Mrs. Payne is a 45-year-old female presenting for her annual exam. She has not had a visit in over 5 years. The nurse practitioner will interview her, update her medical history, conduct a physical exam, address recommendations regarding her smoking, weight, and lack of exercise. The patient will be educated on menopause, nutrition, physical activity, weight loss, smoking cessation, and cancer screenings. She is scheduled for follow up on lab results and a 3-week visit to monitor her progress.
Practices of Cancer Screening In developed and developing countriesJulfikar Saif
Brief comparison between practices in screening in different developed countries along with developing countries like bangladesh and india done. The factors hindering screening programs in developing countries sought. Existing resources mentioned.
Practices of Cancer Screening In developed and developing countriesJulfikar Saif
Brief comparison between practices in screening in different developed countries along with developing countries like bangladesh and india done. The factors hindering screening programs in developing countries sought. Existing resources mentioned.
Twenty five year follow up for breast cancer incidence 12-feb2014Miguel Pizzanelli
Twenty five year follow-up for breast cancer incidence
and mortality of the Canadian National Breast
Screening Study: randomised screening trial
OPEN ACCESS
Anthony B Miller professor emeritus, Claus Wall data manager, Cornelia J Baines professor
emerita, Ping Sun statistician , Teresa To senior scientist , Steven A Narod professor Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 3M7, Canada; 2Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario M5G 1N8, Canada; 3Child Health Evaluative Services, The Hospital for Sick Children, Toronto, Ontario, Canada
The cervical cancer overview with key stats around the world and in Nepal.
Discussion on the sensitivity and specificity of different cervical cancer screening techniques.
HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mu...Dr.Samsuddin Khan
Background: HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
Methods: From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).
Results: Ninety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/µL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.
Conclusion: The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Cervical cancer by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
Cervical cancer develops in a woman's cervix (the entrance to the uterus from the vagina).
Almost all cervical cancer cases (99%) are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact.
Although most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer in women.
Cervical cancer is the fourth most common cancer in women. In 2018, an estimated 570 000 women were diagnosed with cervical cancer worldwide and about 311 000 women died from the disease.
Effective primary (HPV vaccination) and secondary prevention approaches (screening for, and treating precancerous lesions) will prevent most cervical cancer cases.
When diagnosed, cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively. Cancers diagnosed in late stages can also be controlled with appropriate treatment and palliative care.
With a comprehensive approach to prevent, screen and treat, cervical cancer can be eliminated as a public health problem within a generation.
Current knowledge and state of the art about management of abnormal cervical Cancer screening tests and cancer precursors for health providers in low-income settings is presented.
Twenty five year follow up for breast cancer incidence 12-feb2014Miguel Pizzanelli
Twenty five year follow-up for breast cancer incidence
and mortality of the Canadian National Breast
Screening Study: randomised screening trial
OPEN ACCESS
Anthony B Miller professor emeritus, Claus Wall data manager, Cornelia J Baines professor
emerita, Ping Sun statistician , Teresa To senior scientist , Steven A Narod professor Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5T 3M7, Canada; 2Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario M5G 1N8, Canada; 3Child Health Evaluative Services, The Hospital for Sick Children, Toronto, Ontario, Canada
The cervical cancer overview with key stats around the world and in Nepal.
Discussion on the sensitivity and specificity of different cervical cancer screening techniques.
HPV infection, cervical abnormalities, and cancer in HIV-infected women in Mu...Dr.Samsuddin Khan
Background: HIV-infected women are at a higher risk of cervical intraepithelial neoplasia (CIN) and cancer than women in the general population, partly due to a high prevalence of persistent human papillomavirus (HPV) infection. The aim of the study was to assess the burden of HPV infection, cervical abnormalities, and cervical cancer among a cohort of HIV-infected women as part of a routine screening in an urban overpopulated slum setting in Mumbai, India.
Methods: From May 2010 to October 2010, Médecins Sans Frontières and Tata Memorial Hospital Mumbai offered routine annual Pap smears and HPV DNA testing of women attending an antiretroviral therapy (ART) clinic and a 12-month follow-up. Women with abnormal test results were offered cervical biopsy and treatment, including treatment for sexually transmitted infections (STIs).
