mdatl.com
 
vicodin online
 
News Events Profiles Clinical Management Directory
 
 
 
 

Archive for February, 2017

Show Your Love App Provides Essential Health Information to Women before Pregnancy

Sunday, February 19th, 2017

Despite important advances in medicine and prenatal care in recent years, birth outcomes are worse in the United States than in many developed countries. Many babies are born early or have low birthweight. Each year, about 1 in every 33 babies born in the United States is affected by a birth defect, a leading cause of death in the first year of life according to the Centers for Disease Control and Prevention (CDC). To address this problem, the CDC Foundation today announced a new preconception health app that will help women of reproductive age explore how to protect their health and the health of babies they may give birth to in the future.

The Show Your Love app, funded through a CDC Foundation collaboration with Anthem, Inc., is part of CDC’s Show Your Love Campaign. The campaign’s main goal is to increase the number of women who plan their pregnancies and engage in healthy behaviors before becoming pregnant and to reduce the number of birth defects. The campaign’s message is that if a woman chooses to have a child, she can show love for her child by taking important steps to live healthy well before becoming pregnant.

“Many women have questions about how to plan for pregnancy. The new Show Your Love app fills the knowledge gap empowering women with tools and resources to protect their health and the health of their future family,” said Judith Monroe, M.D., FAAFP, CDC Foundation president and CEO. “We are grateful to Anthem for their support in making this app available to women around the country.”

Show Your Love emphasizes preconception health, described by CDC as the health of women and men during their reproductive years. Preconception health focuses on women taking important steps now to protect their health and the health of the family they may want to have in the future.  These steps include working with their doctors to control and treat medical conditions such as diabetes and high blood pressure, quitting smoking, becoming physically active and making healthy food choices.

The app helps women who wish to become pregnant plan their pregnancy and chart their course, offering features to help maintain a healthy lifestyle including:

  • Assessment on behaviors including healthy eating, exercise and tobacco cessation.
  • Supportive messaging sent to users’ phones.
  • Daily tracking of behaviors.
  • Educational resources and tools on healthy behaviors.
  • Helpful reminders including doctors’ appointments, ovulation cycles and medication schedules.

“We know that delivering a healthy baby starts with a healthy mother-to-be,” said Craig Samitt, M.D., chief clinical officer for Anthem, Inc. “We’re excited to team with the CDC Foundation on the development of this groundbreaking app that can help women get healthy before they decide to become pregnant and, in doing so, help reduce the number of babies born too early or with low birth weight.”

The Show Your Love app is available for free on the iTunes and Google Play store.

Share

Legislative Alert: Oppose HB 71

Monday, February 20th, 2017

Despite opposition by the health care community, HB 71 (Chairman Richard Smith) passed the House Insurance Subcommittee and went to the full House Insurance Committee on February 17.

HB 71 does the following:

  • As a condition of medical staff participation, physicians are mandated to accept the same insurance plans as the hospital;
  • As a condition of medical staff participation, the hospitals “shall receive the power to contract for the network participation of its providers (employed and private practice) with health benefit plans of such insurers, provided that such health care providers shall be responsible for negotiating all other terms, conditions and prices.”

The Medical Association of Georgia (MAG) opposes HB 71 as this bill violates the physicians right to contract with whom the physician wants and ultimately destroys physician autonomy. This bill also raises concerns with antitrust and the Medicare Conditions of Participation. MAG is not aware of any state in the country that mandates a physician contract with any specific payer to practice at a hospital.  MAG believes patients will have problems with access to care (primary and specialty) as physicians that simply provide emergency coverage will resign from hospitals since they do not utilize their services for their patients.

MAG suggests physicians contact the following House Insurance Committee Members and have them OPPOSE HB 71:

Representative

Office Phone

Email

Rep. Richard Smith

404.656.6831

richard.smith@house.ga.gov

Rep. Eddie Lumsden

404.656.0325

eddie.lumsden@house.ga.gov

Rep. John Carson

404.656.0287

john.carson@house.ga.gov

Rep. Shaw Blackmon

404.656.0177

shaw.blackmon@house.ga.gov

Rep. Buzz Brockway

404.656.0188

buzz.brockway@house.ga.gov

Rep. Johnnie Caldwell, Jr.

