Since the key findings
from this research will be of interest, all healthcare providers who
participate will receive a complimentary summary of the results.
Whether you utilize an
EMR today, or are planning to purchase an EMR down the road, would you be
willing to share some insight?
Please use this link
to contribute your thoughts. All responses are aggregated and
Mosquitoes With West Nile Virus Appearing In Various Parts of the US
The Connecticut Department of Public Health's State Mosquito Management
Program has announced that mosquitoes in Bridgeport tested positive for West Nile Virus on June 21st - the first cases identified by CAES (Connecticut Agricultural Experiment Station) in 2011. Tennessee - the state's Public Health Laboratory confirmed WNV in
mosquitoes in Memphis, Nashville and Knoxville. State officials urge
citizens to use repellants and take other precautions to prevent
mosquito and other insect bites.
Abelardo C. Moncayo, PhD, director of the Vector-Borne Diseases program for the Tennessee Department of Health, said:
"These positive tests tell us that individuals bitten by mosquitoes
in Tennessee could be at risk for contracting West Nile Virus. We can
help control mosquito populations and lessen the risk of infection by
emptying containers with standing water, keeping doors and windows
screened, and wearing mosquito repellent when outside."
Authorities inform that Tennessee is the 10th state so far in 2011 to
show positive tests for WNV in mosquitoes, horses or birds. Officials in South Dakota inform that peak WNV transmission occurs from
mid-July through mid-September. There have been over 1,700 human cases
reported in the state since 2002, including 26 deaths.
Ohio - two mosquito pools in the City of Columbus tested positive for WNV. No human cases have been reported in the state so far. According to the CDC's "2011 West Nile Virus Human Infections in the United States", up to June 28th there has been one human case of WNV infection, reported in Mississippi - a non-neuroinvasive disease case.
AAUCM, AMA, Other Groups Say Proposed Rules for Demonstrating Meaningful Use Are Unrealistic
Medical associations are warning that overly strict meaningful use criteria proposed by the Dept. of Health and Human Services for the next phase of the Medicare and Medicaid electronic medical records incentive program could dissuade physicians from participating. While stage 1 requires that 40% of all permissible prescriptions be transmitted electronically, stage 2 would increase the threshold to 50%. The American Medical Association and 38 other members of organized medicine sent a letter outlining their concerns to the Office of the National Coordinator for Health Information Technology, which is developing the objectives for the program.
States Working to Implement Medicaid Provisions of ACA
Medicaid programs will expand and change significantly over the next few years, largely because of the Affordable Care Act (ACA). An additional 16 million newly eligible people are expected to enroll in Medicaid by 2014. At that point, Medicaid programs also will have implemented a new method to calculate income, as well as new eligibility and enrollment systems that coordinate with the health insurance exchanges that will be established through the ACA. While many of these changes do not take place until 2014, many states already have begun working toward implementation. Given the dire budget situation in many states, however, these implementation efforts have been a challenge. Since 2008, states have confronted declining revenues and been forced to make multiple budget cuts, closing almost $230 billion in budget gaps between fiscal years 2009 and 2011. Because Medicaid is one of the top line items in most state budgets, states have cut funding for those programs for several years. To make the problem worse, Medicaid spending is "countercyclical." As the economy declines, the number of eligible enrollees increases while funding decreases, contributing to the overall budget pressures. While state lawmakers are forced to control Medicaid spending, their options for cutting program costs are somewhat limited by federal requirements. For example, the maintenance of effort requirements tied to the federal stimulus bill and the ACA prohibit states from reducing eligibility levels. As a result, states have implemented other measures, including provider payment cuts. States also have eliminated optional benefits, increased deductibles and/or copayments for certain services, and expanded or created new Medicaid managed care plans. Several states have focused on reducing pharmaceutical costs by implementing formularies, requiring generic substitution or limiting the number of covered prescriptions. The ACA includes several opportunities for states to receive federal funding to explore new Medicaid strategies. For example, the Department of Health and Human Services (HHS) will award state grants for the Medicaid Incentives for Prevention of Chronic Diseases Program, which rewards Medicaid beneficiaries for participating in prevention programs that positively impact their health. HHS also has awarded "early innovator" grants to seven states for designing and implementing the information technology (IT) infrastructure needed to operate the health insurance exchanges, including the means of coordinating with state Medicaid programs. Additionally, the ACA includes several Medicaid demonstration projects that states can pursue, such as pediatric accountable care organizations, the emergency psychiatric care demonstration project and the payment system demonstration project. Federal funding is tied to several of these projects. The ACA also provides grant opportunities or increases in the states' federal medical assistance percentage, or FMAP, for implementing such innovative programs as the community first choice option or home- and community-based services. Recognizing the enormous tasks ahead for the states, HHS and the Centers for Medicare & Medicaid Services (CMS) have signaled their commitment to working with them as they implement the ACA. For example, CMS indicated it will provide an enhanced federal match to states for developing and administering the IT infrastructure for their new eligibility and enrollment systems. In a recent letter to the nation's governors, HHS Secretary Kathleen Sebelius said the Obama administration will work hard to identify cost drivers for the states and offered several suggestions to help states save money, including cutting optional benefits, managing care for high-cost enrollees, controlling pharmaceutical spending and addressing program integrity. States will continue to be the laboratory for innovation. The AMA's Advocacy Resource Center provides tools and resources to state medical societies to support their state legislative and regulatory efforts, including implementation of the ACA. Visit the Advocacy Resource Center website for more information.
Scientists Discover Mutation That Could Cause H1N1 To Spread Faster
Scientists at the Massachusetts Institute of Technology have examined H1N1 and discovered that a single mutation could make the flu more dangerous. They found that the 2009 H1N1 virus, like the first version of the 1918 virus, had a protein structure that did not bind efficiently to cells in the human respiratory tract. In their study in the journal PLoS ONE, the researchers describe how they were able to create a version of H1N1 with a single mutation that greatly increased the virus' binding strength. Moreover, the MIT team noted that further testing showed the mutated version of the virus spread rapidly in ferrets that were used as a model for the human response to influenza.
Study Finds Growing Lack Of Teamwork Between ED, Primary Care Physicians
Coordination between ED physicians and PCPs is often disjointed, according to a study by the Center for Studying Health System Change. Researchers interviewed 21 pairs of ED physicians and PCPs who practiced at the same hospital in 12 communities and found numerous hindrances to teamwork. For example, the availability of more hospitalists and fewer PCPs hinders ED physicians and PCPs from developing close working ties. Moreover, there are technological barriers, with ED physicians and PCPs often using electronic health systems that cannot talk to each other. Lastly, there are financial barriers, such as when follow-up care discussions go unreimbursed and distract both ED physicians and PCPs. The study authors recommend a wide range solutions focusing on better coordination.
Jackson Healthcare is proposing a new federal law in March 2011 to address the high cost of defensive medicine.