Results: Ninety-five women were screened. Median age was 38 years (IQR: 33–41); median nadir CD4-count 143 cells/µL (IQR: 79–270); and median time on ART 23 months (IQR:10–41). HPV DNA was detected in 30/94 women (32%), and 18/94 (19%) showed either low-grade or high-grade squamous intraepithelial lesions (LSIL/HSIL) on Pap smear. Overall, >50% had cervical inflammatory reactions including STIs. Of the 43 women with a cervical biopsy, eight (8.4%) had CIN-1, five (5.3%) CIN-2, and two (2.1%) carcinoma in situ. All but one had HPV DNA detected (risk ratio: 11, 95% confidence interval: 3.3–34). By October 2011, 56 women had completed the 12-month follow-up and had been rescreened. No new cases of HPV infection/LSIL/HSIL were detected.
Conclusion: The high prevalence of HPV infection, STIs, and cervical lesions among women attending an ART clinic demonstrates a need for routine screening. Simple, one-stop screening strategies are needed. The optimal screening interval, especially when resources are limited, needs to be determined.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Cervical cancer by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
Cervical cancer develops in a woman's cervix (the entrance to the uterus from the vagina).
Almost all cervical cancer cases (99%) are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact.
Although most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer in women.
Cervical cancer is the fourth most common cancer in women. In 2018, an estimated 570 000 women were diagnosed with cervical cancer worldwide and about 311 000 women died from the disease.
Effective primary (HPV vaccination) and secondary prevention approaches (screening for, and treating precancerous lesions) will prevent most cervical cancer cases.
When diagnosed, cervical cancer is one of the most successfully treatable forms of cancer, as long as it is detected early and managed effectively. Cancers diagnosed in late stages can also be controlled with appropriate treatment and palliative care.
With a comprehensive approach to prevent, screen and treat, cervical cancer can be eliminated as a public health problem within a generation.
Current knowledge and state of the art about management of abnormal cervical Cancer screening tests and cancer precursors for health providers in low-income settings is presented.
The Papanicolaou test (also called Pap smear, Pap test, cervical smear, or smear test) is a screening test used in gynecology to detect premalignant and malignant (cancerous) processes in the ectocervix. http://docturs.com/dd/pg/groups/2392/cervical-smear-test-pap-test/
Nulife module 6 screening for malignancies editedManinder Ahuja
These six modules from 2-7 are on mid life health care of women and were made with intention of training general gynecologist and other speciality into care of mid life women and have Mid Life OPD cards as mainstay of care.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
5. Mrs. Payne, is a 45-year-old female who is here for a health maintenanceMrs. Payne, is a 45-year-old female who is here for a health maintenance
exam. It looks like she hasn’t had a visit for over five years. Patient statesexam. It looks like she hasn’t had a visit for over five years. Patient states
she would like to be check out since its been a while and needs to have ashe would like to be check out since its been a while and needs to have a
Pap smear and mammogram.Pap smear and mammogram.
Nurse practitioner student (working with Dr. Stephanie Lee at her familyNurse practitioner student (working with Dr. Stephanie Lee at her family
medicine clinic): Will interview patient and find out if she has any concerns,medicine clinic): Will interview patient and find out if she has any concerns,
update her past medical history, do a brief review of systems and physicalupdate her past medical history, do a brief review of systems and physical
exam. Will also update patient’s immunization status, address suggestionsexam. Will also update patient’s immunization status, address suggestions
and recommendations on her smoking, excessive weigh, lack of exercise,and recommendations on her smoking, excessive weigh, lack of exercise,
and osteoporosis prevention. Will educate about menopause, nutrition,and osteoporosis prevention. Will educate about menopause, nutrition,
physical activity, weight loss, smoking cessation, and breast cancerphysical activity, weight loss, smoking cessation, and breast cancer
screening. Mrs. Payne to schedule a follow up on her lab results and also ascreening. Mrs. Payne to schedule a follow up on her lab results and also a
three week follow up visit to monitor her progress.three week follow up visit to monitor her progress.
CASE OVERVIEW
7. RECOMMENDATIONS FOR BREAST CANCER
SCREENING MAMMOGRAPHY
American Cancer Society- Women ages 40 to 44 should have the choice to start annual breast cancer screening
with mammograms if they wish to do so. The risks of screening as well as the potential benefits should be
considered. Women age 45 to 54 should get mammograms every year. Women age 55 and older should switch to
mammograms every 2 years, or have the choice to continue yearly screening.
