The document summarizes revised standards for adult immunization practices published in 2003. The standards were developed by over 100 experts from more than 60 organizations to encourage best practices for adult vaccination. The revised standards are more comprehensive than the original 1990 standards and focus on accessibility of vaccines, assessing patient vaccination status, patient education, proper administration techniques, strategies to improve rates, and community partnerships. Adoption of the standards aims to increase adult vaccination rates and meet Healthy People 2010 goals, as success rates are much lower for adult versus childhood immunization.
Vaccination in adults - Slideset by Professor Paolo BonanniWAidid
The slideset by professor Paolo Bonanni on vaccination in adults makes an overview on influenza, streptococcus pneumoniae, diphtheria, tetanus, pertussis, Human Papilloma Virus (HPV), measles, mumps, rubella, varicella and tick borne encephalitis. Where we were and where we are.
Presentation by Dr Jennifer Hoyle, Northern Care Alliance: Influenza in Greater Manchester, at ECO 21 event at Haydock Park Racecourse on Thursday 12 December 2019.
Vaccination in adults - Slideset by Professor Paolo BonanniWAidid
The slideset by professor Paolo Bonanni on vaccination in adults makes an overview on influenza, streptococcus pneumoniae, diphtheria, tetanus, pertussis, Human Papilloma Virus (HPV), measles, mumps, rubella, varicella and tick borne encephalitis. Where we were and where we are.
Presentation by Dr Jennifer Hoyle, Northern Care Alliance: Influenza in Greater Manchester, at ECO 21 event at Haydock Park Racecourse on Thursday 12 December 2019.
Vaccine Hesitancy in the United States Sarah Thomson
Lab meeting presentation concerning vaccine hesitancy in the United States, resulting disease outbreaks and consequences, and recommendations for better public health communication efforts.
October 7, 2019
On October 7, 2019, the Harvard Global Health Institute will host a one-day symposium to explore what enabled this visionary program, and to showcase how it has transformed not just the worldwide HIV/AIDS response but global health delivery more broadly.
There are many lessons learned in PEPFAR’s story - from what it took to build a supply chain where there was none, to establishing the use of generic antiretroviral therapies (ARTs) and leveraging human capacity. This event convened the early architects of PEPFAR as well as experts and implementers currently leading the charge. We took a historically informed look at what it will take to stop global transmission, and shared tools useful for others hoping to move the needle on vexing problems in global health.
For more information, visit our website at https://petrieflom.law.harvard.edu/events/details/15-years-of-pepfar
). The BPS looks at how physical and mental health are influenced by interacting biological, psychological (thoughts, emotions, and behavior) and social (socio-economic and cultural) factors. The BPS model was proposed by Engel (1981) contrary to the dominant biomedical model (BM) that states that illness can be attributed to some deviation from the normal state due to an external agent like a virus or injury or due to genetic or developmental abnormality. The BM model cannot make provision for the person as a whole or from a psychological or social nature (Engel, 1977). The biological factors of etiology, incidence, transmission, and prevention by immunization and the need for vaccinating HCWs to prevent the spread of the virus and the causes for low rates of immunization are presented. The psychological analysis looks at motivation, risk perceptions and altruistic behaviors that affect immunization of HCWs. The methods used to encourage HCWs uptake of flu vaccines and the need for mandatory immunization policies are discussed. Finally, the social and ethical issues regarding mandatory immunization policies are put in perspective
Vaccine Hesitancy in the United States Sarah Thomson
Lab meeting presentation concerning vaccine hesitancy in the United States, resulting disease outbreaks and consequences, and recommendations for better public health communication efforts.
October 7, 2019
On October 7, 2019, the Harvard Global Health Institute will host a one-day symposium to explore what enabled this visionary program, and to showcase how it has transformed not just the worldwide HIV/AIDS response but global health delivery more broadly.
There are many lessons learned in PEPFAR’s story - from what it took to build a supply chain where there was none, to establishing the use of generic antiretroviral therapies (ARTs) and leveraging human capacity. This event convened the early architects of PEPFAR as well as experts and implementers currently leading the charge. We took a historically informed look at what it will take to stop global transmission, and shared tools useful for others hoping to move the needle on vexing problems in global health.
For more information, visit our website at https://petrieflom.law.harvard.edu/events/details/15-years-of-pepfar
). The BPS looks at how physical and mental health are influenced by interacting biological, psychological (thoughts, emotions, and behavior) and social (socio-economic and cultural) factors. The BPS model was proposed by Engel (1981) contrary to the dominant biomedical model (BM) that states that illness can be attributed to some deviation from the normal state due to an external agent like a virus or injury or due to genetic or developmental abnormality. The BM model cannot make provision for the person as a whole or from a psychological or social nature (Engel, 1977). The biological factors of etiology, incidence, transmission, and prevention by immunization and the need for vaccinating HCWs to prevent the spread of the virus and the causes for low rates of immunization are presented. The psychological analysis looks at motivation, risk perceptions and altruistic behaviors that affect immunization of HCWs. The methods used to encourage HCWs uptake of flu vaccines and the need for mandatory immunization policies are discussed. Finally, the social and ethical issues regarding mandatory immunization policies are put in perspective
1Global Vaccination (attach this please with the previou.docxfelicidaddinwoodie
1
Global Vaccination (attach this please with the previous sections)
WHO estimates that three million cases of disease could be avoided annually with an appropriate prevention by vaccination.
Immunization System in Malasyia (more info please add to US)
Religious Views of Vaccination (Malaysia)(please attach this with the previous sections)
Grabenstein (2013) noted that polio immunization is obligatory when disease risk is high and the vaccine shown to have benefits far outweighing its risks.
National Immunization Program (NIP)
The Malaysian National Immunization Program (NIP) was introduced in the early 1950s and it has been given free to the children for their protection against major childhood diseases. The immunization program offers protection against major childhood diseases that can be prevented with vaccines including diphtheria, tetanus, pertussis, Haemophilus influenzae type b, hepatitis B, measles, mumps, rubella, tuberculosis, polio and some diseases caused by the human papillomavirus. This program is available at all government clinics across the country.
