HUMAN PAPILLOMAVIRUS
New guidelines aim to boost vaccination rates
Emphasizing that vaccination against human papillomavirus (HPV) should be routinely offered for children at ages 9 or 10 years, the American Cancer Society (ACS) has issued updated guidelines designed to improve on-time HPV vaccination rates. Introduced in 2006, the HPV vaccine has led to substantial decreases in genital warts, recurrent respiratory papillomatosis, cervical precancers, and cervical cancers, yet vaccination rates in the US lag far behind rates in other high-income countries and behind rates for other adolescent vaccines in the US.
Besides offering the HPV vaccine series at age 9 or 10, the ACS recommends catch-up vaccinations for all persons through age 26 who are not adequately vaccinated. However, adults ages 22 to 26 should be informed that vaccination at older ages is less effective for lowering cancer risk. For this reason, the ACS does not recommend catch-up HPV vaccination for adults over age 26.
The updated guidelines are an adaptation of the current Advisory Committee on Immunization Practices recommendations for HPV vaccination.
Source: Saslow D, Andrews KS, Manassaram-Baptise D, Smith RA, Fontham ETH. Human papillomavirus vaccination 2020 guideline update: American Cancer Society guideline adaptation. CA Cancer J Clin. [e-pub July 8, 2020]
CANNABIS
Adverse cardiovascular reactions raise concerns
In a major scientific statement, the American Heart Association reviews the evidence on therapeutic and recreational cannabis use and concludes that cannabis has few if any cardiovascular benefits but is associated with serious cardiovascular adverse reactions such as tachycardia, premature ventricular contractions, atrial fibrillation, and ventricular dysrhythmias. Whether cannabis triggers or potentiates major adverse cardiovascular events such as acute myocardial infarction and dysrhythmias is an open question requiring more research.
To enable better research into this important issue, the authors recommend policy and legal changes that "better reflect the existing science behind cannabis, starting in the United States at the federal level with removal of cannabis from Schedule I of the US Controlled Substances Act... Meanwhile, the negative health implications of cannabis should be formally and consistently emphasized in policy, including a doubling down on the American Heart Association's commitment to limiting the smoking and vaping of any products and banning cannabis use for youth."
Source: Page RL II, Allen LA, Kloner RA, et al. Medical marijuana, recreational cannabis, and cardiovascular health: a scientific statement from the American Heart Association. Circulation. [e-pub August 5, 2020]
ANTIBIOTIC OVERUSE
Many providers do not think they are the problem
Because overuse of antibiotics contributes to antibiotic resistance, outpatient antibiotic stewardship is an important strategy for minimizing development of drug-resistant bacteria. Yet according to a recent national survey, many primary care physicians do not recognize antibiotic resistance and inappropriate prescribing as significant issues in their practice.
The online survey included responses from 1,550 internal, family, and pediatric medicine physicians in the US recruited from an opt-in panel of healthcare professionals. Findings included the following:
* Although 94% of respondents agreed that antibiotic resistance was a problem in the US, only 55% said that it was a problem in their practice.
* Similarly, 91% agreed that inappropriate antibiotic prescribing was a problem in outpatient settings, but only 37% considered it a problem in their practice.
* Most (60%) said that they prescribed antibiotics more appropriately than their peers.
* Nearly all (91%) believed that antibiotic stewardship was appropriate in office-based practices, but they ranked antibiotic resistance as less important than other public health issues such as obesity, diabetes, opioid abuse, smoking, and vaccine hesitancy.
* About half (47%) believed they would need a lot of help to implement stewardship. Many said they would be likely to implement antibiotic stewardship efforts in response to feedback or incentives from payers or health departments.
The study authors concluded that primary care physicians do not generally recognize the issue of antibiotic resistance or inappropriate prescribing in their own practices. To improve outpatient antibiotic stewardship, the authors recommend that healthcare stakeholders explore opportunities for feedback and incentives to encourage better prescribing practices.
Source: Zetts RM, Garcia AM, Doctor JN, Gerber JS, Linder JA, Hyun DY. Primary care physicians' attitudes and perceptions towards antibiotic resistance and antibiotic stewardship: a national survey. Open Forum Infect Dis. 2020;7(7):ofaa244.
OLICERIDINE
FDA approves new I.V. opioid
Indicated for short-term use in a hospital or other appropriate clinical facility, oliceridine (Olinvyk) is an opioid agonist indicated to manage moderate-to-severe acute pain in adults in whom the pain is severe enough to require an I.V. opioid and alternative treatments to treat it are inadequate. It may be used to manage pain during inpatient and outpatient procedures conducted in controlled clinical settings but it is not indicated for home use.
Oliceridine's benefits and risks are similar to those of other opioids. It should not be given to patients with significant respiratory depression; acute or severe bronchial asthma in an unmonitored setting or in the absence of resuscitative equipment; known or suspected gastrointestinal obstruction; or known hypersensitivity to the drug.
Source: US Food and Drug Administration. FDA approves new opioid for intravenous use in hospitals, other controlled clinical settings. News release. August 7, 2020.
OPIOIDS AND SEDATIVES
Pre-op use linked to higher morbidity
To study the impact of preoperative use of prescription opioids, sedatives, and antidepressants on postoperative outcomes following colorectal surgery, researchers conducted a retrospective database and medical record review. The review included all patients age 18 and older who underwent colorectal resection for all indications, excluding trauma, between January 1, 2013, and December 31, 2016, at the University of Kentucky. The primary outcomes measured were the rates of 30-day postoperative morbidity and mortality. Among the findings:
* About 30% of the participants used opioids, 18% used sedatives, and 28% used antidepressants preoperatively.
* Use of these medications was associated with significantly increased rates of intra-abdominal infection and prolonged intubation.
* Hospital stay for patients using opioids or sedatives preoperatively was prolonged by 2 days.
* Taking opioids alone was associated with an increased likelihood of having ostomy creation (51.5%), dirty/infected wound classification (21.8%), prolonged operation time (23.4%), and higher rates of readmission (17.9%).
* Opioid and sedative use were associated with increased 30-day morbidity and mortality following colorectal procedures when controlling for all significant predictors.
The authors say their findings highlight the need to evaluate opioid and sedative use during pre-op assessments and to advise patients to decrease use of these drugs before surgery.
Sources: Gan T, Jackson NA, Castle JT, et al. A retrospective review: patient-reported preoperative prescription opioid, sedative, or antidepressant use is associated with worse outcomes in colorectal surgery. Dis Colon Rectum. 2020;63(7):965-973. GI surgical outcomes worse with preop use of opioids, sedatives. HealthDay News. August 13, 2020.