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Australia is running out of oral morphine. What does this mean for pain relief in palliative care?

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Australia is currently in a singular situation since it is concurrently opioid epidemic and we’re experiencing a shortage of these essential medicines.

The Therapeutic Products Agency has approved eight oral morphine products list of shortagesThe supply problem for these products is not expected to be resolved before October or November of this yr.

This is an issue for the near future 100,000 people receiving palliative care who may depend on opioids akin to morphine to administer each day chronic pain.

So why are we missing out and what are doctors and patients doing?

Opioids are essential for people in palliative care

Palliative care goals to supply quality of life for individuals with illnesses which have little or no probability of recovery. Anyone can need palliative care, including infants, children, and adolescents, not only adults and older people.

Patients may remain in palliative care for days, weeks, and even months and typically struggle with chronic pain each day. Opioid drugsakin to morphine, are commonly used to alleviate pain, suffering and discomfort.

Patients can receive palliative care in a range of settings, including at home or in specialist centres.
Studio DC/Shutterstock

Morphine is a robust painkiller, often used when other medications, akin to ibuprofen and acetaminophen, aren’t any longer effective. It works block the pathways in the brain which register the feeling of pain.

Morphine could be taken as a tablet, capsule or liquid orally, by injection, or intravenously. pump patient controls. The eight morphine products Australia has shortlisted are all oral forms (tablets and liquids).

Liquid forms of morphine taken orally are a very important form of medication for individuals who cannot take tablets, including young children, elderly patients, and other people who’ve difficulty swallowing.

Why are we missing these drugs?

Since the emergence of COVID-19, we now have seen continued shortages of many medicines on account of Supply chain disruptions and other issuesThere are currently 377 drugs on the Therapeutic Goods Administration list. list of shortages. However, the shortage of morphine-containing medicines does not look like attributable to COVID-19.

In June last yr, the international company Mundipharma, which produced the one registered brand liquid morphine used in Australia, Ordine, he advised the federal government has stopped deliveries. Australian company Arrotex Pharmaceuticals is set to take over supply. However, supplies will not be expected to return to normal until their products grow to be available – likely in late 2024.

While the present shortage is oral morphine, other opioids are also coming out of stock, akin to fentanyl (six products on the shortlist) and oxycodone (three products). That’s because when one drug, like morphine, is in short supply, demand for similar drugs increases.

Can you replace one opioid with one other?

There are many differing types of opioid medications, which implies that when one is unavailable, a patient could also be switched to a different. What matters is which medication is being replaced – and at what dose.

Because of how the body metabolizes opioids, a dose of one drug may fit kind of effectively than the identical dose of one other opioid. In these cases, the pharmacist must calculate what is called an “equivalent pain dose” when switching opioids.

In addition to calculating the equivalent dose when changing to a different opioid, your doctor may additionally reduce dose by 50%This is because stronger opioid medications akin to fentanylat higher concentrations they’re very dangerous and usually tend to cause respiratory difficulties and even death.

Bottle of oxycodone next to oral syringe.
There are many varieties of opioids. They could be taken in some ways, including orally in liquid or capsule form.
photo by makasan/Shutterstock

Dose adjustment The way the drug is administered is also vital. For example, the dose needed when injecting morphine is normally much lower than when taken orally as a tablet or liquid.

What is being done about this shortage and what next?

The Australian government has approved three foreign substitute products to fill the gap until supply returns to normal. They are sponsored by an Australian company Medsurge healthcare and include two liquid formulations of morphine sulfate and one liquid formulation of morphine chloride. Both work in the identical way and are equally effective in treating pain.

In Australia, there are reports that some patients still do not need access to opioid medications inside the Australian health care system. paying as much as $4,000 source your individual supplies from abroad.

But these are stopgap measures, just like those currently getting used to handle the shortage of intravenous fluids, and are one other example of why the Australian Government needs to speculate in local medicines production.

If you or a loved one needs pain relief through palliative care, there are still many options. Talk to your doctor to find out the perfect approach to maintain you or your beloved pain-free.