Parents are responsible for ensuring that their children are protected from dangerous infectious diseases that can be prevented with a vaccine. Below is the national immunization schedule to ensure your child receives the vaccination at the right time (Malaysian MOH, 2017).
Vaccine Safety Surveillance
National Centre of Adverse Drug Reactions (ADR) Monitoring, National Pharmaceutical Control Bureau (NPCB) is responsible to monitor the safety of medicines and vaccines that are registered in Malaysia. NPCB is responsible for collecting all reporting adverse events related pharmaceutical products including vaccines. All reported adverse events will be documented and serious cases following vaccination will be investigated promptly to identify the cause of the adverse events. NPCB will make further investigation in terms of product quality and regulatory action will be taken based on the results of the investigation. Types of regulatory action that can be taken are the suspension of the product registration, product recall or cancellation of the product registration.
ADR reporting system has been introduced in Malaysia to enable health providers to participate in monitoring the safety of medicines and vaccines by reporting the adverse events. Ministry of Health Malaysia (MOH) has organized trainings to the health professionals on the importance of reporting of Adverse events following immunization (AEFIs) as described in the Guidelines for the Pharmacovigilance of Vaccines. Ongoing training will be conducted more actively to increase awareness among health care providers to report AEFI and importance of disseminating the information to parents/guardians.
Currently, the AEFI reporting system has been extended to the public whereby the parents/guardians of children who experience any adverse events can report to us by themselves (Malaysian MOH, 2017).
Immunization System in the US ...
Implementation and evaluation of anursing assessmentstandin.docxwilcockiris
Implementation and evaluation of a
nursing assessment/standing orders–
based inpatient pneumococcal
vaccination program
Carl Eckrode, MPH, RRT-NPS,b Nancy Church, RN, MT,a and Woodruff J. English III, MDa
Portland and Gresham, Oregon
Background: Pneumococcal vaccination is recommended for patients aged 65 years and greater; inpatient vaccination has been
suggested as means to increase vaccination rates is this population. Our hospital implemented an inpatient pneumococcal vacci-
nation program, and expanded the population of interest to include patients aged 2 to 64 years with risk factors for pneumococcal
bacteremia. We studied the outcomes of this program to determine if the rate of pneumococcal vaccination opportunities and
pneumococcal vaccination rate could be significantly increased through the application of an in-hospital pneumococcal vaccina-
tion program, based on standing orders and assessment by Registered Nurses, when compared to our previous method of physi-
cian assessment and written vaccination order for each patient.
Methods: Subjects were inpatients admitted to non-intensive care units of our hospital from August to December of 2004. Cases
were aged greater than 65 years, or were greater than 2 years of age with selected risk factors. Patients with previous pneumococcal
vaccination with the past five years, in terminal or comfort care, those allergic to vaccine components, patients who received organ
or bone marrow transplants in the year prior to the study, and those physicians barred them from the vaccination protocol were
excluded. Program effectiveness was evaluated through retrospective evaluation of medical records to determine if subjects had
been evaluated for vaccination eligibility, and if subjects were eligible, whether or not they had received pneumococcal vaccination.
Results: Overall vaccination opportunity rate after implementation of the standing orders-based program increased form 8.6% to
59.1%, and overall vaccination rates improved form 0% to 15.4%. The study found a statistically significant difference in the rate
of pneumococcal vaccination opportunities (x2 = 182.46, p = .00) and the pneumococcal vaccination rate (x2 = 56, p = .00)
between the two methods of assessment and vaccination; these results are attributable to the study intervention.
Conclusions: The study program contributed to increased overall vaccination opportunity and vaccination rates, when compared
to the previous method. The overall rates of vaccination attained by this program were often lower than those reported in the ex-
isting literature for other program designs; however, this may be due to an unusually high rate of vaccination refusal. (Am J Infect
Control 2007;35:508-15.)
The significance of invasive pneumococcal disease
cannot be understated, because disease caused by
Streptococcus pneumoniae has been reported to be
responsible for an estimated 36% of community-
acquired pneumonia, an estimated 50% of nosocomial
pneumonias,.
EVALUATION OF VACCINE ADHERENCE AND ROLE OF A CLINICAL PHARMACIST IN PAEDIAT...PARUL UNIVERSITY
Background: Immunization is one of the decisive factors in preventing various life threatening diseases. Vaccines have thrived as one of the most successful healthy intervention on that have diminished the occurrence of various infectious diseases and improved the quality of life in the population. Although the vaccine coverage has been gradually increasing, the average total immunization coverage is far less than desired outcome. Objective: The objective of our study were to enhance the quantity of vaccine delivered in the paediatric care setting, to improve Awareness of vaccination at community level by a more active involvement of clinical pharmacist on vaccination errors and missed opportunities in paediatric care setting, to analyse the extent of knowledge, attitude and practice of parents to minimize vaccination errors and avoid vaccine misconception thereby improving vaccine adherence. Results: It is a prospective observational study was conducted on 253 paediatric subjects upto 3years of age for a period of six months in a secondary care hospital, Hyderabad. The study was divided into Pre- intervention and post-intervention phases and was performed using a KAP questionnaire. The socio- demographic details were collected by using data collection form and their knowledge, Attitude and practice levels were assessed by using KAP questionnaire regarding child vaccination. Out of 253 subjects were enrolled in the study, the percentage distribution of the respondents age showed that the age group of 25-29 were predominant. The respondents with single child were observed to be more with a frequency of 132 out of 253 who received complete awareness about vaccination. Majority of the respondents were under graduates which was the main reason for lack of knowledge on immunization. Of the total 253 study population, male child were 128(50.50%) and female child were 125(49.40%). In the study, the majority of the children were neonates (103) which is 40.71%. majority of children were immunized with polio (75.49%) and least was varicella (3.55%). Of the total population, delayed or missed vaccine was 72 out of 253 i.e. 28.40% which was observed in both the genders. Missed vaccine opportunities were mostly observed for PCV, Rotavirus, and MMR. Conclusion: This study lead to optimal disease prevention through vaccination in multiple population groups while maintaining high levels of Safety and the clinical pharmacist’s interventions certainly will be helpful in providing education on immunization and improving immunization rates in the underdeveloped and developing countries. KAP questionnaire can be used in future researches on immunization and allow for better understanding of relation between mothers knowledge and immunization of children.
