October 2016

To date state laws limiting opioids have frequently settled on 7 days for initial prescribing Photo by daniaphoto

States aim to limit opioid prescriptions

In an effort to curb the nation's opioid crisis, state legislators are pursuing laws to limit prescribing, resulting in pushback from some doctors worried about the clinical implications, or in some cases physicians backing off from treating chronic pain patients.

Safe prescribing can lessen overdose risk

In what one commentator called an “appalling” finding, 90% of patients in a recent study admitted to a hospital with a prescription opioid overdose eventually received another opioid prescription##mdash;often from the same clinician. Efforts to improve safe prescribing hope to fix the problem.

Well-being assessment considers more than physical health

Health and well-being are entwined concepts, part of a comprehensive model of health that measures medical, physical, psychological, functional, and sensory aspects. When this more comprehensive model is applied, more patients can be found to have significant vulnerabilities that could affect chances of death or incapacitation within the next 5 years.

Millennials, the same doctors in a changed environment

Some older physicians may peg millennials as entitled, self-centered, and lazy, lacking the dogged passion for medicine of generations before them. But those who teach them say that behavioral differences among this group may have more to do with environmental and individual factors than generational ones.

Managing food poisoning's aftermath in ambulatory care

Internal medicine staff can be the starting point for acute cases of food poisoning, starting the screening process on the telephone and helping determine which patients should be sent right to the ED. But they can also help patients afterward, as they manage potentially long-term complications.

Time to curb the rising costs of prescription drugs

The U.S. will see the largest increase in per capita costs in pharmaceuticals among developed markets through 2018. The CREATES Act: Ending Regulatory Abuse, Protecting Consumers, and Ensuring Drug Price Competition would approve federal and state regulation on costs to allow for return on investment by manufacturers but ensure affordability for patients.

ACP to small practices: We've got your back

Internists in small practices worry that the payment disruptions from the Medicare Access and CHIP Reauthorization Act (MACRA) will be the straw that breaks the camel's back for profitability. ACP is committed to ensuring that this doesn't happen.

States step in on opioid prescribing

This issue covers such topics as legislative issues regarding prescribing, potential overdoses by patients taking narcotics, and a new way to look at overall health.

Updated warnings on fluoroquinolones, new diabetes drug

This column reviews a warning on fluoroquinolones with a risk of disabling and potentially permanent side effects, as well as approval of an injection to improve glycemic control in adults with type 2 diabetes.

The pros and cons of using scribes

Scribes allow clinicians to talk to their patients eye-to-eye, without a computer screen in the middle. They also come with all the complications of employee management.

MKSAP Quiz: Evaluation for a skin eruption

A 47-year-old man is evaluated for a skin eruption. Approximately 2 weeks ago, his wife noted an erythematous macule on his back. Over the ensuing week, the site became progressively larger. He notes mild fatigue but no fevers. He recently returned from a vacation in Massachusetts, which included outdoor activities such as bike riding and walking to the beach. He reports no known tick attachment. On physical examination, temperature is 37.2##deg;C (100.0##deg;F), blood pressure is 117/68 mm Hg, pulse rate is 52/min, and respiration rate is 18/min. The skin lesion is shown. Which of the following is the most appropriate management?.