Nearly a quarter of young patients prescribed opioids while being treated for sarcoma continue to use opioids after treatment is completed according to findings published in CANCER, highlighting the need for safe deprescribing.
Individuals with sarcoma, a type of cancer in the bones or soft tissues, often develop damaged and fractured bones and undergo major surgical operations, and physicians may prescribe opioids for pain management. It was not clear whether doing so raises the risk for opioid misuse and overdose in these young patients.
Melissa Beauchemin, PhD, RN, CPNP-PC, CPON, of Columbia University School of Nursing, and her colleagues sought to determine the rate of new persistent opioid use among adolescents and young adults treated for sarcoma. Persistent opioid use was defined as at least two opioid prescriptions in the 12 months after treatment was completed.
The team drew from a large insurance claims database to analyse information on patients aged 10–26 years old who had not received prior opioids and who were diagnosed with sarcoma between 2008 and 2016.
Among the 938 patients in the analysis, 64% received opioid prescriptions during treatment. After completing cancer therapy, 14% of patients overall and 23% of those who used opioids during treatment continued to use opioids and met the criteria for new persistent use. Being covered by Medicaid versus commercial insurance, having bone tumours versus soft tissue tumours, and receiving concurrent lorazepam (often prescribe to treat anxiety and sleeping problems) were associated with persistent opioid use.
“Adolescents and young adults are a vulnerable population because they have benefitted less than younger and older cancer patients from recent advances. These results highlight the need to monitor young patients with sarcoma for posttreatment opioid use, given the potential negative impacts of long-term opioid use, including misuse and overdose,” said Dr Beauchemin. “Age- and developmentally appropriate strategies to effectively manage pain while minimising opioid exposure are urgently needed.”
Dr Beauchemin stressed that for young people needing opioids for effective pain management, early and safe discontinuation of opioids should be prioritised. “Further, there is a critical need for clinical practice guidelines to support clinical decision making to safely and effectively manage pain specifically for adolescents and young adults with cancer,” she said.
Empagliflozin, normally used to reduce blood sugar levels in adults with Type 2 diabetes, may also decrease blood vessel dysfunction associated with ageing such as arteriosclerosis, according to a new study published in the journal GeroScience.
First, the researchers studied the role ageing plays in human blood vessel function and stiffness. Then they evaluated how treatment with the sodium glucose co-transporter 2 (SGLT2) inhibitor empagliflozin improved blood vessel function and reduced arterial stiffness in aged male mice.
“Cardiovascular disease is the main cause of death in older adults in the US,” explained Camila Manrique-Acevedo, MD, associate professor of medicine. “Weight loss, physical activity, antihypertensive therapy and lipid-lowering drugs have shown variable effectiveness at improving blood vessel function and reducing arterial stiffness. But additional approaches are needed to improve vascular health in older adults.”
The study first compared blood vessel function and stiffness in 18 healthy human patients, average age 25, with 18 patients, average age 61. They found the older patients had impaired endothelial function and increased aortic stiffness when compared to the younger patients.
“Our findings in young and older adults confirm previous clinical data demonstrating the impact of aging on blood vessel function and arterial stiffness,” Associate Prof Manrique-Acevedo said. “Importantly, we were able to replicate this data in a rodent model.”
To investigate the effects of empagliflozin on vascular ageing, researchers fed empagliflozin to 72-week-old mice in their diet, while their control group received standard food. After six weeks, researchers discovered the mice given empagliflozin experienced improved blood vessel function, reduced arterial stiffness and other vascular benefits.
“To our knowledge, this is the first study to examine the potential role of SGLT2 inhibition in reversing vascular ageing,” Associate Prof Manrique-Acevedo said. “And our findings highlight the need for further clinical investigations to determine the potential role of SGLT2 inhibition as a therapeutic tool to delay or reverse vascular ageing in humans.”
A US doctor has been hailed as a hero after he gave his life to stop a gunman firing upon a church congregation.
The Orange County Sherriff’s Department hailed the doctor’s ultimate sacrifice following the tragic shooting, which took place at a the Geneva Presbyterian Church in Laguna Woods, California, on Sunday afternoon.
John Cheng, MD, 52, was attending a church lunch with his mother when 68-year-old David Chou chained the doors shut and opened fire on a group of elderly parishioners.
Acting without hesitation, Dr Cheng, a prominent sports medicine physician, quickly tackled the suspect, allowing church members to restrain him, according to a statement from the Orange County Sheriff’s Department.
