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.”
