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General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP)

General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP)

Guideline Title General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP). Bibliographic Source(s) National Center for Immunization and Respiratory Diseases. General recommendations on immunization. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Surveill Summ. 2011 Jan 28;60(2):1-64. [239 references] PubMed Guideline Status This is the current release of the guideline. This guideline updates a previous version: Kroger AT, Atkinson WL, Marcuse EK, Pickering LK, Advisory Committee on Immunization Practices (ACIP) Centers for Disease. General recommendations on immunization: recommendations of the Advisory Committee on Immunization Practices (ACIP) [published errata appear in MMWR Morb Mortal Wkly Rep 2007 Mar 23;56(11):256]. MMWR Recomm Rep 2006 Dec 1;55(RR-15):1-48. Centers for Disease Control and Prevention (CDC), Advisory Committee on Immunization Practices (ACIP). Update: recommendations from the Advisory Committee on Immunization Practices (ACIP) regarding administration of combination MMRV vaccine. MMWR Morb Mortal Wkly Rep 2008 Mar 14;57(10):258-60. The Advisory Committee on Immunization Practices (ACIP) General Recommendations Work Group (GRWG) revises the General Recommendations on Immunization every 3 to 5 years. Disease/Condition(s) Vaccine-preventable diseases, including the following: Diphtheria Haemophilus influenzae type b infection Hepatitis A and B Herpes zoster Human papillomavirus (HPV) infection Influenza Measles Meningococcal disease Mumps Pertussis Pneumococcal infection Polio Rotavirus infection Rubella Tetanus Tuberculosis Typhus Varicella (chickenpox) Yellow fever Guideline Category Prevention, Risk Assessment Clinical Specialty Family Practice, Infectious Diseases, Internal Medicine, Pediatrics, Preventive Medicine Intended Users Advanced Practice Nurses, Health Care Providers, Nurses, Physician Assistants, Physicians, Public Health Departments Guideline Objective(s) To provide updated recommendations to the 2006 statement by the Advisory Committee on Immunization Practices (ACIP) To help vaccination providers in the United States to...

Conference Highlights: RSNA 2010

RSNA 2010, the annual meeting of the Radiological Society of North America, was held from November 29 to December 3 in Chicago. The features below highlight just some of the studies that emerged from the meeting. » Assessing Breast Cancer Screenings With MRI » Delaying or Preventing Osteoarthritis in At-Risk Patients » Can Walking Slow Cognitive Decline? Assessing Breast Cancer Screenings With MRI The Particulars: Guidelines currently recommend annual screening with breast MRI in women with a known gene mutation or a strong family history that indicates a lifetime risk of breast cancer greater than 20%. However, there is insufficient evidence to recommend for or against MRI screening in women who have already had breast cancer. Data Breakdown: A retrospective review of initial screening breast MRI examinations of 1,026 women was conducted in a 5-year study. Of these 1,026 women, 327 had a genetic or family history of breast cancer, and 646 had a personal history of treated breast cancer. MRI testing identified 25 of 27 cancers in the group, amounting to a sensitivity rate of 92.6%. The cancer yield in women with a personal history of breast cancer (3.1%) was double that of women with a genetic or family history (1.5%). Take Home Pearl: Women with a personal history of breast cancer should consider annual screening with MRI in addition to mammography. Additional studies are necessary to establish guidelines for screening these women. Delaying or Preventing Osteoarthritis in At-Risk Patients [back to top] The Particulars: Osteoarthritis is one of the most common forms of arthritis and affects an estimated 27 million Americans over the age of 25. Known risk factors for cartilage degeneration...

