Saturday, June 13, 2015

Proton Pump Inhibitors May Increase Heart Attack Risk


The New York Times (6/11, Bakalar) “Well” blog reports that research published in PLOS One suggests that “proton pump inhibitors...may increase the risk for heart attack.”
        The Washington Post (6/11, Bernstein) “To Your Health” blog reports that “after combing through 16 million electronic records of 2.9 million patients in two separate databases,” investigators “found that people who take the medication to suppress the release of stomach acid are 16 percent to 21 percent more likely to” experience a heart attack. Nicholas J. Leeper, an author of the study, “said the Food and Drug Administration ‘should be aware of these findings,’ but agreed that only a large, prospective clinical study...could establish whether the drugs are actually causing more heart attacks.”
        On its website, CBS News (6/11, Seidman) reports, however, that “analysis of patients using another type of antacid drugs called H2 blockers...did not show this increased risk.” The study received funding from The National Institutes of Health.
        Medscape (6/11, Pullen) reports that in an email to Medscape Medical News, Joel Rubenstein, MD, chair of the American Gastroenterological Association Institute Clinical Practice Section, wrote, “I would advise against making any changes in the management of patients based on this study. The results are intriguing and deserve further study. But the signal of an association is a weak one, and could easily be due to confounding by other factors, such as obesity, or due to initial misdiagnosis of angina as [gastroesophageal reflux disease].”

CDC To Issue Warning To US Physicians About MERS


David Muir reported on ABC World News (6/10, story 8, 1:05, Muir) that the CDC will issue a warning as early as tomorrow about “the deadly MERS virus.” The CDC is “sounding the alarm for American doctors now,” as more than 1,200 people have been infected around the world and the death toll is “approaching 500.” Richard Besser, MD, added that “the big concern is that the person who brought it into South Korea and spread it around hospitals might be something called a ‘super spreader’ – someone who can spread it to people easier than others.”
        The New York Times (6/11, Choe, Subscription Publication) reports, “With at least nine deaths, 122 confirmed cases and more than 3,400 who may have been exposed,” South Korea is now “experiencing an outbreak of MERS second in size only to that in Saudi Arabia, where it originated in 2012.” Yesterday, experts with the World Health Organization visiting that country “recommended that ‘all patients’ with fevers or respiratory symptoms be questioned about possible exposure to MERS.” The article also discusses the quarantine in place until June 18 in the village of Jangdeok where a case of MERS was reported. While villagers rail against the strict measures of the quarantine, people elsewhere in South Korea are voicing anger at the government for not doing more to contain the MERS outbreak.
        The Wall Street Journal (6/11, Kwaak, Gale, Subscription Publication) reports that fatality rates from MERS are significantly lower in South Korea than they have been in the Middle East. This week, the WHO disclosed that researchers around the globe are investigating if the MERS virus there has mutated.
        Meanwhile, the AP (6/11, Kim) reports that yesterday, “experts from the World Health Organization and South Korea...urged the reopening of more than 2,700 schools closed over fears” of the virus.
        In an opinion piece for CNN (6/10, Vox), physician journalist Ford Vox, MD points out that the US could learn some lessons from the outbreak of MERS in South Korea. Dr. Vox draws parallels to last year’s Ebola outbreak in Dallas, TX, in which poor communication and panic figured prominently. Currently, “South Korea is dealing with familiar problems of panic and insufficient guidance, but it is also putting into place some innovative new measures surrounding quarantine that our public health officials should consider,” such as “monitoring cell phone signals for those under quarantine and...using monitors who frequently call and check on those under quarantine.”
        The NPR (6/10, Hu) “Goats and Soda” blog and “All Things Considered” program focus on smartphone monitoring of people under quarantine orders. Focusing on the economic effects of the MERS outbreak in South Korea are the AP (6/11, Lee), Bloomberg News (6/11, Gale), and Reuters (6/11, Park, Kim).

