The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists
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Inadvertent puncture during use, disassembly, or disposal of needles or sharp devices (called collectively, "sharps") creates risk beyond a simple puncture. Sharps injury has always been a risk for health care workers, but emergence of certain blood-borne pathogens has intensified the need to act. ⋯ Injury analysis at long-term care facilities and at the national level reveals several trends that can be used to shape policy and select interventions. Policy, practice, and training need to address new devices engineered to prevent sharps injuries, sharps disposal containers, and prophylaxis after percutaneous injury.
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Pain is a common complaint in the elderly patient. Chronic pain can be either nociceptive or neuropathic. ⋯ Several pharmacologic treatments have been shown to provide relief for neuropathic pain, including tricyclic antidepressants, anticonvulsants, tramadol, and opioids. Topical analgesics may also provide some benefit.
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Practice Guideline
Guidelines for medication therapy management services in long-term care facilities.
Included in the Medicare prescription drug benefit (Medicare Part D) was a provision that sponsors of Medicare Part D prescription drug plans (PDP) provide a medication therapy management (MTM) program for "targeted beneficiaries." Medicare beneficiaries who reside in long-term care facilities also are eligible for Medicare Part D and these MTM services. Long-term care facilities encompass skilled nursing facilities and any medical institution or nursing facility for which payment is made for institutionalized individuals under Medicaid, as defined in section 1902(q)(1)(B) of the Social Security Act, and other payer sources. The design and implementation of MTM services for Medicare beneficiaries who reside in long-term care facilities is complicated because of the Centers for Medicare and Medicaid Services' (CMS) requirement of medication regimen review (MRR) for nursing facility residents. ⋯ Moreover, it is newly defined, recently updated, and expanded in Appendix PP of the State Operations Manual (SOM) under "Guidance to Surveyors of Long Term Care Facilities." Changes to Appendix PP were effective December 18, 2006. The American Society of Consultant Pharmacists (ASCP) considers MRR and MTM to be distinct processes even though they share common goals regarding quality, safety, and cost-effectiveness. This document differentiates MTM services from MRR services and establishes guidelines by which MTM can be performed in the long-term care setting.
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When groups of people relocate from their homelands to other nations, especially if the movement is involuntary, minority populations are created in the countries that receive them. The issues related to these diaspora and diasporic communities--any groups that have been dispersed outside their traditional homelands--are financial, social, historical, political, or religious. In health care, issues include heritable diseases, cultural barriers, patients' health care beliefs, and unique disease presentations. In long-term care, many residents and health care providers have relocated to the United States from other countries.
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To evaluate the proportion of patients aged 65 years and older who are prescribed propoxyphene (PP) versus those aged 65 and younger. ⋯ Compared with nationally reported data, the rate of PP prescribing is relatively low. However, despite the recommendation to avoid the use of PP in elderly patients, its use occurs in a higher proportion of patients age 65 years or older than in younger patients. Studies evaluating the prescribing rates of potentially inappropriate medications should be put in context by comparing reported data with that of a younger cohort.