This is not a traditional tort reform approach that seeks to limit or “cap” physician liability. It proposes a no-fault system that benefits physicians in three important ways:
In essence, this proposal would be similar to the workers’ compensation system. It would:
Here’s how you can help…
STEP 1: Review the proposal clicking through the next several slides
STEP 2: Give us your opinion in the survey following the proposal
After you've taken the survey, please pass this onto your colleagues, and encourage them to take the survey.
Click here to begin...
One In Three US Adults May Have Pre-Diabetes, CDC Reports
Approximately one of three American adults may have so-called pre-diabetes, a 39% jump over 2008 estimates, according to a report released by the Centers for Disease Control and Prevention. According to this new CDC data, half of all Americans over the age of 65 are prediabetic and 27% have diabetes. Minorities are still at higher risk compared with Caucasians: 16 % of American Indians/Alaska Natives, more than 12% of African-Americans and nearly 12% of Hispanic adults now have diabetes, compared with a little more than 8% of Asian-Americans and 7% of non-Hispanic whites. In 2008, the CDC estimated that 23.6 million Americans had diabetes and an additional 57 million adults had prediabetes.
FDA Approves Head Lice Treatment For Children And Adults
The Food and Drug Administration approved Natroba (spinosad) Topical Suspension 0.9% for the treatment of head lice infestation in patients ages 4 years and older. Natroba provides another option for the topical treatment of head lice infestations, which are especially prevalent in the pediatric population. Natroba is a topical drug product and should be applied only to the child's scalp or hair.
Global Fees Reach MA: Urgent Care Centers Are No Longer the Target of This Cost-Reduction Phenomenon
Blue Cross Blue Shield of Massachusetts and the Beth Israel Deaconess Physician Organization have signed an alternative quality contract, thereby covering 40 percent of Blue Cross HMO members under so-called "global payments." The move is a signal that global payments, a system designed to reward doctors for keeping patients healthy and reducing the number of medical procedures, is gaining traction among Massachusetts doctors, reports the Boston Business Journal. The agreement sets a global, or fixed, payment per patient adjusted for age, sex, and health status as well as payments tied to performance on quality measures, health outcomes and patient care experiences. The contract's global payment covers all services received by a patient, including primary, specialty and hospital care, Blue Cross officials said in a statement. Now, instead of getting paid for every visit, test and procedure, doctors at Beth Israel will receive a budget to care for their Blue Cross HMO patients. If the physicians group goes over-budget, they split the loss with Blue Cross. If they come in under budget, they share the surplus, based on how much they improved the care of patients with certain conditions. If the doctors can't show improvement in patients' conditions or that patients are getting more preventative tests, they don't share the surplus. Beth Israel is the largest physicians group to join the Blue Cross payment system since the insurer started advocating for this contract two years ago. "It's rooted in a group that initially was skeptical," Blue Cross CEO Andrew Dreyfus told WBUR. "It took a long time for the group to come around and I think by the way our discussions with them improved (the contract)." This new way of paying for healthcare already seems "very encouraging," Dreyfus said. "Quality is improving at a faster rate with physicians who are practicing under our new payment model than with physicians who are outside of our payment model."
The Global Fee structure is good for the insurance companies, but not healthy for the public and physicians. The public needs to keep in mind that once an individual is assigned a "fixed dollar amount" to their visit, there is no incentive for a physician or health care system to invest in new diagnostic technologies and/or diagnostic tests, that will not be reimbursed. When purchasing insurance, always ask your insurance company, on what basis will my doctor be reimbursed? Do they endorse Global Fees? If so, walk away. They are only looking at their bottom line. We have not seen any data that shows that health care insurances are reducing premiums with this tactic.
CT Imaging Study May Increase Acute Abdominal Pain Patients' Confidence In Physician's Diagnosis
ED patients who have acute abdominal pain are four times more confident that doctors have correctly diagnosed their conditions when a CT imaging study is used to facilitate diagnosis, according to a study published in the online version of the Annals of Emergency Medicine. Researchers from the University of Medicine and Dentistry of New Jersey surveyed 1,168 patients with non-traumatic abdominal pain and found that 20% were confident in a diagnosis based on patient history and physical exam only. But 90% of patients reported confidence in their diagnosis when the medical evaluations also included blood work and a CT scan.
Will consumer driven algorithms be the next phase vs. as opposed to scientific based processes?
Signs Of Flu Season Upon Us, CDC Officials Announce
The first signs that the flu season is upon us have arrived, says the CDC. In some states, for example Georgia, reported cases of flu have suddenly risen so rapidly that state authorities are referring to a "regional outbreak". It seems that the virus strains identified so far closely match those used in this year's vaccinations, which is good news for those who had the jab.
The CDC has announced December 5 to 11th as National Influenza Vaccination Week. The aim is to stress the importance of vaccinations and to get as many people as possible immunized.
In a communiqué, the CDC wrote:
"National Influenza Vaccination Week provides an opportunity for public health professionals, health care professionals, health advocates, communities, and families from across the country to work together to promote flu vaccination before the traditional winter peak in flu activity."
During the 2010-2011 flu season, three influenza strains are expected to be present. Health authorities say every person aged 6 months or more should be vaccinated. Having the flu jab does not only protect you, but also those around you.
The three flu strains that will be circulating during the current/coming flu season, according to the CDCs' Advisory Committee on Immunization Practices, are:
An A/H3N2 strain
A B strain
The H1N1 (2009) pandemic strain, which for a while was informally termed "swine flu"
The current vaccine protects against these three strains. The CDC says 160 vaccines have been distributed throughout the USA.
Dr. Anne Schuchat, Assistant Surgeon General of the U.S. Public Health Service and CDC's Director of the National Center for Immunization and Respiratory Diseases, said:
"The new vaccination recommendation shows the importance of preventing the flu in everyone. People who do not get vaccinated are taking two risks: first, they are placing themselves at risk for the flu, including a potentially long and serious illness, and second, if they get sick, they are also placing their close contacts at risk for influenza."
Howard K. Koh, M.D., M.P.H.,Assistant Secretary for Health, said:
"The bottom line is, anyone - even healthy people - can get sick from the flu. Lead the way to better health for all by getting your flu shot."
The CDC says that the National Influenza Vaccination Week must engage at-risk audiences - people who have not yet been immunized, individuals who are hesitant or unsure whether having the jab is good for them.
Dear Insurance Carriers:
InQuicker.com, an online ER and Urgent Care check-in system, encourages patients "tired of waiting for hours in the ER waiting room" to check in on the web before they arrive, skipping the hours in the waiting room.
With story after story of emergency room overcrowding flooding the news 1,2,3,4,5,6, the question arises as to why this web site – and its participating hospitals – are advocating treatment for non-emergencies? It seems that the emergency medicine community is sending a mixed message; on one hand they purport that the emergency room is intended for life-and-limb treatment, i.e., emergencies, yet they are encouraging patients to come to the emergency room for non-emergency care when perhaps those patients would be better served at an urgent care center.
