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This revision of the "General Recommendations on Immunization" updates the 1980 statement. Changes from that statement clarify information on possible interference with the immune response by spacing immunobiologic agents. Recommendations for vaccinating persons with allergies are revised. New sections dealing with many aspects of immunization procedures have been added.
These recommendations include information on two vaccines recently licensed for use among infants: Haemophilus b Conjugate Vaccine (PRP-T [ActHIB, OmniHIB]), manufactured by Pasteur Mérieux Vaccins, and TETRAMUNE, manufactured by Lederle Laboratories/Praxis Biologics. This statement also updates recommendations for use of other available Haemophilus b vaccines (PRP-D [ProHIBiT]; HbOC [HibTITER]; and PRP-OMP [PedvaxHIB]) for infants and children.
Nutritional recommendations for diabetics are nowadays more flexible and better adapted to the individual patient. They resemble those offered to the public at large. Caloric intake is determined by body size and weight as well as physical activity. Approximately 60% of the energy should be consumed in the form of carbohydrates and monounsaturated fatty acids. The proportion of fatty acids and carbohydrates is fixed according to the individual nutritional habits. The intake of saturated and polyunsaturated fatty acids should be restricted. Meals and carbohydrates should be distributed over the day as three main meals with two to three snacks in between. Recommendations should always be adapted to the practical possibilities of the individual and to his particular metabolic situation.
For the treatment of sicca symptoms as a manifestation of Sjögren's syndrome there are various tear substitutes as well as artificial saliva. The appropriate substances are discussed in this article. In addition to reducing symptoms, some of the effective compounds offer the advantage of infection prophylaxis in the form of better lubrication of the mucous membranes in the airways as well as reduced susceptibility to candidiasis. The presence of bromhexin in the catalogue of the statutory medical insurance agencies is recommended. Certain of the available drugs are still only available in foreign pharmacies.
More than 40000 hematopoietic cell transplants (HCTs) are performed worldwide each year. With improvements in transplant technology, larger numbers of transplant recipients survive free of the disease for which they were transplanted. However, there are late complications that can cause substantial morbidity. Many survivors are no longer under the care of transplant centers, and many community health care providers may be unfamiliar with health matters relevant to HCT. The Center for International Blood and Marrow Transplant Research (CIBMTR), European Group for Blood and Marrow Transplantation (EBMT), and American Society for Bone Marrow Transplantation (ASBMT) have developed these recommendations to offer care providers suggested screening and prevention practices for autologous and allogeneic HCT survivors.
Yersinia pestis, the etiologic agent of plague, is endemic in the western United States; 105 cases were reported between 1970 and 1979. Plague may manifest in one of three clinical forms; bubonic, septicemic, or pneumonic. Bubonic and septicemic plague represent relatively little risk for human-to-human transmission to contacts, although heavily infected secretions, such as drainage from a bubo, pose a theoretical risk, especially if they are aerosolized from a syringe during diagnohree clinical forms; bubonic, septicemic, or penumonic. Bubonic and septicemic plague represent relatively little risk for human-to-human transmission to contacts, although heavily infected secretions, such as drainage from a bubo, pose a theoretical risk, especially if they are aerosolized from a syringe during diagnohree clinical forms; bubonic, septicemic, or penumonic. Bubonic and septicemic plague represent relatively little risk for human-to-human transmission to contacts, although heavily infected secretions, such as drainage from a bubo, pose a theoretical risk, especially if they are aerosolized from a syringe during diagnostic aspirations. Pneumonic plague may be highly contagious to contacts and poses a greater risk. The Plague Branch, Center for Disease Control recommends that all patients with plague be placed in strict isolation for the first 48 hours of treatment because of the possibility that pneumonia may supervene. If it does not, wound and skin precautions are adequate for the duration of hospitalization. Untreated plague pneumonia is an epidemiologic emergency. All contacts must be identified promptly and those with face-to-face exposure should receive abortive antibiotic therapy. All contacts should be under surveillance, with twice-daily temperature checks, for seven days.
