March 2025 Medical Director Report

Pikes Peak LTC Ethics Committee

• Meeting the first Friday of Every Month from 12-1pm
• Join Zoom Meeting
  https://zoom.us/j/93138547873?pwd=QUFDZnJIN3R1OGlkcXluck5UNXFaUT09

Does Tamiflu Really Help?

Evaluation of Oseltamivir Used to Prevent Hospitalization in Outpatients With Influenza: A Systematic Review and Meta-Analysis | Clinical Pharmacy and Pharmacology | JAMA Internal Medicine | JAMA Network

I will be reviewing some of the newer data on Tamiflu use for influenza treatment and prophylaxis. You may see my guidance on its use change. I think you will certainly see the guidance on its use change for next season. – Dr. Shepherd

Results  Of 2352 studies identified, 15 were included. The intention-to-treat infected (ITTi) population was comprised of 6166 individuals with 54.7% prescribed oseltamivir. Across study populations, 53.9% (5610 of 10 471) were female and the mean age was 45.3 (14.5) years. Overall, oseltamivir was not associated with reduced risk of hospitalization within the ITTi population (RR, 0.79; 95% CI, 0.48 to 1.29; RD, −0.17%; 95% CI, −0.23% to 0.48%). Oseltamivir was also not associated with reduced hospitalization in older populations (mean age ≥65 years: RR, 1.01; 95% CI, 0.21 to 4.90) or in patients considered at greater risk of hospitalization (RR, 0.65; 0.33 to 1.28). Within the safety population, oseltamivir was associated with increased nausea (RR, 1.43; 95% CI, 1.13 to 1.82) and vomiting (RR, 1.83; 95% CI, 1.28 to 2.63) but not serious adverse events (RR, 0.71; 95% CI, 0.46 to1.08).

Conclusion: Based on the available RCT data in this systematic review and meta-analysis, there is a lack of convincing evidence that oseltamivir reduces serious complications in outpatients with influenza, although its use is associated with an increase in nonsevere gastrointestinal adverse events. This meta-analysis provides important data for clinicians, patients, and policy makers to contextualize the evidence and inform guidelines. Future research should focus on the conduct of an adequately powered placebo-controlled trial in a suitably high-risk population.

Outbreak Investigation of Listeria monocytogenes: Frozen Supplemental Shakes (February 2025) | FDA

CDC and public health officials in several states are investigating an ongoing multistate outbreak of Listeria that started in 2018. Many people from this outbreak lived in long-term care facilities or were hospitalized before becoming sick. This outbreak has been linked to frozen supplement shakes under the brand names of Sysco Imperial and Lyons ReadyCare; they have since been recalled by the FDA. 

Updated Surveyor Guidance

• Psychotropic use is still a major concern.
• Ensure you are tracking behaviors that we are treating with a psychotropic
  • please consider tracking behaviors for days or weeks prior to initiating a psychotropic. This will provide the best documentation to justify the use of the psychotropic.
• Involvement of the Medical Director in QAPI and availability of the Medical Director seems to be an emphasis.
• Please text me and let me know if you are in survey.

Medication Administration: Have a dose for topical medications.

• Please remember to provide a dose for all creams, ointments, powders, etc…
• Example: icy-hot, apply a thin layer on the right shoulder every 8 hours.
• Example: Diclofenac gel can be dispensed as 2g or 4 g.
• Tag for this is listed below for your review

Measles

Measles is highly contagious. Symptoms include fever, cough, runny nose, conjunctivitis/pinkeye. The symptoms start 2 to 4 days prior to the onset of a rash. The rash is described as maculopapular.

As of 3/6/2025 there have been 222 recognized cases of measles in the United States. Most of the cases are among children who have not received the MMR vaccine.

• Nasal skin lead to severe health complications such as pneumonia, encephalitis, and death. The virus is transmitted through airborne spread via infectious droplets. The virus remains infectious in the air and on surfaces for up to 2 hours. Patient is harboring the measles virus are contagious from 4 days before the rash starts 3 to 4 days afterwards. Incubation period is approximately 7 to 10 days. from the time of exposure to the onset of the rash is typically 10 to 14 days, with a range of 7 to 21 days.
• — Adults at high risk should have at least 1 documented dose of MMR.
• — Adults with a high risk of exposure such as healthcare workers and international traveler should have 2 documented doses of MMR.
• — Teenagers and adults previously vaccinated with 1 dose of MMR vaccine should receive a second dose
• — Those with no evidence of immunity should receive 1 dose of MMR immediately followed by second dose at least 28 days later.
• — If vaccination status is in question, titers can be ordered which should help determine whether or not a person has been vaccinated or exposed.
• — If you suspect someone has measles it is best practice to isolate the patient immediately.
• – There is no antiviral therapy for measles.
• Measles is immediately reportable by both laboratories and providers. Report any patient suspected of having measles to your local health department or to CDPHE by phone 303-692-2700 (after hours 303-370-9395).
• Measles PCR testing on respiratory (throat or nasopharyngeal swab) specimens is the preferred test and can be done at the CDPHE Lab.
• Adults not at high risk of exposure should have at least one documented dose of MMR vaccine in their lifetime, or other evidence of immunity.
• Adults at high exposure risk, including students at post-secondary institutions, health care workers, and international travelers, should have two documented doses of MMR vaccine.
• Measles | Colorado Department of Public Health and Environment

Measles Vaccination for Specific Groups | Measles (Rubeola) | CDC

Healthcare personnel without presumptive evidence of immunity should get 2 doses of MMR vaccine, separated by at least 28 days. Although birth before 1957 is considered acceptable evidence of immunity in routine circumstances, healthcare facilities should consider vaccinating healthcare personnel born before 1957 who lack laboratory evidence of immunity or laboratory confirmation of disease.

2022 AHA/ACC Heart Failure Guideline Update