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MIAMI--(business WIRE)--Unified TelData Inc., (UTDi) has introduced the successful implementation of a seven site, Avaya SIP based communique manager with Modular Messaging into the Treasure Coast Hospice MPLS community. With its newfound flexibility and performance, Treasure Coast Hospice hopes to be able to set the normal for different corporations within the hospice business.
After the acquisition of an extra hospice, Treasure Coast become coping with some significant becoming pains. Already an Avaya consumer, the addition of a 2d hospice onto the network became straining the previous environment. plenty of the time spent through IT was plugging holes in preference to providing an answer that might meet the wants of an increasing organization.
To create the top-rated atmosphere, Treasure Coast wanted to live with Avaya because the firm believed Avaya delivered better of Breed options. UTDi was introduced in to consult on the implementation. moreover its business skills, UTDi also brought Treasure Coast to a SIP provider solution that eventually has saved them thousands of bucks.
during the ingenious fee solutions provided through UTDi, Treasure Coast become able to subsidize 65% of the funding for its enlargement. consequently, hospice had the cash necessary to put in force a protracted-term plan that delivered an commercial enterprise strategy to communications.
through careful planning, problem identification and a detailed knowing of the culture, UTDi was in a position to design an Avaya answer that no longer handiest met the growing to be needs of Treasure Coast nowadays, but additionally provided the essential scalability to allow the business to proceed on its direction of growth. Treasure Coast might now focus on developing a far better adventure for its sufferers, knowing its network changed into sound.
“Treasure Coast Hospice had a comparatively clear imaginative and prescient of what we wanted to be able to accomplish from the onset, we just weren’t exactly bound how we were going to get there,” spoke of Jeff Potter, Director of IT for Treasure Coast Hospice.
Potter persisted, “because of our partnerships with UTDi, we've a equipment in place that caters to a extremely challenging atmosphere. Avaya items offered the technical talents we obligatory and UTDi showed us a way to put into effect the answer and maximize the merits for our enjoyable environment.”
“This turned into a challenging and moneymaking project. We were working with disparate methods but dedicated to developing the atmosphere Treasure Coast expected,” observed Jason Bergeron, options expert for UTDi.
“Streamlining the process to a flexible and scalable ambiance changed into the most reliable goal, but getting there could be backyard of their funds constraints,” mentioned Lyhn Haller, CEO of UTDi. “by introducing a SIP answer, deploying a brand new SIP based provider carrier and offering our new device for functions plan, Treasure Coast turned into in a position to get the better of Breed solutions they mandatory on a conceivable funds.”
Unified TelData, Inc. (UTDi) provides clever options for world-category communications to a broad latitude of purchasers globally together with AVMED, Liberty scientific, PRC, IBM SECU, United manner, Blue Coat, Lockheed Martin, U.S. Navy, 450 Congressional places of work nation-vast, Alameda County, and the metropolis and County of San Francisco. A full-provider solutions issuer with places of work nationwide, UTDi presents its client’s intelligently architected solutions in addition to deployment, on-website practicing, technical support, financing options, and upkeep classes. UTDi is a country wide Avaya Platinum company partner, ranking among the true 10 Avaya purchasers in the u.s.. be taught more at www.utdi.com.
SAN DIEGO, Nov. 21, 2006 -- Daycom systems, Inc. introduced nowadays that it has been named a Platinum BusinessPartner via Avaya Inc., a number one global issuer of communications networks and capabilities for organizations.
The Platinum certification, the maximum Avaya offers, is an industry-diagnosed designation that indicates Daycom has met a sequence of rigorous criteria to ensure advanced technical competency and to deliver premiere-in-type client provider and assist as measured by an independent survey organization.
Daycom sells Avaya company communications techniques, design, implementation, and ongoing protection capabilities nationwide to organizations like Cymer. Cymer is a riding drive at the back of the ever-smaller and extra powerful semiconductor chips found in nearly each electronic equipment, providing the mild sources utilized in manufacturing built-in circuits. Daycom offers the company with professional technical tips and Avaya contact center solutions, and works in tandem with Avaya to supply the safety services to offer protection to their know-how atmosphere. in keeping with Dave Almos, director of IT Operations, Cymer, "At Cymer, we are very selective about the relationships we kind, so when an extended-time period partner like Daycom presents us insights, we pay consideration."
