A statewide prescription monitoring program affects emergency department prescribing behaviors.

STUDY OBJECTIVE: Ohio recently instituted an online prescription monitoring program, the Ohio Automated Rx Reporting System (OARRS), to monitor controlled substance prescriptions within Ohio. This study is undertaken to identify the influence of OARRS data on clinical management of emergency department (ED) patients with painful conditions. METHODS: This prospective quasiexperimental study was conducted at the University of Toledo Medical Center Emergency Department during June to July 2008. Eligible participants included ED patients with painful conditions. Patients with acute injuries were excluded. After clinical evaluation, and again after presentation of OARRS data, providers answered a set of questions about anticipated pain prescription for the patient. Outcome measures included changes in opioid prescription and other potential factors that influenced opioid prescription. RESULTS: Among 179 participants, OARRS data revealed high numbers of narcotics prescriptions filled in the most recent 12 months (median 7; range 0 to 128). Numerous providers prescribed narcotics for patients (median 3 per patient; range 0 to 40). Patients had filled narcotics prescriptions at different pharmacies (mean [SD] 3.5 [4.4]). Eighteen providers are represented in the study. Four providers treated 63% (N=114) of the patients in the study. After review of the OARRS data, providers changed the clinical management in 41% (N=74) of cases. In cases of altered management, the majority (61%; N=45) resulted in fewer or no opioid medications prescribed than originally planned, whereas 39% (N=29) resulted in more opioid medication than previously planned. CONCLUSION: The use of data from a statewide narcotic registry frequently altered prescribing behavior for management of ED patients with complaints of nontraumatic pain.

Fluconazole as a prophylactic measure for tinea gladiatorum in high school wrestlers.

OBJECTIVE: To evaluate the use of prophylactic oral fluconazole in reducing the incidence of tinea gladiatorum in high school wrestlers. DESIGN: A prospective longitudinal study was conducted on high school wrestlers in northwest Ohio between 1997 and 2007. SETTING: Two northwest Ohio high school wrestling teams. PARTICIPANTS: High school wrestlers (373). INTERVENTIONS: Prophylactic fluconazole at a daily oral dosage of 100 mg for a 3-day regimen prior to the onset of the competitive interscholastic wrestling season and 6 weeks into the wrestling season. Guardians of participants signed consent forms outlining the risks associated with fluconazole prior to being enrolled into the study. MAIN OUTCOME MEASURES: Incidence of tinea gladiatorum in participants. RESULTS: Over the course of this 10-year study, out of 373 participants using prophylactic fluconazole, the incidence rate of tinea gladiatorum dropped from 67.4% to 3.5%. It should be noted that more than 50% of these infections occurred within the initial year of this study when the second administration of fluconazole was given at week 8 instead of week 6. No adverse effects were reported over the 10-year study period. CONCLUSIONS: The twice-per-season regimen of 100 mg daily for 3 days was highly effective in dramatically reducing the incidence of these skin lesions. The success of our study is 2-fold: First, fluconazole provided prophylaxis. Second, the overall incidence of fungal disease throughout the entire wrestling team was markedly decreased because most of the wrestlers participated in this study, significantly reducing exposure to these lesions through wrestling practice. No adverse effects in the use of fluconazole over this 10-year study period were reported.

Hemoglobin Bassett produces low pulse oximeter and co-oximeter readings.

Variant hemoglobins can have altered oxygen affinity and can produce changes in oximeter readings. We present a case of hemoglobin Bassett, a possible cause of low pulse oximeter and co-oximeter readings in a 63-year-old woman.