Emergency rooms are designed to treat patients suffering from life threatening injuries or serious illnesses. In contrast, urgent care centers are designed to lighten the load on local emergency rooms by treating non-life threatening injuries. The urgent care center is available for any non-life threatening medical illness or injury, providing direct attention without waiting hours for treatment (whether waiting at home or in the emergency room).
As an insurance carrier, why should you be concerned about this trend? Treating non-emergency cases in an emergency environment will ultimately have a negative effect on your bottom line. Hospitals and their emergency rooms run up bills and then charge you, the insurance provider, emergency room visit fees and facility fees. In contrast, treatment at an urgent care center costs hundreds if not thousands of dollars less.7
By educating consumers to “Know Where to Go” 8 and encouraging your participants to utilize urgent care centers for non-emergency care, you will be promoting better health care, helping to solve the health care crisis and helping your bottom line.
Franz Ritucci, M.D.
President, American Academy of Urgent Care Medicine
InQuicker.com - Online ER and Urgent Care Check-In System
According to the web site InQuicker.com, patients "tired of waiting for hours in the ER waiting room" can check in on the web before they arrive, skipping the hours in the waiting room.
Emergency medicine seems to be sending mixed messages - on one hand they purport that the ED is for emergency/life and limb treatment, yet they want to see patients that perhaps would be better served at an urgent care center. Are complaints and data of "overcrowding" in the nation's EDs just noise? It's unfathomable that insurance carriers would support this; if a patient pays out of pocket for non-emergency care appointment using a system such as InQuicker.com, then the insurance company pays a higher rate for treatment and care! Yet the insurance industry wants urgent care centers to accept global fees for their patients!
What are your thoughts on this? Click Here to send comments to the AAUCM.
Cheap Generics Threaten QA Efforts
Four-dollar generic drug programs may boost access to medications but make it tougher to monitor quality of care, researchers warned.Many pharmacies that offer low-cost generics don't submit claims to insurers when patients pay cash, noted Niteesh K. Choudhry, MD, PhD, and William H. Shrank, MD, MSHS, both of Brigham and Women's Hospital and Harvard in Boston. "The consequences of missing these claims is not insignificant," they cautioned in a perspective piece in the Nov. 11 issue of the New England Journal of Medicine.Eight of the 10 largest retail pharmacy chains, including Wal-Mart, Target, and Walgreens, have programs that charge $4 to $9.99 for a one-month supply or $10 to $12 for a three-month supply of some of the most widely used generic medications. As atorvastatin (Lipitor) and clopidogrel (Plavix) go off patent over the next several years, the role of such programs and their impact on public health will only grow, Choudhry and Shrank speculated. "Lower medication costs should have desirable effects on medication use, especially as the patents on more therapies for chronic conditions expire, and these low-cost programs have been a welcome advance for low-income patients," they noted in the article. However, an ironic side effect of the programs' failure to report filling patients' prescriptions when paid in cash is that these patients would be misclassified as nonusers or "nonadherers" to their medication regimen in the pharmacy claims databases that are increasingly used for quality assurance, Choudhry and Shrank wrote. These databases -- used to target interventions to improve adherence, to evaluate effectiveness and safety of medications outside of clinical trials, for pay-for-performance contracts, and to track utilization and expenditure -- "can contribute to long-term improvements in the healthcare system and may thereby directly benefit both current and future patients," Choudhry and Shank explained in their paper. With healthcare reform coming into play, the need to monitor the performance of health systems is even more pressing, they noted. The simplest solution may be to ensure that pharmacists submit all prescription benefit claims regardless of method of payment, which may require providing an incentive to do so without violating conflict-of-interest or kickback regulations, the researchers suggested. Other possibilities would be to use the electronic systems pharmacies use to record transactions and monitor inventory, to use electronic prescribing data instead of prescriptions filled, or to use electronic health records integrated with pharmacy and insurance claims. "Of course, obstacles related to the cost of maintaining these data, privacy concerns, and incentives for data sharing will need to be overcome," Choudhry and Shank wrote. But, they concluded, "we must be certain not to diminish our ability to measure and improve the quality of U.S. healthcare."
Health Care Reform: New Perspectives on Contracting and Partnerships
A nationwide survey of contracting executives in hospitals, health plans and multi-specialty physician groups
Analysis: More Americans Abandoning Prescriptions Due To Price
More Americans are abandoning their prescriptions at pharmacies rather than pay higher prices for them, according to a recent analysis of 80 million pharmacy claims conducted by Wolters Kluwer Pharma Solutions. The data showed that this phenomenon increased by 55% during the second quarter of 2010, compared to 2006 statistics. This finding is crucial because conventional wisdom indicated that prescription drugs were not susceptible to economic downturns since sick people must take medication in order recover, yet, this new evidence suggests that people are in fact deciding whether to pick up prescriptions based on price. This dovetails with the AAUCM suggestions that Urgent Care centers should provide self dispensing to patients at affordable prices where permitted by state regulations.
Doc Shortage to Worsen After Healthcare Reform
A new estimate from the Association of American Medical Colleges (AAMC) pegs the projected physician shortage at 50% worse than it would have been if healthcare reform hadn't passed. By 2015 -- one year after the majority of the provisions in the Affordable Care Act (ACA) will have taken effect -- the nation will be short 63,000 physicians, a figure that includes both primary care doctors and specialists. Previous estimates put the shortage at 39,600. By 2020, there will be 45,000 too few primary care physicians, and 46,000 too few specialists, according to the AAMC. The Affordable Care Act (ACA) contains several provisions that will add an estimated 3,500 new physicians to the work force over the next 10 years, including primary care grants and reshuffling residency programs. However, the ACA provides insurance coverage for an additional 32 million Americans, so the number of new patients seeking medical care will far outweigh the number of doctors trained to provide it. In addition, the Census Bureau projects a 36% growth in the over-65 population in the next decade, which means an influx of Medicare recipients. Couple that with a projection that nearly one-third of all physicians are expected to retire in the next decade, and the "need for timely access to high-quality care will be greater than ever," the AAMC said in a press release. The AAMC said that although medical school enrollment continues to increase, more residency training slots are needed, and Congress should overturn a 1997 law that put a freeze on Medicare-funded residency positions. "Unless Congress supports at least a 15% increase in residency training slots (adding another 4,000 physicians a year to the pipeline), access to healthcare will be out of reach for many Americans," the group said in its press release. The problem will be most pronounced for people living in rural and underserved areas where finding a doctor can already be a difficult task, according to the report. Urgent Care is poised to fill this need!