When he leapt to the defence, Dr Cheng sustained multiple gunshot wounds and succumbed to his injuries. He leaves behind his wife and two children, as well as devastated colleagues at his practice, who referred to him as a protector, ABC 7 reported.
“Officials said that were it not for the actions of Dr Cheng, there most certainly would have been many more lives lost,” said the California Medical Association in a statement released a day after the shooting.
“Our nation continues to be plagued by an epidemic of gun violence,” they wrote. “Physicians as healers are often on the front lines of these tragic events, treating the wounds of the victims of gun violence.”
Five other victims sustained gunshot wounds and were taken to local hospitals for treatment. The suspected shooter, who is in custody and being charged with murder and attempted murder, allegedly drove from Las Vegas to attack the church, at which members of the Taiwanese Presbyterian Church have had a space since 2009. He knew no-one at the church but spent about an hour mingling with them to gain their trust, NPR reported.
The shooting is being investigated as a hate crime, since the suspect was reportedly upset about political tensions involving China and Taiwan, the sheriff’s department noted.
At a media briefing, Orange County District Attorney Todd Spitzer praised Dr Cheng’s actions.
Dr Cheng knew that there were many parishioners at risk, Spitzer said. He charged across the room, and did everything he possibly could to disable the assailant. “He sacrificed himself so that others could live,” he added.
Don Barnes, the Orange County Sheriff-Coroner, was in agreement, saying that “there is no doubt that Dr. Cheng’s actions that day saved the lives of many other church members. He is a hero and will be remembered by this community as such.”
Studies have demonstrated positive effects of vibrator use on a number of sexual and urinary outcomes in women, according to a review of published literature presented at at the American Urological Association annual meeting.
Though limited in number, the studies induced favourable changes in blood flow and muscle tone of genital tissues, improved multiple aspects of sexual arousal and satisfaction, increased orgasmic response, and decreased sexual distress. In women with pelvic floor dysfunction, vibrator use was associated with decreased urine leakage and urinary symptoms and significantly improved pelvic muscle strength. Vibrator use also decreased pain and improved sexual enjoyment in women with vulvodynia.
“Medical providers, especially gynaecologists, urologists, and FPMRS [female pelvic medicine and reconstructive surgery specialists] need more education on women’s sexual health and vibrators,” said Alexandra Dubinskaya, MD, of Cedars-Sinai Medical Center in Los Angeles. “We need to remove the stigma from vibrators and I do believe this soon will be possible as we are now normalising discussion about women’s sexual health.”
Vibrators should be viewed as another form of technology that can be applied to benefit patients in clinical practice, said Rachel S. Rubin, MD, of Georgetown University in Washington.
“I believe we use technology to make our lives better in almost every way … and the bedroom should not be absent of technology,” she said. “Sex tech is incredible now, from what it used to be. It’s no longer just the seedy stores with newspaper over the windows, but really high-end wonderful devices for couples for all genders. There are so many health benefits to these devices.”
“I believe that if we get male partners interested in devices in the bedroom, everyone’s sexual health will improve,” she stated.
According to Dr Dubiskaya, therapeutic vibratory stimulation has its origin in the now-disproven condition known as female hysteria, associated with excessive emotions and thought to be related to marital relationships, orgasm, and pregnancy. Practitioners were said to have to turned to vibrators to relieve hysteria by stimulating the female patients to orgasms, referred to as “paroxysms”, and turned to vibrators when the practice started to take a toll on their hands and wrists. It’s a now-familiar idea that was popularised by Rachel Maines in her 1998 book “The Technology of Orgasm”, which even inspired a movie.
However, there is no actual evidence in support of this supposed practice as Dubisankya claims. Hallie Lieberman and Eric Schatzberg, the chair of the School of History and Sociology at Georgia Tech, were some of the few who actually bothered to check Maines’s 465 citations. “Maines fails to cite a single source that openly describes use of the vibrator to massage the clitoral area,” they wrote in a contentious paper. “None of her English-language sources even mentions production of ‘paroxysms’ by massage or anything else that could remotely suggest an orgasm.”
Nevertheless, vibrator use is now widespread despite its seedy reputation it had acquired in modern times. In a survey conducted over a decade ago, a majority of women and more than 40% of men reported the use of a vibrator at some point in their lives.
To assess the evidence supporting vibrators’ medical benefits in women, the researchers conducted a systematic literature review, focusing on studies related to sexual health, pelvic floor function, and vulvar health. They found 21 meeting the inclusion criteria, 11 of which were studies of female sexual dysfunction, nine on pelvic floor dysfunction, and one on vulvodynia.