Empowering Patients to Reduce Their CVD Risk

According to the American Heart Association (AHA), nearly 80 million adults have at least one type of cardiovascular disease (CVD), and it is the most deadly disease in the United States. Studies indicate that if CVD were completely eradicated, life expectancy could increase by nearly 7 years. In the July 27, 2010 issue of Circulation, the AHA released a scientific statement on individual-level interventions that are designed to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults. “Individual-level interventions that target dietary patterns, weight reduction, and new physical activity habits often result in impressive rates of initial behavior changes,” says Dariush Mozaffarian, MD, DrPH, who co-chaired the panel that developed the scientific statement. “Unfortunately, many of these behavioral changes are often not maintained for the long term.” The purpose of the scientific statement is to provide evidence-based recommendations on individual-level strategies—for example, in the healthcare setting—for implementing physical activity and dietary interventions in all adults, regardless of racial or ethnic background and socioeconomic demographic. The most efficacious and effective strategies were summarized (Table), and guidelines were provided to translate these strategies into practice. The AHA committee reviewed 74 studies conducted among U.S. adults between 1997 and 2007. The studies measured the effects of behavioral change on blood pressure and cholesterol levels, physical activity and aerobic fitness, and diet. “There has been an explosion of data emerging on behavioral research and science over the past decade,” Dr. Mozaffarian notes, “and the time was right to systematically review the evidence base for behavioral strategies to improve physical activity and diet to reduce the burden of CVD.” Cognitive...
Hospital-Based Physicians Could See 2.3% Pay Hike in 2011

Hospital-Based Physicians Could See 2.3% Pay Hike in 2011

Hospital-based physicians are predicted to receive a 2.3% increase in base salary in 2011, according to a new healthcare salary survey by the Hay Group management consulting firm. This increase is just under the 2.7% raise forecasted for nurses this year. All healthcare employees are projected to receive a 2.6% increase, up from 2.3% in 2010. The survey was conducted in November 2010 and covers 90 hospitals and health systems in the United States. The Federal Open Market Committee of the Federal Reserve estimated in November that inflation in 2011 would fall between 1% and 2%, so a 2.6% increase would keep healthcare employees ahead of the inflation rate. Base salaries across all industries are expected to rise by 2.8% in 2011. That said, almost 20% of employers indicated on the Hay Group survey that they would freeze salaries at every level. Only 4% plan to institute a freeze in the healthcare...

Antipsychotic Use in Children

In recent months, the use of antipsychotic medications in children and adolescents has been debated largely because these agents are increasingly being used in youth for non-psychotic disorders and off-label indications. In addition, there has been disagreement about the validity of certain childhood diagnoses. For example, bipolar disorder data suggest that there may be a lack of psychosocial interventions for disruptive and aggressive spectrum disorders, even if antipsychotic treatment is prescribed. Furthermore, there has been concern surrounding the adverse effects related to antipsychotic use. These effects may be more severe and have long-term health implications when they occur during early human development. “A careful risk-benefit evaluation is necessary before deciding to initiate and to maintain antipsychotic treatment in younger patients.” Even though the debate over use of antipsychotic medications in younger patients continues, there has been an increase in the available controlled efficacy database for antipsychotics for schizophrenia, bipolar mania, and autistic disorder. In turn, this has led to FDA approval of four of the most prescribed atypical antipsychotics in youth. Aripiprazole, olanzapine, quetiapine, and risperidone have FDA-approved pediatric indications for bipolar mania and for schizophrenia. Aripiprazole and risperidone are also indicated for irritability and aggression associated with autistic disorder, and we now have controlled trial data for disruptive behavior disorders (mostly with risperidone) and tic disorders. Assessing Tolerability Studies comparing antipsychotic adverse effect rates in children and adolescents with those in similar adult studies have indicated that younger patients were at higher risk for a number of antipsychotic-induced side effects, including sedation, extrapyramidal side effects, withdrawal dyskinesia, prolactin elevation, weight gain, and some metabolic abnormalities. There is a concern that...