"With the Avaya Platinum Certification, Daycom has been and may proceed to be one of the premier expertise providers in southern California and to our consumers across the nation," said Rick Day, the President and CEO of Daycom."The Daycom group labored very hard to comprehensive the certification requirements, which might be very stringent. most effective a small, select group of resellers have attained it."
The Avaya BusinessPartner certification program has three degrees of big difference - Silver, Gold and Platinum. For Daycom to obtain the Platinum score, the company had to meet selected client service and performance standards thatincluded:
o consumer delight ratings. Daycom acquired a rating of89 percent in an impartial survey taken from a broadbase of shoppers.
o certified employees who have demonstrated talents insales, design and implementation. Avaya has one in every of theindustry's main courses to certify income andtechnical professionals in IP telephony, unifiedcommunications, contact facilities, and features. AvayaProfessional Certification is a modern application withAssociate, professional, and skilled stage credentials. Eachlevel of Avaya Certification requires passing two or moreexams within the required application enviornment of knowledge.
Daycom has continuously received good honors from Avaya, including a three superstar service certification, degree three carrier assessment certification, and individual certifications in IP Telephony Implementation, IP Telephony protection, Messaging and phone middle certification, in addition to certifications with Microsoft, extreme and Juniper networking infrastructure.
"Avaya's method with its BusinessPartner application is to make sure that valued clientele have a constant, high-quality experience, whether they buy direct from Avaya or indirect through a associate like Daycom," spoke of Ken Archer, vice president, North the united states Channels, Avaya. "Daycom's dedication to certification, which requires continuous construction of assist capabilities and constant beginning of sophisticated customer service, is a tremendous price each to Avaya and its valued clientele."
About Daycom methods
Daycom methods, a provider of business communications solutions given that 1992, is headquartered in San Diego and has presence across the U.S.. Daycom provides know-how solutions together with voice and facts networks, IP Telephony techniques, CRM and phone middle purposes, security and instant solutions. Daycom is an authorized companion of Avaya, satisfactory, Spectralink, Packeteer, and many different main vendors in built-in IP community expertise. Daycom also presents a full portfolio of services - including network Planning, Design, assignment administration, Implementation, aid Desk, maintenance, and far off management functions. website: www.daycom.com
Avaya Inc. designs, builds and manages communications networks for more than 1 million groups global, including over 90 % of the FORTUNE 500(R). focused on groups gigantic to small, Avaya is a global chief in at ease and authentic internet Protocol (IP) telephony methods and communications utility applications and features. using the convergence of voice and statistics communications with enterprise applications - and wonderful with the aid of finished worldwide services - Avaya helps purchasers leverage existing and new networks to achieve sophisticated enterprise outcomes. For more suggestions visit the Avaya website: www.avaya.com.
Carolina Bump, Daycom858email@example.com
Deb Kline, Avaya908firstname.lastname@example.org Thomas industry replace
DALLAS, may additionally 2, 2017 /PRNewswire/ -- BT today announced it has achieved the acquisition of IP trade, a issuer of unified communications and collaboration options for trading floor environments and command-and-control dispatch centres, following approval by using the united kingdom's competitors & Markets Authority (CMA).
As announced on February 1, the acquisition of IP trade will enhance BT valued clientele' capacity to unify buying and selling and handle room communications:
further announcements will observe as we comprehensive the mixing of IP trade into BT.
For further informationEnquiries about this news release should be made to the BT community Newsroom on its 24-hour quantity: 020 7356 5369. From outside the united kingdom dial + 44 20 7356 5369. All news releases can also be accessed at our internet web page: http://www.btplc.com/news
BT's intention is to make use of the energy of communications to make a better world. It is among the world's leading suppliers of communications functions and solutions, serving consumers in one hundred eighty countries. Its principal activities encompass the supply of networked IT capabilities globally; native, national and international telecommunications capabilities to its customers to be used at home, at work and on the movement; broadband, tv and internet products and capabilities; and converged fixed-cell items and capabilities. BT carries six consumer-facing strains of enterprise: customer, EE, enterprise and Public Sector, international capabilities, Wholesale and Ventures, and Openreach.
