Archive for February 3, 2014

Advisory Committee on Immunization Practices Recommended Immunization Schedule for Adults Aged 19 Years or Older — United States, 2014

MMWR Early Release  February 3, 2014  V.63 N.1 P.1–4

Carolyn B. Bridges, MD1, Tamera Coyne-Beasley, MD2, Advisory Committee on Immunization Practices (ACIP)*, ACIP Adult Immunization Work Group (Author affiliations at end of text)

Vaccines are recommended for adults on the basis of their age, prior vaccinations, health conditions, lifestyle, occupation, and travel. Reasons for current low levels of vaccination coverage for adult vaccines are multifactorial and include limited awareness among the public about vaccines for adults and gaps in incorporation of regular assessments of vaccine needs and vaccination into routine medical care (1–4).

Updated standards for immunization of adults were approved by the National Vaccine Advisory Committee (NVAC) in September 2013 (5). These standards acknowledge the current low levels of vaccination coverage among adults and the role that all health-care providers, including those who do not offer all recommended adult vaccines in their practices, have in ensuring that their patients are up-to-date on recommended vaccines.

NVAC recommends that providers assess vaccination needs for their patients at each visit, recommend needed vaccines, and then, ideally, offer the vaccine or, if the provider does not stock the needed vaccines, refer the patient to a provider who does vaccinate. Vaccinating providers should also ensure that patients and their referring health-care providers have documentation of the vaccination….

PDF

http://www.cdc.gov/mmwr/pdf/wk/mm63e0203a2.pdf

February 3, 2014 at 8:08 pm

Advisory Committee on Immunization Practices Recommended Immunization Schedules for Persons Aged 0 Through 18 Years — United States, 2014

MMWR Early Release  February 3, 2014 V.63 N.1 P.1-2

Iyabode Akinsanya-Beysolow, MD

Each year, the Advisory Committee on Immunization Practices (ACIP) reviews the recommended immunization schedules for persons aged 0 through 18 years to ensure that the schedules reflect current recommendations for Food and Drug Administration–licensed vaccines.

In October 2013, ACIP approved the recommended immunization schedules for persons aged 0 through 18 years for 2014, which include several changes from the 2013 immunization schedules….

PDF

http://www.cdc.gov/mmwr/pdf/wk/mm63e0203a1.pdf

February 3, 2014 at 8:06 pm

The Alvarado score for predicting acute appendicitis: a systematic review.

BMC Med 2011.:139.

Ohle R, O’Reilly F, O’Brien KK, et al.

HRB Centre for Primary Care Research, Division of Population Health Sciences, Royal College of Surgeons in Ireland, 123 St. Stephen’s Green, Dublin 2, Ireland.

BACKGROUND

The Alvarado score can be used to stratify patients with symptoms of suspected appendicitis; the validity of the score in certain patient groups and at different cut points is still unclear. The aim of this study was to assess the discrimination (diagnostic accuracy) and calibration performance of the Alvarado score.

METHODS

A systematic search of validation studies in Medline, Embase, DARE and The Cochrane library was performed up to April 2011. We assessed the diagnostic accuracy of the score at the two cut-off points: score of 5 (1 to 4 vs. 5 to 10) and score of 7 (1 to 6 vs. 7 to 10). Calibration was analysed across low (1 to 4), intermediate (5 to 6) and high (7 to 10) risk strata. The analysis focused on three sub-groups: men, women and children.

RESULTS

Forty-two studies were included in the review. In terms of diagnostic accuracy, the cut-point of 5 was good at ‘ruling out’ admission for appendicitis (sensitivity 99% overall, 96% men, 99% woman, 99% children). At the cut-point of 7, recommended for ‘ruling in’ appendicitis and progression to surgery, the score performed poorly in each subgroup (specificity overall 81%, men 57%, woman 73%, children 76%). The Alvarado score is well calibrated in men across all risk strata (low RR 1.06, 95% CI 0.87 to 1.28; intermediate 1.09, 0.86 to 1.37 and high 1.02, 0.97 to 1.08). The score over-predicts the probability of appendicitis in children in the intermediate and high risk groups and in women across all risk strata.

CONCLUSIONS

The Alvarado score is a useful diagnostic ‘rule out’ score at a cut point of 5 for all patient groups. The score is well calibrated in men, inconsistent in children and over-predicts the probability of appendicitis in women across all strata of risk.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3299622/pdf/1741-7015-9-139.pdf

February 3, 2014 at 2:04 pm

Clinical practice. Suspected appendicitis.

N Engl J Med 2003 Jan 16; 348(3) :236-42.

Paulson EK, Kalady MF, Pappas TN

Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA. pauls003@mc.duke.edu

An otherwise healthy 22-year-old woman comes to the emergency department with acute abdominal pain of 18 hours’ duration in the right lower quadrant.