The sexual dysfunction studies showed that vibratory stimulation facilitated vasodilation and blood flow, improved tissue perfusion and metabolism, decreased muscle tone, and increased relaxation. Clinically, use of vibrators was found to be associated with improvement in the Female Sexual Function Index score, as well as increased arousal, orgasm, and genital sensation.
Patients who used vibrators reported increased sexual desire, satisfaction, and overall sexual function, as well as reduced time to orgasm, achievement of multiple orgasms, and reduced distress.
The pelvic floor dysfunction studies showed that vibratory stimulation was linked to a reduction in use of hygienic pads among women with stress urinary incontinence and urine leakage, as well as urinary symptoms. There was improvement in pelvic-floor muscle tone, QoL and patient satisfaction with the treatment.
The vulvodynia study focused on vibratory stimulation for relief of pain and associated symptoms. Dr Dubinskaya said that after 4 to 6 weeks of vibrator use, women reported antinociceptive and desensitising effects, reduced pain, and increased sexual enjoyment. More than 80% of the study participants expressed satisfaction with the treatment, and 90% said they were comfortable with their doctor offering a vibrator as a form of therapy.
Dr Dubisankya is recruiting for a clinical trial to identify which conditions can be most effectively treated with vibrator use.
Testing has shown that a new radiation shielding system offered equivalent radiation protection to the standard lead gowns worn in the catheterisation lab. By using such independent, adjustable shields instead of wearing shielding, the occupational shoulder and back strain inherent to wearing those heavy gowns can be eliminated.
The Rampart shielding system consists of an adjustable stand made of lead equivalent acrylic shielding – was found to block 96% to 98% of radiation scattered to the operator’s head, torso, and waist during an average week of cardiac angiography, according to medical radiation specialist Glenn Ison.
This was equivalent or better than shielding provided by lead gowns and a ceiling-mounted lead shield, Ison said in a presentation at the EuroPCR meeting.
“We found it’s like walking on the moon, doing cases without a lead gown. It’s quite strange,” he remarked.
The researchers had operators wear radiation monitors to measure operator scatter dose to the head, torso, and waist (both under and over their lead gowns) with and without the Rampart.
Dr Ison also pointed out that head and face protection in particular was substantially better with the Rampart shield (radiation exposure -96% vs -70% with standard practice).
Indeed, the shielding of the cumbersome lead gowns — which can weigh up to 13.6kg — only extends to major areas of the torso and waist. Adding on protective glasses and shin guards further adds to this weight.
Ison cited a survey showing that half of interventional cardiologists reported neck or back pain during their careers.
“The ability to maintain protection from scatter radiation whilst lowering or even removing the weight of current lead gowns is a game changer for operators with current back or neck troubles and a way to prevent such problems in the future,” he said. “The longer you’ve been in the game, the more this appeals.”
He added that anaesthetic and nursing staff also had a new highly shielded area to stand in, thanks to the new system.
In response to a panellist question of whether the Rampart would restrict the operator’s arm movements and impede emergency CPR, Ison noted that other companies are working on different shielding types, perhaps some with ceiling-mounted designs making it easier for operators to move around.
“Any benefit to reduce radiation exposure to the operators and staff is an important step forward. The occupational hazards for interventional cardiology are not small, and we need to focus on ways to improve this in the future. To me this is a good step forward,” commented Roxana Mehran, MD, interventional cardiologist at Mount Sinai Health System in New York City.
Ison cautioned that the shield’s effectiveness depends on being correctly positioned. “You must make sure it’s locked in correctly” and test it according to table size and shape, he advised. “Use of real-time audible alarm radiation monitors would be advised.”
A trial has directly comparing emollients found that no one type of emollient is better than another when it comes to atopic dermatitis (AD) in children. The results from the study are published in The Lancet Child & Adolescent Health and British Journal of General Practice.
Emollients are recommended for the one in five children with AD. Lack of research in this area means guidelines vary widely in what is recommended, which leads to confusion and waste.
In the study, 550 children with AD aged under 12 years were randomised to use one of four types of emollient (lotion, cream, gel or ointment) as their main emollient for 16 weeks. Parents completed diaries about their child’s AD for a year, and some were interviewed to gain an in-depth understanding of how they used the emollients and what they thought of them. All children also had an independent examination of their skin.
Used alongside other AD treatments, there was no difference in effectiveness of the four types of emollient used in the study. Skin reactions such as itching or redness were common with all emollienttypes. Awareness of the different types of emollient was low, and users had different preferences based on how the emollients look and feel. For example, some people liked how lotions quickly soaked in whereas others preferred the “barrier” provided by ointments.