The FDA warned that Lamictal (lamotrigine), approved to treat seizures and bipolar disorder, can cause aseptic meningitis, an inflammation of the meninges that cover the brain and spinal cord not caused by bacterial infection. The agency is working with the drug's manufacturer, GlaxoSmithKline, to update the prescribing information and Patient Medication Guide to include information on this risk. The FDA became aware of the association between Lamictal and aseptic meningitis through routine adverse event monitoring and communications with the drug's manufacturer. Since the drug's approval in December 1994 through November 2009, there were 40 cases of aseptic meningitis identified in patients taking Lamictal. The symptoms were reported to occur within 1-42 days after starting Lamictal. Thirty-five of the 40 patients required hospitalization and in most cases, symptoms ended after Lamictal was discontinued. In 15 cases, symptoms, often more severe, returned when patients restarted the drug. For more information, visit www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm222212.htm .
The FDA is informing patients and healthcare professionals about the potential for developing eosinophilic pneumonia during treatment with Cubicin (daptomycin), an intravenous antibacterial drug. In 2007, pulmonary eosinophilia was added to the Adverse Reactions, Post-Marketing Experience section of the Cubicin product label. Since then, the Agency has reviewed published case reports of Cubicin-associated eosinophilic pneumonia, and conducted a review of post-marketing adverse event reports from the FDA's Adverse Event Reporting System (AERS). The FDA's review identified seven cases of eosinophilic pneumonia between 2004 and 2010 that were most likely associated with Cubicin. Based on these reviews, the FDA determined that eosinophilic pneumonia can be associated with Cubicin use and requested that the manufacturer of Cubicin include this information in the Warnings and Precautions and Adverse Reactions, Post-Marketing Experience sections of the drug label. Healthcare professionals should closely monitor patients being treated with Cubicin for eosinophilic pneumonia. Patients receiving Cubicin should immediately contact their healthcare professional if they develop a new or worsening fever, cough, shortness of breath, or difficulty breathing. For more information, visit www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm220273.htm.
Abbott received FDA approval for two new dosage strengths of Simcor: 40 mg of simvastatin–the most commonly prescribed dose of simvastatin–with either 500 mg or 1,000 mg of niacin extended-release. Simcor is used along with diet in people who cannot control their cholesterol levels by diet and exercise alone. Simcor is approved to raise HDL cholesterol and lower levels of elevated total cholesterol, LDL cholesterol, and triglycerides and is prescribed when treatment with either simvastatin or niacin extended-release alone is not considered adequate. Simcor is already available in the following strengths: 500/20 mg, 750/20 mg and 1,000/20 mg. For more information, visit www.abbott.com.
Influenza Vaccines for 2010-2011 Season
The FDA has announced that it has approved vaccines for the 2010-2011 influenza season in the U.S. Seasonal influenza vaccine protects against three strains of influenza, including the 2009 H1N1 influenza virus, which caused the 2009 pandemic. Because the 2009 H1N1 virus emerged after production began on the seasonal vaccine last year, two separate vaccines were needed to protect against seasonal flu and the 2009 H1N1 pandemic flu virus. This year only one vaccine is necessary. Vaccines for the 2010-2011 seasonal influenza contain the following strains: A/California/7/09 (H1N1)-like virus (pandemic (H1N1) 2009 influenza virus), A/Perth/16/2009 (H3N2)-like virus, and B/Brisbane/60/2008-like virus. The brand names and manufacturers for the upcoming season's vaccines are Afluria (CSL Limited), Agriflu (Novartis Vaccines and Diagnostics), Fluarix (GlaxoSmithKline Biologicals), FluLaval (ID Biomedical Corporation), FluMist (MedImmune Vaccines Inc.), Fluvirin (Novartis Vaccines and Diagnostics Limited), and Fluzone and Fluzone High-Dose (Sanofi Pasteur Inc.).
Each year, experts from the FDA, WHO, CDC, and other institutions study virus samples and patterns collected worldwide to identify strains likely to cause the most illness during the upcoming season. Based on that information and the recommendations of the FDA's Vaccines and Related Biological Products Advisory Committee, manufacturers included the respective three strains in the 2010-2011 vaccines. The closer the match between the circulating strains and the strains in the vaccine, the better the protection against influenza disease. For more information, visit www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm220718.htm.
Many Emergency Department Visits Could Be Managed At Urgent Care Centers and Retail Clinics
Researchers analyzed samples of patient records and found 13.7% of all ED visits could take place at a retail clinic – 7.9% when hours are restricted – and an additional 13.4% of ED visits could take place at a urgent care center — 8.9% when hours are restricted. That is, a total of 27.1% of all ED visits could be managed at a retail clinic or urgent care center — 16.8% when hours are restricted. Assuming the smallest of each of these savings and assuming that 16.8% of the 104 million ED visits that did not result in a hospital admission in 2006 could take place in one of these alternative settings, the potential savings to the health care system would be approximately $4.4 billion annually, or 0.2% of national health care spending.
Relationship Between Patient Panel Characteristics and Primary Care Physician Clinical Performance Rankings
An intrinsic assumption underlying physician clinical performance assessment is that the measures represent physician performance. However, the same physician may have higher or lower measured quality scores depending on the panel of patients he or she manages. Researchers looked at data from a large academic primary care network; 125,303 adult patients who had visited any of the nine hospital-affiliated practices or four community health centers [at Massachusetts General Practice] between January 1, 2003, and December 31, 2005 report that the primary care doctors who were rated in the top third of measured quality were more likely to care for older patients with greater comorbidity who made more frequent visits to see a primary care physician. Because older patients with more comorbidities are often seen more frequently, they may have stronger relationships with their physicians, and physicians caring for such patients may have more opportunities to complete process measures. Those physicians were also less likely to care for minority, non–English-speaking, Medicaid, and uninsured patients than the doctors in the bottom third of the rankings.
Dengue Information for Clinicians
Dengue infection is caused by any of four distinct but closely related dengue virus (DENV) serotypes (called DENV-1, -2, -3, and -4). Dengue viruses are flaviviruses, a family which includes other medically important vector-borne viruses (e.g., West Nile virus, St. Louis encephalitis virus, etc.). Dengue is currently the most frequent cause of acute febrile illness among returning U.S. travelers from the Caribbean, Central and South America, and Asia. It is widespread throughout the tropics and sub-tropics and an outbreak was recently identified in Key West, Florida. The primary method of transmission is through the bite of an infected Aedes aegypti. mosquito. Dengue may also be transmitted from mother to fetus in utero or to neonate at parturition. Incubation period is 3-14 days. Infected persons may be asymptomatic in up to 53-89% of cases. Clinical presentation in those who become ill can range from a mild non-specific febrile syndrome, to classic dengue fever (DF), or in the most severe forms of the disease (2-4% of cases), dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS). Early clinical recognition and treatment for those who develop DHF or DSS can save lives. Dengue should be considered when persons that live in or have traveled to a dengue endemic area in the two weeks prior to symptom onset have fever and two of the following signs and symptoms:
Patients at risk for severe disease:
Previously infected with another dengue virus
Chronic renal failure Infants
Laboratory testing is necessary to confirm whether local transmission is occurring and to identify circulating virus types (PCR). Serum samples collected during the first five days post onset should be submitted for PCR testing to DOH Tampa Laboratory. Most convalescent serum samples (>6 days onset) should be submitted for IgM antibody detection by ELISA at a commercial laboratory. Either PCR or ELISA samples can be collected in a red or tiger top tube. Your county health department can provide guidance on how and when to submit samples to DOH Laboratories. The Florida Department of Health is relying on physicians to identify suspect cases of dengue and report them to their county health department. Please contact your county health department by the next business day if you suspect dengue to ensure prompt mosquito control efforts.