This article was originally published on : theconversation.com
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Health and Wellness

In the USA, bird flu was detected in pigs. Why does this matter?

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Last week, the U.S. Department of Agriculture reported that a pig at a backyard farm in Oregon had been infected with bird flu.

As the bird flu situation continues to evolve, now we have learned that the A/H5N1 strain of the virus infects a spread of animals, including quite a lot of birds, wildlife and dairy cattle.

Fortunately, now we have not seen sustained spread of the virus between people at this stage. However, the detection of the virus in pigs represents a worrying development in the trajectory of this virus.

How did we get here?

The most concerning sort of bird flu currently circulating is clade 2.3.4.4b A/H5N1, the influenza A strain.

Since 2020, the A/H5N1 2.3.4.4b virus has spread to a big selection of birds, wildlife and livestock which have never previously been infected with avian influenza.

While Europe is a hotspot for A/H5N1, attention is currently focused on the US. In 2024, dairy cattle were infected for the first time, with over The problem affects 400 herds in a minimum of 14 US states.



Bird flu has huge consequences for breeding and industrial food production, as infected poultry flocks should be slaughtered and infected cows may result in contamination dairy products. That said, pasteurization should make the milk secure to drink.

Although farmers have suffered heavy losses as a consequence of H5N1 bird flu, it may well also mutate to cause a pandemic in humans.

Birds and humans have various kinds of receptors in their respiratory tract to which influenza viruses attach, corresponding to a lock (receptors) and a key (virus). The attachment of the virus allows it to enter the cell and body and cause disease. Avian influenza viruses are adapted to birds and spread easily amongst birds but not in humans.

So far, human cases have mainly occurred in individuals who stayed at the facility close contact with infected livestock or birds. In the US, the majority were agricultural employees.

The fear is that the virus will mutate and adapt to humans. One key step for this to occur could be to vary the virus’s affinity from bird receptors to receptors found in the human respiratory tract. In other words, if the virus “key” has mutated to raised fit the human “lock”.

Recent testing of sample A/H5N1 2.3.4.4bz infected person, disturbing results were obtainedidentifying mutations in the virus which will increase transmission between human hosts.

Why are pigs an issue?

A pandemic strain of influenza in humans can arise in several ways. One involves close contact between humans and animals infected with their very own specific influenza viruses, creating opportunities mixing of genes of avian and human viruses.

Pigs are the perfect vessel for mixing genes to supply a human strain of pandemic flu because they’ve receptors in their respiratory tract that each avian and human influenza viruses it may well get tied up.

This signifies that pigs will be infected with each avian influenza virus and human influenza virus. These viruses can exchange genetic material, mutate and simply transmit to humans.


Conversation, CC BY-SA

Interestingly, there have been pigs in the past less vulnerable to A/H5N1 viruses. However, the virus has recently mutated they infect pigs more easily.

In a recent case in Oregon, A/H5N1 was detected in a pig on a non-commercial farm following an outbreak of disease amongst poultry kept on the same holding. This A/H5N1 strain originated from wild birdsand never the one common in US dairy cows.

Pig infection is a warning. If the virus makes its way into industrial piggeries, it might create a much higher level of pandemic risk, especially as winter approaches in the U.S., when seasonal human flu cases begin to extend.



How can we minimize the risk?

Surveillance is vital to early detection of a possible pandemic. This includes comprehensive testing and reporting of infections in birds and animals financial compensation and support measures for farmers to encourage timely reporting.

Strengthening global surveillance of influenza is crucial because unusual spikes in pneumonia and severe respiratory illnesses could signal a human pandemic. Our EPIWATCH system looks for early warnings of such activity, which can accelerate vaccine development.

If a cluster of human cases occurs and influenza A is detected, further testing (called subtyping) is vital to find out whether it’s a seasonal strain, an avian strain resulting from transmission of the virus, or a brand new pandemic strain.

Early identification can prevent a pandemic. Any delay in identifying an emerging pandemic strain allows the virus to spread widely across international borders.