For the 12 months ended 31 March 20161, BT community's said earnings changed into £19,012m with mentioned profit earlier than taxation of £2,907m.
British Telecommunications plc (BT) is a unconditionally-owned subsidiary of BT community plc and encompasses essentially all agencies and belongings of the BT group. BT group plc is listed on stock exchanges in London and new york.
1The outcomes for the length had been revised to replicate the result of the investigation into our Italian business. aspect of which is decided out in our third quarter results announcement posted on 27 January 2017. This financial advice is unaudited.
For extra guidance, consult with www.btplc.com
About IP trade
established in 2005, IP exchange is a pioneer in the design of superior SIP (Session Initiation Protocol) communications and for ultra-legit, high-capacity, precise-time unified communications and collaboration solutions for buying and selling ground environments and command-and-handle dispatch centres.
IP change presents high-capability communications for monetary buying and selling gurus in agencies of all sizes. IP change offers inventive, scalable unified trading solutions that merge voice, statistics, and streaming media into a single platform for expanded efficiency, profitability and client carrier.
IP change also presents robust, customisable communications options for command centre authorities to maximise situational consciousness and collaboration.
IP trade deploys licensed and tested end-to-end solutions that combine with leading unified communications systems from Alcatel, Avaya and Cisco and with main voice recording solutions.
source BTrelated hyperlinks
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Immigration and diversity are fundamental characteristics of the American experience, but all too often history is taught from the point of view of the white majority. This can give rise to racism, harmful stereotypes and alienation of students of color in their own classrooms, according to research from organizations like the National Education Association.
Senator Greg Taylor (D-Indianapolis) laments the fact that he didn’t learn much about contributions by Native Americans, African Americans or other races until he was in law school at Indiana University. Living in a multicultural home and raising biracial children, he began to contemplate how to teach his children about the authentic, complete history of this country – and how to bring together people of diverse backgrounds and cultures.
Now, as a lawmaker in the Indiana Senate, he hopes these gaps in education are rectified in part by Public Law 231, sponsored by Taylor, passed during the 2017 legislative session and signed by Governor Eric Holcomb.
“There is a void in the system, so I drafted a bill for students to learn about contributions by all races,” Taylor said.
The purpose, he explains, is to learn about history so we don’t repeat it. But he also seeks to both empower racial minorities with cultural pride and engender acceptance and understanding among all.
I have a dream …
The country’s first ethnic studies department was created at the University of California, Berkeley in 1969, which also developed the first ethnic studies Ph.D. program in the 1980s. But only Florida and one county in California have similar programs at the K-12 level, Taylor points out, and in Florida it covers only Hispanic culture.
The National Council for the Social Studies curriculum guidelines stress that “the total school environment should reflect commitment to education about ethnic diversity, including pervasive treatment of this subject matter in standard courses, unbiased curriculum materials and teachers who are educated to understand and appreciate cultural pluralism.”
Education about the achievements of ethnic groups can enhance the self-image of students who identify with them. Studies by the National Education Association’s research review Academic and Social Value of Ethnic Studies indicate this leads to self-confidence, a feeling of belonging and higher academic achievement because students typically learn more when they feel accepted and valued. A new study by the Stanford Graduate School of Education indicates that a high school ethnic studies course pilot study boosted attendance and academic performance of at-risk students.
Nationally, non-white students constituted a majority of America’s public school students for the first time in 2014. Notably, Indiana has a significant Native American population. Census reports indicate that 18,462 Indiana residents reported Native American as their only race in 2010. Native Americans comprised 0.3 percent of the state’s population that year, with the population exceeding 0.5 percent in Miami and Wabash counties.
“This course opens up a dialogue about all races and ethnicities – and real history,” Taylor says.
How a bill became law
Taylor’s proposal began as Senate Bill 337 to amend the Indiana Code regarding education. Supported by the Indiana State Teacher’s Association and signed into law by Governor Eric Holcomb on July 1, it requires all schools within the state to offer at least one semester of study of ethnic and racial groups to high school students.
Before SB 337, a similar bill passed the Senate in 2016, making ethnic studies mandatory not just for schools to offer, but as required coursework for all students. “The Chairman for Education in the House doesn’t like to make things mandatory,” Taylor explains, “so he wouldn’t hear the bill.”