CDC guidelines for clinical management of dengue infection http://www.cdc.gov/dengue/clinicallab/clinical.html
More information on the 2009 Key West dengue outbreak: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5919a1.htm
Dengue Clinical Sample Submission Guidelines
When dengue is suspected in a patient, a sample should be promptly submitted to either the Dept. of Health or a commercial laboratory such as Quest or LabCorp. The following categories will help you determine which laboratory is appropriate:
This Year's Flu Vaccine To Include H1N1, Influenza B, and New Strain H3N2
The swine flu, which nearly caused a national panic last year before collapsing by year's end, remains very low across the US, with no indication it will worsen as the fall flu season nears. However, this year, unlike last year, there will be a single vaccine that will cover H1N1, the seasonal influenza B, and a new strain, H3N2. Also, unlike last year when the federal government paid for the swine flu vaccine and set up special locations, this year, the combined vaccine will be disseminated mostly through commercial facilities, including private doctors' offices, clinics and pharmacies.
More ED Crowding Expected Under New Healthcare Law
EDs may grow even more crowded with longer wait times under the nation's new health law. Even though the new measure may help millions of Americans secure insurance, there is already a shortage of front-line family physicians in some places and experts think that will get worse. What's more, people without insurance aren't the ones filling up the nation's EDs. In fact, the biggest users of ED's by far are Medicaid recipients, and the new health insurance law will increase their ranks by about 16 million.
Number of People Visiting Hospital EDs Climbed In Massachusetts
The number of people visiting EDs has climbed in Massachusetts. After the passage of the insurance law in 2006, officials hoped it would increase access to primary care doctors for the uninsured, which would improve their health and lessen their reliance on EDs for the flu, sprains, and other urgent care. Yet, according to a report from the Division of Health Care Finance and Policy, expanded coverage may have contributed to the rise in ED visits, as newly insured residents entered the healthcare system and could not find a primary care doctor or get a last-minute appointment with their physician. In fact, ED visits rose by 9% from 2004 to 2008, to about 3 million visits a year according to state data.
Infant Tylenol, Motrin And Zyrtec Medications Recalled By Johnson and Johnson
Infant Tylenol, Motrin And Zyrtec Medications Recalled By Johnson And JohnsonJohnson & Johnson's McNeil Consumer Healthcare, in consultation with the FDA, is voluntarily recalling all unexpired lots of certain over-the-counter Children's and Infants' liquid products, including Tylenol, Mocrin, Zyrtec and Benadryl, manufactured in the US and sold in the United States, Canada, Dominican Republic, Dubai, Fiji, Guam, Guatemala, Jamaica, Puerto Rico, Panama, Trinidad & Tobago, and Kuwait. The company says this voluntary recall is being initiated because some of the products may not meet required quality standards. McNeil Consumer Healthcare adds that this recall is not being undertaken on the basis of adverse events.
High-Dose Aspirin May Provide Acute Migraine Relief
High-dose aspirin matched a triptan drug for relief of acute migraine, Oxford researchers found after reviewing 13 studies in which 4,222 people received either aspirin with or without an antiemetic, placebo, or an active comparator, most often sumatriptan 50 mg or 100 mg. A fourth of patients treated with 900 to 1,000 mg of aspirin, with or without an antiemetic, were pain free after two hours, and half of patients had no more than mild residual pain. Results for most outcomes were similar for patients treated with sumatriptan.
Nonsterile Eye and Nose Drops Recalled
The manufacturer of several eye and nasal drops has voluntarily recalled a number of its products due to potentially nonsterile conditions at its manufacturing facilities. Although no adverse events related to the eye and nose drops have been reported, manufacturer US Oftalmi recalled specific lots of eye and nose drops because the nonsterile products may cause eye infections, according to a company statement. Included in the recall are:
Over-the-Counter Version of Heartburn Drug Zegerid Approved
The FDA has approved the over-the-counter version the prescription heartburn drug Zegerid. Zegerid OTC (omeprazole 20 mg/sodium bicarbonate 1100 mg capsules) will be marketed by Schering-Plough HealthCare Products, Inc., the consumer healthcare division of Merck & Co. Zegerid OTC, a proton pump inhibitor, treats frequent heartburn by controlling and suppressing acid for a full 24 hours. Zegerid OTC contains a patented dual-ingredient formulation that combines omeprazole with sodium bicarbonate, which protects the omeprazole from acid in the stomach. Zegerid OTC capsules will be available in their original prescription formula, and are expected to be available in the first half of 2010.
Lamictal XR Approved for Epilepsy Therapy
The FDA has approved Lamictal XR (lamotrigine) extended-release tablets as once-a-day, add-on therapy for epilepsy in patients >13 years with primary generalized tonic-clonic seizures. This is an expanded label, as Lamictal XR is already approved for partial onset seizures (with or without secondary generalization) for patients in this age group.
Crestor Approved to Reduce Risk of Stroke, MI
The FDA has approved Crestor (rosuvastatin calcium) to reduce the risk of stroke, myocardial infarction, and arterial revascularization procedures in individuals without clinically evident coronary heart disease but with an increased risk of cardiovascular disease (CVD) based on age (men >50 and women >60), high-sensitivity C-reactive protein >2 mg/L, and the presence of at least one additional CVD risk factor, such as hypertension, low HDL-C, smoking, or a family history of premature coronary heart disease.
Smartphone Medical Applications Become More Readily Available To Consumers
Medical emergency applications for smartphones are finding their way into the marketplace for consumers. For example, AED Nearby will help users locate the nearest defibrillator when sudden cardiac arrest occurs. A number of members of the American College of Emergency Physicians said they have found some of the consumer applications useful. But, ACEP spokesman Ryan Stanton said, "If you don't know the setting or the background behind the information, sometimes it can be misinterpreted," meaning that "emergent conditions" can go untreated.