SOCIO-CULTURAL AND BEHAVIORAL FACTORS INFLUENCING CHILDHOOD IMMUNIZATION PR...GABRIEL JEREMIAH ORUIKOR
Abstract: Background: Immunization is one of the most cost-effective interventions with proven strategies to reach
the vulnerable populations. It is also a proven tool for controlling and eliminating life threatening infectious diseases.
It also prevents illness, disability and deaths from vaccine preventable diseases averting estimated 2-3 million deaths
each year.
Method: A descriptive survey research design was adopted, one hundred 100 nursing mothers were used for the
study. The instruments used for the study was a self-structured questionnaire. Simple random sampling technique
was used to select the sample for the study. Data collected were analysed using frequency, counts and percentage
table for demographic information.
Result: The findings of the study revealed that behaviour/attitude of healthcare workers and lack of enough
information were determinants of incomplete routine immunization, while life style, religion and belief were not
determinants of incomplete routine immunization. However, level of education, distance to health facility, life style,
religion and belief were jointly determinants of incomplete routine immunization among nursing mothers in Jericho
specialist hospital.
Conclusion: Based on the findings of the study; it is therefore recommended that State Government and
Philanthropists should assist in building more health care facilities close to the communities for easy accessibility.
Effort should be geared towards public campaign using local dialect to encourage them to complete routine
immunization. In addition, community mobilization should be strengthening especially among nursing mothers to
be fully informed about the merits of completing the routine immunization and to avert childhood morbidity and
mortality in our society.
Factors Associated with Human Papilloma Virus Vaccine Uptake amongst Girls Ag...PUBLISHERJOURNAL
Human papillomavirus (HPV) infection is a sexually transmitted infection. HPV vaccine since its first licensure in 2006 has proven to be safe, highly immunogenic, and induces strong direct and indirect protection against HPV and its sequelae. The study was designed to determine the socio-demographic, health care, and parental factors associated with human papillomavirus vaccine uptake amongst girls aged 9-14 years. The study was a cross-sectional study employing a simple random sampling method and a total of 364 girls were interviewed following the set criteria using questionnaire data. Data were cleaned, coded, and analyzed using SPSS version 22.0. Findings were presented as frequencies, percentages, odd ratios, and p-values using univariate, bivariate, and multivariate analysis. From the study, statistically significant sociodemographic factors such as age (p=0.0000), schooling status (p=0.0000), level of education (p=0.007442), attitudes towards the HPV vaccine (p=0.005175), Receiving vaccine doses from different vaccination sites (p=0.0000), and Ethnicity (p=0.0000), healthcare factors such as outreaches in communities (p=0.0000), information received (p=0.0000), encouragement from health workers (p=0.0000), availability of vaccines (p=0.0000) and parental factors such as knowledge about HPV vaccine(p=0.001), parental hesitancy (p<0.001), level of education (p=0.0000), social economic status (p=0.001), attitudes towards HPV vaccine, (p=0.0000) and HPV vaccine awareness (p=0.0000) were found statistically associated with HPV vaccine uptake amongst girls aged 9-14 years. From the study findings, the study variables such as sociodemographic, and health-related factors were found to be statistically associated with HPV vaccine uptake amongst girls aged 9-14 years. Therefore, effort should be brought to all levels of intervention so that HPV uptake is taken into consideration if the need for good health among girls needs to be achieved.
Keywords: Human papillomavirus virus, sexually transmitted infection, Health care, HPV vaccine, Cancer.
Published in Living Well Magazine (March/April 2016 edition), BiondVax's CEO considers whether flu prevention will be possible through the M-001 universal flu vaccine.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
1. Review and Special Articles
Standards for Adult Immunization Practices
Gregory A. Poland, MD, Abigail M. Shefer, MD, Mary McCauley, MTSC, Peggy S. Webster, MD,
Patricia N. Whitley-Williams, MD, Georges Peter, MD, and the National Vaccine Advisory Committee,
Ad Hoc Working Group for the Development of Standards for Adult Immunization Practices
Abstract:
Since the Standards for Adult Immunization Practices were first published in 1990,
healthcare researchers and providers have learned important lessons on how to better
achieve and maintain high vaccination rates in adults. The success rate of childhood
immunization far exceeds the success rate of adult immunization. Thus, information and
practices that will produce higher success rates for adult vaccination are crucial, resulting
in overall societal cost savings and substantial reductions in hospitalizations and deaths.
The Standards, which were developed to encourage the best immunization practices,
represent the collective efforts of more than 100 people from more than 60 organizations.
The revised Standards are more comprehensive than the 1990 Standards and focus on the
accessibility and availability of vaccines, proper assessment of patient vaccination status,
opportunities for patient education, correct procedures for administering vaccines,
implementation of strategies to improve vaccination rates, and partnerships with the
community to reach target patient populations. The revised Standards are recommended
for use by all healthcare professionals and all public and private sector organizations that
provide immunizations for adults. All who are involved in adult immunization should strive
to follow the Standards in order to create the same level of success achieved by childhood
vaccination programs and to meet the Healthy People 2010 goals.
(Am J Prev Med 2003;25(2):144 –150)
Introduction
I
n the United States, years of clinical and programmatic experience have been translated into successful childhood immunization practices. As a result,
vaccination rates among infants and children are near
or at all-time highs. Today, most childhood vaccinepreventable diseases rarely occur or are non-existent.