Wednesday, May 27, 2015

PULMONARY MEDICINE POWERPOINT 3 (TUBERCULOSIS)

1)Self-Study Modules


Module 1: Transmission and Pathogenesis of TB (text only version)
Download complete Power Point Presentation   (2M)
Download Participant Guide   (832K)
·         Introduction (5 slides)
·         History of TB (10 slides)
·         TB Transmission (9 slides)
·         Drug-Resistant TB (6 slides)
·         TB Pathogenesis (16 slides)
·         Progression from LTBI to TB Disease (9 slides)
·         Sites of TB Disease (4 slides)
·         TB Classification System (4 slides)
·         Case Studies (5 slides)

·         Introduction (3 slides)
·         Epidemiology of TB (16 slides)
·         TB Case Rate (6 slides)
·         Case Studies (3 slides)

Module 3: Targeted Testing and the Diagnosis of Latent TB Infection and TB Disease (text only version)
Download complete Power Point Presentation   (2M)
Download Participant Guide   (430K)
·         Introduction (3 slides)
·         Targeted Testing (8 slides)
·         Diagnosis of LTBI (60 slides)
·         Diagnosis of TB Disease (50 slides)
·         Reporting TB Cases (5 slides)
·         Case Studies (16 slides)

Module 4: Treatment of Latent TB Infection and TB Disease (text only version)
Download complete Power Point Presentation   (1.8M)
Download Participant Guide   (358K)
·         Introduction (4 slides)
·         Treatment of LTBI (59 slides)
·         Treatment of TB Disease (73 slides)
·         Case Studies (17 slides)

Module 5: Infectiousness and Infection Control (text only version)
Download complete Power Point Presentation   (1.3M)
Download Participant Guide   (380K)
·         Introduction (3 slides)
·         Infectiousness (9 slides)
·         TB Infection Control (18 slides)
·         Administrative Controls (5 slides)
·         Environmental Controls (10 slides)
·         Respiratory-Protection Controls (15 slides)
·         TB Risk Assessment (5 slides)
·         TB Infection Control in the Home (9 slides)
·         Case Studies (12 slides)

2)Core Curriculum on Tuberculosis: What the Clinician Should Know

Table of Contents



3)Prevention and Control of Tuberculosis in Correctional and Detention Facilities

Table of Contents

·         Introduction (3 slides)
·         Background (10 slides)
·         Screening (42 slides)
·         Case Reporting (3 slides)
·         Airborne Infection Isolation (4 slides)
·         Environmental Controls (5 slides)
·         Respiratory Protection (8 slides)
·         Discharge Planning (12 slides)
·         Contact Investigation (22 slides)
·         Program Evaluation (13 slides)
·         Collaboration and Responsibilities (4 slides)
·         References and Additional Resources (3 slides

4)Guidelines for Preventing the Transmission of M. tuberculosisin Health-Care Settings



·         Introduction 
(7 slides)
·         Transmission and Pathogenesis 
(14 slides)
·         Fundamentals of Infection Control 
(7 slides)
·         Recommendations for Preventing M. tuberculosis Transmission in Health-Care Settings (30 slides)
·         Infection Control Program (5 slides)
·         TB Risk Assessment (17 slides)
·         TB Testing Frequency (3 slides)
·         Evaluation (4 slides)
·         Training and Education (1 slide)
·         Managing TB Patients: General Recommendations (51 slides)
·         Diagnosis (2 slides)
·         AII Precautions for Specific Settings (16 slides)
·         Training and Education (1 slide)
·         Infection Control Surveillance (1 slide)
·         Evaluation (3 slides)
·         Collaborate with Health Departments (1 slide)
·         Environmental Controls (7 slides)
·         Respiratory Protection (12 slides)
·         Estimating Infectiousness of Patients (5 slides)
·         Treatment Procedures for LTBI and TB Disease(8 slides)

5)Investigation of Contacts of Persons with Infectious Tuberculosis

·         Introduction(8 slides)
·         Decisions to Initiate a Contact Investigation (10 slides)
·         Assigning Priorities to Contacts (7 slides)
·         Diagnostic and Public Health Evaluation of Contacts (12 slides)
·         Medical Treatment for Contacts with LTBI (6 slides)
·         When to Expand a Contact Investigation (3 slides)
·         Communicating Through the News Media (6 slides)
·         Staff Training for Contact Investigations (2 slides)
·         Contact Investigations in Special Circumstances(13 Slides)
·         Source-Case Investigations(6 slides)

    source:  http://www.cdc.gov

 

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