The first human case of A/H5N1 in Australia was in a baby who became infected while traveling in India and was hospitalized for the disease in March 2024. Tests then identified influenza A (which might have been seasonal influenza or bird flu), but subtype to discover A/H5N1 was delayed.

This sort of delay may very well be costly if human-borne A/H5N1 emerges and is taken into account seasonal influenza because the influenza A test is positive. 5% of positive tests for influenza A undergo further subtyping in Australia and most countries.

In light of the current situation, there needs to be a low threshold for subtyping influenza A strains in humans. Rapid tests that may tell the difference between seasonal flu and H5 A flu are emerging and may form a part of governments’ pandemic preparedness.

The risk is higher than ever before

The U.S. Centers for Disease Control and Prevention states that the current risk posed by H5N1 to the general public stays low.

However, with the H5N1 virus already in a position to infect pigs and showing worrying mutations in adapting to humans, the risk level has increased. Given that the virus is so common amongst animals and birds, the statistical probability of a pandemic is higher than ever before.

The excellent news is that we’re higher prepared for a flu pandemic than other pandemics because vaccines will be produced in the same way as seasonal flu vaccines. Once the genome of the pandemic flu virus is understood, vaccines will be updated to match it.

Partially matched vaccines and a few are already available countries corresponding to Finland vaccinate high-risk farm employees.

This article was originally published on : theconversation.com
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Health and Wellness