404.656.5087

johnnie.caldwell@house.ga.gov

Rep. Park Cannon

404.656.7859

park.cannon@house.ga.gov

Rep. Heath Clark

404.657.1803

heath.clark@house.ga.gov

Rep. Matt Dollar

404.656.5138

matt.dollar@house.ga.gov

Rep. Chuck Efstration

404.651.7737

chuck.efstration@house.ga.gov

Rep. Bubber Epps

404.656.7855

bubber.epps@house.ga.gov

Rep. Dan Gasaway

404.656.0325

dan.gasaway@house.ga.gov

Rep. Rich Golick

404.656.5943

rich.golick@house.ga.gov

Rep. Lee Hawkins

404.656.0213

lee.hawkins@house.ga.gov

Rep. Carolyn Hugley

404.656.5058

Carolyn.hugley@house.ga.gov

Rep. Jeff Jones

404.656.0178

jeff.jones@house.ga.gov

Rep. Howard Maxwell

404.656.5143

howard.maxwell@house.ga.gov

Rep. John Meadows

404.656.5141

john.meadows@house.ga.gov

Rep. Brad Raffensperger

404.656.0254

brad.raffensperger@house.ga.gov

Rep. Bert Reeves

404.656.0298

bert.reeves@house.ga.gov

Rep. Renitta Shannon

404.656.7859

renitta.shannon@house.ga.gov

Rep. Jason Shaw

404.656.7153

jason.shaw@house.ga.gov

Rep. Mickey Stephens

404.656.0265

mickey.stephens@gmail.com

Rep. Steve Tarvin

404.656.0254

steve.tarvin@house.ga.gov

Rep. Darlene Taylor

404.656.0109

darlene.taylor@house.ga.gov

Rep. Sam Teasley

404.463.8143

sam.teasley@house.ga.gov

Rep. Bruce Williamson

404.656.5024

bruce.williamson@house.ga.gov

Share

Barby Simmons, D.O., named to Georgia Composite Medical Board

Sunday, February 19th, 2017
barby simmons

Barby Simmons

Barby Simmons, D.O., a Primary Care physician with Kaiser Permanente of Georgia and The Southeast Permanente Medical Group, has been named to the Georgia Composite Medical Board. The Medical Board is comprised of sixteen members appointed by the Governor and confirmed by the State Senate. Her appointment was announced by Georgia Governor Nathan Deal’s office.

The Medical Board’s mission is to protect the health of Georgians through the proper licensing of physicians and certain members of the healing arts and through the objective enforcement of the Medical Practice Act. The agency licenses physicians, physician assistants, respiratory care professionals, and a number of other medical services and practices in the State of Georgia. The Board also investigates complaints and disciplines those who violate The Medical Practice Act or other laws governing the professional behavior of its licensees.

Dr. Simmons is a member of Kaiser Permanente’s telemedicine team, providing telephone and video visits to patients across metro Atlanta. She has served in a number of leadership roles, including Team Lead for Adult Medicine and as the Physician Director of Coding and Documentation. She earned a bachelor’s degree in Chemistry from Mississippi State University and a medical degree from Nova Southeastern College of Osteopathic Medicine.

Share

Emory Saint Joseph’s Hospital First in Georgia to Offer Advanced Radiosurgery for the Brain

Monday, February 20th, 2017

Winship Cancer Institute at Emory Saint Joseph’s Hospital is the first hospital in the state and one of only seven medical centers in the nation to offer advanced radiosurgery for the brain with the Gamma Knife. The device delivers minimally invasive radiation treatment for malignant and nonmalignant tumors, trigeminal neuralgia (facial pain syndrome) and other neurological disorders.

“This technology pinpoints the tumor with the greatest accuracy to date, and also preserves cognitive function by avoiding critical brain structures. The Gamma Knife is the best combination of all we’ve come to learn about stereotactic radiosurgery for the brain,” says Peter Rossi, MD, Winship director of radiation oncology at Emory Saint Joseph’s.

Gamma Knife treatment is an alternative to open brain surgery, and does not require a surgeon to use a scalpel or make an incision. The procedure treats brain lesions with enough radiation to control them, so that they disappear, shrink or stop growing, often in the most critical, difficult-to-access areas of the brain.