Professor Matthew Ridd, a GP and study lead from Centre for Academic Primary Care at the University of Bristol, said: “A study of this type has been long overdue. It has not been in the interest of the manufacturers to directly compare types of moisturiser in the way we have done in this trial. Our findings challenge conventions about how often moisturisers need to be applied, which types are less likely to cause problems and which patients should be recommended certain types. For example, ointments are often suggested for more severe eczema, yet they were found to be no better.”
Professor Hywel Williams, consultant dermatologist and co-researcher at the University of Nottingham, explained: “Along with anti-inflammatory treatments such as topical corticosteroids, emollients are a really key part of treatment for childhood eczema, preventing flares and helping to soothe the skin and improving the quality of life for children and their carers.
“Our study shows that one size does not fit all, and points to the need for doctors to make parents aware of the different emollient types and to help them choose which one is mostly likely to work for them. At last we have evidence that supports the saying, ‘The best moisturisers are the ones the patient will use.’”
Further work is needed to determine if these findings apply to adolescents and adults with AD, and people with other dry skin conditions.
An American Heart Association scientific statement reviewing new evidence and guidance on ambulatory blood pressure monitoring (ABPM) of children and adolescents published in the journal Hypertension.
The statement provides simplified classifications for ABPM in children and adolescents. ABPM is designed to evaluate a person’s blood pressure during daily living activities, including times of physical activity, sleep and stress.
Key points of the statement:
The statement provides simplified classifications for ambulatory blood pressure monitoring (ABPM) in children and adolescents. ABPM is designed to evaluate a person’s blood pressure during daily living activities, including times of physical activity, sleep and stress.
The new classifications come with guidance on when ABPM is appropriate and how to interpret monitoring results.
Children who have medical diagnoses, such as kidney disease, may have normal office blood pressure but significant abnormalities noted on ABPM. Without taking ABPM into account, this can lead to a more benign prognosis.
Elevated childhood blood pressure is linked to heart and kidney damage during youth and adulthood, as well as brain changes associated with worse cognitive function.
ABPM helps ease concern of spikes in blood pressure caused by measurement anxiety, known as white coat hypertension, and helps assess daily blood pressure patterns.
ABPM is used to confirm whether a child or adolescent with high blood pressure during a clinic measurement truly has hypertension.
A ground-breaking study into the effects of COVID on ICU patients in has confirmed evidence that the virus is associated with impaired function of the right side of the heart.
According to the study investigations, these findings could play a vital role in not only saving the lives of COVID patients, but also help in treating potentially fatal heart and lung issues generally. The findings will also help preparations for any possible future pandemic.
The first of its kind, the COVID-RV study aimed to help improve future care and outcomes for those most at risk from COVID, by gaining a better understanding of the impact the virus has on the sickest patients who require invasive ventilation.
The study was carried out in 10 ICUs across Scotland, examining 121 critically ill patients who were receiving treatment on ventilators due to the impact of SARS-CoV-2 on their system.
The findings revealed that about a third of the patients in the study showed evidence of abnormalities in the right side of the heart – the area that pumps blood to the lungs.
The study’s lead author Dr Philip McCall said that “A combination of factors create the perfect storm for COVID” to damage the right side of the heart, with possibly fatal outcomes as the lungs are unwilling to receive blood due to the infection.
“This is a very difficult condition to spot, unless you are specifically looking for it. That is why the results of this study are so important. We now know that COVID is a problem associated with not just ventilation, but can affect the heart.”
Chief Investigator of the study Dr Ben Shelley said: “The study has revealed that there is no doubt COVID affects the heart and has a major impact on outcomes for the patient.
“However, now that we know this actually happens, and have a better understanding of how it affects people, we can plan for the future and put in place new care plans and treatments to help combat this.
“For example, ultrasound scans can be used differently to focus in on early warning signs and areas we now know to be at risk.
“If we are able to see these warning signs early enough, clinicians can explore the causes of any complications and start new treatments as soon as possible, potentially improving outcomes for the sickest COVID patients.
“This kind of knowledge is invaluable, not only in combatting any future waves of COVID but in planning for future pandemics to allow people to be treated more effectively. These findings also have several fascinating areas which could be expanded on to help care for other lung conditions in general.”
Nearly half of ventilated patients in the study (47%) died because of COVID, a figure that is comparable to national and international death rates. Experts leading the COVID-RV study from NHS Golden Jubilee said that the overall condition of a person’s heart can have a significant impact on how seriously you will be affected by the potentially deadly virus.
