Platelet-rich plasma injections are similar to corticosteroids for pain relief and improvement in function in patients with refractory plantar fasciitis lasting less than 12 weeks.

Does the type of corticosteroid have an effect on pain and functional status of the knee in osteoarthritis (OA) patients receiving intra-articular injections? In patients with knee OA, the type of injected steroid does not appear to alter pain and functional response, based on 3 head-to-head

Jackson, Troy MD; Antono, Brian MD; Grandy, Rebecca PharmD; Smith, Eric MD; Hulkower, Stephen MD; Stigleman, Sue MLSAuthor Information

YES. MONTHLY EXTENDED-RELEASE INJECTABLE NALTREXONE (XR-NTX) TREATS OPIOID USE DISORDER AS EFFECTIVELY AS DAILY SUBLINGUAL BUPRENORPHINE-NALOXONE (BUP-NX) WITHOUT CAUSING ANY INCREASE IN SERIOUS ADVERSE EVENTS OR FATAL OVERDOSES. (STRENGTH OF RECOMMENDATION: A, 2 GOOD-QUALITY RCTS).

Exercise programs should be recommended for community-dwelling adults 60 years and older because they lead to fewer falls.

Introduction:Opioid use disorder (OUD) affects 2 million Americans, yet many patients do not receive treatment. Lack of team-based care is a common barrier for office-based opioid treatment (OBOT). In 2015, we started OBOT in a family medicine practice. Based on our experiences, we developed a financial model for hiring a team member to provide nonbillable OBOT services through revenue from increased patient volume.Methods:We completed a retrospective chart review from July 2015 to December 2016 to determine the average difference in medical visits per patient per month pre-OBOT versus post-OBOT. Secondary outcomes were the percentage of visits coded as a Level 3, Level 4, and Level 5, and the percentage of patients with Medicaid, private insurance, or self pay. With this information, we extrapolated to build a financial model to hire a team member to support OBOT.Results:Twenty-three patients received OBOT during the study period. There was a net increase of 1.93 visits per patient per month (P < .001). Fourteen patients were insured by Medicaid, 7 had private insurance, and 2 were self pay. Twenty-three percent of OBOT visits were Level 3, 69% were Level 4, and 8% were Level 5. Assuming all visits were reimbursed by Medicaid and accounting for 20% cost of business, treating 1 existing patient for 1 year would generate $1,439. Treating 1 new patient would generate $1,677.Conclusions:In a fee-for-service model, the revenue generated from increased medical visits can offset the cost of hiring a team member to support nonbillable OBOT services.

Benjamin Gilmer, MD, MS; Stephen Hulkower, MD, UNC Health Sciences at MAHEC, Asheville, NC ; Courtenay Gilmore Wilson, PharmD, BCPS, BCACP, CDE, CPP, UNC Health Sciences at MAHEC, Asheville, NC; Eshelman School of Pharmacy, University of North Carolina-Chapel Hill ; Brittney Macdonald, MD, MAHEC Family Medicine Residency Program, Asheville, NC ; Jonathan Pozner, MS4, University of North Carolina School of Medicine-Asheville ; Sue Stigleman, MLS, Mountain Area Health Education Center, Asheville, NC.

Chronic medical and common behavioral health conditions have been shown to benefit from team-based care approaches that include integrated behavioral health providers. Team-based integrated care can promote the Quadruple Aim, encompassing health care outcomes, patient satisfaction, provider work/life experience, and the cost of care.

Timothy Plaut, MD; Katelyn Graeme, DO; Sue Stigleman, MLS; Stephen Hulkower, MD, Mountain Area Health Education Center, Asheville, NC ; Tasha Woodall, PharmD, Mountain Area Health Education Center, Asheville, NC; Eshelman School of Pharmacy, University of North Carolina, Chapel Hill.

One nonfatal myocardial infarction (MI) will be avoided for every 126 to 138 adults who take daily aspirin for 10 years (strength of recommendation [SOR]: A, systematic reviews and meta-analyses of multiple randomized controlled trials [RCTs]). Taking low-dose aspirin for primary prevention shows no clear mortality benefit. A benefit for primary prevention of stroke is less certain. Although no evidence establishes increased risk of hemorrhagic stroke from daily low-dose aspirin, one gastrointestinal hemorrhage will occur for every 72 to 357 adults who take aspirin for longer than 10 years (SOR: A, systematic reviews and meta-analyses of multiple RCTs and cohort studies).

Chronic medical and common behavioral health conditions have been shown to benefit from team-based care approaches that include integrated behavioral health providers. Team-based integrated care can promote the Quadruple Aim, encompassing health care outcomes, patient satisfaction, provider work/life experience, and the cost of care.

evidence summary A 2013 network meta-analysis compared beta-blockers with placebo or standard treatment by analyzing 21 randomized trials with a total of 23,122 patients. Investigators found that beta-blockers as a class significantly reduced mortality after a median of 12 months (odds ratio=0.71, 95% confidence interval [CI], 0.64-0.80; number needed to treat [NNT]=23). They also compared atenolol, bisoprolol, bucindolol, carvedilol, metoprolol, and nebivolol with each other and found no significant difference in risk of death, sudden cardiac death, death resulting from pump failure, or tolerability.

Three beta-blockers--carvedilol, metoprolol succinate, and bisoprolol--reduce mortality equally (by about 30% over one year) in patients with Class III or IV systolic heart failure. Insufficient evidence exists comparing equipotent doses of these medications head-to-head to recommend any one over the others.

Cyst qualities dictate technique There are 3 main techniques for the removal of sebaceous cysts: traditional wide excision, minimal excision, and punch biopsy excision. For large cysts that have never become inflamed or ruptured, i favor the minimal excision technique because it’s likely that i’ll be able to remove the entire capsule with minimal scarring and faster healing times. also, for cysts on the face, this method produces a better cosmetic result because of the significantly smaller scar. However, for a cyst that has ruptured internally, has been expressed manually in the past, or recurs following minimal excision, i find traditional wide excision to be best. in these scenarios, it is extremely time-consuming and often impossible to remove the entire capsule using the minimal excision technique.