US Preventive Services Task Force- Biennial screening mammography for women aged 50-74 years (Grade
B recommendation) Decision to start regular, biennial screening mammography before the age of 50 years should be
an individual one and take patient context into account, including the patient's values regarding specific benefits and
harms.
Most guidelines do not recommend routine mammography for women younger than 40 years unless they fall into a
high risk category such as women with a known BRCA mutation.
8. CERVICAL CANCER SCREENING
In 2012, the American College of Obstetrics and Gynecology (ACOG), the American Cancer Society (ACS), American Society for
Colposcopy and Cervical Pathology (ASCCP) and USPSTF guidelines recommend that:
Between the ages of 21-29 years -- screening should be performed every three years.
Between the ages of 30-65 years -- screening can be done every five years if co-tested for HPV (preferred) or every three years with
cytology alone (acceptable). However, they stipulate that certain risk groups need to have more frequent screening. They include
women with compromised immunity, are HIV positive, have a history of cervical intraepithelial neoplasia grade 2, 3 or cancer, or have
been exposed to diethylstilbestrol (DES) in utero (DES is a nonsteroidal estrogen that was given to pregnant women to prevent
miscarriages. However, it was linked to clear cell adenocarcinoma of the vagina and was discontinued in 1971).
Women older than 65 years who have had adequate screening within the last ten years may choose to stop cervical cancer screening.
Adequate screening is three consecutive normal pap tests with cytology alone or two normal pap tests if combined with HPV testing.
Women who have undergone a total hysterectomy for benign reasons do not require cervical cancer screening.
9. LUNG CANCER SCREENING
As of 2013, the USPSTF recommends annual screening with a low-dose CT scan to screen for lung cancer in
patients aged 55-80 years old who have smoked for 30 pack years.
To be considered, the patient should also be currently smoking or have quit within the prior 15 years.
OVARIAN CANCER SCREENING
The USPSTF, the American College of Obstetricians and Gynecologists, and the American College of Physicians
all recommend against routine screening for ovarian cancer in asymptomatic women.
10. SKIN CANCER SCREENING
While skin cancer is the most common type of cancer, the USPSTF is currently reviewing guidelines regarding
screening. Presently, the draft statement states that current evidence is insufficient to assess if there is more harm
or benefit to visual skin cancer screening in adults.
The USPSTF is also currently evaluating if there is any benefit in providing behavioral counseling for skin cancer
prevention.
11. OSTEOPOROSIS SCREENING
For women > 65 years old, screening with dual energy x-ray absorptiometry (DEXA) is recommended.
For women < 65 years old, the USPSTF recommends using the World Health Organization's Fracture Risk
Assessment Tool to risk-stratify
Screening with DEXA is recommended if the risk of fracture is greater than or equal to that of a 65-year-old white
woman without additional risk factors (9.3 percent over 10 years).
IMMUNIZATION: TDAP
Tetanus, diptheria, and acellular pertussis (Tdap) should replace a single dose of Td for adults age 19 through 64
years who have not received a dose of Tdap previously.
14. THE MECHANISMS OF MENOPAUSE
MENOPAUSE- is the permanent end of menstruation; end
of women’s childbearing years
•May occur between ages 40 and 60. On average it occurs
at 51 years. Smoking may speed up the process.
•12 months in a row without menstruation since the last
period
•May affect onset of menopause: surgery, chemotherapy, or
radiation
•Hot flushes lasts between 30 seconds to 10 minutes
•There are available treatments. Talk to the doctor for
details.
• Increased risk of heart disease and osteoporosis
PERIMENOPAUSE- is the gradual transition to menopause
•Ovaries don’t abruptly stop; only slow down
•May get pregnant; ovulation may occur
•Lasts for 2—8 years
•Symptoms
•Menstrual irregularity
•Bleeding
•Heavy and >1 week consult a doctor
•Hot flushes
•Vaginal dryness
•Mood swings
15. THE MECHANISMS OF MENOPAUSE
Managing hot flushes
•Wear dress with light
layers
•Using fan
•Regular exercise
•Avoiding spicy foods
and heat
•Stress management
Managing vaginal
dryness
•May use water—
soluble lubricant
•Sexual urge may
also change
Managing mood swings
•Talk to the provider for
resources
•Discuss with spouse
16. REQUIRED ANNUAL EXAMINATION FOR WOMEN AGES
45 AND ABOVE
Mammogram
•Starts at 40 (or earlier with certain risk
factors)
•Every 1 to 2 years, depending on risk
Pap Smear
•Starts at 21
•Every three years. Women older than 65 may
be able to stop testing if low risk.