Migraine Sufferers May Be Much More Likely To Have a Heart Attack
People who suffer from migraine headaches may be much more likely to have a heart attack as well as a host of risk factors for heart disease, according to a new study published in the Feb. 10 online edition of Neurology. The study, which compared 6,102 people with migraine and 5,243 without the headaches, found a 4.1 percent incidence of heart attacks in the migraine patients, compared with 1.9 percent in those without the debilitating headache. The researchers also found that people with migraine were more likely to have the classic risk factors for heart attack, stroke, and other cardiovascular problems: diabetes (12.6% versus 9.4 %), high blood pressure (33.1% versus 27.5%), and high cholesterol (32.7% versus 25.6%).
Salmonella Montevideo Outbreak
The FDA, along with the CDC and the U.S. Department of Agriculture, is working closely with the Rhode Island Department of Health and other states in the investigation of an outbreak of Salmonella Montevideo infection associated with certain salami products.
The CDC reports that 202 people have been infected with a matching strain of Salmonella Montevideo in at least 42 states and the District of Columbia. Recently, the CDC and public health officials in multiple states conducted an epidemiologic study by comparing foods eaten by 41 ill and 41 well persons. Preliminary analysis of this study has suggested pepper-coated salami as a possible source of illness.
On Jan. 23, 2010, Daniele International Inc. recalled ready-to-eat varieties of Italian sausage products, including salami. The recalled meat products have an extended shelf life up to one year. Recent test results provided by the Rhode Island Department of Health revealed that an opened container of black pepper used at the salami manufacturing facility of at least some of the recalled products were positive for Salmonella Montevideo and that the DNA fingerprint matched the outbreak strain.
The FDA is actively investigating the supply chain of the black pepper used in the manufacturing of the recalled meat products to see if it poses a risk to consumers. The agency has collected and is currently analyzing black pepper samples. To date, all the samples collected and analyzed by the FDA have tested negative for Salmonella; however, sample collection and analysis continues.
FDA Adds Cardio Warnings to Weight-Loss Drug
The FDA said the weight-loss drug sibutramine (Meridia) should not be taken by patients with history of cardiovascular disease following a review of additional data showing an increased risk of heart attack and stroke among that population.
The agency said the manufacturer, Abbott, has agreed to add the contraindication to its labeling, which will be expanded to include patients with a history of the following:
Healthcare professionals should monitor patients for increase in blood pressure and heart rate and should discontinue therapy if either increase is observed. Patients should also discontinue use of sibutramine if they do not lose 5% of their baseline body weight within the first three to six months of treatment, as the drug may not be effective and puts the patient at unnecessary risk.
Measuring Medicine Using Kitchen Spoons May Lead to Under or Overdosing
Individuals using standard spoons from their home kitchen to dispense liquid medications may be pouring too little or too much of the drugs, researchers found after evaluating 195 college students. Participants were told to imagine they were at home and needed to take 5 mL - one teaspoon - of cold and cough medicine. With that in mind, the subjects were then asked to pour the same 5-mL dose into a 15-mL spoon, and a 45-mL spoon in a randomized order. Despite the fact that most students had 'above average' confidence that they had poured accurate doses, investigators found that dosages actually varied depending on the size of the spoon. When using the medium-sized tablespoon, the students underdosed by more than eight percent, on average. And when using the larger tablespoon, they overdosed by nearly 12 percent, on average.
Drug-Resistant E. Coli Called Significant Threat
First-line use of carbapenem antibiotics for urinary tract infections may become necessary if the spread of drug-resistant E. coli continues. An E. coli strain expressing a beta-lactamase enzyme known as CTX-M-15 has suddenly emerged in community-acquired infections worldwide, apparently originating in the Indian subcontinent and spread by travelers. In a review published online by Faculty of 1000 Medicine, Pitout suggested this strain is among the most worrisome of a series of recently emerging, community-acquired E. coli clones that express so-called extended spectrum beta-lactamases. These enzymes break down cephalosporin and monobactam antibiotics which have been first-line treatments for urinary tract infections. The bacteria remain susceptible to carbapenems such as meropenem (Merrem) and doripenem (Doribax). But their wider use would be likely to spur the emergence of new bacterial strains resistant to them, further diminishing the available treatment options.
Nitrogen Dioxide, Particulate Matter May be Linked to Increased Pneumonia
According to research published in the American Journal of Respiratory and Critical Care Medicine, two common air pollutants may put patients at risk of severe pneumonia. In a study of 349 patients who had been hospitalized for community-acquired pneumonia and 494 controls, researchers found that both nitrogen dioxide and particulate matter were associated with more than a twofold increased risk of community-acquired pneumonia. Notably, the same relationships were also found when estimating air pollution levels via bicubic spline interpolator and land use regression methods.
Analysis Finds New Mothers Remain at Risk for H1N1
The New England Journal of Medicine has determined that the H1N1 virus is not only dangerous to pregnant women, it's a threat to new mothers, too. This is based on a study involved 94 pregnant women and eight new mothers who were hospitalized during the first four months of the pandemic, before a vaccine became available. As a result of the findings, the Centers for Disease Control and Prevention recently revised its guidelines, recommending that flu drugs be given to women who show signs of the flu soon after they give birth.
FDA Okays New Indication for COPD Inhaler
The FDA has expanded the approved indications for inhaled tiotropium bromide (Spiriva HandiHaler) to include reducing exacerbations of chronic obstructive pulmonary disease (COPD), in addition to its previous approval for COPD maintenance. Tiotropium is a bronchodilator that works by antagonizing acetylcholine receptors in airway tissues. As before, the drug includes several cautions including:
Common side effects include upper respiratory tract infection, dry mouth, sinus infection, and sore throat.
800,000 Doses of Childrens’ H1N1 Vaccine Recalled
Hundreds of thousands of H1N1 shots for children aged 6 months to three years have been recalled because tests indicate the doses lost strength, falling about 12% below the government standard. The shots, made by Sanofi Pasteur, were distributed across the country last month and most have already been used, according to the Centers for Disease Control and Prevention. Tests done before the shots were shipped showed that the vaccines were at the required potency. No potency problem has been detected in the same vaccine packaged in other types of syringes or vials. Experts suspect the antigen may be sticking to the walls of the pre-filled syringes.
FDA Gives Emergency Approval for New Swine Flu Test
The FDA has granted emergency use authorization for an H1N1 influenza virus detection test to be used on the portable GeneSTAT platform. This GeneSTAT "lab in a box" allows point-of-care testing for novel H1N1 and determines infection status in about 50 minutes without need for a technician or pathologist, according to the manufacturer, DxNA. A sample is collected by cheek or nasal swab and put in a closed cartridge that screws into the unit. Because the device is portable, fast, easy to use, and comparatively cheaper than PCR testing done in reference labs, it could be especially useful in rural areas and developing nations.
