Closer Look
To keep up with fentanyl, rule aims to adjust dosing for methadone treatment
Phill Magakoe/AFP via Getty Images
Here's another way fentanyl has aggravated the opioid crisis: Current guidelines for prescribing methadone to treat opioid addiction don't take into account the potency of the synthetic opioid that has overtaken the U.S. drug supply. It's so strong that patients who begin methadone treatment at a "standard" dose now experience severe withdrawal symptoms. New federal regulations are intended to make more explicit the flexibility clinicians can use, Neeraj Gandotra, chief medical officer of the Substance Abuse and Mental Health Services Administration, told STAT's Lev Facher.
Now opioid treatment providers need authorization to exceed the 30-milligram recommendation. The new rule would allow prescribers to go higher if they document their reasoning in the patient's record. Experts agree caution is needed with methadone, which is an opioid itself. Lev notes the proposed changes to dosage caps represent just a tiny sliver of a far broader debate about methadone access. Read more.
health tech
AI-based tool for medical note-taking add speed but subtracts human review
When your doctor enters the exam room where you've been waiting, it's not uncommon for a medical scribe to come in, too, to sum up the visit and save physician labor. Some hospitals enlist a scribe platform based on AI to do the job, with those medical notes vetted before completion. Yesterday Microsoft-owned Nuance Communications took that one step further, offering an early adopter program to some providers that bypasses the human reviewer in its current AI platform.
That means fully AI-generated notes are returned within minutes of a patient visit, eliminating the lag of human quality control. "We're getting much more aggressive," Peter Durlach, Nuance's chief strategy officer, told STAT. That approach and its accelerated release pose questions about the level of independent scrutiny applied to the product, STAT's Casey Ross and Brittany Trang report, especially because it's combined with the powerful but still experimental technology known as GPT-4. Read more.
Health inequities
Pulse oximeter inaccuracies in adults extend to kids
Numerous studies have shown pulse oximeters work less well in adults with darker skin, leading to erroneous readings that can overestimate the amount of oxygen in a person's blood and make them appear healthier than they really are. A new study in JAMA Pediatrics shows the same problems occur in children, STAT's Usha Lee McFarling reports.
The authors analyzed the electronic health records of nearly 800 patients at the Children's Hospital of Philadelphia, comparing pulse oximeter readings with blood oxygen readings taken within one minute and found hidden hypoxemia — low blood oxygen levels not detected by the fingertip devices — in 12% of Black children compared to 4% of white children. Such errors, an accompanying editorial said, were an example of unanticipated biases in medical devices that require "systematic real-world processes to identify and correct."
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