17. RECOMMENDED VACCINATION NEEDED GIVEN THE
CURRENT CONDITION
Influenza vaccine
•All persons aged 6 months or older who do not have a
contraindication should receive annual influenza
vaccination with an age-appropriate formulation of
inactivated influenza vaccine (IIV) or recombinant
influenza vaccine (RIV).
•In addition to standard-dose IIV, available options for
adults in specific age groups include: high-dose or
adjuvanted IIV for adults aged 65 years or older,
intradermal IIV for adults aged 18 through 64 years,
and RIV for adults aged 18 years or older.
Tdap vaccine
•1 dose followed by tetanus and diphtheria toxoids (Td) booster
every 10 years for adults who have not received tetanus and
diphtheria toxoids and acellular pertussis vaccine (Tdap) or for
whom pertussis vaccination status is unknown
•Adults with an unknown or incomplete history of a 3-dose
primary series with tetanus and diphtheria toxoid-containing
vaccines should complete the primary series that includes 1 dose
of Tdap.
•Unvaccinated adults should receive the first 2 doses at least 4
weeks apart and the third dose 6–12 months after the second
dose.
18. RECOMMENDED VACCINATION NEEDED GIVEN THE
CURRENT CONDITION
Pneumonia vaccine
•CDC recommends pneumococcal polysaccharide vaccination for:
•All adults 65 years or older
•People 2 through 64 years old with certain medical conditions
•Adults 19 through 64 years old who smoke cigarettes
22. MRS. PAYNE DIET
Skips Breakfast
Lunch: sandwich or leftover pasta, an apple or orange, water, and usually a couple of cookies
Dinner: Lean meats, rice, strawberries/blackberries, water
Dessert: cake or ice cream, chips or another helping of dessert while watching TV.
24. DAILY TARGET (BASED ON AGE AND SEX)
(USDA, 2017)
•6 oz of grains (at least ½ should be whole grains)
•2 ½ cups of vegetables
•2 cups of fruits
•3-4 servings of dairy
•5 oz of protein daily
25. BASIC GUIDELINES
Start with a few realistic changes
Enjoy your food but eat less
Avoid oversized portions
Balance calories between portion size and activity level
26. MAKE HEALTHY CHOICES
Make half of your plate fruits and vegetables
Choose variety/color
Switch to 1% or skim milk and eat low-fat or fat-free dairy or equivalent substitutes
Make at least half your grains with whole grains such as whole wheat pasta/bread or brown rice,
instead of white rice
27.
28. FOODS TO LIMIT
Saturated and Trans Fats
•Use small amounts of unsaturated
fats such as olive, canola, safflower,
or corn oils.
•Margarine without trans fat or
partially hydrogenated oil
Sodium
•Check labels (less than 2,300mg/day)
•Buy low-sodium, reduced sodium, or no-salt-added products
•Consume fewer foods with high sodium such as cheese,
processed meats, frozen entrees, packaged mixes, canned
soups and vegetables, pickled foods, condiments (salad
dressing, soy sauce, catsup, and mustard)
•Add herbs and spices instead of salt
29. FOODS TO LIMIT
Added Sugar
•Substitute water or unsweetened beverages for
sugary drinks
•Choose fruit as a naturally sweet dessert or sweet snack
instead of foods with added sugars
•Make sweet desserts and snacks, such as cookies, cakes, pies,
and ice cream, a once-in-a-while treat and choosing a small
portion when you enjoy them
•Choose packaged foods that have less or no added sugars such
as plain yogurt, unsweetened applesauce, or frozen fruit with
no added sugar or syrup
Alcohol & Caffeine
•Up to 1 drink per day for women and up to 2 drinks
per day for men
30. CALCIUM
•Calcium intake: For pre-menopausal women 1000
mg/daily is recommended.
