Multimodal Local Opioid Prescribing Intervention Outcomes in Chronic Noncancer Pain Management.

BACKGROUND: Opioid misuse in the United States has made it challenging for physicians to treat chronic noncancer pain (CNCP). We implemented an educational program aimed at promoting safe opioid prescribing practices in hopes of increasing the level of appropriateness associated with prescribing opioids for CNCP. METHODS: We conducted a quality-improvement study with a retrospective chart review of adult patients who were prescribed opioids for CNCP for at least 90 consecutive days at 2 academic primary care clinics. Patients were reviewed at baseline (July 2014-May 2015) and after initial interventions (January 2016-June 2016; ie, following multimodal educational activities on appropriate opioid prescription implemented from June 2015-December 2015). An opioid appropriateness score was calculated based on documentation of 9 items. Categorical variables were analyzed with Fisher exact tests and continuous variables by 2-sample t tests and regression analysis. Binary logistic regression was used for multivariable modeling. Mann-Whitney test was used to compare appropriateness scores before and after intervention. RESULTS: A total of 177 and 96 patients were evaluated at baseline and postintervention, respectively. Patient demographic characteristics were not statistically different. Overall, postintervention level of appropriateness was significantly different from preintervention (P < .0001), with means increasing from 5.54 preintervention to 6.29 postintervention. Both clinics had significant improvement from baseline (both P values <.003). CONCLUSIONS: Clinician education on best practices while treating CNCP is associated with an increase in the level of opioid use appropriateness.

Intravenous bevacizumab for complications of hereditary hemorrhagic telangiectasia: a review of the literature.

BACKGROUND: Hereditary hemorrhagic telangiectasia (HHT) is a multisystem disease that is marked by mutations regulating vasculature formation. Epistaxis is the most commonly reported symptom, but gastrointestinal bleeding, anemia, hepatic issues, and pulmonary disease are also common. There is a growing body of evidence in the literature concerning using the monoclonal antibody against vascular endothelial growth factor (VEGF), bevacizumab, in patients with HHT. This treatment is gaining support for managing HHT because it directly inhibits the VEGF proteins that can be elevated as a result of the HHT mutations. We reviewed the current literature on the outcomes from intravenous bevacizumab treatment for HHT with a focus on epistaxis outcomes. METHODS: A systematic review of the literature was performed using Ovid MEDLINE, Scopus, and Cochrane databases. English citations, both national and international, were reviewed and filtered for relevance. RESULTS: Eighteen studies were included in this review. The majority of citations were case reports. All studies reported improvements. Specifically, 14 reported improvements in epistaxis, and 11 reported hemoglobin improvement following intravenous (IV) bevacizumab. Lack of uniformity in data presentation prevented a meta-analysis. CONCLUSION: This is the first systematic review analyzing the data involving HHT patients treated with bevacizumab. The results show that patients treated with bevacizumab have global improvements as well as specific improvements in hemoglobin levels. Although all of the studies reported improvements, there are several limitations, including inconsistencies in outcome reporting. A large, randomized, controlled study is needed to further investigate hemorrhage and epistaxis outcomes in HHT patients treated with intravenous bevacizumab.