Gamma Knife radiation beams are targeted only to the specific area of the brain requiring treatment without harming surrounding healthy tissue. Patients are able to avoid whole brain radiation therapy, and do not experience side effects such as memory loss.

The Gamma Knife treatment lasts from 20 minutes to two hours, and patients go home the same day. The day of the procedure, patients receive an MRI, and then the treatment team, consisting of a neurosurgeon, radiation oncologist and physicist, carefully plan and identify the area of the brain to be treated, so radiation can be delivered precisely.

Before treatment begins, patients are fitted with either a specialized mesh mask that molds to their face or a frame, in order to stabilize their head during the procedure. Patients are then moved automatically into the machine for treatment. “There is minimal pain involved for patients,” says Shannon Kahn, MD, Winship radiation oncologist at Emory Saint Joseph’s. “After being fitted with either the head frame or mask, patients lay on a table with a comfortable mattress and often sleep during treatment. After treatment is complete, patients can go home the same day.”

Joseph Garrett, the first patient at Emory Saint Joseph’s to be treated with the Gamma Knife was pleased with the positive outcome of his treatment. Garrett first experienced vision problems, and was later diagnosed with a benign brain tumor wrapped around the optic nerve. “I didn’t experience any side effects at all,” says Garrett about the painless treatment and his immediate return to normal activities.

Watch the video: https://youtu.be/PrrYY8-UeDM

Share

The Use of Dexmedetomidine in Pediatric Anesthesia

Wednesday, February 15th, 2017

By Lydia Joseph, M.D.

precedexFor many years, the sight of a screaming, crying child emerging from anesthesia was the hallmark of a successful anesthetic. A cranky child exhibited signs of a clear airway and adequate circulation, leading to discharge from the post anesthesia care unit.

Pediatric post-surgical pain had been classically under appreciated and thus undertreated. Over time, however, the attitudes toward pediatric pain have evolved along with the specialty of pediatric anesthesia as a whole. We now know that being in pain can be emotionally traumatic for a child, leading to behavioral and developmental setbacks later on in life.

Now we are seeing that even our choice of anesthetic has the potential to impact a child long after the surgical encounter. In order to make hospitals more hospitable for a child and parent, we must give the assurance of safe anesthesia practice in addition to adequate pain control.

Anesthesiologists are continually using research to improve the safety, quality and efficacy of anesthetics. In recent years, the drug dexmedetomidine has come to the forefront of pediatric anesthesia. In U.S. hospitals, the use of dexmedetomidine in the pediatric setting has doubled between 2010 and 2015[i].

Not only is dexmedetomidine an effective anesthetic and analgesic, but it is also an answer to problems found in pediatric anesthesia: 1) the need for an ‘opioid sparing’ or ‘multimodal technique’, and 2) the concern about the toxicity of common anesthetics, which may impair the brain development of babies and young children. In fact, recent animal model data suggest that dexmedetomidine can actually protect the developing brain from the neurotoxicity of other anesthetics.

Dexmedetomidine (now off patent from trade name Precedex) is an alpha 2 receptor agonist. It has sedative as well as analgesic properties and was approved for use by the U.S. Food and Drug Administration (FDA) in December 1999.

Although it is heavily used in practice, it still is not specifically approved for pediatric use. While the drug has some disadvantages, there are many desirable properties.

Of commonly used anesthetics, dexmedetomidine induces sedation that more closely resembles physiological sleep in terms of EEG[ii]. It has been shown to be effective in reducing emergence delirium, an issue that is seen especially in the pediatric population[iii]. It also has been shown to reduce acute post-surgical pain and opioid use. Most importantly, it does all these things without reducing respiratory drive.

The disadvantages of dexmedetomidine include transient hypertension, hypotension and bradycardia.

Dexmedetomidine can be used as an infusion or as a bolus dose intraoperatively. An infusion is given at a dose of 0.2mcg/kg/hr to 0.7/mcg/kg/hr.

A recent meta-analysis of the efficacy of intraoperative dexmedetomidine found that the optimal bolus dose was ~0.5 mcg/kg[iv]. The endpoints of the analysis of optimal dosing were primarily the post-operative opioid consumption and post op pain intensity.

