When Evidence Says No, But Doctors Say Yes (Via Paolo)

https://www.propublica.org/article/when-evidence-says-no-but-doctors-say-yes

Years after research contradicts common practices, patients continue to demand them and doctors continue to deliver. The result is an epidemic of unnecessary and unhelpful treatment. by David Epstein, From ProPublica and The Atlantic.

 

 

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Via G. Johnson, NEJM: Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use

Opioid-Prescribing Patterns of Emergency Physicians and Risk of Long-Term Use
Michael L. Barnett, M.D., Andrew R. Olenski, B.S., and Anupam B. Jena, M.D., Ph.D.
N Engl J Med 2017; 376:663-673February 16, 2017
DOI: 10.1056/NEJMsa1610524

http://www.nejm.org/doi/full/10.1056/NEJMsa1610524
https://www.ncbi.nlm.nih.gov/pubmed/28199807

Abstract:
Background
Increasing overuse of opioids in the United States may be driven in part by physician prescribing. However, the extent to which individual physicians vary in opioid prescribing and the implications of that variation for long-term opioid use and adverse outcomes in patients are unknown.

Methods
We performed a retrospective analysis involving Medicare beneficiaries who had an index emergency department visit in the period from 2008 through 2011 and had not received prescriptions for opioids within 6 months before that visit. After identifying the emergency physicians within a hospital who cared for the patients, we categorized the physicians as being high-intensity or low-intensity opioid prescribers according to relative quartiles of prescribing rates within the same hospital. We compared rates of long-term opioid use, defined as 6 months of days supplied, in the 12 months after a visit to the emergency department among patients treated by high-intensity or low-intensity prescribers, with adjustment for patient characteristics.

Results
Our sample consisted of 215,678 patients who received treatment from low-intensity prescribers and 161,951 patients who received treatment from high-intensity prescribers. Patient characteristics, including diagnoses in the emergency department, were similar in the two treatment groups. Within individual hospitals, rates of opioid prescribing varied widely between low-intensity and high-intensity prescribers (7.3% vs. 24.1%). Long-term opioid use was significantly higher among patients treated by high-intensity prescribers than among patients treated by low-intensity prescribers (adjusted odds ratio, 1.30; 95% confidence interval, 1.23 to 1.37; P<0.001); these findings were consistent across multiple sensitivity analyses.

Conclusions
Wide variation in rates of opioid prescribing existed among physicians practicing within the same emergency department, and rates of long-term opioid use were increased among patients who had not previously received opioids and received treatment from high-intensity opioid prescribers. (Funded by the National Institutes of Health.).

Journal Club Articles, 2/1/2017

Risk of Acute Kidney Injury After Intravenous Contrast Media Administration
Hinson JS
Annals of Emergency Medicine, Article in Press
http://dx.doi.org/10.1016/j.annemergmed.2016.11.021
https://www.ncbi.nlm.nih.gov/pubmed/28131489
Full text via NYSL: http://www.sciencedirect.com.dbgateway.nysed.gov/science/article/pii/S0196064416313889/pdfft?md5=b2de7b46b233f6c18147311a8bafcc15&pid=1-s2.0-S0196064416313889-main.pdf

Is ketamine a lifesaving agent in childhood acute severe asthma?
Hendaus MA
Ther Clin Risk Manag. 2016 Feb 22;12:273-9.
http://dx.doi.org/10.2147/TCRM.S100389
https://www.ncbi.nlm.nih.gov/pubmed/26955277
Full text: https://www.dovepress.com/getfile.php?fileID=29100