However, similar success in vaccinating adults has not
been achieved.
Goals for adult immunization feature prominently in
Healthy People 2010,1 a comprehensive, nationwide
health promotion and disease prevention agenda from
the U.S. Department of Health and Human Services.
The target is 90% coverage for annual influenza immunization among adults aged Ն65 years and 90% for one
dose of pneumococcal vaccine. Success will require a
dramatic increase from rates in 2000, which were only
From the Mayo Vaccine Research Group, Mayo Clinic (Poland),
Rochester, Minnesota; National Immunization Program, Centers for
Disease Control and Prevention (Shefer, McCauley), Atlanta, Georgia; Abott Laboratories (Webster), Abbott Park, Illinois; University of
Medicine and Dentistry of New Jersey–Robert Wood Johnson Medical
School (Whitney-Williams), New Brunswick, New Jersey; Brown Medical School (Peter), Providence, Rhode Island.
Address correspondence and reprint requests to: National Vaccine
Program Office, Centers for Disease Control and Prevention, 4770
Buford Highway, MS K-77, Chamblee GA 30341.
The full text of this article is available via AJPM Online at
www.ajpm-online.net.
144
Am J Prev Med 2003;25(2)
Published by Elsevier Inc.
66% for influenza vaccine and 50% for pneumococcal
vaccine.2
Increasing the use of these two vaccines among older
adults could have tremendous health impacts. Influenza and its complications kill approximately 40,000
individuals every year in the United States.3 Another
100,000 individuals suffer so severely from influenza
that hospitalization is required.4 The overwhelming
majority of these deaths and hospitalizations occur in
the elderly. When vaccine viruses are well matched to
circulating viruses, vaccination lowers the risk of infection among healthy adults by up to 90%.4,5 Although
influenza vaccination is somewhat less effective among
the elderly, vaccination has been estimated to reduce
their risk of influenza-related hospitalization and death
by up to 70%.4,6 – 8 The Centers for Disease Control and
Prevention (CDC)9 estimate that for each additional 1
million elderly people vaccinated each year, 900 deaths
and 1300 hospitalizations would be averted. Furthermore, economic studies find overall societal cost savings and substantial reductions in hospitalizations and
deaths if people aged Ն65 years receive the influenza
vaccine.4,6,7
In recent years, pneumococcal infections have accounted for Ͼ100,000 hospitalizations for pneumonia,
Ͼ60,000 cases of bacteremia and other forms of invasive disease, and about 7000 deaths from invasive
pneumococcal disease.10 –12 In 1998, Ͼ50% of these
deaths occurred among people aged Ն65 years. Over0749-3797/03/$–see front matter
doi:10.1016/S0749-3797(03)00120-X
2. all, vaccine effectiveness against invasive pneumococcal
disease among immunocompetent people aged Ն65
years is 75%,13 and the vaccine has been shown to be
cost effective for people in this age group as well.14
Based on 1998 projections, annually 76% of invasive
pneumococcal disease cases and 87% of resulting
deaths occurred in people who were eligible for pneumococcal vaccine in the United States.12
Additional health benefits could also be gained by
reaching immunization targets for younger high-risk
adults. Healthy People 20101 targets are 60% coverage
with influenza and pneumococcal vaccines among
high-risk adults aged 18 to 64 years. In 1999, only 31%
of these adults reported receiving influenza vaccine,
and only 17% received pneumococcal vaccine (Centers
for Disease Control and Prevention, unpublished data,
1999). In 1998, 41% of deaths attributed to invasive
pneumococcal disease occurred among individuals
aged 18 to 64 years who had a medical indication for
the pneumococcal vaccine.12
Despite the availability of a vaccine that is Ͼ95%
effective in preventing hepatitis B, approximately
80,000 individuals, mostly adolescents and adults, are
infected annually in the United States.15,16 About 6% of
newly infected people become chronically infected and
face a 15% to 25% lifetime risk of death from chronic
liver disease. Annually, an estimated 4000 to 5000
chronically infected people die prematurely from
chronic liver disease.17 Without an improvement in
vaccinating adults at increased risk of hepatitis B infection, transmission of hepatitis B will continue for
decades.
Vaccines also remain underutilized among other
groups of adults, especially among certain racial/ethnic
populations. For example, the rates of influenza and
pneumococcal vaccination in African-American and
Hispanic populations are significantly lower than those
among whites.18 In addition, adult immunization is not
limited to pneumococcal, influenza, and hepatitis B
vaccines. All adults should be immune to measles,
mumps, rubella, tetanus, diphtheria, and varicella, and
adults who are susceptible to hepatitis A and polio
should be vaccinated if they are at risk for exposure.
Further, certain vaccines, such as travel vaccines or
vaccines occupationally required, should be reviewed
and provided if appropriate. The CDC’s Advisory Committee on Immunization Practices (ACIP) has recently
published an Adult Immunization Schedule (http://
cdc.gov/nip/recs/adult-schedule.htm).
Revising the Standards
The Standards for Adult Immunization Practices, developed to encourage best practices, were first published in 1990.19 Since then, the healthcare system has
changed dramatically. For example, there has been a
shift toward managed care, resulting in a change in
Table 1. Standards for adult immunization practices
Make vaccinations available.
1. Adult vaccination services are readily available.
2. Barriers to receiving vaccines are identified and
minimized.
3. Patient “out-of-pocket” vaccination costs are minimized.
Assess patients’ vaccination status.
4. Healthcare professionals routinely review the
vaccination status of patients.
5. Healthcare professionals assess for valid
contraindications.
Communicate effectively with patients.
6. Patients are educated about risks and benefits of
vaccination in easy-to-understand language.
Administer and document vaccinations properly.
7. Written vaccination protocols are available at all
locations where vaccines are administered.