WATCH: Joshua Joseph What kind of America do we want to be? – Essence

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“; } }); // Drag and scroll functionality const playlistContainer = document.getElementById(‘playlist’); let isDown = false; let startY; let scrollTop; playlistContainer.addEventListener(‘mousedown’, (e) => { isDown = true; playlistContainer.classList.add(‘active’); startY = e.pageY – playlistContainer.offsetTop = playlistContainer.addEventListener(‘mouseleave’; playlistContainer.classList.remove(‘active’); playlistContainer.addEventListener(‘mouseup’, () => { isDown = false; playlistContainer.classList.remove(‘active’); }); mousemove’, (e) => { if (!isDown) return; e.preventDefault(); const y = e.pageY – playlistContainer.offsetTop; const walk = (y – startY) * 3; .scrollTop = scrollTop – walk; }); } } if (” !== ‘efoc24’) { // Check DoubleVerify Quality Targeting signals before rendering the player if ( ‘unknown’ !== typeof PQ ) { PQ.cmd. push(function() { // If DVQT signals are not available after 500 ms, render the player anyway. const timeout_id = setTimeout( jwPlayerRender, 500 ); // Get “Authentic Direct” signals. PQ.getTargeting({ signals: [‘abs’] }, function(error, targetingData) { clearTimeout(timeout_id); jwPlayerRender(error? undefined: targetingData); }); }); } else { jwPlayerRender(); } function jwPlayerRender( dvqt_signals=”” ) { let jw_ad_tag ​​= {“client”:”googima”,”adscheduleid”:”G7hR9pQ2″,”schedule”:[{“tag”:”https://pubads.g.doubleclick.net/gampad/ads?correlator=&iu=/21698916284/ess/VideoNews&env=vp&gdfp_req=1&output=vast&sz=400×300%7C640x480%7C1000x1%7C1920x1080&description_url=__page-url__&tfcd=0&npa=0&vpmute=1&vpa=auto&vad_type=linear&url=__page-url__&vpos=preroll&unviewed_position_start=1&v=SRYaJJB3&pmnd=0&pmxd=60000&ad_rule=1&cust_params=ttid%3DSRYaJJB3%26frnch%3D__item-franchise__%26environment%3Dproduction%26kwblock%3DAbb%2CCapOne%2CLincoln%2CUPS%2CVG%2CATTCric%2CDisney”,”offset”:”pre”},{“tag”:”https://vid.springserve.com/vast/670880?url=https://www.essence.com/news/watch-joshua-jospeh-what-type-of-america-do-we-want-to-be/h=450&w=800&cb=2033″,”offset”:”50%”}]”offers”:{“bidders”:[{“id”:”jw-video-SRYaJJB3″,”name”:”jwdemand”,”publisherId”:”evcxFIDZ”,”siteId”:”WT5iFegj”,”placementId”:”24399785″}]”settings”:{“disableConsentManagementOnNoCmp”:true,”mediationLayerAdServer”:”dfp”,”floorPriceCents”:200,”floorPriceCurrency”:”usd”,”buckets”:[{“increment”:0.1,”max”:30,”min”:0},{“increment”:0.5,”max”:50,”min”:30}]}}}; // Configure ad tag on the fly… let additional_params = {}; // Input DVQT signals. if ( dvqt_signals && dvqt_signals.ABS.length > 0 ) { additional_params.ABS = dvqt_signals.ABS.join(“,”); } // Create a string of additional_parameters. let extra_params_str=””; for (enter additional_parameters) { let value = additional_parameters[key]; additional_params_str += `${key}=${value}`; if ( key !== Object.keys( additional_params .pop() ) { additional_params_str += ‘&’; } } // Update ad tag cust_params (must be URL encoded). if ( Object.keys( additional_parameters ). length > 0 ) { let ad_schedule = jw_ad_tag.schedule; if ( ‘undefined’ !== ad schedule type ) { for (let i = 0; i < ad_schedule. length; i++) { let address_address = new URL(jw_ad_tag. schedule[i].label); let query_params = new URLSearchParams(ad_url.search); query_params.set("cust_params", query_params.get("cust_params") + `&${additional_params_str}`); ad_url.search = query_params.toString(); jw_ad_tag.schedule[i].tag = ad_url.toString(); } } } let playerId; if ("undefined" !== type jwplayerQueue) { playerId = 'jw-video-SRYaJJB3'; jwplayerQueue.push({ 'instanceId': 'playerInstance_SRYaJJB3', 'playerId': playerId, 'config': { pid: 't6KP9zcV', playlist: "https://cdn.jwplayer.com/v2/media/SRYaJJB3", autostart: !jw_ad_tag, repeat: true, mute: true, aspect ratio: "16:9", share: {sites: ["facebook", "twitter", "email", "linkedin"]}, cast: {}, float: {disibility: true}, autoPause: {viewability: true}, displaytitle: true, displaydescription: true, controls: true, related: {displayMode: 'shelfWidget'}, interactive: {} , ad: jw_ad_tag ​​​​} }); } // Load video. jQuery(window).trigger("jw:loadplayers"); function waitForJWPlayer(callback) { if (type jwplayer !== 'undefined') { callback(); } else { setTimeout(function() { waitForJWPlayer(callback); }, 500); } } waitForJWPlayer(function() { jwplayer(playerId).on('adsManager', function (adsManagerLoaded) { let adsManager = adsManagerLoaded.adsManager; let videoElement = document.getElementById(playerId ); let config = { anId: '929481' , campId: '640x360', ias_xps: "autoplay", // autoplay state ias_xbp: "2", // video destination type ias_xar: "1" // autoplay state } // Start IAS integration googleImaVansAdapter. init(google, adsmanager, videoitem, config } } });

This article was originally published on : www.essence.com
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Health and Wellness

Primary care involves more than primary care physicians. A new review shows how patients can gain better access to healthcare

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Today there are Australians more likely than previous generations suffered from complex and chronic diseases similar to diabetes, heart disease and depression.

This means they’re more likely to need health care from a wide range of providers, similar to nurses, podiatrists, psychologists and physiotherapists, in addition to general practitioners. This is named “multidisciplinary care”. It works best when the abilities of all these professions can be found to the patient in a coordinated way.

However, the role of the health professions and how they’re financed have been frozen in laws and policy for a long time. All changes are gradual and chaotic. This mainly involved adding more items to the Medicare schedule, with each specialist practicing individually.

The result was greater inequality of access. Because less than half Alliance visits are billed collectively, with most patients paying almost A$70 for every consultation, and sometimes much more. Those who cannot afford the out-of-pocket costs and can’t discover a bulk invoicing specialist are missing out.

