Tag Archives: Pharmacy

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What do elder care, robots and Japan have in common?

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While there is no shortage of attempts to stop or reverse it, we are all still aging. This year, for the first time in our history, there will be more of us over 65 than under 5 years old.

This demographic shift, combined with our increasing longevity, will continue to exacerbate the disparities between the elderly population and those available to care for them. Japan is at the forefront of this new world; providing lessons for us all to consider.

Relatable challenges

Two key concepts are critical to understanding the situation an increasing number of countries, including the U.S., are facing: demographic transition and dependency ratio. According to Population Reference Bureau (PRB), the first describes the long-term shift in birth and death rates.

For example, Japan and most countries in Europe are in what PRB identifies as the third phase, which is low levels of both fertility and mortality. A major implication of this being a shrinking working population and an increasing elderly population.

The second concept, dependency ratio reflects the relationship between the number of those who need care (children or elderly) and those who can provide care. In this case, Japan has a high elderly dependency ratio.

In addition to Japan’s aging workforce and increasing elderly population, its immigration laws, and language barriers are limiting its ability to supplement its shrinking workforce with skilled labor from other countries.

Domo arigato

These issues related to an increase in the aging population and a decrease in the labor pool able to care for them will become more common in more countries. Technology may provide some solutions and Japan is at the forefront of exploring these options.

Current real-world experiments to use robots for eldercare fall into the following categories, as outlined in this graphic by Reuters: lifting, moving, monitoring and entertainment and companionship.

While no one believes robots will replace the need for humans in caring for the elderly, robots and other technologies can address a significant number of tasks that then free up healthcare specialists to provide more specific, complicated, or individualized support.

Consider the tools we have now that already allow us to remotely monitor patients; conduct virtual video visits; alert emergency services; clean the floor; and order groceries. None of these options were available a generation ago. At the pace of technological development, we can expect even more advances within the next generation.

To infinity… and beyond!

As leaders, what can we do today to prepare for tomorrow? In addition to recognizing the significant demographic shifts around the world and keeping an eye on the tech pioneers making the link between robots and healthcare, those in the healthcare industry can stay ahead of the curve by thinking outside traditional solutions for opportunities to solve care problems.

In other words, cross-functional teams can work together to ensure we are maximizing the technology we already have, like video calling, email, and document sharing to provide care solutions instead of just addressing operational productivity. HR can begin to understand and plan for labor shortages by creating career pipelines that attract and grow new talent as well as draw from national and international sources. Leaders at all levels can support and embrace opportunities to participate in innovative professional development that embraces new technologies, like virtual reality.

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Common pain relievers may promote C. difficile

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A 2015 study by the Centers for Disease Control found that Clostridioides difficile (C. diff), a bacterium that causes inflammation, caused almost 500,000 infections among patients in the United States in a single year.

C. diff is the most commonly diagnosed cause of antibiotic-associated diarrhea and has surpassed methicillin-resistant Staphylococcus aureus (MRSA) as the most common healthcare-associated infection in many U.S. hospitals. Healthcare costs attributed to C. diff infections can reach nearly $5 billion each year.

This hardy type of bacteria is very difficult to treat. An estimated 15,000 deaths are directly attributable to C. diff infections, making it a substantial cause of infectious disease death, with most deaths occurring among people age 65 years or older.

Commonly occurring in older hospitalized adults after the use of antibiotic medications, C. diff affects the normal flora of the gut. The use of nonsteroidal anti-inflammatory drugs (NSAIDs), which reduce fever, also promote C. diff infection.

David Aronoff, a microbiologist and infectious diseases expert at Vanderbilt University in Nashville, and researchers from the University of Michigan and the University of Arizona conducted a study with mice that they infected with C. diff.

They divided the mice into two groups and treated one group with an NSAID (indomethacin) before infection. At the end of the observation period, about 20 percent of the mice in the treatment group were still alive; about 80 percent of the group that did not receive the NSAID had also survived.

Aronoff and his team determined that even brief exposure to the NSAID before C. diff inoculation increased the severity of infections and shortened survival. Further cellular and genetic analyses revealed that the NSAID exposure altered the gut microbiota and depleted the production of prostaglandins, which play an important role in gastrointestinal health.

Those observations align with previous studies reporting that NSAIDs can cause or exacerbate inflammatory diseases such as colitis, also by inhibiting the body’s production of prostaglandins.

In this new study, the researchers concluded that NSAID-driven changes worsened C. diff infections by impairing epithelial cells and disturbing the normal immune response. Although the team studied the impact of only one NSAID, indomethacin, these findings might extend to other common NSAIDs, including ibuprofen and aspirin since they all have roughly the same biological mechanism.

Experts agree that C. diff infections are on the rise and are becoming increasingly difficult to treat, which may encourage researchers to find new and better ways of targeting such a stubborn bacterium.

According to Aronoff, although it’s too early for the results of this study to guide clinical care, the results might guide how people with C. diff are treated, particularly with pain management, as well as encourage future studies.

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Evidence continues to show that youth e-cigarette use is growing

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Yet another survey is demonstrating that teenagers are adopting the use of electronic cigarettes at an alarming rate. One of the latest, released in December 2018, is called “Monitoring the Future.” It was administered by the University of Michigan and was given to 14,000 eighth-, 10th and 12th-graders across the United States.

Other risk behaviors monitored in the survey, such as opioid use, binge drinking, and conventional cigarette use, either remained level or declined. The use of nicotine vaping products showed the largest and most significant increase in any category since the survey began in 1975.

Electronic cigarettes are marketed as a smoking cessation aid, but with the numbers of teens adopting their use, they are potentially doing more harm than good. There has been a considerable amount of evidence over the years that these products are attractive to adolescents and teens.

This latest survey shows an increase in usage from 11 percent to 21 percent among twelfth-graders in the past year and an increase from 8 percent usage to 16 percent among 10th-graders.

“Vaping is reversing hard-fought declines in the number of adolescents who use nicotine,” said Richard Miech, the lead author and principal investigator of the study. “These results suggest that vaping is leading youth into nicotine use and nicotine addiction, not away from it.”

Miech went on to comment, “Vaping is making substantial inroads among adolescents, no matter the substance vaped. In 2018 we saw substantial increases in vaping across all substances, including nicotine, marijuana, and adolescents who reported vaping ‘just flavoring.’ Factors that make vaping so attractive to youth include its novelty and the easy concealability of the latest vaping devices, which better allows youth to vape without adults knowing about it. If we want to prevent youth from using drugs, including nicotine, vaping will warrant special attention in terms of policy, education campaigns, and prevention programs in the coming years.”

There was a near doubling of the use of vaping for marijuana products in all age groups. Twelfth-graders’ usage went from 4.9 to 7.5 percent; 10th-graders from 4.3 to 7.0 percent; and eighth-graders rate increased from 1.6 to 2.6 percent.

Efforts to regulate the marketing and sales of electronic cigarettes seem to have fallen short. Further, there are an increasing number of products, both nicotine and marijuana, that are what appeal to youth.

Research shows that it is not just the drug that is appealing but the sweeter flavorings that enhance the pleasure and create a greater enjoyment of nicotine vapes for those who would otherwise not respond positively. The use of flavoring in marijuana vape products attracts younger, teen and adolescent user populations.

Nicotine and marijuana are harmful to developing brains, vascular systems and lungs. Much more needs to be done to prevent the lifelong health, work and social difficulties that the vulnerable youth population will suffer with the use of electronic cigarettes.

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