There was also a prior attempt by Sen. Taylor in 2014. He drafted and submitted SB 47, which would have added the “Study of Black History” to the curriculum of elementary and high school social studies classes. That bill failed.
That’s when Taylor’s legislative assistant introduced him to Garry Holland, interim education chair of the NAACP, who “started making contact with Sen. Taylor to introduce a less specific course known as an ethnic studies course,” Holland said. (EDITOR'S NOTE: Holland's role has been clarified in an edit.)
Holland had organized a team of African American, Native American, Latino and Asian cultural education experts from the faculty at Indiana University-Purdue University Indianapolis for input, but the proposal “didn’t go anywhere for a few years,” he said.
In 2017, Taylor and co-author Senator Dennis Kruse (R-Auburn), with Holland’s assistance, made the course an elective. As an elective, it is not part of the Core 40, except as one of the number of possible electives needed to graduate. Once they decided to pursue it as an elective course, it became more palatable to the GOP education leaders in the General Assembly and at DOE.
Specifically, the law requires that after July 1, 2017, all school corporations, charter schools and accredited nonpublic schools shall offer the study of ethnic studies and racial groups as a semester elective course in its high school curriculum at least once every school year.
A mandatory elective
The problem is that ethnic studies is already in the elective course study in the state standards, Taylor acknowledges. In fact, according to Michael Brown, Director of Legislative Affairs with the Indiana Department of Education, it is acceptable for schools to use the pre-existing course to meet their legal obligation.
The difference is that now it’s mandatory for schools to offer it. “Not many schools were offering it. Only one jurisdiction offered it,” Taylor states. “This makes it mandatory for all schools to offer it.”
All Souls Unitarian Church on Indy’s Northeastside will host a one-day seminar July 22 exploring the concept of whiteness in current American society.
The bill initially decreed that ethnic studies be offered as a regular class only if nine or more students signed up. “Schools often terminate courses because of a lack of participation,” Brown explains. “For example, it’s not cost effective to pay a teacher to teach three students that sign up for an ancient civilization course. So, I suppose that schools could cancel the class due to not enough students signing up for the course.”
But if a law requires that a class be offered, and if some students sign up for it, is it a violation of that law to cancel it? Sidestepping questions about compliance with the law if low turnout resulted in canceling the class under the new law, Taylor says that plan “didn’t work; some schools still wanted to provide it.”
Thus, the legislature created an amendment: if not enough sign up for the class, it can be offered online as a course access program administered by the DOE. As Brown says, “if an organization or school wishes to teach racial and ethnic studies online, the school (as long as the organization/school is on DOE’s approved catalog) would have to let the student take the course.” However, he indicates that the DOE is “still working out the details of the course access program and its parameters since this law passed last session.”
As Taylor acknowledges, the “timing was off” to commence immediately, so the new program will be implemented in the spring. “When we’re in session, kids are already signing up for classes. There wasn’t time to start this in the fall.”
Postponing the requirement until spring allows teachers time to determine exactly what they plan to teach and write a curriculum.
Or not. According to Brown, they can simply rely on Course #1516, Ethnic Studies. “I think the law is pretty flexible on the courses used, especially with the course access option the law allows.”
It’s up to the teachers to set their curriculum for every course, regardless of whether the course is required for graduation or not, according to Brown, who adds that the DOE does not create standards for courses that are not required for graduation. “Teachers are charged with creating their curriculum, not the state. It’s up to the district or the teachers to determine what ethnicities and races they are going to teach. The DOE does not approve curriculum; that’s a local decision.”
He believes the author of the bill did not want a defined set of standards, in part because each area of the state may want to concentrate on different ethnic and racial subject areas. For example, “Fort Wayne has a large Burmese population, so teachers in Fort Wayne may want to write a majority of their curriculum around this population so students have a better understanding of Burmese culture,” he writes in an email.
School districts know the ethnic breakdown in their area, Taylor says, even if students don’t self-identify. “Some [Native Americans] never had a chance to identify with their heritage.”