8. Persons who administer vaccines are properly trained.
9. Healthcare professionals recommend simultaneous
administration of indicated vaccine doses.
10. Vaccination records for patients are accurate and easily
accessible.
11. All personnel who have contact with patients are
appropriately vaccinated.
Implement strategies to improve vaccination rates.
12. Systems are developed and used to remind patients and
healthcare professionals when vaccinations are due and
to recall patients who are overdue.
13. Standing orders for vaccinations are employed.
14. Regular assessments of vaccination coverage levels are
conducted in a provider’s practice.
Partner with the community.
15. Patient-oriented and community-based approaches are
used to reach target populations.
provider incentives and reimbursement for preventive
services. Also in the past decade, healthcare researchers
and providers have learned many valuable lessons
about what is needed to achieve and maintain high
vaccination rates among adults.
This revision of the Standards for Adult Immunization Practices (Table 1) reflects the experience of the
past 10 years. The Standards represent the collective
efforts of more than 100 people from more than 60
organizations, including professional societies, state
and local health departments, immunization programs,
and immunization providers. The National Vaccine
Advisory Committee (NVAC) led this effort. As the
Federal Advisory Committee is charged by the Secretary
of Health and Human Services to ensure the adequate
delivery of safe and effective vaccination products in
the United States, the NVAC itself is composed of
people who represent the spectrum of those with an
interest in immunization, including physicians, researchers, developers, manufacturers, state and public
health agencies, and more than 20 federal agencies.
The revised Standards also incorporate information
from two important reports published by NVAC in the
last decade on the status of adult immunization20 and
on adult immunization programs in nontraditional
settings.21
Am J Prev Med 2003;25(2)
145
3. Information published from the Guide to Community
Preventive Services reviews strategies to improve immunization service delivery and provides a broader base of
evidence to support the Standards.22,23 Based on research published in the 1990s concerning techniques
proven to improve immunization rates among adults,
three new standards were constructed and require the
following: (1) systems that remind patients and providers when an immunization is due, (2) standing orders
from physicians that enable other personnel to prescribe and deliver vaccinations, (3) regular assessments
of coverage rates at clinics, and (4) pertinent information provided to clinic staff to ensure current patient
immunizations.
The Standards supplement research with expert consensus in areas where research does not offer guidance
but experience does. The revised Standards are more
comprehensive than the previous version and organized to focus on the provider’s ongoing process of
minimizing barriers that prevent patients from receiving vaccines, assessing for valid indications and contraindications, keeping patients’ immunizations current,
and communicating effectively with patients about
vaccines.
Today, more tools are available to support immunization providers. The revised Standards include links to
websites that contain information on model standingorder policies, instructions for setting up reminder/
recall systems, and templates for personal vaccination
records. The tools are currently available free on CDROM, but will soon be available online. In addition,
information about federal requirements and programs,
including Vaccine Information Statements, the Vaccine
Adverse Event Reporting System (VAERS), and the
National Vaccine Injury Compensation Program
(VICP) is current and has been made easily accessible
in the Standards.
pede appropriate vaccination of certain populations.
For example, although Medicare ensures coverage benefits for vaccines for those aged Ն65 years, in 2001 an
estimated 17% and 13% of adults aged 35 to 44 years
and 45 to 64 years, respectively, did not have health
insurance.2 In addition, even though many adults may
have insurance coverage, the medical insurance may
not cover vaccination.
Overall improvement in our healthcare system will
take time. However, we can do much now to improve
the delivery of vaccination services for adults. The
following Standards for Adult Immunization Practices
and the accompanying discussion are intended to address these issues.
Applying the Standards
Standard 3: Patient “out-of-pocket” vaccination costs
are minimized. Resources should be identified to keep
patient vaccination costs as low as possible, specifically
for those patients aged Ն65 years and for vaccines not
covered by Medicare Part B. In the public sector,
patient fees should include only the cost of vaccine and
administration that cannot be funded through another
source. In the private sector, routinely recommended
vaccination services should be included in basic benefits packages. System and policy changes should be
addressed to provide adequate reimbursement to providers for delivering vaccinations to their adult
population.
Once the revised Standards are implemented on a
practice-by-practice or program-by-program basis, immediate results can be expected for improved adult
immunization. Long-term sustainable improvement in
adult immunization necessitates an infrastructure to
organize immunization efforts by providers and federal
agencies, as well as state and local health departments.
Such an infrastructure is lacking.24 Partnerships among
healthcare professionals, state and local health departments, medical and nursing organizations, and insurance companies will need to be strengthened. Factors
that cause low vaccination coverage among adults must
be addressed. These factors include provider behaviors
and practices that may affect accurate identification of
patients in need of vaccination, attitudes toward the
healthcare system that may impact adults seeking and
accepting vaccines, and financial issues that may im146
The Standards
Make Vaccinations Available
Standard 1: Adult vaccination services are readily available. Primary care healthcare professionals who serve
adults should always include routinely recommended
vaccinations as part of their care. Specialists, whose
patients may be at increased risk of vaccine-preventable
diseases, should also include routinely recommended
vaccinations as part of their care. For selected vaccines
(e.g., meningococcal vaccine for college entrants and
vaccines for international travelers), patients may be
referred to another provider.
Standard 2: Barriers to receiving vaccines are identified
and minimized. Barriers to receiving vaccines may include requiring a physical examination before vaccination, requiring an additional visit for vaccination, long
waiting periods, and lack of educational materials that
are culturally appropriate. Prior to vaccine administration, simply observing the patient, asking if the patient
is well and questioning the patient/guardian about
vaccine contraindications is sufficient.