•To meet these needs, 3-4 serving of dairy products are
required. Examples of this include: 8 oz of yogurt, 1
cup of milk, 1.5 oz of cheese. (Each serving can provide
around 300mg of calcium)
•Calcium Rich Foods
https://health/gov/dietaryguidelines/2015/guidelines/appe
ndix-11
https://www.choosemyplate.gov/dairy-calcium-sources
VITAMIN D
•600-4000 IU daily
•Dietary sources include fish and fortified
dairy, grains, and cereals
•Vitamin D Rich Foods
https://ods.od.nih.gov/factsheets/VitaminD
-HealthProfessional/
31. RESOURCES
Choose My Plate provides information on healthy eating http://www.choosemyplate.gov/
My Plate Checklist Calculator: Find out the number of calories needed to maintain vs. lose
weight https://www.choosemyplate.gov/MyPlate-Daily-Checklist-input
33. PHYSICAL ACTIVITIES
Background
Mrs. Payne is 5’6” 180 lbs. with a BMI of 29 kg/m2
.
She has three children and used to walk during her lunch break but has stated she has stopped because she is too busy.
She also states, “I weigh too much. I would feel better physically and emotionally if I could only lose about 10 or 20 pounds. But I don't know where to start.”
According to the BMI table her weight falls into the overweight category.
Reduction in her weight will reduce her risks of diabetes, hypertension, and cardiovascular disease.
Exercise and physical activity needs to be addressed and by her statement indicates she wants to take the steps towards being more active.
34. QUESTIONS TO ASK/FURTHER ASSESSMENT:
• What activities do you enjoy?
• What daily activities do you do?
• What does the family and kids like to do for fun?
• Do you like the outdoors?
• Do you have family outings?
• Do you enjoy exercise or physical activities with others?
Asking questions will reveal more about the patient and what
exercises and physical activities to suggest in her area or
with her family.
38. INTERVENTIONS
Developing Self Awareness
•Self-awareness helps people learn about
interactions among mind, body, and spirit.
•Increase a sense of control and counters
self-defeating perceptions.
Techniques for Developing Self-Awareness
1. Monitoring Stress Warning Signs
2. Learning and Practicing a Relaxation Response
Technique
3. Using Mini-Relaxations
4. Alternative and Complementary Therapies
5. Expressive Writing.
39. INTERVENTIONS
Nutrition: Healthy Diet
•Food is viewed as a positive influence on
health, physical performance and state of
mind. Nutrition is an important component
of early intervention strategies to improve
physical, cognitive, emotional, social, and
spiritual functioning.
Physical Activity
•One of the most effective way to lose weight and
improve self-esteem is to combine exercise with
nutritious eating. Regular physical activity also
increases the ability of older people and those with
certain chronic, disabling conditions, to perform
activities of daily living.
40. INTERVENTIONS
Sleep Hygiene
•Health and the ability to meet life’s
many demands and manage stress
effectively require proper rest.
Cognitive-Behavioral Restructuring and
Affirmations
•A conceptually based short term interventions to modify this
thinking and related behaviors and thereby reduce stress. It is a
technique or series of strategies that help people evaluate their
thoughts, challenge them, and replace them with more rational
cognitive and behavioral responses. An affirmation is a positive
thought, in the form of a short phrase or saying, which has meaning
for the individual.
41. INTERVENTIONS
Social Support
•Having supportive family, friends
and coworkers is an important
contributor to effective coping and
stress hardiness.
Assertive Communication and Empathy
•Is the most effective way to communicate. It is non-
judgmental, express feelings and opinions and reaffirms
perceived rights.
•Empathy is the ability to consider another person’s
perspective and to communicate this understanding back to
that person.
42. INTERVENTIONS
Healthy Pleasures
•Activities that brings feelings of
peace, joy, and happiness.
Spiritual Practice
•Activities that help people find meaning, purpose
and connection.
Clarifying Values
•Recognize the things and values that are important to them, reflect on where they are in life, evaluate
what needs to be changed, and generate an action plan for that change.
43. INTERVENTIONS
Setting Realistic Goals
•Developing an action plan for change to work
toward a more balanced health-promoting
lifestyle that is consistent with a person’s values
and beliefs.
Humor
An enjoyable and effective antidotes to stress for many people.
Humor produces laughter. Laughter creates predictable
physiological changes in the body.
45. REFERENCES:
CDC. (2017). Recommended immunization schedule for
adults aged 19 years or older, by vaccine and age group.
Retrieved from https://
www.cdc.gov/vaccines/vpd/pneumo/
Edelman, C.L., Kudzma, E.C., Mandle, C.L.
(2014). Health promotion throughout the life span (8th ed.).
Saint Louis, MO: Elsevier
Health.gov (2015). 2015-2020 Dietary guidelines for
Americans.
Retrieved from https://health.gov/dietaryguidelines/2015/