On physical examination, she is afebrile, with tenderness on deep palpation in the right lower quadrant, and has no peritoneal signs. Pelvic examination reveals tenderness in the right adnexa without a mass.

How should this patient be further evaluated?

PDF

http://www.nejm.org/doi/pdf/10.1056/NEJMcp013351

February 3, 2014 at 2:02 pm

Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America.

Clin Infect Dis 2010 Jan 15; 50(2) :133-64.

Solomkin JS, Mazuski JE, Bradley JS, et al.

Department of Surgery, the University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0558, USA. joseph.solomkin@uc.edu

Evidence-based guidelines for managing patients with intra-abdominal infection were prepared by an Expert Panel of the Surgical Infection Society and the Infectious Diseases Society of America.

These updated guidelines replace those previously published in 2002 and 2003.

The guidelines are intended for treating patients who either have these infections or may be at risk for them. New information, based on publications from the period 2003-2008, is incorporated into this guideline document.

The panel has also added recommendations for managing intra-abdominal infection in children, particularly where such management differs from that of adults; for appendicitis in patients of all ages; and for necrotizing enterocolitis in neonates.

PDF

http://cid.oxfordjournals.org/content/50/2/133.full.pdf+html

UPDATED

Clin Infect Dis 2010; 50(2):133–164

Solomkin et al

In the 15 January 2010 issue of the journal, in the article by Solomkin et al (Solomkin JS, Mazuski JE, Bradley JS, et al.  Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America.Clin Infect Dis 2010;50(2):133–164), there were 2 errors:

First, recommendation 38 should read as follows: “The empiric use of antimicrobial regimens with broad-spectrumactivity against gram-negative organisms, including meropenem, imipenem-cilastatin, doripenem, or piperacillin-tazobactam alone; or ciprofloxacin, levofloxacin, or ceftazidime or cefepime, each in combination with metronidazole, is recommended for patients with high-severity community-acquired intra-abdominal infection, as defined by APACHE II scores >15 or other variables listed in Table 1 (Table 2)” [not “The empiric use of antimicrobial regimens with broadspectrum activity against gram-negative organisms, including meropenem, imipenem-cilastatin, doripenem, piperacillin-tazobactam, ciprofloxacin or levofloxacin in combination with metronidazole, or ceftazidime or cefepime in combination with metronidazole, is recommended for patients with high-severity community- acquired intra-abdominal infection, as defined by APACHE II scores >15 or other variables listed in Table 1”].

Second, in table 5, the frequency of dosing for gentamicin should be “every 24 hours” [not “every 2–4 hours”].

The authors regret these errors.

PDF

http://cid.oxfordjournals.org/content/50/12/1695.full.pdf+html

February 3, 2014 at 2:00 pm

Hyponatremia is a specific marker of perforation in sigmoid diverticulitis or appendicitis in patients older than 50 years.

Gastroenterol Res Pract. 2013;2013:462891.

Käser SA, Furler R, Evequoz DC, Maurer CA.

Source

Department of General, Visceral, Vascular, and Thoracic Surgery, Hospital of Liestal of The University of Basel, Rheinstrasse 26, 4410 Liestal, Switzerland.

Abstract

Introduction.

This study aimed to evaluate symptoms and signs, inflammation markers, electrolytes, and ECG signs of increased vagal tone as markers of colon perforation in sigmoid diverticulitis or appendicitis.

Methods.

The records of all patients older than fifty years (only these had routine ECG done) admitted to our emergency station between January 2008 and December 2010 with sigmoid diverticulitis (n = 198, diagnosed by computer tomography) or appendicitis (n = 84, diagnosed intraoperatively) were retrospectively evaluated. Pain score, heart rate, blood pressure, and body temperature were assessed at presentation. Before starting infusion therapy, blood was taken to do a blood count and to analyze CRP, the electrolytes, and creatinine levels. Then an ECG was done.

Results

The perforation rate was 37% (n = 103). Body temperature, heart rate, sodium, CRP, and leukocytes correlated significantly with infectious colon perforation. However, only body temperature, CRP, and sodium correlated significantly with infectious colon perforation if compared by logistic regression analysis. The prevalence of hyponatremia (sodium level <136 mmol/L) was 29% in the group with infectious colon perforation and 16% in the group without (P = 0.013).

Conclusion.

Hyponatremia is a specific marker of infectious colon perforation in patients older than fifty years.

PDF

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3586515/pdf/GRP2013-462891.pdf

February 3, 2014 at 1:56 pm


Calendar

February 2014
M T W T F S S
 12
3456789
10111213141516
17181920212223
2425262728  

Posts by Month

Posts by Category