Assess Patients’ Vaccination Status
Standard 4: Healthcare professionals routinely review
the vaccination status of patients. Healthcare professionals should review and document the vaccination
American Journal of Preventive Medicine, Volume 25, Number 2
4. status of all new patients during initial office visits and
also review vaccination status on an annual basis thereafter. Healthcare professionals should ascertain if the
patient has medical risk factors, lifestyle risk factors, or
an occupation for which certain vaccines may be indicated. Healthcare professionals should record this information in the patient’s chart and preventive health
summary. Healthcare professionals should also routinely review pneumococcal vaccination status at the
time of influenza vaccination.
Standard 5: Healthcare professionals assess for valid
contraindications. Failure to differentiate between
valid and invalid contraindications often results in the
needless deferral of indicated vaccinations. Healthcare
professionals should ask about prior adverse events in
connection with a vaccination and about any conditions
or circumstances that might indicate vaccination
should be withheld or delayed. Healthcare professionals should refer to current ACIP recommendations on
valid and invalid contraindications as well as on valid
indications for vaccine use (www.cdc.gov/nip).
Communicate Effectively with Patients
Standard 6: Patients are educated about risks and benefits of vaccination in easy-to-understand language. Healthcare professionals should discuss with the patient the
benefits of vaccines, the diseases that the vaccines
prevent, and any known risks from vaccines. These
issues should be discussed in the patient’s native language, whenever possible. Printed materials, accurately
translated into the patient’s language, should be provided. For most commonly used vaccines, the U.S.
federal government has developed Vaccine Information Statements for use by both public and private
healthcare professionals to give to potential vaccine
recipients. For vaccines covered by the National Childhood Vaccine Injury Act, including those vaccines used
in children, these forms are required. These statements
are available in English and other languages. Healthcare professionals should allot ample time with patients
to review written materials and address questions and
concerns. Information and assistance can be obtained
by calling the Immunization Hotline (1-800-232-2522)
or accessing the website (www.cdc.gov/nip).
Healthcare professionals should respect each patient’s right to make an informed decision to accept or
reject a vaccine or to defer vaccination until more
information is collected.
Administer and Document Vaccinations Properly
Standard 7: Written vaccination protocols are available
at all locations where vaccines are administered. The
medical protocol should detail procedures for vaccine
storage and handling, vaccine schedules, contraindications, administration techniques, management and re-
porting of adverse events, and record maintenance and
accessibility. These protocols should be consistent with
established guidelines. CDC-recommended storage and
handling procedures are available on the Internet at
http://gravity.lmi.org/lmi_cdc/geninfo.htm.
Healthcare professionals should promptly report all
clinically significant adverse events following vaccination to VAERS, even if the healthcare professional does
not believe that the vaccine caused the event. Reporting is required for those vaccines given to adults and
medical conditions covered by the National Childhood
Vaccine Injury Act of 1986, as amended. Healthcare
professionals should be aware that patients may report
to VAERS; if they choose to do so, they are encouraged
to seek the help of their healthcare professional. Report forms and assistance are available by calling 1-800822-7967 or on the Internet at www.fda.gov/cber/
vaers/vaers.htm.
The VICP is a no-fault system that compensates
people of any age for injuries or conditions that may
have been caused by a vaccine recommended by CDC
for routine administration to children. Healthcare professionals should be aware of the VICP in order to
address questions raised by patients. Information about
the VICP is available on the Internet at www.hrsa.gov/
bhpr/vicp.htm or by calling 1-800-338-2382.
Since VAERS and VICP are separate programs, a
report of an event to VAERS does not result in the
submission of a compensation claim to VICP. Such a
claim must be filed independently in the U.S. Court of
Federal Claims. A brief description and contact information for both programs are provided on each Vaccine Information Statement for vaccines covered by the
VICP.
Standard 8: People who administer vaccines are properly trained. All people who administer vaccinations
should be fully trained in vaccine storage and handling,
vaccine schedules, contraindications, administration
techniques, management and reporting of adverse
events, and record maintenance and accessibility. Office staff should receive continuing education on these
issues annually. With appropriate training, people
other than physicians and nurses can administer vaccines. Healthcare professionals should contact public
health authorities or other medical authorities in their
state for more information concerning which individuals are permitted to administer vaccines.
Standard 9: Healthcare professionals recommend simultaneous administration of all indicated vaccine doses. Administering indicated vaccines simultaneously is
safe and effective. Simultaneous administration decreases the number of required visits and the potential
for missed doses. Measles, mumps, and rubella (MMR)
vaccine and tetanus and diphtheria (Td) toxoids
should always be administered in their combined product. Giving influenza and pneumococcal vaccine at the
Am J Prev Med 2003;25(2)
147
5. same time (but in separate arms) is also safe and
effective. Healthcare professionals should respect the
choices of patients and their caregivers.
Standard 10: Vaccination records for patients are accurate and easily accessible. Patient vaccination histories
should be recorded on a standard form in an easily
accessible location in the medical record to facilitate
rapid review of vaccination status. Accurate record
keeping helps ensure that needed vaccinations are
administered and unnecessary vaccinations are not
administered. Records should indicate the vaccine, the
date of administration, the vaccine manufacturer and
lot number, the signature and title of the person
administering the vaccine, and the address where the
vaccine was administered. The medical record at the
primary care provider’s office, clinic, or worksite should
include all vaccinations received (such as those received at a specialist’s office, influenza vaccination
clinic, or pharmacy).
Record keeping may be paper-based or computerized. Computer systems make record maintenance,
retrieval, and review easier.
Healthcare professionals should give patients a personal record of vaccinations they have received, including the dates and places of administration. Patients
should be encouraged to bring their vaccination
records to all medical visits.
Information and a modifiable template of these
forms and records are available at www.ahcpr.gov/
ppip/adultflow.pdf and are also available on CD-ROM
and can be ordered on the Internet at www.atpm.org/
Immunization/whatworks.html.
Standard 11: All personnel who have contact with
patients are appropriately immunized. Healthcare professionals and other personnel (including first responders) who have contact with patients should be appropriately immunized (e.g., annual influenza vaccination,
hepatitis B vaccination). Institutions should have policies to review and maintain the appropriate vaccination
of staff and trainees.