“To assist teachers, the DOE provides resources to help them write their curriculum. Also, we have a dedicated social studies specialist to help troubleshoot questions that teachers may have and to update our resources.”
Bruce Blomberg, a former social studies teacher, is the DOE’s social studies specialist. As such, he provides teachers and schools with resources. Brown explains that assistance includes free resources for teachers to establish their curriculum, as well as links and ideas as to how teachers can take advantage of free or reduced admission to museums or historical places. “For example, if a district has a high concentration of Cambodian families and our resources are lacking for this demographic, I know that our specialist would provide resources to teachers so they can teach their students about Cambodian culture.”
If Trump's proposed budget eliminating support for the arts, humanities and public broadcasting ever becomes a reality, Indianapolis would be affected in ways you may not have considered.
In addition, he says, many school corporations “bring teachers together to facilitate collaboration so teachers can create and drive the curriculum that best fits the needs of the students they serve.”
Therefore, it’s likely that teachers will design and teach curricula differently, depending on the ethnic composition of the class or school. This creates the potential that studies of some ethnicities will never be offered by certain schools, which begs the question: who is the target audience of these classes – the minority being studied or the general population who, it is hoped, will gain an appreciation of other cultures?
The goals are different for different audiences. The National Education Association references three studies and research on five curricula that determined that ethnic studies curricula designed primarily for students who are members of the group under study result in high levels of student engagement. A positive impact on student achievement and attitudes toward learning is another result of this curricula. Ethnic studies curricula designed for diverse student groups that include white students, however, tend to focus more on influencing their understanding of, and attitudes about, race and/or people who differ from themselves.
Taylor wants to reach both audiences and achieve both goals, but tailoring the message for two different audiences requires maintaining a sensitive balance in dealing with cultural differences while targeting common misconceptions and fallacies.
Indiana Native American Indian Affairs Commission executive director Kerry Steiner says the INAIAC trusts “Indiana teachers to deliver a quality education to our students.” However, textbooks and lesson plans are littered with misinformation and myths at all levels of education. Textbooks aren’t all that’s wrong with racial studies education. Learning facts directly from the source is important. The danger of not vetting people presenting themselves as Native American is that misinformation can then be passed along, perpetuating myths and stereotypes – the very things the new law seeks to remedy.
“Ensuring that only vetted Native Americans speak to Indiana students is important because it means gaining knowledge from a qualified source,” Steiner elaborates. “Let’s say, for example, that you’re interested in learning more about the solar system. Your next-door neighbor has a telescope and has been gazing at the stars for years. You would probably learn something by talking with your neighbor, but if you want accurate, in-depth information from a qualified source, you’d probably want to talk with an astronomer as an expert in this field. We see similar situations in Indiana. There are a lot of people who have immersed themselves in the Native American community and who are knowledgeable, but it’s not their history they are talking about when they visit a classroom. The story belongs to the Native people — the experts when it comes to conveying information about their tribe and culture.”
Indiana Department of Education and INAIAC are already working together to make resources available to educators.
“The INAIAC wants to help teachers ensure that their students are receiving accurate information from qualified Native American Indians, so we are asking that guest speakers who come to the classroom to talk about Native American culture are vetted through our office in advance,” Steiner says, adding that a qualified speaker is someone who has been approved by their tribe to talk about their history and culture.
In a perfect world, education about ethnic diversity would permeate the social studies curriculum in every grade of elementary and secondary schools. However, fear of offending students led to elevating ethnic studies to a high school-level class instead of a course for middle school students, which is what Sen. Taylor originally wanted.
“I was told it would be too shocking for kids,” he reveals, pointing out that a class about the Holocaust is mandatory for Indiana students. “We don’t worry about Holocaust being offensive; it’s required here, even though it didn’t happen here.”
Waiting until students are in high school may not be the right time to introduce ethnic studies. According to the National Education Association’s research review, research indicates that the overwhelming dominance of Euro-American perspectives leads many students of color to disengage from academic learning. High school students of color cite it as a factor in their disinterest in studies and even middle school students expressed a dissatisfaction with “learning about white people all the time,” according to the NEA’s research review.