More than 40,000 hematopoietic cell transplants (HCTs) are performed worldwide each year. With improvements in transplant technology, larger numbers of transplant recipients survive free of the disease for which they were transplanted. However, there are late complications that can cause substantial morbidity. Many survivors are no longer under the care of transplant centers and many community health-care providers may be unfamiliar with health matters relevant to HCT. The Center for International Blood and Marrow Transplant Research (CIBMTR), European Group for Blood and Marrow Transplantation (EBMT), and American Society for Blood and Marrow Transplantation (ASBMT) have developed these recommendations to offer care providers suggested screening and prevention practices for autologous and allogeneic HCT survivors.
OBJECTIVE: The aim of this study is to evaluate, in women with grade 1 essential hypertension, the response of cardio-respiratory and blood pressure (BP) after 6 weeks of supervised physical exercise (PE) vs only recommended exercise. METHODS: Eighteen consecutive hypertensive women whose BP control was stable were assigned randomly into two exercise groups. Group A including nine patients in an aerobic PE programme supervised by a physiotherapist, aged (mean +/- SD) 35.5 +/- 5.5 years old. Group B, nine patients aged 37.7 +/- 7.2 years old, received only oral and written instructions about the benefits of aerobic PE for controlling BP. We used a treadmill for walking to observe the cardio-respiratory and BP response at the beginning and at the end of the period of exercise training, and the response in all the patients, and to test whether there were any differences between the two groups. RESULTS: There were significant differences in cardio-respiratory parameters in group A, in basal VO2/kg post- vs pre-rehabilitation 27.6 +/- 5.1 vs 23.1 +/- 4.6, change 4.4 +/- 2; O2 pulse 10.9 +/- 0.9 vs 10.4 +/- 1.6, varied 0.5 +/- 0.1; furthermore we observed heart rate 73.3 +/- 12.37 vs 86.6 +/- 12.8, change -13.4 +/- 12.1 and metabolic equivalents of oxygen 9 +/- 1.2 vs 6.6 +/- 2.7, change 2.5 +/- 1.6, while in BP in group A, the differences were 153.1 +/- 7.1 vs 148.8 +/- 13.6, change -6.3 +/- 0.7 mm/g, p < 0.01 between pre- and post-rehabilitation. There were also significant differences between pre- and post-rehabilitation in group A in systolic BP 153 +/- 7.3 vs 135.1 +/- 16, change -18.1 +/- 4.1, p < 0.001 and diastolic BP 92.6 +/- 10.1 vs 83.5 +/- 9.1, change -9 +/- 4, p < 0.05; no change in group B. Finally, an improvement was observed in pulse pressure post-rehabilitation in group A 61.4 +/- 15.2 vs 51.6 +/- 11.4, change -9.8 +/- 3.9 vs group B 59.4 +/- 11.2 vs 59.3 +/- 10.6, only -0.1 +/- 0.8, p < 0.001. CONCLUSIONS: These results suggest that supervised PE in hypertensive women significantly improves cardio-respiratory and BP values, as well as vascular adaptability.
Payment-for-quality programs are emerging in the wake of rising healthcare costs and a demonstrated need for quality improvement in healthcare delivery in the United States. These programs, also known as "pay-for-performance" or "pay-for-value" programs, attempt to realign financial incentives with the quality of care delivered. The American Heart Association's Reimbursement, Coverage, and Access Policy Development Workgroup provides in this statement a set of principles and recommendations for the development, implementation, and evaluation of these programs. The statement also suggests future areas for research around the realignment of financial incentives to improve both the quality of care delivered and patient outcomes.