Amneal Receives FDA Approval For Nizatidine
Oral Solution is pleased to announce that it has received The FDA has approved Amneal Pharmaceuticals to manufacture Nizatidine Oral Solution in 15 mg/mL. It is a therapeutically equivalent alternative to Axid® Oral Solution (a licensed trademark of Braintree Labs). Nizatidine Oral Solution is the first available generic in oral solution form. Nizatidine Oral Solution is an anti-acid indicated in the treatment and prevention of ulcers, the treatment of heartburn and the stomach disorder GERD (gastroesophageal reflux disease) as well as conditions associated with excess acid secretion. Nizatidine belongs to a class of medications known as H2-blockers that inhibit the action of histamine on stomach cells, thus reducing stomach acid production.
New Jersey May Restrict Physician-Industry Relationships
Many states are mulling restrictions on relationships between doctors and industry. This week, New Jersey joined the list of states challenging such relationships, precipitated by a critical report from the state attorney general's office. The New Jersey Attorney General released a report this week recommending that his state impose tough new rules governing physician interactions with drug and device makers, including:
If these recommendations were to be enacted, New Jersey would have some of the toughest rules in the U.S. The state's doctors are already worried, arguing that they made physicians do extra work and don't slap down the bad actors in industry. For the time being, these are recommendations. What’s next?
Treating Cluster Headaches With High-Flow Oxygen Appears Effective
According to a study in JAMA , patients with a cluster headache, which is characterized by bouts of excruciating pain usually near the eye or temple, were more likely to report being pain-free within 15 minutes of treatment with high-flow oxygen than patients who received a placebo treatment. Cluster headache attacks typically last for 15 minutes to three hours untreated and have a frequency of one every other day for up to eight attacks a day. Attacks usually occur in bouts, or clusters, lasting for weeks or months, separated by remissions lasting months or years, according to background information in the article. The current treatment for acute attacks of cluster headache is injection with the drug sumatriptan, but frequent dosing is not recommended because of adverse effects. Another treatment option is the inhalation of high-dose, high-flow oxygen, but its use may be limited because of the lack of a good quality controlled trial.
Intranasal Monovalent Vaccine Administration Instructions
Administration of the Intranasal Influenza A (H1N1) 2009 Monovalent Vaccine can be confusing, leading to incorrect dosing. Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal is indicated for the active immunization of individuals 2-49 years of age against influenza disease caused by pandemic (H1N1) 2009 virus. Dosage and administration instructions for intranasal H1N1 monovalent vaccine is available here.
Senate Affirms Screening Mammography for Women in Their 40s
On Thursday, Senators voted on an amendment that would require insurers to cover mammograms for women ages 40-49, essentially deciding to disregard the U.S. Preventive Services Task Force’s recent recommendation that women under 50 shouldn't undergo routine mammograms. This deals a significant blow to the power and credibility of the USPSTF. The amendment would increase coverage and eliminate copays for more women's preventive services. The USPSTF recommendations on any given procedure are important because the healthcare reform bill that was passed by the House and the bill being considered by the Senate would require insurance companies to cover all medical services that receive a grade of "A" or "B" from the USPSTF. In its recent recommendations, the task force downgraded mammography in women under 50 to a "C" grade, which means there is limited evidence to support its use. That would mean that insurance plans wouldn't be required to cover screening mammography for those women, unless the secretary of Health and Human Services (HHS) used her discretionary power to require plans to cover services with lower grades.
FDA Okays Sixth Seasonal Flu Vaccine
The FDA has approved the seasonal influenza subtype A and B vaccine Agriflu for patients ages 18 and older. The approval was based on a demonstration that the vaccine created levels of antibodies in blood likely to be effective in flu prevention. Side effects in Agriflu's clinical trials included pain, swelling and redness of injection site, headache, muscle ache, and malaise. The drug should not be administered to patients with severe allergies to eggs or any other vaccine ingredient. The new vaccine is not approved for prevention of the 2009 H1N1 virus. seasonal flu. The drug is distributed in single dose, prefilled syringes for single injection in the upper arm. Agriflu is the sixth drug approved for vaccination against the 2009-2010 seasonal influenza virus. The drug was made available through the agency's accelerated approval pathway, which makes devices and products for serious or life-threatening diseases available sooner than usual if they demonstrate safety and efficacy.
CDC Watching H1N1 Mutation
The CDC is keeping a careful eye on a mutation in some strains of the pandemic H1N1 flu that Norwegian researchers isolated from three patients with severe disease. According to Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, the mutation has been seen "sporadically" in the U.S. The U.S. mutation has been associated with mild disease although the Norwegians isolated it from the first two patients who died of the disease in that country. The CDC will be watching to see if the mutation spreads and if it is more common in cases of severe disease.
Cell-Based, Egg-Free Method Produces Novel 2009 H1N1 Vaccine Virus
FluGen, an emerging leader in the development, production and delivery of influenza vaccines, announced that its proprietary CHO-cell-based production system has generated novel 2009 H1N1 influenza vaccine virus without the use of eggs during any step of production. Unlike traditional vaccine production methods, FluGen's CHO-based system does not use eggs. The company expects its cell-based, egg-free method to readily transfer to full-scale vaccine production and is in the process of developing a highly-efficient, production-scale system that will be available in the near future. FluGen's system would avoid the costly and time-consuming steps of egg-based production, including propagation of the virus in eggs and production of the vaccine itself in eggs. This egg-based process, by which all influenza vaccines are now produced, can take up to six months to deliver vaccine. The worldwide shortages of seasonal and novel 2009 H1N1 vaccine, exacerbated by this year's influenza pandemic, highlight the need for a quicker, cleaner, egg-free vaccine production methods.
Question: Does controlling systolic blood pressure to lower than 130 mm Hg lead to fewer bad outcomes than controlling it to lower than 140 mm Hg?
Results: In this open-label study of nondiabetic patients with systolic blood pressure (SBP) of at least 150 and at least one other cardiovascular disease risk factor, controlling the SBP to lower than 130 mm Hg reduced more adverse events than controlling the SBP to lower than 140 mm Hg. (LOE = 1b) Reference
Urgent Care Clinic Industry Expanding Again
It's beginning to look like convenient care is on the rise - and not just in the retail clinic sector. While the retail clinic market expansion has gotten most of the attention, the urgent care industry is seeing some new growth as well. Recent estimates suggest that the volume of U.S. urgent care clinics has gone from a steady decline to a growth rate of about two clinics a week. While the growth in retail clinics is likely to outstrip that by a considerable margin, it's still worth noting for an industry which had stalled throughout the 90s. Observers note that the growth in urgent care centers compliments, rather than competes with, emerging retail clinics. While urgent care centers see a slightly more acute patient, treating conditions like fractures and sprains, lacerations and abdominal illnesses, retail clinics typically limit themselves to low-complexity treatments for conditions such as strep throat and bladder infections. Retail clinics are actually beginning to refer to urgent care centers, in fact, according to urgent care administrators.
