ItemFirst Do No Harm - The Indiana Providers Guide to the Safe, Effective Management of Chronic Non-Terminal Pain(State of Indiana, 2013) Bell-Sharp, Kim; Gregory, Eigner; Brooks, Tracy L.; Elliott, Alicia; Cragen, Debbie; Ersin, Ozlem H.; Croasdell, Lori; Fernandes, Taya; Duwve, Joan; Fielding, Stephen M.; Gentry, Mark E.; Greene, Marion S.; King, Timothy E.; Kelley, Kristen; Konchalski, Jan; Kuzma, Abigail; LaHood, Amy; MacKie, Palmer J.; McMahan, Deborah; Mowry, James B.; Park, Esther J.; Pontones, Pam; Ring, Barry S.; Robinson, Natalie; Roth, Daniel C.; Rumsey, Todd C.; Schreier, Eric M.; Stone, Cynthia L.; Straub, Tom; Welch, Peggy; Sybesma, J. Michelle; Symmes, Shelly; Whitworth, Michael; Vaught, Cynthia; Weitlauf, Sharon L.; Weaver, Tamara; Zachodni, Carla"First Do No Harm: The Indiana Healthcare Providers Guide to the Safe, Effective Management of Chronic Non-Terminal Pain" was developed by the Indiana Prescription Drug Abuse Prevention Task Force’s Education Committee under the leadership of Dr. Deborah McMahan. This provider toolkit, based on expert opinion and recognized standards of care, was developed over many months with the input of healthcare providers representing multiple specialties and all corners of the state. First Do No Harm provides options for the safe and responsible treatment of chronic pain, including prescriptions for opioids when indicated, with the ultimate goals of patient safety and functional improvement. It was developed as an interactive compendium to the new Medical Licensing Board rule addressing Opioid Prescribing for Chronic, Non-terminal Pain to give healthcare providers tools they can use to comply with the rule. ItemCommercial Insurance Coverage Decline Associated with Affordable Care Act: What's Next?(Ohio Valley Society of Plastic Surgeons, 2017-02-15) Fielding, Stephen M.; Jerkins, David; Johnson, R. MichaelBACKGROUND: A key feature of the Affordable Care Act was the establishment of insurance exchanges and subsidies to assist Americans in obtaining affordable commercial insurance. This study was undertaken to determine whether this effort has met its goal. METHODS: A review of all patients requiring surgery for maxillofacial trauma at a level 1 trauma center was undertaken for time periods before the Affordable Care Act was passed (2008 and 2009), while partially in effect (2012), and after the establishment exchanges and subsidies (2014). Insurance statuses were recorded and rates of commercial insurance coverage during each period were compared. RESULTS: A total of 1,123 patients were included. Of these, 511 were treated before passage of the Affordable Care Act, 288 were treated in 2012, and 324 were treated in 2014. Before passage, 50.5% of patients had commercial insurance. This number was virtually unchanged in 2012. However, after the insurance exchanges and subsidies were established, the percentage of patients with commercial insurance fell to 36.73% (p = 0.004). CONCLUSIONS: Surprisingly, the establishment of insurance exchanges and subsidies through the Affordable Care Act was associated with a decline in rates of commercial insurance coverage. Trends in reimbursement patterns will need to be followed if the law is repealed and replaced. ItemEffects of 12, 13 dibutyrate (PDBu) on resting and capsaicin-stimulated glutamate release in adult rat dorsal root neurons in culture(2003-07-31) Richard, Joyce; Richter, Judith; Agbor-Baiyee, WilliamThis investigation explored the role of PKC as an activator of VR1 through the use of capsaicin, a natural ligand for VR1, and the PKC activating phorbol ester 12,13 dibutyrate (PDBu). Direct effects of 30nM, 300nM, and 3000nM capsaicin and 0nM, 0.3nM, 1.0nM, 3.0nM, 10nM, and 30nM PDBu on glutamate release from adult rat dorsal root ganglia (DRGs) were examined. Based on those observations, the concentration of capsaicin causing the least glutamate release and the concentrations of PDBu that did not elicit significant glutamate release were selected to study effects of capsaicin on same cell type acutely sensitized with the selected concentrations of PDBu. It was found that glutamate released from combinations of 30nM capsaicin and 1.0nM PDBu (p<0.036) as well as 30nM capsaicin and 3.0nM PDBu (p<0.01) were statistically significant from the stimulation control—which was 30nM capsaicin alone.