Taylor believes ethnic studies are more important now than ever and that it benefits the community. He cites police shootings and the “Trump effect” that has brought racism out of the shadows. “People worry about how to overcome it. We need to talk about it. If we can [implement this], there’s nothing we can’t do,” he says, noting that teachers in Indiana receive cultural competency training to help them teach sensitive material.
“It will take the school board and administration to take this seriously if it’s to succeed,” Taylor says.
The indigenous people are stepping forward to save the planet — and to save us from ourselves.
As Sen. Taylor explains, the legislature passed the bill, and it is now law, but it’s up to the DOE to implement it. He doesn’t know how the DOE will evaluate the success of the program. “The administration has to adopt a policy.”
The DOE is not an investigative agency, so it does not provide oversight, Brown explains. “The only check or approval will come in the course access area, which still is a work in progress. It’s up to the teachers to evaluate the effectiveness of the courses by testing students. Teachers would be the ultimate evaluators of this course.”
However, Indiana’s standards are reviewed periodically. The next social studies standards review will take place in 2020. Brown points out that when he sat down with the social studies specialist Bruce Blomberg and Sen. Taylor, they asked him to gather members of different ethnic and racial communities so they could be members of the committee that will review Indiana’s standards.
One unscientific and long-term method of determining the value of the classes could come from looking at academic achievement. A K-12 study by Stanford University in January 2016 consulted during the drafting of this bill indicates that when students of color with below 2.0 grades are provided with culturally-relevant studies, their overall academic performance improves markedly.
“If you put cultural competency into the classroom, it changes [the students’] analytical reasoning,” Taylor concludes. “It’s about student achievement, not just learning about other cultures. You will see school districts with an uptick in academic performance because people will get along through better understanding.”
That kind of evaluation again brings up the question of who is the intended audience, but it also raises another: will white students take the class?
Sen. Taylor expresses some concern that it will offend a parent who might pressure a legislator to get rid of the program. “This is a conservative state; that lends it to more opposition.”
Challenges aside, Sen. Taylor says Indiana has “started down the path” – a bit surprising for a very conservative state legislature. It was a tough bill to pass, he confesses, but he hopes for change and says he expects to be pleasantly surprised by the results.
He considers the program “very important” and says it “moves Indiana forward.” As Sen. Taylor says, “If we do it right, it could cause people to embrace other cultures. Division benefits no one.”Community journalism can only survive with community support. If local, independent journalism matters to you, please consider supporting NUVO with a paid membership. In 2019, 100 percent of membership dollars go towards our editorial budget/paying writers.
DENVER — A multidisciplinary approach that centers on individual patient needs and uses continuous peripheral nerve blocks as a primary analgesic "drastically" reduces opioid prescriptions in patients undergoing elective total joint arthroplasty (TJA), new research shows.
"It must be patient centered, and there must be cooperation between acute pain medicine and orthopedic surgery," lead author André P. Boezaart, MD, PhD, professor of anesthesiology and orthopedic surgery at the University of Florida College of Medicine, Gainesville, told Medscape Medical News.
"We set up our pain management strategy 5 years ago. We now have close to 3000 procedures, and our data keep improving. This is why we wanted to share our results," Boezaart said.
In large part, the success of the approach hinges on very effective analgesia that is achieved with continuous peripheral nerve blocks "that actually work," he said.
"Continuous means we leave the block in for 3 to 5 days, and we send the patients home with these catheters. The approach was unpopular among surgeons because of secondary block failure, where the block works great on day 1, the patient goes home, and then gets readmitted for pain. And that really spoils the whole thing. But we have solved that problem and in our hands, these blocks work," he said.
The findings were presented here at the American Academy of Pain Medicine (AAPM) 2019 Annual Meeting.Novel Nerve Block
Boezaart noted that secondary block failure occurs in about 30% of cases. Taking matters into his own hands, he developed a continuous peripheral nerve block that does not fail.
"This is because we put the catheter in the correct space. It's a space deep to the membrane around the nerve. If you are not deep to that membrane, the block will not work. Outside that membrane, the block will work the first day because you are using a high concentration of lidocaine, but the next day when you use a small concentration the block won't work and we've got secondary block failure."
He noted that his center does a large number of joint replacements and a 30% rate of nerve block failure is "not an option."