The substance concentration of ionized calcium (cCa2+) in blood, plasma or serum preanalytically may be affected by pH changes of the sample, calcium binding by heparin, and dilution by the anticoagulant solution. pH changes in whole blood can be minimized by anaerobic sampling to avoid loss of CO2, by measuring as soon as possible or by storing the sample in iced water to avoid lactic acid formation. cCa2+ and pH should be determined simultaneously. Plasma or serum: if centrifuged in a closed tube and measured immediately the pH of the sample will be close to the original value. If delay has occurred between centrifugation and the measurement, causing substantial loss of CO2, equilibration of the sample with a gas mixture corresponding to PCO2 = 5.3 kPa prior to the measurement is recommended. Conversion of the measured values to cCa2+ (7.4) is only valid if the pH is in the range 7.2-7.6 Ca2+ binding by heparin can be minimized by using either of the following: a final concentration of sodium or lithium heparinate of 15 IU/ml blood or less, by use of calcium titrated heparin with a final concentration less than 50 IU/ml blood. Dilution effect can be avoided by use of dry heparin in capillaries or syringes. When heparin solutions are used errors due to dilution or calcium binding can be reduced using syringes with a heparin solution containing free calcium ions corresponding to the mean concentration of ionized calcium in normal plasma. Conditions for blood collection, storage, and transport to avoid preanalytical errors are described.
The object of this investigation was to describe the choice of recommended/non-recommended anti-anginal preparations in a group of patients in a hospital and prescribed by the general practitioner on discharge and during the subsequent three years. Eighty-nine patients participated in the investigation. Sixty-nine of these received medicinal treatment at the conclusion of the period. The investigation demonstrates that the recommendations by the Danish Drug Committee were followed in 90% of the cases during the last year of observation. It is concluded that the activities of the Danish Drug Committee may influence the choice of anti-anginal preparations on discharge from hospital and during the subsequent three years.
These recommendations of the Immunization Practices Advisory Committee update for 1986-1987 the information on the vaccine and antiviral agent available for control of influenza. Changes include addition of statements about: updating of the influenza strains in the vaccine for 1986-1987; immunization and amantadine prophylaxis for household members who provide home care for high-risk persons; optimal time for conducting routine vaccination programs; concurrent administration of influenza vaccine and childhood vaccines; immunization of children receiving long-term aspirin therapy; and other sources of information about influenza and control measures.
The Recommended Dietary Allowances serve two basic uses: As guidelines for planning diets and food supplies and as a tool for evaluating nutritional adequacy of food consumed. Establishing standards to serve these functions is not simple. Differences in individuals in different population groups dictate allowances with relatively high margins of safety to prevent deficiencies. Even so, anomalies arise. Surveys have shown that intakes of vitamin A and protein are likely to exceed their respective allowances. On the other hand, calcium and thiamin intakes of older women and iron in teenage boys and women in the reproductive years are difficult to meet in terms of nutrient density ratios. In addition, insufficient data make it impossible to set allowances for some essential trace elements--and, other essential elements may yet be discovered. Thus the allowances are not guaranteed to represent the totality of nutritional needs.
Since 1989, a rapid increase in the incidence of infection and colonization with vancomycin-resistant enterococci (VRE) has been reported by U.S. hospitals. This increase poses important problems, including a) the lack of available antimicrobial therapy for VRE infections, because most VRE are also resistant to drugs previously used to treat such infections (e.g., aminoglycosides and ampicillin), and b) the possibility that the vancomycin-resistant genes present in VRE can be transferred to other gram-positive microorganisms (e.g., Staphylococcus aureus). An increased risk for VRE infection and colonization has been associated with previous vancomycin and/or multiantimicrobial therapy, severe underlying disease or immunosuppression, and intraabdominal surgery. Because enterococci can be found in the normal gastrointestinal and female genital tracts, most enterococcal infections have been attributed to endogenous sources within the individual patient. However, recent reports of outbreaks and endemic infections caused by enterococci, including VRE, have indicated that patient-to-patient transmission of the microorganisms can occur either through direct contact or through indirect contact via a) the hands of personnel or b) contaminated patient-care equipment or environmental surfaces. This report presents recommendations of the Hospital Infection Control Practices Advisory Committee for preventing and controlling the spread of vancomycin resistance, with a special focus on VRE. Preventing and controlling the spread of vancomycin resistance will require coordinated, concerted efforts from all involved hospital departments and can be achieved only if each of the following elements is addressed: a) prudent vancomycin use by clinicians, b) education of hospital staff regarding the problem of vancomycin resistance, c) early detection and prompt reporting of vancomycin resistance in enterococci and other gram-positive microorganisms by the hospital microbiology laboratory, and d) immediate implementation of appropriate infection-control measures to prevent person-to-person transmission of VRE.
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