FDA Monitors LASIK Safety and Quality
The FDA has begun a three-phase, quality-of-life study of patients who have received laser-assisted in situ keratomileusis (LASIK). The joint venture between the FDA, National Eye Institute, and the Department of Defense hopes to identify the frequency and predictors of problems associated with the surgery to determine whether further regulation of the excimer laser in the procedure is necessary. The first phase of the study, which began this July, asked patients to self-report surgery outcomes and postoperative quality of life through an online survey. The second phase will evaluate a select, active-duty population of patients treated at the Navy Refractive Surgery Center. The final phase will consist of a national, multicenter clinical trial studying the impact of quality of life in the general population. The third phase is expected to end in 2012. A decade-long survey that ended this April found that 95.4% of patients were satisfied with the results of LASIK surgery. In 2008, the FDA announced the surgery was safe and well accepted, but that aggressive marketing of the procedure resulted in inappropriate clinical decision-making. The FDA issued warning letters to 17 ambulatory surgical centers for inadequate adverse event reporting systems at the sites, though inspections failed to identify the problems associated with LASIK device use at those facilities. Ambulatory surgical centers are among several other places required under 1990 legislation to report device-related patient death and serious injury to the FDA and device manufacturer, including a written protocol for the adverse event report.
FDA Warns Four Drugmakers to Halt Sales of Unapproved Codeine Sulfate Tablets
The FDA issued warnings to four drugmakers to halt sales of unauthorized codeine sulfate tablets. The FDA said it never approved the opioid analgesic tabs - which are considered narcotics - and their efficacy is questionable. Companies and products issued warning letters include:
The companies have 15 days to respond with a plan to cease marketing the drugs, 90 days to end manufacturing, and 180 days to cancel distribution of existing product.
Drunk Driving Continues To Be a Problem
Drunk driving continues to be a major problem across the US. Last year alone, 11,773 people were killed in crashes where one of the drivers was over the legal limit, a figure that represents nearly a third of all deaths caused by traffic accidents. Aside from the emotional and physical toll, the financial fallout is considerable, costing $51 billion annually in the US. Although such figures may already seem alarmingly high, they may be more significant when analyzed in the context of individual EDs, because the median ED costs of treating drunk drivers are about four times as much as those for sober drivers.
Seasonal Influenza Information Guide
Annual vaccination against seasonal influenza is recommended for
· All persons who want to reduce their risk of becoming ill with influenza or of spreading it to others
· All children and teens ages 6 months through 18 years
· All persons age 50 years and older
· All children and teens receiving long-term aspirin therapy
· All women who will be pregnant during the influenza season
· Adults and children with any of the following conditions:
o a chronic disorder of the pulmonary (including asthma) or cardiovascular (except hypertension) system
o a chronic disease of the blood. liver. or kidneys; immunosuppression (e.g., including that caused by medications. HIY); or metabolic disorder (e.g., diabetes)
o a neurologic or n uromuscular disorder (e.g., cognitive dysfunction)
· All residents of nursing homes or other chronic-care facilities
· All healthcare personnel
· All household contacts (including children) and caregivers of (1) children ages 0-59 months (especially younger than 6 months; (2) adults age 50 years and older; and (3) persons with high risk medial conditions
· Persons planning to travel to an area of the world with influenza activity (e.g., to the tropics at any time of the year)
Contraindications and Precautions
· Do not give influenza vaccine to a person who has had an anaphylactic reaction to a prior dose of the vaccine or any of its components (e.g., eggs). Minor illnesses with or without fever do not contraindicate use of influenza vaccine.
· Do not give nasal spray LAIV to persons who are younger than age 2 years; age 2 through 4 years with possible reactive airways disease (e.g., history of recurrent wheezing or a recent wheezing episode*); age 50 years or older; pregnant; have a chronic disease that is an indication for routine influenza vaccination; or are a child or teen receiving long-term aspirin therapy. Injectable TIV is preferred for persons who have close contact with severely immunosuppressed persons during periods when the immunocompromised person requires protective isolation.
· Guillain-Barré syndrome within 6 weeks following a previous dose of influenza vaccine is a precaution for vaccination with TIV or LAIV.
*Ask parents of children 2-4 years: “In the past 12 months, has a healthcare provider ever told you that your child had wheezing or asthma?” If yes, do not give LAIV; instead give TIV.
Vaccine Dosing and Administration
· TIV: Give 0.25 mL if age 6-35 monyhs; give 0.5 mL if age 3 years or older. Give 1M with a 22-25g, 1-1½” needle. Choose vaccine according to patient’s age (i.e., FluZone: 6 months and older; Fluvirin: 4 years and older; Afluria, Fluarix, and FluLaval: 18 years and older).
· LAIV (FluMist): Give 0.2 mL (0.1 mL sprayed into each nostril) to healthy non-pregnant persons ages 2 through 49 years.
· Give 2 doses to all children younger than age 9 years who are receiving influenza vaccine for the first time or who failed to receive the 2nd dose in the preceding year. Separate the 2 doses by at least 4 weeks.
· The most common side effects from TIV are soreness and redness at the injection site, lasting 1-2 days
· The most common side effect from LAIV are runny nose and nasal congestion.
Talking Points with Patients
· Influenza is a serious respiratory disease caused by a virus. It is not the same as the common cold or an intestinal illness.
· An average of 36,000 deaths and more than 200,000 hospitalizations related to seasonal influenza occur in the U.S. each year.
· Vaccination is usually 70-90% effective in preventing influenza in healthy adults and children. Its effectiveness may be lower if the circulating influenza viruses are not matched by the vaccine strains, but vaccinated persons will likely have milder illness.
· Unvaccinated healthy people who get influenza can spread their infection to others who are most vulnerable to its complications.
Timing: Vaccination should begin as soon as vaccine becomes available and should continue until supply is depleted.
Current information on H1NI influenza can be found at www.cdc.gov/h1n1flu
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Patients With Cardiovascular Disease
Past Situation Updates
Emergency Use Authorization (EUA) of Medical Products
CDC Conference Calls for Clinicians
Hosted by CDC’s Clinician Outreach and Communication Activity (COCA)
CDC Clinical Reminders
Posted by CDC’s Clinician Outreach and Communication Activity (COCA)
Clinical Data Collection Forms and Templates
Previous Conference Calls
Caring for a Sick Person in Your Home
Interim Guidance for People With Heart Disease, Stroke, or Cardiovascular Disease
Home Care Guidance: Physician Directions to Patient/Parent
Resources for Laboratories
Centers for Public Health Preparedness (CPHP) H1N1 Online Training
Travelers' Health Resources
Travelers' Health Presentations
FDA Zicam Warning
Due to reports of post-viral anosmia associated with the use of three zinc-containing intranasal Bacteriophages are viruses that attack and eat bacteria. Boston University researchers engineered some that penetrate and dissolve the protective walls or biofilsm around antibiotic-resistent 'superbug' colonies.Due to reports of post-viral anosmia associated with the use of three zinc-containing intranasal
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