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Addictive Opioids Still Overprescribed After Surgery: Study

THURSDAY, April 19, 2018 (HealthDay News) — Doctors continue to prescribe far too many opioid painki..

THURSDAY, April 19, 2018 (HealthDay News) — Doctors continue to prescribe far too many opioid painkillers to patients following surgery, a new study indicates.

In fact, one of every three patients prescribed an opioid, such as Oxycontin, didn't take a single pill during their recuperation, said lead researcher Elizabeth Habermann. She is scientific director for surgical outcomes at the Mayo Clinic in Rochester, Minn.

"Their entire prescription amount went unused," Habermann said. "That showed us there's an opportunity to prescribe a certain select group of patients zero opioids, and they may be able to take care of their pain with acetaminophen [Tylenol] or NSAIDs alone." NSAIDs are nonsteroidal anti-inflammatory drugs, such as Motrin or Advil.

Overall, nearly two-thirds of opioids prescribed after surgery went unused by patients, the study found. These drugs wound up lingering in patients' homes, inviting abuse and the potential for addiction, Habermann said.

"Fewer than 10 percent of patients disposed of their leftover opioids. We know from the literature that many individuals who are taking heroin actually started their use of narcotics with leftover prescription opioids prescribed to others. So this is a huge risk to our community," she explained.

Mayo undertook the study because there is a lot of variation in how many opioids are prescribed to patients, and some indication that the amounts being prescribed are too high, Habermann said.

The research team surveyed 2,550 adults who underwent 25 different elective procedures at three different medical centers.

A few weeks after their surgery, the patients were asked how many opioids they had been prescribed, how many they had used to deal with their pain, and whether they'd thrown away the leftovers.

About 28 percent of patients said they had been prescribed too many opioids, versus 8 percent who said they were prescribed too few, the findings showed.

Certain procedures proved painful enough that patients took a good amount of opioids, and even requested refills. These included total knee replacements, spinal fusions, rotator cuff surgery, lung removal and tonsillectomy, according to the researchers.

But there were many more procedures where people needed little to no opioids to deal with their pain. These included surgical removal of thyroid glands, carpal tunnel surgery, breast lumpectomy, mastectomy and hernia repair.

The findings were to be presented Thursday at the American Surgical Association annual meeting in Phoenix. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.

Linda Richter is director of policy research and analysis at the National Center on Addiction and Substance Abuse. The study "just adds to the evidence that, despite all the attention the opioid epidemic has been receiving, opioid overprescribing remains a serious problem in the United States," she said.

"The fact that opioid overprescribing has fueled the prescription opioid crisis, which has recently morphed into an illicit opioid crisis, is no secret," Richter continued. "The fact that it's continuing to happen on this scale despite all we now know about the adverse consequences is frankly quite depressing."

Habermann suggested that doctors need to adopt a patient-centric approach to prescribing opioids, using the best medical evidence to target these drugs to the procedures that appear to require heavier levels of pain management.

Mayo has used the study over the past six months to develop guidelines that will help surgeons prescribe opioids based on the procedure patients are undergoing and the likelihood that they will be in extreme pain during recovery, Habermann noted.

"We don't want to withhold necessary opioids from our surgical patients, but these data have helped us better target how much to prescribe," she pointed out.

"In orthopedic surgery, we've been able to decrease the amount prescribed by 50 percent, and there's been no associated increase in refills," she added. "That shows patients are getting as many as they need."

In the meantime, patients who've been prescribed too many opioids should dispose of them, Habermann said.

"The [U.S. Food and Drug Administration] actually has a website where it suggests flushing leftover opioids down the toilet," she said. "Ideally, we don't want pharmaceuticals entering our water supply, but in the case of opioids that is suggested so we can have them unavailable to others."

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Burkina Faso: Growing Violence Threatens Health Care

Away from the worlds attention, Burkina Faso has been slipping into violence. In less than a year, t..

Away from the worlds attention, Burkina Faso has been slipping into violence. In less than a year, the number of displaced has increased fivefold, from 50,000 last December, to 270,000 in August. As ever, the most vulnerable suffer most: the very young, and the very old.