ACIP recommendations for vaccinating healthcare
workers are available on the Internet at www.cdc.gov/
nip/publications/ACIP-list.htm.
Implement Strategies to Improve Vaccination
Rates
Standard 12: Systems are developed and used to remind patients and healthcare professionals when vaccinations are due and to recall patients who are overdue. Evidence shows that reminder/recall systems
improve adult vaccination rates. Systems may be designed to alert patients who are due (reminder) or
overdue (recall) for specific vaccine doses or they may
alert patients to contact their provider to determine if
vaccinations are needed. Reminders or recalls can be
148
mailed or communicated by telephone; an autodialer
can be used to expedite telephone reminders. Patients
who might be at high risk for not complying with
medical recommendations may require more intensive
follow-up.
Provider reminder/recall interventions inform those
who administer vaccinations that individual patients are
due or overdue for specific vaccinations. Reminders
can be delivered in patient charts, by computer, and/or
by mail or other means, and content of the reminders
can be specific or general. Information about these
strategies and resources to assist in their implementation are available on CD-ROM and can be ordered on
the Internet at www.atpm.org/Immunization/whatworks.html. Model reminder recall templates are also
available at www.ahcpr.gov/ppip/postcard.pdf.
Standard 13: Standing orders for vaccinations are employed. Evidence shows that standing orders improve
vaccination coverage among adults in a variety of
healthcare settings, including nursing homes, hospitals,
clinics, doctor’s offices, and other institutional settings.
Standing orders enable nonphysician personnel such as
nurses and pharmacists to prescribe or deliver vaccinations by approved protocol without direct physician
involvement at the time of the interaction. Standing
orders overcome administrative barriers such as lack
of physician personnel to order vaccines. Further,
the Centers for Medicare and Medicaid allow standing order exemption from Medicare rules (www.cms.
hhs.gov/medicaid/ltcsp/sc0302.pdf).
Information about this strategy and its implementation is available on CD-ROM and can be ordered on the
Internet at www.atpm.org/Immunization/whatworks.
html.
Standard 14: Regular assessments of vaccination coverage rates are conducted in a provider’s practice. Evidence shows that assessment of vaccination coverage
and provision of the results to the staff in a practice
improves vaccination coverage among adults. Optimally, such assessments are performed annually. Provider assessment can be performed by the staff in the
practice or by other organizations, including state and
local health departments. Effective interventions that
include assessment and provision of results may also
incorporate incentives or compare performance to a
goal or standard. This process is commonly referred to
as AFIX (assessment, feedback, incentives, and exchange of information). Coverage should be assessed
regularly so that reasons for low coverage in the practice, or in a subgroup of the patients served, can be
identified and interventions implemented to address
them.
Information about this strategy and its implementation is available on CD-ROM and can be ordered on the
Internet at www.atpm.org/Immunization/whatworks.
html. Software to assist in conducting coverage rate
American Journal of Preventive Medicine, Volume 25, Number 2
6. assessments and feedback is available at www.cdc.
gov/nip.
Partner with the Community
Standard 15: Patient-oriented and community-based
approaches are used to reach target populations. Vaccination services should be designed to meet the needs
of the population served. For example, interventions
that include community education, along with other
components such as extended hours, have been demonstrated to improve vaccination coverage among
adults. Vaccination providers can work with partners in
the community, including other health professionals
(e.g., pharmacists), vaccination advocacy groups, managed care organizations, service organizations, manufacturers, and state and local health departments to
determine community needs and develop vaccination
services to address them.
Conclusion
The revised Standards for Adult Immunization Practices provide a concise, convenient summary of the
most desirable immunization practices. The Standards
have been widely endorsed by major professional organizations. This revised version of the Standards for
Adult Immunization Practices is recommended for use
by all healthcare professionals and payers in the public
and private sectors who provide immunizations for
adults. Everyone involved in adult immunization
should strive to follow these Standards. Not all practices
and programs have the resources necessary to fully
implement the Standards; nevertheless, those lacking
the resources should find the Standards useful to guide
current practice and to guide the process of defining
immunization needs and obtaining additional resources in the future.
These Standards are approved by the National Vaccine Advisory Committee (NVAC), the National Coalition for Adult
Immunization (NCAI), the Advisory Committee on Immunization Practices (ACIP), and the U.S. Public Health Service,
and endorsed, as of December 1, 2001, by the American
Medical Association, Infectious Diseases Society of America,
American Academy of Family Physicians, American Academy
of Pediatrics, American College of Obstetricians and Gynecologists, Society of Adolescent Medicine, Health Resources
and Services Administration, National Medical Association,
National Association of County and City Health Officials,
Association of State and Territorial Health Officers, Council
of State and Territorial Epidemiologists, Association of Professionals in Infection Control and Epidemiology, Inc., Chiron, State of Washington Department of Health, Society of
Teachers of Preventive Medicine, Immunization Action Coalition, Partnership for Prevention, National Coalition for
Adult Immunization, American Academy of Otolaryngology
Head and Neck Surgery, American Health Care Association,
Hepatitis B Foundation, American College of Preventive
Medicine, American Pharmaceutical Association, American
Society for Health System Pharmacists, State of Maine Department of Health, National Alliance for Hispanic Health,
American Academy of Physician Assistants, National Association of School Nurses, Memphis County Health Department,
Maine Ambulatory Care Association, Institute for Advanced
Studies in Aging and Geriatric Medicine, The Arizona Partnership for Adult Immunization, National Foundation for
Infectious Diseases, and the National Partnership for
Immunization.
The NVAC was charted in 1988 to advise and make
recommendations to the director of the National Vaccine
Program and the assistant secretary for health, Department of
Health and Human Services, on matters related to the
prevention of infectious diseases through immunization and
the prevention of adverse reactions to vaccines. The NVAC is
composed of 15 members from public and private organizations representing vaccine manufacturers, physicians, parents, and state and local health agencies, and public health
organizations. In addition, representatives from government
agencies involved in health care of allied services serve as
ex-officio members of the NVAC.
