JAMA network open
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Despite epidemic rates of addiction and death from prescription opioids in the United States, suggesting the importance of providing alternatives to opioids in the treatment of pain, little is known regarding how payers' coverage policies may facilitate or impede access to such treatments. ⋯ Wide variation in coverage of nonpharmacologic treatments for low back pain may be driven by the absence of best practices, the administrative complexities of developing and revising coverage policies, and payers' economic incentives. Such variation suggests an important opportunity to improve the accessibility of services, reduce opioid use, and ultimately improve the quality of care for individuals with chronic, noncancer pain while alleviating the burden of opioid addiction and overdose.
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Cannabinoids have antispastic and analgesic effects; however, their role in the treatment of multiple sclerosis (MS) symptoms is not well defined. ⋯ The results suggest a limited efficacy of cannabinoids for the treatment of spasticity, pain, and bladder dysfunction in patients with MS. Therapy using these drugs can be considered as safe.
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Comparative Study
Comparison of 2 Natural Language Processing Methods for Identification of Bleeding Among Critically Ill Patients.
To improve patient safety, health care systems need reliable methods to detect adverse events in large patient populations. Events are often described in clinical notes, rather than structured data, which make them difficult to identify on a large scale. ⋯ Bleeding is a common complication in health care, and these results demonstrate an automated and scalable detection method. The rules-based natural language processing approach, compared with ML, had the best performance in identifying bleeding, with high sensitivity and negative predictive value.
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There is a paucity of data on persistent opioid use and factors associated with persistent opioid use among workers' compensation claimants. ⋯ A high proportion of persistent opioid use was observed in this workers' compensation cohort. Interventions to lower persistent opioid use in this population should target patients with the characteristics identified in this study.
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This is the first cost-effectiveness analysis of a brief therapy, the Attempted Suicide Short Intervention Program (ASSIP), for individuals who attempt suicide. ⋯ The ASSIP intervention is a cost-saving treatment for individuals who attempt suicide. The findings support the use of ASSIP as a treatment for suicide attempters. Further studies are needed to determine cost-effectiveness in other contexts.