In order to attain universal healthcare coverage, the world needs an additional 43 million health workers, according to research from the Institute for Health Metrics and Evaluation (IHME) published in The Lancet. Sub-Saharan Africa, South Asia, and North Africa and the Middle East were found to have the largest shortfalls in health worker coverage.
“These are the most comprehensive estimates to date of the global health care workforce,” said senior author Dr Rafael Lozano, Director of Health Systems at IHME. “Health care workers are essential to the functioning of health systems, and it’s very important to have these data available so that countries can make informed decisions and plan for the future.”
Four categories of health worker were studied: physicians, nurses and midwives, dental personnel, and pharmaceutical personnel. In 2019, they estimated that more than 130 countries had shortages of physicians and more than 150 had shortages of nurse and midwives. When comparing current levels of health care workers to the minimum levels needed to meet a target score of 80 on the universal health coverage (UHC) effective service coverage index, researchers estimated a shortage of more than 43 million health care workers, including 30.6 million nurses and midwives and 6.4 million physicians.
“We found that the density of health care workers is strongly related to a nation’s level of social and economic development,” said lead author Dr. Annie Haakenstad, Assistant Professor at IHME. “There are different strategies and policy approaches that may help with addressing worker shortages, and these should be tailored to the individual situation in each country. We hope that these estimates can be used to help prioritize policy interventions and inform future planning.”
The study revealed more than a 10-fold difference in the density of health care workers across and within regions in 2019. Densities ranged from 2.9 physicians for every 10 000 people in sub-Saharan Africa to 38.3 per 10 000 in Central Europe, Eastern Europe, and Central Asia. Cuba also stood out, with a density of 84.4 per 10 000 compared to 2.1 in Haiti.
Similar disparities were observed in measuring numbers of nurses and midwives, with a density of 152.3 per 10 000 in Australasia compared to 37.4 per 10 000 in Southern Latin America. Despite steady increases in the health care workforce between 1990 and 2019, substantial gaps persisted.
The researchers cited existing literature that highlights factors that contribute to worker shortages, including out-migration of health workers, war and political unrest, violence against health care workers, and insufficient incentives for training and retention. They noted that high-income locations should follow WHO guidelines on responsible recruitment of health personnel to avoid contributing to workforce gaps in lower-income regions.
The study findings demonstrated just how poorly prepared the world was when the COVID pandemic struck, further straining health systems that already were short of crucial frontline workers. These estimates will help policymakers, hospitals, and medical clinics prepare for future pandemics by focusing on training and recruitment. The authors also note that there is still much to learn about the impact of the pandemic on the health workforce. This includes gender dynamics in human resources for health (HRH) and how the departure of women from formal employment for care-taking duties at home may have depleted the health workforce, among other stressors on HRH during the pandemic.
In a study published in Nature, a research team has shown that the BA.2 subvariant of omicron is similar to BA.1 in both the severity of illness it causes and in its ability to cause infection.
BA.2 is the dominant subvariant of Omicron in nearly seven dozen countries. The study’s findings stand in contrast to an earlier study that relied on recombinant virus bearing spike proteins from BA.1 and BA.2.
“That study indicated BA.2 may be more pathogenic than BA.1,” said Prof Yoshihiro Kawaoka, who led the present study. “But when we used authentic virus, we found that BA.2 is not more pathogenic.”
Prof Kawaoka and research associate professor and co-author Peter Halfmann, said that their findings suggest that other parts of the omicron virus may attenuate the pathogenicity of its spike proteins alone.
Relying on rodent models for the disease, researchers and their collaborators tested viruses isolated from human samples. Both subvariants of omicron caused less severe illness compared to earlier strains, including delta and the original wild strain of the virus.
The study team also found that existing therapeutic monoclonal antibodies and antiviral drugs remain effective against BA.2.
However, plasma from vaccinated people and from people who recovered from earlier infections was less effective at neutralising both subvariants of omicron compared to earlier virus strains, and plasma from people infected with BA.1 was less effective at neutralising BA.2.
But the researchers also found that plasma from people who were vaccinated and then infected with BA.1 or earlier variants exhibited a smaller decrease in effectiveness against BA.2.
“If you’re vaccinated and then infected, you’re protected against many different variants,” said Prof Kawaoka, especially compared to prior infection alone or vaccination alone.
The researchers are now testing the newest sub-variants of omicron, including BA.2.12.1, which has begun to rapidly spread in New York state.
