Chicken Soup

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Chicken Soup

  1. 1. The Clinical Advisory Newsletter for Physicians and Clinical Staff March 2005 EditionChicken Soupby Paul McLeod, M.D., MED3OOO Chief Medical Executive Planning Ahead . . .Everyone knows that chicken soup will speed recovery in patients with a common cold. This is Immunizationa consensus-based recommendation resulting from the collective experience of an expertpanel of mothers and grandmothers passed authoritatively along from generation to Awarenessgeneration. The validity of this recommendation is not to be trifled with and nay-sayers should FREE POSTERS INCLUDEDtake heed. We also know that increasing fluid intake will improve symptoms of constipationand that we should admonish patients from prolonged use of irritant laxatives to avoid theconsequences of dependence. This is information passed from faculty to medical studentsnationwide each year. Both sets of recommendations have some things in common. Neither isevidence-based. Neither is correct. (See the January issue of The American Journal ofGastroenterology.)Many of the commonly made recommendations in medicine are not based on good evidence. Istill remember the last conversation I had with my family medicine residency director upon Clinical Background.completion of the program. “Paul,” he said, “I want you to know that half of what we taught you Vaccines are one of the most successfulis wrong… I just don’t know which half.” and cost-effective public health tools forGood news! The technology revolution has provided an opportunity for physicians to get good preventing serious disease and death.evidence-based answers to their questions quickly and with minimal expense. Better yet, this Diseases that were once commonplace ainformation is available even to solo physicians, as long as they can access the Internet. generation ago are now relatively rare. Disease such as polio, measles, mumps,A practicing physician can now search for answers to their clinical questions using: whooping cough, diphtheria, and rubella • Evidence-based medicine (EBM) online resources and are a distant memory for most Americans. However, the success of vaccines has • Clinical guides given rise to a phenomenon whereby manyThese resources present not only the evidence, but the method used to obtain it—Meta- people don’t understand the importance ofanalysis, Systematic Review, Randomized Controlled Trial, Cohort Studies, Case Control childhood immunizations and whatStudies, Case Reports, or Expert Opinion. In addition, your search can be purpose-specific, diseases can be prevented. Preciselydiagnosis-specific, or symptom-specific. Some sites are geared more toward physicians; because many parents today have notothers have a more “patient friendly” approach and are useful for patient education. seen some of these diseases and the devastation they can cause, they are lessSome EBM Databases that I recommend are: concerned about immunizations as a parental priority. However, these diseases • Cochrane Library: All the English literature meticulously searched for clinical trials, have not been completely eradicated. with conclusions based on evidence from valid randomized trials only. Remember, Many are still around and still circulating this only gives you information from clinical trials results. Cost: $235/year. Web site: around the world. www.thecochranelibrary.com. Each day 11,000 babies are born who will • ACP Journal Club: One hundred Journals systematically reviewed; includes need to be immunized against twelve diseases before age two. Despite recent structured abstracts and clinical commentary. Cost: $78/year. Web site: www.acpjc.org. gains in childhood immunization coverage, over 1 million of our nation’s two-year-olds • DynaMed: Eighteen primary care journals (e.g., BMJ, JAMA, Lancet, NEJM, are still missing one or more of the Pediatrics), twelve secondary sources (ACP, Cochrane Library), and four drug recommended immunizations. sources. Cost: $200/year. Web site: www.dynamicmedical.com. Vaccines arent just for kids. Far too many adults become ill, are disabled, and die • Medical Inforetriever: One hundred four journals surveyed, synopsis of 1300 articles, each year from diseases that could easily evidence-based guidelines, drug information, and clinical calculators. Web-based, have been prevented by vaccines. Thus desktop, and PDA versions. This is a great resource. It is very robust and easy to everyone from young adults to senior use at the point of care. Since it comes in a PDA version you can “take it with you” to citizens can benefit from immunizations. the hospital or nursing home. Cost: $249/year. Web site: www.infopoems.com. Tools and Recall Information on the • First Consult: Differential diagnosis, disease state information, and patient education following page. —another one of my favorites. The information is condensed and to the point. Cost: $149/year. Web site: www.firstconsult.com. © Copyright 2005. MED3000 Group, Inc. All Rights Reserved
