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Provider training and refinement of naloxone administration procedures are needed to improve treatment outcomes and reduce provider stigma. Social networking sites such as Twitter may have potential for offering psychoeducation to health care providers.

Background/Objective: The insufflator-exsufflator has been shown to be effective in assisting cough in individuals with spinal cord injury. However, many institutions do not use this device. The study was performed to assess use of the device and attitudes among health care providers. Methods: We developed a questionnaire with 4 categories of questions: knowledge of the device, type of facility, clinical practice with the device, and patient and provider satisfaction. The questionnaire was mailed to members of the American Paraplegia Society. Results: Eighty-six questionnaires (16%) were returned. The device was being used in 49% of the institutions. The device was most commonly used with a tracheostomy; use did not correlate with size or type of facility. Patient and provider satisfaction with the insufflator-exsufflator was high. Conclusions: The insufflator-exsufflator is used as a means of removal of secretions in approximately one half of institutions polled. Satisfaction with the device is high.

Purpose: Data suggest an increase in prescription opioid abuse in recent years. Young veterans represent a group with major risk factors for prescription opioid abuse. The objectives of this study are: (A) to determine the prevalence of chronic opioid use in young veterans over time; (B) to describe the prescribing patterns and monitoring of chronic opioid therapy in young veterans; and (C) to assess opioid management within Veterans Affairs Palo Alto Health Care System (VAPAHCS) with an emphasis on effectiveness and safety.Methods: This is a Veterans Affairs Research and Development (R&D) Committee and IRB-approved retrospective, single-center study of young veterans aged 18-30 years on chronic opioid therapy during the study years January 1, 2003, to October 1, 2008. A subset of the study population who were receiving long-acting opioids for a minimum of 6 months was included in the effectiveness and safety analyses. Data were obtained from the Veterans Integrated Service Network (VISN 21) data warehouse, outpatient prescription records, and from electronic chart review.Results: The prevalence of chronic opioid use in young veterans has increased from 3 percent in 2003 to 4.5 percent in 2007. Patients on average were exposed to two Zdifferent opioids and had three different opioid prescribers. Nearly 80 percent of the opioid prescriptions during the study were prescribed by primary care providers and less than 1 percent was from pain specialists. Only 31 percent of patients on chronic opioids had undergone urine drug testing and only 5 percent had signed opioid treatment agreements. No difference in median pain score was observed following initiation of long-acting opioid therapy, and 22 percent of patients (4 of 18) met the prespecified definition of being a responder to long-acting opioid therapy. Five patients (28 percent) on long-acting opioids experienced adverse drug reactions.Conclusion: The prevalence of chronic opioid use in young veterans has been on the rise in recent years. Young veterans receiving care at VAPAHCS have often had multiple opioid prescribers and have trialed multiple opioid analgesics. Many improvements in appropriate monitoring and management of these patients can be made, which may include providing more training to current staff, the development of an opioid refill clinic, and greater utilization of the pain management specialists. Further larger study is warranted to identify successful strategies for improving prescribing and monitoring of opioids as well as potential predictors of response to chronic long-acting opioid therapy.

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