Some clinicians may choose to pretreat patients to address the possible side effects of hypotention and bradycardia. In my practice, dexmedetomidine is especially useful in patients with obstructive sleep apnea who are very sensitive to opioids. I have also found that one has to be careful with dosage, timing and addition of other analgesics when using dexmedetomidine to avoid over-sedation in the PACU.

So, why not just stick with opioids? For years, opioids have been a mainstay of anesthesia and pain control because of their safety and efficacy. However, concern over the role of opioids in addiction/dependence has led to bad press.

In addition, opioids have many negative side effects. Effects such as respiratory depression can be even more prevalent in newborns given the immaturity of their hepatic and renal metabolism and consequent accumulation of drugs. Prolonged use of opioids for children who undergo several procedures (e.g. burns) can cause hyperalgesia cheapest cialis 20mg uk. In other words, opioids can cause patients to become even more sensitive to pain.

Opioids continue to be the tried-and-true option for surgical pain control, but adjunctive medications are a good idea to diminish some of the undesirable side effects.

An area of intense interest in pediatric anesthesia is the effect of anesthetics on a child’s developing brain. Several anesthetics, such as sevoflurane, nitrous oxide, ketamine, propofol and benzodiazepines, have all been implicated in neurodegenerative changes in developing animal brains[v][vi][vii]. Whether or not these results can be translated to long-term cognitive impairment in humans is currently being studied.

This brings special attention to a drug like dexmedetomidine, which has not shown these neurodegenerative changes in animal brains when used at low clinical doses. In fact, animal studies have shown the diminution of neuronal cell death when dexmedetomidine was used concurrently with anesthetic gases, ketamine or propofol, thus making it neuroprotective.

SmartTots, a collaborative effort by the FDA and the International Anesthesia Research Society (IARS), coordinates and funds research in this area[viii]. One of the currently ongoing SmartTot studies, Toxicity of Remifentanil and Dexmedetomidine (T-Rex), aims to look at dexmedetomidine and the opioid remifentanil as a potentially neuroprotective anesthetic regimen that can be used as alternative to inhalational anesthetics during long procedures[ix]. Of course, in a prospective clinical trial, the neuropsychological assessment of children exposed to dexmedetomidine will take years to complete.

There are several barriers to the study of pediatric medications, which is why about 50 percent of drugs used in children are ‘off-label’. Further study is definitely needed on the use of dexmedetomidine in children. So far, dexmedetomidine is recognized as a safe and effective sedative and analgesic. The studies done on its neuroprotective qualities thus far are quite promising. Depending on the clinical scenario, dexmedetomidine is worth adding to our anesthetic/analgesic arsenal.

[i] IMS Health, Inpatient Healthcare Utilization System (IHCarUS). June 2014-May 2015. Data extracted Nov 2015.

[ii] Mason KP1, Lerman J.; Dexmedetomidine in children: current knowledge and future applications. Anesth Analg. 2011 Nov;113(5):1129-42.

[iii] Makkar JK, Bhatia N, Bala I, Dwivedi D, Singh PM; A comparison of single dose dexmedetomidine with propofol for the prevention of emergence delirium after desflurane anaesthesia in children. Anaesthesia. 2016 Jan;71(1):50-7

[iv] Bellon MLe Bot AMichelet DHilly J, Maesani MBrasher CDahmani S; Efficacy of Intraoperative Dexmedetomidine Compared with Placebo for Postoperative Pain Management: A Meta-Analysis of Published Studies. Pain Ther. 2016 Jun;5(1):63-80.

[v] Andropoulos DB, Ahmad HB, Haq T, Brady K, Stayer SA, Meador MR, Hunter JV, Rivera C, Voigt RG, Turcich M, He CQ, Shekerdemian LS, Dickerson HA, Fraser CD, Dean McKenzie E, Heinle JS, Blaine Easley R. The association between brain injury, perioperative anesthetic exposure, and 12-month neurodevelopmental outcomes after neonatal cardiac surgery: a retrospective cohort study. Paediatr Anaesth. 2014 Mar;24(3):266-74.