  2. 2. The Clinical AdvisoryNewsletter for Physicians and Clinical Staff March 2005 Edition Chicken Soup . . . continued by Paul McLeod, M.D., MED3OOO Chief Medical Executive April is Infant Immunization Awareness Month Practice guidelines can be obtained from: Tools and Recall Information for Immunizations • National Guideline Clearinghouse: Web site: www.guideline.gov. Tools • Primary Care Clinical Practice Guidelines: Web site: The following are some web sites that http://medicine.ucsf.edu/resources/guidelines. provide information and tools you can use to educate patients as to the need for • American Academy of Pediatrics: Web site: www.aap.org. ensuring that their children’s, and their, immunizations are up to date: • American Academy of Family Physicians: Web site: www.aafp.org. • http://www.cdc.gov/nip/events/niiw/200 All are good sources and tend to be evidence based. 5/05default.htm: The official site for National Infant Immunization Week. Includes lists of These are plenty of resources to get you started. I think you will find them a great community events, as well as information that you asset to your practice. So the next time someone asks “Do topical solutions of can download to create your own event. NSAIDs help the pain of osteoarthritis?”. . . . Look it up! • http://www.idph.state.ia.us/common/pd f/immunization/adults_protect_yourselv es.pdf: A brochure from the Iowa Department of FREE Immunization Awareness Posters to display in Patient Rooms are Health that can be printed and handed out to your attached. adult patients. • http://www.cdc.gov/nip/diseases/adult- vpd.htm: CDC’s National Immunization Program (NIP) site on vaccine-preventable diseases for adults. • http://www2a.cdc.gov/nip/scheduler_le /default.asp: CDC’s NIP site that allows parents to make up an immunization schedule for their child. • http://www.cdc.gov/nip/publications/def ault.htm#bfp: NIP’s brochures and flyers page. Many different brochures and flyers covering vaccinations that you can download and print for your office. Patient Recall Through the MED3OOO IQ data warehouse, reports are available to identify the number and percentage of your pediatric patients who have received their pediatric immunizations and who are eligible for their pediatric immunizations at both 8 months and 20 months. The upcoming attention that will be paid to National Infant Immunization Week may The Clinical Advisory is a clinical publication from MED3OOO dedicated to make this the perfect time to recall these informing physicians and clinical staff about tools and information to improve the patients. If you would like to discuss either quality of patient care. MED3OOO . . .Clearly the Best. these reports or an automated patient recall process using M3Connect Corporate Headquarters: MED3OOO, Inc., 680 Andersen Drive, Foster Plaza 10, technology, please contact Geoff Coleman Pittsburgh, PA 15220 For more information on our clinical initiatives, visit at Geoff_Coleman@MED3000.com. www.MED3000.com or call Geoff Coleman at 1-888-811-2411. © Copyright 2005. MED3000 Group, Inc. All Rights Reserved Don’t delay, schedule your appointment today.
  3. 3. © Copyright 2005. MED3000 Group, Inc. All Rights Reserved
  4. 4. © Copyright 2005. MED3000 Group, Inc. All Rights Reserved
  5. 5. CHILDHOOD AND ADOLESCENT IMMUNIZATION AND SCREENING SCHEDULEPediatric immunizations can protect your child from deadly diseases that were once major concerns ofparents around the country. In fact, a concerted effort to immunize all children has virtually eliminatedsome of these diseases. It is important for children to receive these preventive services as early aspossible, based on the schedule below. Please notify your clinician if your child has not received allappropriate services, so a plan can be made to get “caught up.” (Likewise, you should notify your owndoctor if you have not received all of the recommended pediatric immunizations yourself.) Thefollowing are minimum guidelines for preventive services needed by most people. Your clinician mayrecommend additional preventive services, based on your own medical history. Likewise, your clinicianmay determine that some of these services are not necessary for your particular health situation. Key Recommended for all people Recommended only for persons at increased risk 1 2 4 6 12 15 18 24 4-6 11-12 13-18 Immunizations Birth month months months months months months months months years years yearsDiphtheria and Tetanus (Lockjaw)Toxoids, Acellular Pertussis DTaP DTaP DTaP DTaP DTaP(Whooping Cough) VaccineTetanus and Diphtheria Toxoids TdHaemophilus Influenzae Type BConjugate (Meningitis, etc.) Hib Hib Hib HibVaccineHepatitis A Vaccine Hepatitis A SeriesHepatitis B Vaccine HepB HepB HepBInactivated Poliovirus (Polio) IPV IPV IPV IPVVaccineInfluenza (Flu) Vaccine Influenza (yearly, each flu season) Influenza (yearly, each flu season)Measles, Mumps, Rubella MMR MMR(German Measles) VaccinePneumococcal Conjugate PCV PCV PCV PCV(Pneumonia) VaccinePneumococcal Polysaccharide PPV(Pneumonia) VaccineVaricella (Chickenpox) Vaccine VaricellaSource: United States Department of Health and Human Services, Centers for Disease Control and Prevention, The Advisory Committee on Immunization Practices. “RecommendedChildhood and Adolescent Immunization Schedule, United States, 2005,” approved by the American Academy of Pediatrics (AAP) and the American Academy of Family Physicians(AAFP). More information, including a customized pediatric immunization schedule based on your child’s date of birth, is available at www.cdc.gov/nip. The specific recommendationsof your physician may vary. 1 2 4 6 12 15 18 24 4-6 11-12 13-18 Screening Procedures Birth month months months months months months months months years years yearsChlamydia Screening(women only)Tuberculosis Screening For certain individuals at high riskVisual Impairment Screening Routine screening in children younger than 5 yearsSource: United States Department of Health and Human Services, Agency for Healthcare Research and Quality, U.S. Preventive Services Task Force. Based on recommendationsrated “A” or “B” by this task force. More detailed information is available at www.ahrq.gov/clinic/uspstfix.htm. The specific recommendations of your physician may vary.The American Academy of Pediatrics recommends a History and Physical Examination at birth and at ages 2-4 days, 1 month, 2 months, 4 months,6_months, 9 months, 12 months, 15 months, 18 months, and 24 months, and annually thereafter.(Source: American Academy of Pediatrics, Committee on Practice and Ambulatory Medicine, “Recommendations for Preventive Pediatric Health Care.” Pediatrics. Vol.105, No. 3, March 2000, pp. 645-646. More detailed recommendations from this organization are available at www.pediatrics.org/cgi/content/full/105/3/645.)