For the study, the investigators reviewed prescribing practices and outcomes after implementing the Patient & Family Centered Care quality improvement initiative to minimize postoperative opioid use at their center in early 2014.
The initiative was developed by arthroplasty surgeons and acute pain specialists for patients undergoing primary hip and knee replacement.
"The extent of the opioid crisis is well-known, and orthopedic surgeons are the third highest opioid prescribers. Also, 15% of opioid-naïve patients undergoing TJA will become chronic opioid users postoperatively," Boezaart said.
The authors stratified patients according to potential risk factors for developing opioid use disorder. They based their pain medication prescribing decisions on four patient categories. These included opioid-free, narcotic-naïve, standard use, and chronic use patients.
Prescribed pain medications included acetaminophen, NSAIDs, tramadol, and hydrocodone. Oxycodone was only used for patients who were chronic opioid users before surgery. These prescriptions were limited to 56 tablets.
Chronic use patients were also required to develop a prescription plan with their prescribing pain management physician, Boezaart said.Better Outcomes, Cost Savings
The review included 2793 patients undergoing primary TJA from January 2014 to January 2018.
During that time, the number of opioid pills prescribed per surgeon for inpatients decreased by 45.8% and for outpatients by 53.2%.
In addition, hospital length of stay decreased from 3.2 to 1.5 days, and the readmission rate for chest pain, urinary tract infections, pneumonia, and other postoperative diagnoses dropped from 7.9% to 5.6%. There were zero readmissions for pain.
The need to discharge patients to a skilled nursing facility also dropped dramatically.
In contrast, before the comprehensive pain strategy was in place, 40% of patients were discharged to such a facility. Following the initiative, this rate dropped to 10%, with the remainder of patients discharged home. "This represented a huge savings in healthcare costs," Boezaart noted.
"Our physician-led strategy has been highly effective and has resulted in reduction in total opioid use, while maintaining patient satisfaction and improving quality metrics," Boezaart said.
"With the stimulating catheters we have a 100% success rate. It is the core analgesic component of our pain team management strategy. It cuts off the message of pain from the knee to the brain and it keeps it cut off for days. We are now able to send 20% of patients home on the same day as surgery. They go home with catheters and no opiates."
However, it takes a considerable amount of skill to place the catheter correctly, Boezaart said. To this end, he and his colleagues have launched a website (www.raeducation.com) that offers courses to learn the technique.Thwarting the Path to Addiction
Commenting on the findings for Medscape Medical News, Robert B. Bolash, MD, Cleveland Clinic, Ohio, said previous research has shown that up to 75% of patients who develop heroin use disorder begin their path to addiction with a prescribed opioid.
"Elucidating effective nonopioid pain management strategies, as was shown in this presentation by Andre Boezaart et al, is one approach which has shown success in providing durable pain relief after joint arthroplasty while decreasing the number of prescribed opioids," Bolash said.
The findings show that employing a peripheral nerve block and proactively stratifying patients based on their individualized risk factors for developing opioid use disorder resulted in improvement of important quality metrics critical of both patient satisfaction and healthcare cost containment, he added.
"I applaud the authors in choosing the continuous femoral nerve block over a more advanced technique to manage lower extremity pain. Femoral nerve blocks have a record of long-standing safety and are approachable to perform by the nearly all regional anesthesiologists," said Bolash.
By roughly halving the number of prescribed opioids in both groups, the authors didn't simply show an incremental decrease in prescribed analgesics, but a drastic reduction. At the same time, patients had improved satisfaction and shorter lengths of stay — two critical metrics that are increasingly important in contemporary healthcare systems, he added.
"With the growth and ubiquity of joint arthroplasty procedures being performed across the globe, we should carefully consider adopting some or all of the techniques employed by Boezaart et al in the design of each of our institutions' joint arthroplasty care paths."
Boezaart receives royalty payments from TeleFlex for the invention of the stimulating and nonstimulating continuous nerve block catheter (StimuCath™, UltraCath™, FlexBlock™) and various publishing companies for sales on textbooks. Bolash reports financial relationships with Abbott/St Jude, Jazz Pharmaceuticals, and Medtronic Inc.
American Academy of Pain Medicine (AAPM) 2019 Annual Meeting: Abstract #258. Presented March 08, 2019.
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