Good Nutrition Critical to Chemotherapy

Great strides have been made in treating cancer to achieve a 5-year survival rate of 68%. Targeted therapies and advances in genetics are enabling more personalized patient care for several cancer types. Treating cancer patients goes beyond the cancer itself; clinicians need to treat the whole patient. Nutrition is an often overlooked element of care. Weight loss has been shown to be a poor prognostic sign in cancer. Malnutrition can impair the response to treatment, quality of life, and the immune system. Patients need recommendations that extend beyond the broad strokes of adding calories, drinking more, and picking up nutritional supplements. Specific food restrictions or recommendations can depend on chemotherapy treatment, disease, and symptoms. A personalized approach to nutritional care must include a medication review, an assessment for nutritional risk, weight loss, food intake, symptoms, and comorbidities. It has been estimated that 80% of cancer patients never receive an evaluation from a registered dietitian (RD). Meeting Patient Needs Medical, surgical, and radiation oncologists likely realize the need to address nutrition. However, practitioners are increasingly overloaded and time demands hamper achievement of this objective. New solutions for the patient are needed. Pharmacists who are specially trained in drug toxicity, drug interactions, and counseling can help meet many patient needs. Several academic centers have integrated clinical pharmacist practitioners into outpatient oncology clinics. Specialist pharmacists in Medco’s Oncology Therapeutic Resource Center integrate food restrictions or recommendations within the counseling they routinely provide by phone to a population of about 900,000 people. This is particularly important for those taking oral cancer medications because intake influences absorption and bioavailability, thus circulating drug levels. “…80%...

An RA Update

In the June 15, 2008 issue of Arthritis Care & Research, the American College of Rheumatology (ACR) published updated guidelines on the use of nonbiologic disease-modifying anti-rheumatic drugs (DMARDs) for the treatment of rheumatoid arthritis (RA). The guidelines also provide recommendations for the use of biologic agents for the first time. The ACR recommendations are the culmination of a systematic review of evidence that updates guidelines that were previously released in 2002. They were developed for specialists who are familiar with assessing RA activity and disease severity. Assessing DMARD Therapies  The ACR recommendations provide evidence-based suggestions for when to initiate biologic and nonbiologic DMARDs. Recommendations should be based on the level of disease activity, duration of RA, and factors that pertain to prognosis. Nonbiologic DMARD combinations recommended in the guidelines and used most commonly include methotrexate plus hydroxycholoroquine, methotrexate plus sulfasalazine, methotrexate plus leflunomide, sulfasalazine plus hydroxychloroquine, and sulfasalazine plus hydroxychloroquine followed by methotrexate. Monotherapy with either methotrexate or leflunomide, however, is recommended as initial therapy for most patients with RA for all disease durations and degrees of disease activity. Biologic therapies have assumed a significant role in the treatment of RA, particularly for patients with severe RA and high disease activity after failure of nonbiologic DMARDs. The updated guidelines recommend appropriate times to consider biologics and provide safety considerations that should be recognized when using these therapies. Biologic DMARDs are separated according to disease duration (less than 6 months and 6 months or longer). Patients with early RA and only low or moderate disease activity are not considered candidates for biologic therapy....

Conference Highlights: CHEST 2010

The CHEST 2010 annual meeting offers clinical instruction in pulmonary, critical care, and sleep medicine. These features include research presented on diabetes drugs fighting lung cancer progression, how diet impacts COPD, and the role of electronic media in daytime function and sleep disorders. » Diabetes Drugs May Fight Lung Cancer Progression » Diet Impacts Lung Function in COPD » Electronic Media, Daytime Function, & Mood in Teens Diabetes Drugs May Fight Lung Cancer Progression The Particulars: Previous research has suggested an association between metformin and/or thiazolidinedione (TZD) use and the risk of developing lung cancer. A study was conducted to determine the influence of metformin and TZDs on lung cancer presentation and course. Data Breakdown: Researchers reviewed the medical records of 157 patients with diabetes who had a history of lung cancer. Patients who were exposed to either metformin or TZDs were significantly less likely to have metastatic disease (20.0% vs 42.4%) or a small cell or squamous cell carcinoma. They also demonstrated improved survival (hazard ratio, 0.56). There were no significant differences between the age, sex, and smoking histories of the group exposed to metformin or TZDs prior to their lung cancer diagnosis. Take Home Pearl: Use of metformin and/or TZDs appears to lower risks of advanced lung cancer. These medications also correlated with an improved survival rate among patients with diabetes who developed concomitant lung cancer. Diet Impacts Lung Function in COPD [back to top] The Particulars: The role antioxidants play in lung function in patients with COPD is unclear. A study was conducted to assess the role of antioxidants with regard to lung function in men and women with COPD. Data...

