ASCO issues first Clinical Practice Guidelines for chronic pain in adult cancer survivor

Health Care Comments Off

The American Society of Clinical Oncology (ASCO) has release the first guidelines on management of chronic pain in adult cancer survivors. Published online July 25, 2016 in the Journal of Clinical Oncology, these recommendations were developed by an expert panel with multidisciplinary representation, who used a systematic review of RCTs (1996 to 2015), observational studies and clinical experience to formulate the guidelines.

Some key recommendations in the new guidelines include the following:

• Patients should be screened for pain at each encounter.

• Clinicians should conduct an initial comprehensive pain assessment to explore the multidimensional nature of pain – pain descriptors, associated distress, functional impact, and related physical, psychological, social, and spiritual factors).

• Clinicians should be aware of chronic pain syndromes resulting from cancer treatments, the prevalence of these syndromes, risk factors for individual patients, and appropriate treatment options.

• Evaluate and monitor for recurrent disease, second malignancy, or late-onset treatment effects in patients with new-onset pain.

• Patient and family/caregivers should be involved in all aspects of pain assessment and management.

• Non opioid analgesics like NSAIDs, acetaminophen and adjuvant analgesics including selected antidepressants and selected anticonvulsants may be prescribed to relieve chronic pain if there are no contraindications and after assessment of the risks of adverse effects of pharmacologic therapies. Topical analgesics may also be prescribed.

• A trial of opioids may be prescribed in carefully selected cancer survivors with chronic pain who do not respond to more conservative management and who continue to experience pain-related distress or functional impairment. Assess risks of adverse effects of opioids used for pain management. Taper the dose, if they are no longer needed to avoid abstinence syndrome.

• Clinicians should clearly understand terminology such as tolerance, dependence, abuse, and addiction as it relates to the use of opioids for pain control and should incorporate universal precautions to minimize abuse, addiction, and adverse consequences.

• Clinicians should understand pertinent laws and regulations regarding the prescribing of controlled substances.

• Non pharmacologic therapies such as physical therapy, occupational therapy, cognitive-behavioral therapy, distraction, mindfulness, acupuncture, transcutaneous electrical nerve stimulation may be recommended.

Even one hour of daily activity reduces health risks from prolonged sitting

Health Care Comments Off

A meta-analysis of 16 trials involving more than 1 million men and women has yet again found in favor of physical activity as against a sedentary lifestyle, as reported in a study published online 27th July 2016 in The Lancet. This is the first meta-analysis to use a harmonized approach to directly compare mortality between people with different levels of sitting time and physical activity.
According to the study, prolonged sitting enhances all-cause mortality, with most deaths being due to cardiovascular disease and cancer (breast, colon, and colorectal). And, high levels of moderate intensity physical activity, about 60–75 min per day, may eliminate mortality risk associated with prolonged sitting time, but not the high risk associated with high TV-viewing time.
• Daily sitting time was not associated with increased all-cause mortality in those in the most active quartile of physical activity.
• Compared with the referent (<4 h of sitting per day and highest quartile of physical activity [>35•5 MET-h per week]), there was no increased risk of mortality during follow-up in those who sat for >8 h/day but who also reported >35•5 MET-h per week of activity.
• Those who sat the least (<4 h/day) and were in the lowest activity quartile (<2•5 MET-h per week) had a significantly higher risk of dying during follow-up. These are results that may have significant implication for hundreds of office workers, who have sedentary jobs and have to sit for long hours at their work place … that it is important to be physically active, even if it is for only an hour in a day. Brisk walking is the simplest and most inexpensive form of exercise.

HIV and Viral hepatitis – Hepatitis B is a more dangerous infection than HIV

Health Care Comments Off

• Viral hepatitis and HIV coinfection is a common problem and challenge to the treating clinician.
• People with HIV who are coinfected with hepatitis B virus (HBV) or hepatitis C virus (HCV) are at increased risk for serious, life-threatening health complications.
• All people living with HIV should be tested for Hepatitis B and C infections.
• HIV and viral hepatitis coinfection can complicate the management of HIV infection.
• Progression of liver disease is faster in individuals with HIV and viral hepatitis coinfection; also, they may not respond as well to treatment.
• Hepatitis B is preventable; hepatitis B vaccination is recommended for high-risk people or those living with HIV who have tested negative for HBV.
• Give Hepatitis B vaccine to all unvaccinated persons after exposure to blood. If the exposed blood is positive for HBV and the exposed person is unvaccinated, treatment with hepatitis B immune globulin is recommended.
• HIV, HBV and HCV have similar routes of transmission. They spread by contact with infected body fluids such as blood, semen and vaginal fluid, or from a mother to her baby during pregnancy or delivery. Because of these shared routes of transmission, people at risk for HIV infection are also at risk for HBV or HCV infection. Of these, hepatitis B is more infectious.
• Hepatitis B virus gets transmitted by percutaneous and mucosal exposures and human bites.
• Hepatitis B can also be transmitted by fomites such as finger stick blood sugar check, multi dose medication vials, jet gun injectors, and endoscopes. Hepatitis B virus can survive on counter tops for up to 7 days and remain capable of causing infection.
• Any scratch, cut and wound should be cleaned with soap and water and covered with a waterproof dressing or plaster. Expressing fluid by squeezing the wound will not reduce the risk of blood borne infection.
• Blood spills from someone with hepatitis B should be cleaned up with appropriate infection control procedures e.g. wearing gloves, and using an appropriate cleaning product for the surface, such as diluted bleach or detergent and warm water.
• Transmission of hepatitis C virus can occur from infected fluid splashes to the conjunctiva. Hepatitis C virus can survive on environmental surfaces for up to 16 hours.

« Previous Entries