  6. 6. ADULT IMMUNIZATION AND SCREENING SCHEDULEIt is important even for people who have no health problems to receive appropriate screening tests andimmunizations. The following are minimum guidelines for preventive services needed by most people.If you have not received the preventive services indicated on this sheet, please notify your clinician.(You should also notify your clinician if you have not received all of the recommended pediatricvaccinations.) Your clinician may recommend additional preventive services, based on your ownmedical history. Likewise, your clinician may determine that some of these services are not necessaryfor your particular health situation. Key Recommended for all people Recommended only for persons at increased risk 19-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ Immunizations years years years years years years years years years years years yearsTetanus (Lockjaw) and Diphtheria 1 Td booster every 10 yearsToxoidsHepatitis A Vaccine 2 HepA vaccinations (6-12 months apart) for certain individuals at high riskHepatitis B Vaccine 3 HepB vaccinations (second vaccine 1-2 months after first, third vaccine 4-6 months after first)Influenza (Flu) Vaccine 1 influenza vaccination annually 1 vaccination annuallyMeningococcal (Meningitis) 1 MEN vaccination, with possible revaccination after 3-5 yearsVaccinePneumococcal Polysaccharide 1 PPV vaccination, with possible revaccination after 5 years 1 PPV vaccination(Pneumonia) VaccineSource: United States Department of Health and Human Services, Centers for Disease Control and Prevention, The Advisory Committee on Immunization Practices. “RecommendedAdult Immunization Schedule, United States, October 2004 – September 2005,” approved by the American Advisory Committee on Immunization Practices (ACIP), the AmericanCollege of Obstetricians and Gynecologists (ACOG), and the American Academy of Family Physicians (AAFP). More information is available at www.cdc.gov/nip. The specificrecommendations of your physician may vary. 19-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75+ Screening Procedures years years years years years years years years years years years yearsBreast Cancer Screening Every 1-2 years(women only)Cervical Cancer Screening At least every 3 years, beginning within 3 years of the onset of sexual activity or age 21, whichever comes(women only) firstChlamydia Screening thru age 25(women only) Fecal occult blood testing every 1-2 years and/or Sigmoidoscopy every 5-10 years,Colorectal Cancer Screening Colonoscopy every 10 years, or Double-Contrast Barium Enema every 5 yearsDiabetes Screening Routine screening in adults with hypertension or hyperlipidemia (e.g., at least every 3 years)Hypertension Screening Routine screening by clinician for high blood pressure (e.g., at least every 2 years) Men with CHD risk Routine screening for all men (e.g., every 5 years)Lipid Screening Women with CHD risk factors Routine screening for all women (e.g., every 5 years)Osteoporosis Screening Routin Routine (e.g., every 2(women only) e years)Prostate Cancer Screening Screening (e.g., every 2 years)Discussion (men only)Syphilis Screening For certain individuals at increased risk for syphilis infectionTuberculosis Screening For certain individuals at high risk
  7. 7. Source: United States Department of Health and Human Services, Agency for Healthcare Research and Quality, U.S. Preventive Services Task Force. Based on recommendationsrated “A” or “B” by this task force, except for Prostate Cancer Screening recommendation. More detailed information is available at www.ahrq.gov/clinic/uspstfix.htm. The specificrecommendations of your physician may vary.

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