Members of the National Vaccine Advisory Committee in
2001 are listed below.
Regular members: Georges Peter, MD (chair), Brown Medical
School, Providence RI; Bruce Gellin, MD, MPH, Executive
Secretary (Martin G. Myers, MD, former Executive Secretary),
National Vaccine Program Office, Atlanta GA; Jeffrey P.
Davis, MD, State Epidemiologist, Wisconsin Division of
Health, Madison WI; Michael D. Decker, MD, MPH, Vice
President, Scientific and Medical Affairs, Aventis Pasteur,
Swiftwater PA; Patricia Fast, MD, PhD, Director, Medical
Affairs, International AIDS Vaccine Initiative, New York City
NY; Mary desVignes-Kendrick, MD, Director, City of Houston
Department of Health and Human Services, Houston TX;
Amy Fine, Health Policy/Program Consultant, Washington
DC; Jerome O. Klein, MD, Professor of Pediatrics and Vice
Chairman for Academic Affairs, Boston University School of
Medicine, Boston MA; Yvonne A. Maldonado, MD, Associate
Professor, Department of Pediatrics, Stanford University
School of Medicine, Stanford CA; Stanley Plotkin, MD, Aventis Pasteur, Doylestown PA; Peter R. Paradiso, PhD, Vice
President, Scientific Affairs, Wyeth-Lederle Vaccines and Pediatric American Home Products, West Henrietta NY; Gregory A. Poland, MD, Chief, Mayo Vaccine Research Group,
Mayo Clinic and Foundation, Rochester MN; Marian Sokol,
PhD, Founding Executive Director, Any Baby Can, Inc., San
Antonio TX; Donald E. Williamson, MD, State Health Officer,
Alabama Department of Public Health, Montgomery AL; and
Patricia N. Whitley-Williams, MD, Associate Professor of Pediatrics, University of Medicine and Dentistry of New Jersey–
Robert Wood Johnson Medical School, New Brunswick NJ.
Liaison representatives: Steven Black, MD, American Association of Health Plans, Director, Vaccine Study Center, Kaiser
Permanente Study Center, Oakland CA; Jackie Noyes, Advisory Commission on Childhood Vaccines, Associate Director,
American Academy of Pediatrics, Washington DC; Robert
Daum, MD, The Food and Drug Administration’s Vaccines
and Related Biologic Products Advisory Committee, Professor
of Pediatrics, University of Chicago, Chicago IL; and John F.
Modlin, MD, Advisory Committee on Immunization Practices,
Am J Prev Med 2003;25(2)
149
7. Chairman, Department of Pediatrics and Professor of Pediatrics and Medicine, Dartmouth Medical School, Lebanon NH.
Ex-officio members: Karen Midthun, MD, Food and Drug
Administration, Director, Office of Vaccines Research and
Review, Center for Biologics Evaluation and Research, Rockville MD; Renata J.M. Engler, MD, Department of Defense,
Chief, Allergy/Immunology Department, Walter Reed Medical Center, Washington DC; Geoffrey Evans, MD, Health
Resources and Services Administration, Medical Director,
Division of Vaccine Injury Compensation, Rockville MD; Ruth
Frischer, PhD, Agency for International Development, Health
Science Specialist, Washington DC; Randolph T. Graydon,
MD, Centers for Medicaid and Medicare Services, Director,
Division of Advocacy and Special Issues, Center for Medicaid
and State Operations, Baltimore MD; Carole Heilman, PhD,
National Institutes of Health, Director, Division of Microbiology and Infectious Diseases, Bethesda MD; Walter A. Orenstein, MD, Centers for Disease Control and Prevention,
Director, National Immunization Program, Atlanta GA; William A. Robinson, MD, Health Resources and Services Administration, Chief Medical Officer, Rockville MD.
Members of the Ad Hoc Working Group for the Development of the Standards for Adult Immunization Practices, who
have authorship responsibility for this article, are listed below.
Executive and writing committee: Gregory A. Poland, MD;
Abigail M. Shefer, MD; Peggy S. Webster, MD; Mary McCauley, MTSC; Edward W. Brink, MD; Marc LaForce, MD; Dennis
J. O’Mara; James A. Singleton, MS; Raymond A. Strikas, MD;
Patricia N. Whitley-Williams, MD; Georges Peter, MD (EB,
MM, DM, AS, JS, and RS are from the National Immunization
Program, Centers for Disease Control and Prevention, Atlanta GA; ML is from Bill and Melinda Gates Foundation,
Seattle WA [formerly of BASICS II, Arlington VA]; GP is from
Mayo Clinic and Foundation, Rochester MN; PW is from
Abbott Laboratories, Abbott Park IL; PWW is from Robert
Wood Johnson Medical School, New Brunswick NJ; and GP is
from Brown Medical School, Providence RI.
Review committee: William J. Hall, MD, FACP, and William
Schaffner, MD, American College of Physicians–American
Society for Internal Medicine; Carol Baker, MD, and Mark
Leasure, MD, Infectious Diseases Society of America; Dennis
Smith, Jeffrey Kang, MD, MPH, Jacquie Harley, and Rachel
Block, Centers for Medicaid and Medicare Services; Geoffrey
Evans, MD, and Rita Goodman, MS, RNC, Health Resources
and Services Administration; Litjen Tan, PhD, American
Medical Association; Viking Hedberg, MD, and Trina M.
Anglin, MD, PhD, Society for Adolescent Medicine; Herbert
Young, MD, and Belinda K. Schoof, MD, American Academy
of Family Physicians; and Ralph Hale, MD, Stanley Gall, MD,
and W. Benson Harer, MD, American College of Obstetricians and Gynecologists.
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American Journal of Preventive Medicine, Volume 25, Number 2