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At least 991 records · Page 55Linked to original sources
PubMed2004

The role of the Vaccine Adverse Event Reporting system (VAERS) in monitoring vaccine safety.

The role of the health professional in supporting the national passive surveillance system is essential, as the first hint of a potential problem usually originates with the astute clinician who reports a case to the appropriate source. The investigation that resulted in the voluntary withdrawal of rotavirus vaccine was triggered by nine reports to VAERS of intussuception, eight of which had occurred within 1 week of the first dose of this vaccine. Health professionals have access to the most complete information related to adverse events experienced by their patients. Any index of suspicion that a serious event or death may be related to vaccination is reason for the health professional to submit a VAERS report. Determination of whether an event was caused by the vaccine is not a prerequisite for filing a VAERS report. When in doubt, providers should report to VAERS. VAERS solicits reports for all events temporally related to vaccination, some of which may be coincidental and some of which may merely indicate a change in the frequency of expected events. Post-marketing surveillance relies on health professionals to report suspicious events, thus improving the quality of reported data and contributing significantly to safeguarding public health. Recommendations for healthcare professionals to report to VAERS recently have been incorporated into the Standards for Pediatric Immunization Practices, which are endorsed by multiple professional organizations. Despite the limitations of spontaneous reports, VAERS provides vital information of clinical importance. The identification of signals in adverse event surveillance may initiate further investigation of potential problems in vaccine safety or efficacy, and facilitate subsequent dissemination of safety-related information to the scientific community and the public. This process begins with voluntary submission of reports of possible vaccine-associated events to VAERS by the informed and conscientious health professional.

Adverse Drug Reaction Reporting Systems↗
PubMed2005

This issue: Managing emergencies part 2.

Pediatric toxicologic exposures are common, and the primary care pediatric practitioner must be prepared to handle emergencies related to poisoning and overdose in children and adolescents. Fortunately, many poisonings in children are unintentional, preventable, and benign. For both simple and complex cases, help is available to medical professionals 24/7 from multiple sources, including an improved toxic exposure database, new research, the network of Certified Specialists in Poison Information at our nation's regional poison control centers, and backup medical and clinical toxicologists. The US system of AAPCC-certified poison control centers has been appropriately labeled "a national safety net" serving the public and medical practitioners in the management of pediatric toxicologic exposures. Increased funding to this system will be critical to update its services for the future, including preparation to detect the increasing threat of new public health emergencies such as chemical and biological terrorist attacks.

Child↗
PubMedDate not supplied

Access to nicotine replacement therapy as part of a statewide tobacco telephone helpline.

PURPOSE: To describe change in Minnesota's QUITPLAN helpline operations following provision of nicotine replacement therapy (NRT) to multisession counseling enrollees. METHODS: NRT access began September 2002. Call volume is reported from September 2001 to May 2003 (pre-NRT = 2734, post-NRT = 12,536). A survey administered at 2 weeks assesses self-reported connection to services (response rate 80%, n = 538/670, pre-NRT vs. 67%, n = 400/595, post-NRT, p < .001). RESULTS: Provision of NRT was followed by an increase in call volume (439 +/- 229 calls/month January through May pre-NRT vs. 1292 +/- 308 calls/month January through May post-NRT, p = .001). Enrollment in multisession counseling increased (17.4% pre-NRT vs. 75.3% post-NRT, p < .001). Among survey respondents, connection to services was not changed (83.8% pre-NRT vs. 88.0% post-NRT, p = .072). At 2 weeks, more respondents who enrolled in multisession counseling reported having a follow-up call scheduled (43.9% pre-NRT vs. 64.1% post-NRT, p = .001). CONCLUSIONS: This is an observational study. Providing NRT as part of a statewide helpline may increase recruitment and encourage callers to enroll in multisession counseling.

Health Services Accessibility↗
PubMed2004

Medical telephone triage and patient behaviour: How do they compare?

QUESTIONS UNDER STUDY: In the medical call centre Medi-24, medical experts advise people with health problems on the optimal treatment. The purpose of the first part of this study was to answer two questions: To what extend do callers and medical experts differ in their judgement of a health problem, and to what degree are patients compliant to experts' advice. METHODS: 834 callers were selected for study inclusion. At the call centre, study participants were asked about their intended behaviour prior to the call and approximately 90% of these were interviewed one week later about their subsequent behaviour following the call. The standardised data were analysed fitting a logistic regression model. RESULTS: 61% of callers had not intended to behave the way they were subsequently advised to do. The compliance rate after the triage call was 56%. Non-compliance was largely due to the caller's recollection errors or to a change in the perceived intensity of the health problem. Advice on self-care resulted in an above average compliance. A high compliance was also found when the advice on emergency treatment coincided with the patient's own intended emergency treatment. CONCLUSION: The high compliance for the self-care advice showed that patients could be persuaded by the Medi-24 service that professional health care was not necessary. It appeared more difficult to persuade those patients to make an emergency consultation who had initially not intended to do so.