To assess how the federal government can remove barriers to team-based care and ensure healthcare employees achieve their full potential or full ‘scope of practice’, the federal government commissioned an independent review last yr.

The final report published yesterday sets a new path for primary care employees. This will make multidisciplinary care accessible to all Australians.

Utilizing the total potential of healthcare employees

The review included extensive consultations, including on two issues papers. The report itself comprises feedback from the consultation, including skeptical comments reflecting differences of opinion.

The title of the report was reflected, Unlocking the potential of our healthcare employeesits primary focus is on changing the foundations and regulations imposed by state and federal governments. This makes the work of healthcare employees more difficult and limits their ability to use their full skills and knowledge to manage patient care.

Over the past a long time the education of health care employees has improved. Professionals are subsequently able to do more than before. However, rules and regulations haven’t progressed, making it difficult for professionals to share these skills and knowledge.

The review found that that is contributing to profession dissatisfaction and other people leaving a wide range of health professions, exacerbating workforce shortages.

The review proposes a new way of documenting and describing what a occupation can do, through a so-called national skills and capabilities framework and matrix.

As with many other recommendations, the review highlights where that is already getting used internationally and how it can be integrated into other policies and frameworks to help with implementation.

Health care employees don’t use all their skills.
Studio DC/Shutterstock

To the frustration of most allied health professions, the review doesn’t recommend greater Medicare payments to allow them to practice independently.

Rather, the review beneficial paying for general practices to develop multidisciplinary teams. This will help professionals collaborate moderately than compete or isolate themselves.

The review also beneficial changing the foundations on healthcare skilled referrals, allowing qualified healthcare professionals to refer directly to non-GP specialists in similar areas. This signifies that if mandatory, your psychologist can refer you directly to a psychiatrist, or your physiotherapist can refer you directly to an orthopedic surgeon, moderately than going back to your GP.

This will weaken the GP’s gatekeeper role and potentially undermine the more holistic care provided by GPs. However, from the patient’s viewpoint, eliminating the intermediate step saves him/her out-of-pocket expenses.

The necessary suggestion recognizes that the health care system is evolving and that policies and regulations must evolve as well. It is subsequently now complementing its recommendations for change by introducing a continuous review approach through an independent mechanism. This would supply evidence-based advice and proposals on:

  • significant workforce innovations
  • new roles in health care
  • workforce models that involve a major change in scope.

When will we see change?

The review outlined a loose implementation timeline that might be described as short, medium and long run. It also assigns responsibility for every element of its recommendations to the suitable authorities and governments.

As almost all the recommendations require legislative changes, and lots of of them require agreement between the Commonwealth and the states, it’s unlikely that any of the changes will come into force this financial yr.

The review beneficial making changes in a scientific, evidence-based and protected way. Implementation would begin in areas of best need, similar to rural and distant Australia, in addition to in practices most ready for change, similar to Aboriginal Controlled Community Health Organizations or Victoria Community Health Centres.

The man is waiting for the doctor
The review beneficial changes to the referral process.
Voronaman/Shutterstock

IN releasing Health Minister Mark Butler described it as a “landmark” report and noted the complexity of implementation, which might require joint motion with states and territories. He noted the necessity for further consultations, but nevertheless adopted a supportive tone.

Can this review speed up real health reform?

Overall, the review found a pleased medium between giving healthcare employees the liberty to act and the stringent and inappropriate rules and regulations that currently limit patient care. It also outlines practical steps to achieve your goals.

The only drawback of the report is the emphasis on harmonizing state and territorial approaches. This would replace the present approach under which each state and territory decides, for instance, which vaccines can be administered by which specialists and which pharmacists can dispense over-the-counter.

One of the advantages of a federation is the potential for state and territory innovation and cross-border learning. Harmonization will limit such experimentation and will lead to greater stagnation seen previously in medical expert policy.

This article was originally published on : theconversation.com
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