[vi] Creeley CE, Dikranian KT, Dissen GA, Back SA, Olney JW, Brambrink AM. Isoflurane-induced apoptosis of neurons and oligodendrocytes in the fetal rhesus macaque brain. Anesthesiology. 2014 Mar;120(3):626-38. 8 29

[vii] Creeley C, Dikranian K, Dissen G, Martin L, Olney J, Brambrink A. Propofolinduced apoptosis of neurones and oligodendrocytes in fetal and neonatal rhesus macaque brain. Br J Anaesth. 2013 Jun;110 Suppl 1:i29-38.

[viii] www.smarttots.org

[ix] Pinyavat T, Warner DO, Flick RP, McCann ME, Andropoulos DB, Hu D, Sall JW, Spann MN, Ing C.Summary of the Update Session on Clinical Neurotoxicity Studies.

J Neurosurg Anesthesiol. 2016 Oct;28(4):356-360.

Share

Regional Anesthesia: A Focus on Peripheral Nerve Blocks

Wednesday, February 15th, 2017

By Christopher W. Hackney, M.D.

Peripheral Nerve BlockIs this something new?This is the most common question I am asked when discussing peripheral nerve blocks with patients.

While various regional techniques have been employed for over a century, the widespread use of peripheral nerve blocks have become a relatively recent phenomenon in the field of anesthesia. At the end of the 19th century, cocaine started to show promise as a powerful anesthetic for medical procedures. Cocaines inception opened the doorway as a potent surgical anesthetic, however that doorway also lead to addiction and dependency for many practitioners.

Throughout the next century, newer advents of local anesthetic provided a resurgence. So while cocaines abuse potential limited its utilization, newer local anesthetics combined with peripheral nerve blocks have become to be powerful tools in minimizing opioid usage and subsequent long- term abuse potential.

In its first decades of use, cocaine not only proved to be habit forming but also carried with it the risk of cardiac toxicity. Innovations into less cardiotoxic formulations, such as procaine and lidocaine, helped pave the way for our current generation of local anesthetics. Bupivaicaine and Ropivaicaine are now the most commonly utilizedused anesthetics for peripheral nerve blocks.

While the former has a greater potential for cardiotoxicity in the event of an overdose, theythese are still vastly superior in improving block duration than previous generations. Combined with peripheral nerve blocks, modern local anesthetics can provide 12 to 24 hours of pain relief.

Peripheral nerve blocks involve the targeted administration of local anesthetic in order to functionally “block” stimulation from a specific area of the body during a surgical procedure. Visualization with an ultrasound machine aides in localization of nerves and the guidance of a needle through which to local anesthetic is administered.

Due to variations in diameter and myelination, local anesthetics affect nerve fibers differently, but the main targets for anesthetization are the type C fiber nociceptors and type A delta fibers. Interrupting the conduction of a pain stimulus from a surgical area can diminish and in many situations eliminate surgical pain.

Because local anesthetics do not discriminate the nerve fibers they affect, other consequences of a peripheral nerve block include loss of touch, proprioception, and temperature discrimination, as well as motor strength to the area.

Orthopedic surgery has historically been the most well- served utilizingusing regional anesthesia. A peripheral nerve block along the cords of the brachial plexus can effectively anesthetize the forearm and hand for surgery. The shoulder itself can also be blocked by an injection at the level of the roots of the brachial plexus.

The lower extremity is susceptible to peripheral nerve blocks in a similar manner. Both the femoral and sciatic nerve are easily isolated to benefit any number of procedures involving the leg and foot.

Visualization of peripheral nerves directed by ultrasound allows for more precise administration of local anesthetics. In addition, ultrasound also allows  to better visualization ofe nerves and the spread of local anesthetic during the procedure. Ultrasound has allowed for much safer placement of peripheral nerve blocks as well improvement in onset and duration genericoitalia.it.

Peripheral nerve blocks for orthopedic procedures are not only important for reducing perioperative pain, but also in necessitating early physical therapy in many procedures such as total knee arthroplasties. For these procedures, a variant of the femoral nerve block, the adductor canal block, is employed and serves to anesthetize the femoral nerve distal to the motor fibers innervating the quadriceps.

