In 2024, the National Youth Tobacco Survey revealed a significant decrease in e-cigarette use among U.S. middle and high school students, with current use dropping from 2.13 million (7.7%) in 2023 to 1.63 million (5.9%) in 2024.
This reduction is mainly due to a decline in high school e-cigarette use, while middle school usage remained stable. The number of youth using e- cigarettes is now about one-third of the peak level in 2019. The survey also noted a decrease in the use of Elf Bar products, attributed to FDA enforcement actions. Despite these positive trends, concerns remain about any youth tobacco use, including nicotine pouches, and ongoing public health efforts are essential.
Embecta is a new fully disposable insulin patch pump for patients with Type 1 and Type 2 Diabetes. This patch pump has a larger reservoir holding 300 units of insulin allowing for extended use for up to 3 days to better accommodate higher insulin needs as seen with Type 2 Diabetes. The pump patch also is great for individuals who are doing multiple daily injections to manage their diabetes therefore improving compliance and convenience for individuals.
Bezisterim is an investigation drug being studied for "potential ability to reduce the neurological symptoms associated with long Covid” Though there is not exact definition of what "long Covid" is, common symptoms are extreme fatigue, brain fog, light headedness, dizziness, and loss of taste and smell. Bezasterim is being investigated for Alzheimer’s and Parkinsons Disease since results showed patients experienced improved cognition and biomarker levels in Alzheimer’s disease. This drug can potentially be an added benefit in LTC if it shows meaningful improvement in motor control and cognition.
Novavax just received Emergency use authorization from the FDA for its new 2024-25 formula of the Covid-19 vaccine. Novavax is different from the other MRNA technology-based vaccines, as this on is protein based and targets the JN.1 strain but effectively covers the KP strains. Authorization of the updated Novavax, gives an additional option of another Covid-19 vaccine meeting FDA standards.
Neffy is the first ever needle-free Epinephrine Nasal spray that received approval from the FDA. Neffy is approved for type 1 allergic reactions, including anaphylaxis in adults and pediatrics that weigh over 66 pounds. This is a breakthrough treatment because up until now EpiPen/epinephrine has only been available as an injectable and can be challenging to self- administer for some individuals who fear needles that are going through an anaphylactic reaction. That delay in administering a needle can be life threatening with anaphylaxis. Neffy will be a safe and accessible therapeutic option and is easy to carry/store - beneficial to the long-term care and community.
References:
https://www.drugtopics.com/fda-updates
September 2024
All nursing homes that participate in the Medicare program must go through an annual recertification inspection, known as standard survey. These surprise visits conducted by the State can last days and is an intense process. Covid-19 and other factors resulted in state surveyors falling months to years behind on the annual survey process. Delayed surveys affect the CMS compliance and five - star quality rating of a nursing home as well and cause some facilities to fall out of compliance due to lack of consistent surveys. CMS finally decided to pilot a new "risk- based survey" as of April 2024. The goal is to use a more focused survey that will take less time for facilities that were consistently "higher- quality". The goal is that shorter quality surveys for these facilities will free up the time and resources for the higher-risk nursing homes and help all facilities to be up to date with annual surveys and their CMS ratings. "Higher quality nursing homes" are considered those that had few to no citations of non-compliance, better higher staffing, and fewer hospitalizations as well as other characteristics related to resident harm, abuse, investigations etc. If this survey pilot is successful, it will be the first change in the survey process in a long time and a potential benefit for all.
As we start off 2025, it is important to review any changes that will take place with regards to CMS surveys and other regulatory updates. The CMS has updated the survey guidance and revised the State Operations Manual that will be effective as of February 24, 2025. Surveyors will begin using the new guidance for all surveys as of the above effective date. The goal is to streamline the survey process and eliminate overlapping citations. The following are some of the guidances that have been revised. Your team should review and ensure that changes in your processes have been made to maintain compliance with new standards.
One of the most common disease states in Long Term Care is Diabetes Mellitus Type 2. We always focus on obtaining glycemic control for these patients. However, often we forget that some of the most common classes of medications used to treat other disease states in diabetic patients, can disrupt the glucose levels. This may require extra monitoring of glucose levels or an adjustment of diabetic medications. Below are five commonly-used medication classes that should be reviewed when prescribing for your diabetic resident:
Medications such as prednisone or methylprednisolone are some of the most commonly known offenders of affecting glycemic control in diabetics and even causing new onset diabetes or steroid induced diabetes. Management of glucose depends on duration of glucocorticoid therapy, and how well the patient’s glucose was controlled prior to initiating therapy.
Many drugs in this class can cause weight gain as a common side effect. As we know, obesity is a risk factor in contributing to or developing diabetes. Antipsychotics can also lead to insulin resistance. Some antipsychotics that more commonly affect glucose are Clozapine, Olanzapine, and Haloperidol. Alternatively, Ziprasidone is known to have less effects on glucose.
Specifically, thiazide diuretics are a common first line therapy and adjunct in the management of high blood pressure. Some thiazide diuretics are Metolazone and Hydrochlorothiazide. Thiazide diuretics can also cause increased glucose levels in addition to affecting electrolyte levels such as potassium (hypokalemia). Studies show that hypokalemia due to thiazide diuretics can cause diabetes and reduce insulin sensitivity.
It is likely that your diabetic resident has other comorbidities such as high cholesterol which require treatment with statins. Statins are also on the list of medications that can reduce insulin secretion and sensitivity. In diabetics, statins may increase the hemoglobin A1C slightly. However, if you look at the risk vs benefit of statin therapy vs the development of diabetes, statin therapy should be initiated as the benefit to prevent cardiovascular disease and can outweigh risks with hyperglycemia.
Beta blockers are commonly used for high blood pressure, coronary artery disease, and heart failure. Metoprolol and atenolol are associated with increasing hemoglobin A1C but also associated with increased risk of hypoglycemia. It is also important to keep in mind that beta blockers can mask the symptoms of hypoglycemia.