Adolescent↗
PubMed2002

Telephone triage in Western Australia.

We describe the development and operations of the first large-scale Australian medical telephone triage centre. Studies have commenced to evaluate efficacy and safety of the service, as well as gauge the impact on demand for healthcare services.

Hotlines↗
PubMed2004

Travel insurance and medical evacuation: view from the far side.

Travel insurers and medical evacuation companies have a responsibility to provide an efficient high-quality service to their clients. These companies often deliver a standard far short of best practice and far short of their promotional brochures. Their services are overdue for governmental review and a lifting of standards. Travellers must be given realistic advice about the risks of foreign travel and that healthcare resources at their destination may be very limited. Travellers must check with their insurer that the policy they buy truly meets their needs. Some people should not travel overseas.

Abdominal Pain↗
PubMed2004

Seeking drugs or seeking help? Escalating "doctor shopping" by young heroin users before fatal overdose.

OBJECTIVE: To identify prescription drug-seeking behaviour patterns among young people who subsequently died of heroin-related overdose. DESIGN: Linkage of Medicare and Pharmaceutical Benefits Scheme and Coroner's Court records from Victoria. SUBJECTS: Two hundred and two 15-24-year-olds who died of heroin-related overdose between 6 January 1994 and 6 October 1999. MAIN OUTCOME MEASURES: Patterns of use of medical services and prescription drugs listed on the Pharmaceutical Benefits Scheme in the years before death, and use of all drugs just before death. RESULTS: Polydrug use was reported in 90% of toxicology reports, and prescription drugs were present in 80% of subjects. Subjects accessed medical services six times more frequently than the general population aged 14-24 years, and more than half of all prescribed drugs were those prone to misuse, such as benzodiazepines and opioid analgesics. A pattern of increasing drug-seeking behaviour in the years before death was identified, with doctor-visitation rates, number of different doctors seen and rates of prescriptions peaking in the year before death. CONCLUSIONS: An apparent increase in "doctor shopping" in the years before heroin-related death may reflect the increasing misuse of prescription drugs, but also an increasing need for help. Identification of a pattern of escalating doctor shopping could be an opportunity for intervention, and potentially, reduction in mortality.

Adolescent↗
PubMed2004

Paediatric telephone triage and advice: the demand continues.

Kidsnet was established in 1997 at the Children's Hospital at Westmead as a paediatric telephone triage service. The demand for Kidsnet increased from 18 327 in 1997/98 to 22 844 in 2001/02, with an average of 1669 callers per month. Most callers were able to proceed to seeking care at a more appropriate time and were satisfied with the service provided. The service is highly valued and the advice given perceived to be accurate. Kidsnet has shown that it can play a key role in providing safe advice to families.

Australia↗
PubMedDate not supplied

A randomized trial of telephone counseling with adult moist snuff users.

OBJECTIVE: To evaluate telephone counseling for moist snuff use. METHODS: We recruited 221 adult males using snuff and randomized them into a telephone-counseling intervention or a quit-manual comparison group. Subjects were contacted by mail at 3 and 6 months to complete a 4-page follow-up questionnaire. RESULTS: A significantly higher proportion of subjects randomized to the intervention quit tobacco at each time point compared to the comparison group. CONCLUSIONS: With appropriate staff training, moist snuff and other types of nonsmoked tobacco should be added to the state-funded smoking cessation quit lines started in recent years.

Adult↗
PubMed2004

Operation Stay Quit: evaluation of two smoking relapse prevention strategies for women after involuntary cessation during US Navy recruit training.

The present study evaluated two relapse-prevention interventions intended to help women smokers maintain the "quit status" mandated during Navy basic training. Women with any smoking experience before entering the Navy (N = 2,781) were assigned to either a control group or to one of two intervention groups (access to a telephone help line or receive a series of monthly mailings) after graduating from basic training. Smoking/quit rates at 3, 6, and 12 months after graduation were assessed with mailed surveys. Response rates to the surveys ranged from 39% to 52%. There were no phone or mail intervention effects: cessation rates for the three conditions at the 12-month follow-up were 43% for control, 45% for the mail intervention, and 41% for the phone intervention. Results suggest the need for more aggressive relapse-prevention efforts, although quit rates were higher than expected "spontaneous" quit rates, indicating an impact of the totally smoke-free recruit training environment.

Adolescent↗