When Alidou Sawadogos elderly mother fell ill, he faced a long and dangerous journey to get treatment for her.

“When she collapsed, a friend called me,” he explains. “By the time I arrived she was already unconscious. I decided to take her to the health center and luckily someone who had a motorcycle helped me. Because of the violence many people who are sick wait at home and die. Everyone is afraid of taking the road to the health center in Barsalogho.”

Across Burkina Faso, the rising insecurity has forced over a hundred health centers to close, or to limit their work. Half a million people now have little or no access to health care. Dedicated health workers, among them Dr Bertrand Dibli in Barsalogho, are struggling to meet the needs, and to stay safe themselves.

“This is one of the few health centers that isnt closed,” he says. “We dont have enough equipment. And the insecurity has caused huge anxiety among health workers. Even coming here to Barsalogho is a huge challenge because the route is so dangerous.”

The ICRC has been working to support Burkina Fasos health professionals, with medical kits, and vaccination campaigns. During his visit to the country, ICRC President Peter Maurer expressed his concern at the multiple challenges facing Burkina Fasos people.

“We are very concerned,” he said. “Very worried about the upsurge in violence, its a vicious circle that is trapping the civilian population between armed groups.”

“We also see,” Mr Maurer added, “that it is not only the violence that is affecting the country, it is also under development, and climate change. Together with the violence that is obstructing the health services, its an accumulation of factors.”

And so the ICRC – jointly with the Burkinabé Red Cross – is also delivering food to the displaced, and helping to improve access to water supplies. All of this, says nurse Jeanette Kientega, is desperately needed by a population uprooted by conflict, and denied access to basic health care.

“By the time they are able to get here, it is often too late” she says. “Sometimes we can help, but if they have already been ill a long time, it is difficult. We try to do what we can.” (more…)

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World Bank and WHO Statement on Partnership & Deployment of Financing to WHO for Ebola Response in DRC

WASHINGTON, August 23, 2019—The World Bank and the World Health Organization (WHO), along with the G..

WASHINGTON, August 23, 2019—The World Bank and the World Health Organization (WHO), along with the Government and other key partners, are working in close partnership on the Ebola Crisis Response in the Democratic Republic of the Congo (DRC). Central to this partnership is the assessment of the financing needs, and deployment of resources, with the goal to put an end to the current deadly outbreak.

The World Bank is today announcing that US$50 million in funding is to be released to WHO for its lifesaving operational work on the frontlines of the outbreak. The WHO is announcing that this US$50 million in funds will close the financing gap for its emergency health response in DRC through to the end of September 2019, and is calling on other partners to mirror this generous support in order to fund the response through to December.

The funding comprises US$30 million from the Pandemic Emergency Financing Facility (PEF) and US$20 million from the World Bank. The US$50 million in grant funding is part of the larger financial package of approximately US$300 million that the World Bank announced last month to support the fourth Strategic Response Plan for the DRC Ebola outbreak.

“WHO is very grateful for the World Banks support, which fills a critical gap in our immediate needs for Ebola response efforts in DRC, and will enable the heroic workers on the frontlines of this fight to continue their lifesaving work,” said Dr. Tedros Adhanom Ghebreyesus, Director-General, World Health Organization. “We keenly await further funding from other partners to sustain the response through to the end of the year.”

The DRC government, working in collaboration with the World Bank, WHO, and other key partners, has finalized the Fourth Strategic Response Plan (SRP4), which outlines the total resources needed for the DRC Ebola Crisis Response from July to December 2019. The financing announced today is part of the World Banks previously announced financial package of up to US$300 million and covers over half of SRP4s needs, with the remainder requiring additional funding from other donors and partners.

“The World Bank is working closely with WHO, the Government of DRC, and all partners to do everything we can to put an end to the latest Ebola outbreak,” said Annette Dixon, Vice President, Human Development at the World Bank. “The partnership between our organizations and the Government is critical for responding to the emergency as well as rebuilding systems for delivery of basic services and to restoring the trust of communities.”

