Advertisement
Substance Use in Anesthesiology Residents

Substance Use in Anesthesiology Residents

Substance use disorders are a serious public health issue, and physicians are not immune to these problems. “Anesthesiologists have long been considered at risk for substance use disorders because of their access to potent drugs, such as opioids,” explains David O. Warner, MD. Few studies, however, have explored the epidemiology of these disorders in physicians in general and anesthesiologists in particular. Current estimates have been based on surveys and reports from clinicians as well as physician health programs, but these data have limitations. “The long-term outcomes of substance use disorders in physicians are not known,” says Dr. Warner. “Gathering more data on substance use disorders can help educate us about preventing and managing these problems.” Compelling New Data on Outcomes of Substance Use In a retrospective study published in JAMA, Dr. Warner and colleagues described the incidence and outcomes of substance use disorders among anesthesiology residents in the United States who entered training between 1975 and 2009. The study included 44,612 residents who contributed 177,848 resident-years for analysis. “One important goal was to inform residency program directors and others about the long-term outcomes for anesthesiology residents who experience substance use disorders. We also wanted to better inform both individual treatment decisions and overall policies,” Dr. Warner says. According to the results, the incidence of substance use disorders increased over the study period, and relapse rates did not appear to improve. Overall, 0.86% of anesthesiology residents entering primary training from 1975 to 2009 had evidence of substance use disorders during their training. Of the residents involved in the study, 384 experienced substance use disorders during training, with an overall incidence...
Guidelines Update: Preventive Treatments for Migraine

Guidelines Update: Preventive Treatments for Migraine

About 38% of people who suffer from migraine could benefit from preventive treatments, but less than one-third currently uses them. Some analyses have shown that migraine attacks can be reduced by more than half with preventive therapies. In 2000, the American Academy of Neurology (AAN) published guidelines for migraine prevention. In the April 24, 2012 issue of Neurology, the AAN and the American Headache Society issued updated guidelines to account for new evidence. One set of guidelines was developed specifically for prescription products, while another was created for OTC drugs and complementary therapies. In each guideline, the safety and efficacy of pharmacologic therapies for migraine prevention was addressed. The reviews addressed the strength of evidence backing a given drug’s superiority relative to placebo. Prescription Drugs for Migraine Among prescription medications, several β-blockers (metoprolol, propranolol, and timolol) and seizure drugs (divalproex sodium, sodium valproate, and topiramate) established “proven efficacy” for migraine prevention based on clinical research. One selective serotonin receptor agonist (frovatriptan) was also proven effective. It’s recommended that clinicians consider offering these medications to migraineurs to reduce the frequency and severity of attacks.             Topiramate was elevated to a Level A recommendation (indicating “proven efficacy”) on the strength of five randomized trials. Other drugs that had previously been used for migraine prevention were downgraded from higher recommendations in 2000 because the current evidence failed to clearly support their efficacy. OTCs & Complimentary Therapies for Migraine Petasites, also known as butterbur, were shown to be effective in preventing migraine. Several NSAIDs were found to be “probably effective,” including fenoprofen, ibuprofen, ketoprofen, naproxen and naproxen sodium,...
[ HIDE/SHOW ]