This technique allows for postoperative pain relief at the surgical site and avoids undesired motor weakness of the quadricep. Both promote early mobility and enhanced range of motion after total knee arthroplasty.

Although direct ultrasound visualization of the nerves with ultrasound is the approach to many blocks, newer techniques have focused on the development of fascial plane blocks. Specifically, the transversus abdominis plane (TAP) block and the pectoralispectoral nerves (PEC) block are allowing anesthesiologists to provide areas where traditional nerve anatomy is more diffuse.

Again uUnder ultrasound guidance, the TAP involves spreading a large volume of local anesthetic between the inner oblique muscle and the transversus abdominis muscle to provide anesthetization to the anterolateral abdominal wall, including the deep muscle and fascia. The TAP block has seen most success in proving to reduce post-operative opioid consumption for a variety of abdominal procedures both open and laparoscopic.

More recently, the pectoralisPEC block is giving anesthesiologists a better way to provide anesthetization to the anterior chest wall and axilla during a variety of breast procedures. These patients have an exceptionally high incidence of postoperative nausea and vomiting (PONV), which can be improved by reducing opioids through the placement of a PEC block.

However, the pectoralisPEC block and other fascial plane blocks are limited in their ability to produce a definitive block. Because their efficacy relies on the distribution of local anesthetic through a fascial plane, the outcome can be highly variable depending on a patients anatomy. For larger resections involving the anterior chest wall, such as partial and total mastectomies, a paravertebral block is more commonly employed. A paravertebral block is performed more proximally along the transverse processes of the spine to target the dorsal and ventral rami at a specific vertebral level. In doing so, a more complete band of anesthesia can be provided to one or more dermatomes along the chest wall.

These blocks represent only a fraction of an anesthesiologists arsenal in combating perioperative pain. Still, peripheral nerve blocks serve as only one part of an anesthetic plan, as they are usually combined with a general anesthetic to better optimize patient comfort. And while opioids may not be entirely eliminated from many patients anesthetic regimens, they are greatly diminished for those patients undergoing a procedure with a peripheral nerve block in place.

Among the anesthesia community, there has always been concern over the perioperative use of opioid pain medication. Opioids carry a range of side effects, from the rather innocuous post-operative itching to life-threatening respiratory depression. However, the current opioid epidemic has placed a greater precedence on reducing opioid use inin an attempt to  trying to prevent future abuse by patients.

Peripheral nerve blocks have been proven safe and effective in the vast majority of procedures, including outpatient surgery. In addition, there are fewer complications associated with peripheral nerve blocks than traditional neuroaxial anesthesia, including spinal and epidural injections.

These procedures have their place in helping minimizing opioid consumption as well but place patients at a higher risk of hypotension and potential bleeding. Peripheral nerve blocks also lend to the advent of newer block techniques, which are helping facilitate greater implementation of regional anesthesia in all surgeries.

Many physicians are also looking at the potential for block additives, including dexamethasone, tramadol, dexmedetomidine, and clonidine to enhance the effect of a peripheral nerve block or extend its duration. Peripheral nerve catheters are also becoming more effectively used to extend block duration past the traditional 24 hours of a traditional single injection.

So while the use of local anesthetic with peripheral nerve blocks promises improved pain relief for patients in the postoperative period, anesthesiologists are also able to provide a much needed alternative to opioid pain medications.

Share

CME: Advancing the Spectrum of Oncology Care

Saturday, February 25th, 2017

February 25, 2017, Georgia Tech Hotel and Conference Center, Atlanta. For more information, visit Piedmont Cancer Symposium.

Share

2017 Day at the Capitol

Thursday, February 23rd, 2017

February 23, 2017, Capitol Building, Atlanta. For more information, visit GAFP

Share

Regional Dinner Meeting- MACRA and Maintaining Physician Autonomy

Thursday, February 9th, 2017

February 9, 2017, Columbus, GA. For more information, visit GAFP

Share

MGMA 2017 Financial Management and Payer Contracting Conference

Sunday, February 19th, 2017

February 19-21, 2017, Las Vegas, NV. For more information, visit FMPC 2017

Share

 

 
Malcare WordPress Security
Resources F T L Subscription Advertising About Us Past Issues Contact