire right side of his pelvis. According to orthopedic surgeon Craig Gerrand, who performed the surgery, it would have been impossible to attach a standard implant because so much bone had to be removed. In order to create the 3-D printed pelvis, the surgeons took scans of the man’s pelvis to take exact measurements of how much 3-D printed bone needed to be produced and passed it along to Stanmore Implants. The company used the scans to create a titanium 3-D replacement, by fusing layers of titanium together and then coating it with a mineral that would allow the remaining bone cells to attach. After the titanium pelvis was attached, the team added a standard hip replacement to complete the surgery. The procedure, which happened three years ago, was an unrivaled success. The man has been walking with a cane and remains happy with the results.

3D printing is revolutionizing the health care sector: The technology has been successfully used to make prosthetic limbs, custom hearing aids, now a pelvis and a human skull, and potentially human tissue by what is called “bioprinting.”

On any given day, one in 25 hospitalized patients – 4 percent – is battling an infection picked up in a hospital or other healthcare facility, according to a new survey by the Centers for Disease Control and Prevention (CDC). That translates to more than 600,000 hospital patients each year. Roughly 74,000 of them have to fight more than one hospital-acquired infection, researchers found. About half of those infections were either linked to a device attached to the patient, like a catheter or ventilator, or occurred after a surgical procedure at the site of the surgery. An infection acquired in this manner in an industrial case would also be covered as a compensable consequence of the initial injury.

Previous estimates had pegged the annual number of infections at 2.1 million in the 1970s and 1.7 million from 1990 through 2002. “The trend, in magnitude, seems to be going in the right direction,” Dr. Mike Bell, deputy director of the Division of Healthcare Quality Promotion at the CDC, told Reuters Health. Despite continuing concern about hospital-acquired infections, especially ones that are resistant to antibiotics, the U.S. does not have a national system for collecting information on the problem.

The new study, led by Dr. Shelley S. Magill of the CDC and published in the New England Journal of Medicine, was based on an analysis of 11,282 patients treated at 183 hospitals in 10 states. The survey in each hospital was done over the course of a day, involving as many as 100 patients per facility. Pneumonia accounted for about 22 percent of the hospital-acquired infections. Another 22 percent were infections at the surgical site, and 17 percent were stomach or intestinal illnesses. Urinary tract and bloodstream infections ranked fourth and fifth, respectively. The most common bacterium responsible was Clostridium difficile, which kills an estimated 14,000 people in the U.S. each year. It was detected in 12 percent of the hospital-acquired illnesses and was responsible for 71 percent of gastrointestinal infections in particular. Nursing homes, emergency departments, rehabilitation hospitals and outpatient treatment centers were not included in the tally.

The researchers estimated that in 2011, 648,000 hospitalized patients had to battle at least one hospital-acquired infection. The total number of infections was estimated at 721,800. To put that number in perspective, about 34 million people are admitted to 5,000 community hospitals in the U.S. each year. The new report “validates the work we’ve been doing, focusing on some of the severe infections related to intensive care, related to devices such as catheters in the bloodstream or the bladder, mechanical ventilation or surgical procedures,” Bell said.

To prevent infections, the National Patient Safety Foundation recommends patients wash their hands regularly and remind their doctors and nurses to do the same. Patients should also make sure both bandages and the skin around any catheters are kept clean and dry, it says.

A former Rancho Cucamonga attorney who once handled some of the Metropolitan Transportation Authority’s toughest legal cases was convicted of stealing nearly $2 million from the transit agency by submitting phony invoices and pocketing settlement money. James Vincent Reiss, who also was convicted of stealing more than $1 million from other clients, pleaded no contest to two felony counts of grand theft. For 15 years, Reiss defended Metro in multimillion-dollar injury lawsuits involving rail and bus passengers until officials realized he was defrauding the agency, said Jane Robison, an L.A. County district attorney’s spokeswoman. Reiss, 52, made the plea as part of a deal in which prosecutors agreed to drop nine other felony counts of theft, forgery and fraud. He is set to be sentenced March 26, and the court is expected to require that he pay more $3 million in restitution and serve a decade in prison.

Reiss created fraudulent documents that led Metro to write checks that he ultimately kept for himself instead of paying plaintiffs who sued the agency. Karen Gorman, acting inspector general for Metro, said a State Bar of California investigation into problems with Reiss’ other clients in 2012 tipped off the agency to the potential for trouble, and officials immediately began auditing his cases. “We aggressively began to investigate – and working with the district attorney’s office we were able to bring Mr. Reiss to justice for his crimes.”

According to a Metro lawsuit filed against Reiss’ law firm in January for malpractice, forgery and negligence, Reiss cost the agency as much as $2.5 million. In 2011, Reiss allegedly told the MTA that it had negotiated a $2.5-million jury award down to $1.765 million. But when the Metro board authorized the settlement and ordered that two checks totaling $1.765 million be written, Reiss kept the money, according to the suit. Reiss then filed an appeal, delaying the case. Metro eventually resolved the case by paying $2.5 million. The suit alleges Reiss also submitted “numerous falsified invoices totaling at least $754,000,” for costs and kept the money.

Prosecutors said that in addition to the MTA, Reiss also took advantage of other clients. In one case, he settled a suit without the client’s knowledge, forged signatures on paperwork and pocketed the money, prosecutors said. In another case involving a trust, he opened a bank account, deposited a client’s money and wrote checks to himself, prosecutors said.

Reiss, was disbarred on March 16, 2013 after a state Bar Court judge called his case an illustration of the “disciplinary consequences of dishonesty,” The State Bar case went on to conclude “the most serious aggravation is found in Reiss’s 10-year pattern of deception in order to cover up mismanagement of his clients’ cases or for his personal economic gain. …Without a hint of remorse, Reiss has refused to acknowledge his misconduct despite overwhelming evidence of his dishonesty and the harm he caused to his clients. While the law does not require Reiss to be falsely penitent, it does require that [he] accept responsibility for his acts and come to grips with his culpability.”