Risk Management: Prescribing Controlled Substances: Managing the Risks

Conclusion Using the three Cs of risk management strategies—collecting information, communicating, and carefully documenting—when prescribing controlled substances supports quality patient care and can decrease the risk of improper prescribing allegations. Appendix 1. Prescribing Controlled Substances: Informed Consent Some, but not all states have promulgated various requirements and recommendations for components of an informed consent discussion when prescribing controlled substances.  The following is a compilation of current individual state requirements and recommendations for informed consent.  Prescribers should determine the state requirements for their state, and may want to consider incorporating these components: The physician shall obtain written, informed consent and discuss the risks and benefits of the use of controlled substances with the patient; persons designated by the patient; or the patient’s surrogate or guardian if the patient is incompetent. Ensure the patient does not have any absolute contraindications and review risks and benefits related to any relative contraindications with the patient. The treatment plan, any alternatives to controlled substance therapy, additional therapies to be used in conjunction with controlled substances (if any) should be reviewed. Inform the patient of the risks of addiction, physical dependence, and abuse; the potential for dose escalation/tolerance. Inform the patient of the risk of the p...
Source: Innovations in Clinical Neuroscience - Category: Neuroscience Authors: Tags: Current Issue Risk Management Source Type: research

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ConclusionHemiplegic spontaneous cervical EDH occurs very rarely. It is often misdiagnosed as ischemic stroke and is likely to be administered with thrombolytic agents, making the patient's symptoms worse. Early diagnosis and rapid management of cervical EDH increase the likelihood of complete recovery of the patient's symptoms. Therefore, if there are unilateral weakness and neck pain without cranial nerve dysfunction and there is no evidence of stroke in the brain imaging, spinal EDH should be considered.
Source: Interdisciplinary Neurosurgery - Category: Neurosurgery Source Type: research
We describe the case of a 37-year-old man with a 20-year history of psoriatic arthritis. The patient presented with abdominal pain, watery diarrhea with mild hematochezia, and a reported 24-pound unintentional weight loss over the past five months. Of note, the patient began treatment with etanercept five months earlier after discontinuation of infliximab for his psoriatic arthritis symptoms. Colonoscopy with terminal ileum intubation revealed active colitis and intestinal biopsy results showed marked ulcerations and non-caseating granulomas, indicative of CD. Etanercept was subsequently discontinued and the patient was st...
Source: Journal of Drugs in Dermatology - Category: Dermatology Tags: J Drugs Dermatol Source Type: research
Authors: Alexis AF, Rendon M, Silverberg JI, Pariser DM, Lockshin B, Griffiths CE, Weisman J, Wollenberg A, Chen Z, Davis JD, Li M, Eckert L, Gadkari A, Shumel B, Rossi AB, Graham NM, Ardeleanu M Abstract Dupilumab, a monoclonal antibody that blocks the shared receptor subunit for interleukin (IL)-4 and IL-13, is currently approved for the treatment of adults with inadequately controlled moderate-to-severe atopic dermatitis (AD). The efficacy and safety of dupilumab for AD among racial subgroups is unknown. This post hoc analysis from three phase 3 trials assessed the efficacy and safety of dupilumab vs placebo by ...
Source: Journal of Drugs in Dermatology - Category: Dermatology Tags: J Drugs Dermatol Source Type: research
Authors: Green LJ, Yamauchi PS, Kircik LH Abstract Psoriasis (PsO) is a common, systemic, chronic inflammatory disease characterized by key clinical symptoms, including itching, pain, and scaling, and is associated with substantial physical, psychosocial, and economic health burdens. Currently, there is no cure for PsO; however, the introduction of biologic therapies has revolutionized the clinical management of patients with PsO by expanding treatment options to include multiple therapies with different mechanisms of action targeting cytokines, including tumor necrosis factor inhibitors (TNFis), interleukin (IL)-1...
Source: Journal of Drugs in Dermatology - Category: Dermatology Tags: J Drugs Dermatol Source Type: research
The objective of this study was to use data from electronic health records to understand prescribing patterns associated with biologic therapies for psoriasis and utilization of concomitant non-biologic psoriasis therapies in patients on biologics. METHODS: A retrospective cohort study was performed using OptumInSight’s electronic health records database. Patients were classified as having psoriasis if they had 2 diagnosis codes for psoriasis or 1 diagnosis for psoriasis and a subsequent prescription for a systemic psoriasis therapy or phototherapy on a separate day. Only patients with at least 1 prescription for a ...
Source: Journal of Drugs in Dermatology - Category: Dermatology Tags: J Drugs Dermatol Source Type: research
rno R Abstract While evidence-based interventions can help the substantial number of veterans diagnosed with comorbid PTSD and depression, an emerging literature has identified sleep disturbances as predictors of treatment nonresponse. More specifically, predicting effects of residual insomnia and nightmares on postintervention PTSD and depressive symptoms among veterans with comorbid PTSD and depression has remained unclear. The present study used data from a clinical trial of Behavioral Activation and Therapeutic Exposure (BA-TE), a combined approach to address comorbid PTSD and depression, administered to veter...
Source: Behavior Therapy - Category: Psychiatry & Psychology Authors: Tags: Behav Ther Source Type: research
This study investigates the extent to which achieving goals during behavioral activation (BA) treatment predicts depressive symptom improvement, and whether goal-related cognitions predict goal achievement or treatment response. Patients (n = 110, mean age 37.6, 54% female) received low-intensity cognitive behavioral therapy for depression, which included setting up to three behavioral goals in each of three BA-focused sessions (i.e., 9 goals per patient). Patients completed items from the Self-Regulation Skills Battery to assess goal-related cognitions and goal achievement for these goals, and depressive symptoms were ass...
Source: Behavior Therapy - Category: Psychiatry & Psychology Authors: Tags: Behav Ther Source Type: research
Abstract Suicide is a growing public health crisis among military veterans. Despite recent attention to this area, there are few empirically supported preventative interventions for suicidality among veterans. In the context of an empirically supported theoretical framework, the Interpersonal Theory of Suicide, the current study targeted suicide risk factors (i.e., perceived burdensomeness and thwarted belongingness) among a sample of 46 veterans selected from a larger clinical trial. Participants were randomized to receive either a newly developed computerized intervention aimed at decreasing perceived burdensome...
Source: Behavior Therapy - Category: Psychiatry & Psychology Authors: Tags: Behav Ther Source Type: research
This study therefore examined the efficacy and acceptability of group BA drawn from clinical trial evidence. Randomized controlled trials of group BA were identified using a comprehensive literature search. Depression outcomes at posttreatment/follow-up, recovery and dropout rates were extracted and analyzed using a random-effects meta-analysis. Treatment moderators were analyzed using meta-regression and subgroup analyses. Nineteen trials were quantitatively synthesized. Depression outcomes postgroup BA treatment were superior to controls (SMD 0.72, CI 0.34 to 1.10, k=13, N=461) and were equivalent to other active therapi...
Source: Behavior Therapy - Category: Psychiatry & Psychology Authors: Tags: Behav Ther Source Type: research
Abstract The majority of people with depression in the United States either never seek treatment or gravitate exclusively to antidepressant medication (ADM), despite the existence of other effective treatments, such as cognitive-behavioral therapy (CBT). Reluctance to use psychotherapy is partly due to lack of appropriate mental health literacy and perceptions of low treatment acceptability (appropriateness for a given problem) and credibility (treatment logicalness, and whether the patient expects improvement). In the current investigation, we examined whether providing psychoeducation about CBT for depression wo...
Source: Behavior Therapy - Category: Psychiatry & Psychology Authors: Tags: Behav Ther Source Type: research
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