The Government of DRC requested US$30 million from the PEF Cash Window to be paid directly to WHO. The PEF Steering Body approved the request bringing the PEFs total contribution to fighting Ebola in DRC to US$61.4 million. The PEF is a financing mechanism housed at the World Bank; its Steering Body is co-chaired by the World Bank and WHO, and comprises donor country members from Japan, Germany and Australia. The quick and flexible financing it provides saves lives, by enabling governments and international responders to concentrate on fighting Ebola—not fundraising.

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Borno State launches first Malaria Operational Plan, reawakens fight against malaria

Maiduguri, 13 August 2019 – Following recommendations from malaria interventions in Borno State Nige..

Maiduguri, 13 August 2019 – Following recommendations from malaria interventions in Borno State Nigeria, the Malaria Annual Operational Plan (MAOP) was developed and launched on 08 August 2019 with technical support from the World Health Organization (WHO) and partners. Aligned to the National Malaria Strategic Plan (2014 -2020), MAOP was developed through a broad-based stakeholders workshop involving malaria stakeholders, reviewed on different thematic areas and endorsed by the Commissioner for Health and Permanent Secretary, Borno State Ministry of Health.

Speaking during the launch, the Borno state Malaria Programme Manager, Mr Mala Waziri described the MAOP as the first to be endorsed and disseminated in Borno State. “WHO has made us proud by supporting the first ever Malaria Operational Plan right from development, review, printing to dissemination.”

Dr Ibrahim Kida, the Ministerial Secretary Borno State Ministry of Health and Incident Manager of the state, described the launch as “an historic event as stakeholders across the health sector made commitments to use the document as an implementation guide for all malaria programs”. The plan was also described as an advocacy tool for planning domestic funds mobilization.

The MAOP has seven objectives among which are: provide at least 50% of targeted population with appropriate preventive measures by 2020; ensure that all persons with suspected malaria who seek care are tested with Rapid Diagnostic Test (RDT) or microscopy by 2020 and all persons with confirmed malaria seen in private or public health facilities receive prompt treatment with an effective anti-malarial drug by 2020.

The MAOP will further ensure that at least 50% of the population practice appropriate malaria prevention and management by 2020, ensuring timely availability of appropriate anti-malarial medicines and commodities required for prevention, diagnosis and treatment of malaria in Borno State by 2020.

In addition, it seeks to ensure that all health facilities report on key malaria indicators routinely by 2020 and finally strengthen governance and coordination of all stakeholders for effective program implementation towards an A rating by 2020 on a standardized scorecard. These strategic objectives have specific targets and the MAOP takes into account the humanitarian response.

“Malaria remains a leading cause of poor health in Nigeria. According to the 2018 WHO Malaria Report, 53million cases are recorded annually in Nigeria, roughly 1 in 4 persons is infected with malaria contributing 25% of the global burden,” says Dr Nglass Ini Abasi, WHO Malaria Consultant for the North East.

“Furthermore, 81,640 deaths are recorded annually (9 deaths every hour), which accounts for 19% of global malaria deaths (1 in 5 global malaria deaths) and 45% malaria deaths in West Africa. The Nigeria Malaria Strategic Plan (NMSP) 2014-2020 has a goal to reduce malaria burden to pre-elimination levels and bring malaria-related mortality to zero and WHO is working assiduously with Government to ensure the burden is reduced accordingly.”

Results from WHO’s Early Warning, Alert and Response System (EWARS) week 30 report from 223 sites, (including 32 IDP camps) show that malaria was the leading cause of morbidity and mortality accounting for 35% of cases and 46% of reported deaths. In addition, results from the Nigeria Humanitarian Response Strategy (NHRS 2019-2021) indicate 7.1million people are in dire need of healthcare and 6.2million are targeted for immediate attention.

Despite recent improvements, insecurity remains a challenge limiting access to the functional health facilities. Easily preventable and treatable diseases such as malaria, acute respiratory infection and diarrheal diseases account for the greatest proportion of morbidity and mortality among the vulnerable population. Furthermore, Malaria is endemic in North East Nigeria and the transmission is perennial with a marked seasonal peak from July to November every year. (more…)

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