Making the Case for Statins

According to national guidelines, patients with ischemic stroke or transient ischemic attack (TIA) should be put on lipid-lowering therapies such as statins during hospitalization. They should continue this treatment even after they are discharged, along with plans for proper diet and exercise. This is a top tier recommendation because studies have shown that lipid-lowering medications and statins, in particular, can dramatically lower the rates of subsequent heart attacks, strokes, and the need for procedures to reopen clogged arteries. Statin Usage Following Acute Stroke Cholesterol-lowering targets have been established by recommendations from the National Cholesterol Education Project Adult Treatment Panel III for patients with documented coronary heart disease and those that have had an ischemic stroke or TIA. For patients who have no other manifestations of atherosclerosis (other than cerebrovascular disease), the latest American Heart Association (AHA)/American Stroke Association (ASA) guidelines recommend intensive lipid-lowering therapy. “We know from prior experience that medications started at the time of discharge are much more likely to be continued by patients in the year after the event,” explains Lee H. Schwamm, MD. “Starting lipid-lowering medications, especially statins, at discharge in appropriately selected patients hospitalized for ischemic stroke or TIA makes good sense and should be considered good clinical practice. “Starting lipid-lowering medications, especially statins, at discharge in appropriately selected patients hospitalized for ischemic stroke or TIA makes good sense and should be considered good clinical practice.” Cholesterol-lowering targets have been established by recommendations from the National Cholesterol Education Project Adult Treatment Panel III for patients with documented coronary heart disease and those that have had an ischemic stroke or TIA. For patients who have...
Infamous Study Linking Autism to Vaccines Called a “Fraud”

Infamous Study Linking Autism to Vaccines Called a “Fraud”

The study that triggered worldwide controversy over childhood vaccinations linked to autism was found to be based on widely discredited research, according to a new report published in the British Medical Journal — the first scientific publication to name the scandal as scientific fraud. A paper published in 1998 by Andrew Wakefield, which linked the childhood MMR vaccine to autism, reverberates to this day – even though the study was renounced by 10 of 13 authors and eventually retracted by the Lancet, the journal that published the study. In the 1998 paper, Wakefield claimed that parents of two-thirds of the 12 children in the study blamed MMR for the sudden onset of inflammatory bowel disease and autism. Current research into the medical records of these children found that allthe child cases in Wakefield’s study were misrepresented, some more so than others. Some children Wakefield claimed to have autism turned out to be healthy, while others who he claimed got sick after they were vaccinated appear to have already been sick before the vaccinations. Additionally, although Wakefield appeared to be an independent researcher, reporter Brian Deer uncovered that Wakefield was payrolled to create evidence against the shot. Further research found that Wakefield also had filed a patent on products such as his own “safer” single measles...
Could New Blood Test Detect Cancer?

Could New Blood Test Detect Cancer?

A blood test that could revolutionize the way doctors detect and treat cancer is one step closer to becoming available. Johnson & Johnson has teamed up with Massachusetts General Hospital to develop and market a blood test that can detect a single cancer cell among a billion healthy cells in a person’s blood. While it might take at least 5 years before the test is widely available, it is a step closer to personalized medicine. Some cancer cells can break away from the origin and travel throughout the peripheral blood. This test uses a microchip resembling a lab slide, which is  covered in 78,000 tiny posts coated with antibodies that bind to tumor cells. Only cancer cells will “stick” to these posts. Studies of the chip have been published in the journals Nature, the New England Journal of Medicine and Science Translational Medicine. The earlier cancer is detected, the more hope there is for a cure. Many cancers are undetectable until they reach a late stage, while others, such as breast cancer, require screening and radiation exposure. Typically, many cancers are diagnosed through needle biopsies. These may not always provide enough of a sample to determine what genes or pathways control a tumor’s growth. Some patients only live long enough to try one or two treatments, so a test that identifies cancer cells in the blood and can gauge success sooner or dictate treatment could give patients more options. Initially the test would be used for those who had cancer in the past or are in the process of being treated, and it would complement existing tests like x-rays, CT scans, and...
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