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At least 1,063 records · Page 59Linked to original sources
PubMed1998

Prevention and control of influenza: recommendations of the Advisory Committee on Immunization Practices (ACIP). Centers for Disease Control and Prevention.

These recommendations update information concerning the vaccine and antiviral agents available for controlling influenza during the 1998-99 influenza season (superseding MMWR 1997;46[No. RR-9:1-25]). The principal changes include a) information about the influenza virus strains included in the trivalent vaccine for 1998-99, b) more detailed information about influenza-associated rates of hospitalization, and c) updated information on the possible relationship between Guillain-Barre syndrome and influenza vaccination.

Adolescent↗
PubMed1998

[Antiretroviral therapy. Announcement of the Advisory Committee of the Chilean Society of Infectology on AIDS].

There are treatments to induce the long term suppression of viral replication and that delays the progression of HIV disease. To be effective, these treatments require the uninterrupted use of a combination of drugs (ideally three), patients must be highly compliant, must be instituted in early stages of the disease and drugs must be used for prolonged periods and given by specialists. These treatments are indicated in all symptomatic patients and in those with early immunologic deterioration or high viral load. Recent infection and acute primary retroviral infections should also be considered for treatment. The treatment sponsored and financed by the ministry of health for its beneficiaries is insufficient at this time, since it is received by a minority of eligible patients due to budgetary reasons, and only two drugs are given which is considered such optimal by most experts. The committee considers that the responsibility for financing, providing and delivering these treatments in proper combination and dosages exceeds the duty of the Ministry of Health and should include all the involved parties. However, the state and its official institutions have a special responsibility to provide with adequate treatments to the poorer segments of our population. They also should promote, supervise and control the proper access of the rest of the population to efficient treatments. The committee also considers that the efforts to prevent new infections must not be neglected and that individuals under successful treatment should not consider themselves as non infectious.

Acquired Immunodeficiency Syndrome↗
PubMed1998

General surgical training--improvements and problems. Vascular Advisory Committee of the Vascular Surgical Society of Great Britain and Ireland.

Surgical training in this country was coveted by many trainees from abroad, who remember their period of clinical apprenticeship with affection. The twin pillars of this success were the considerable clinical workload and a school of surgeons that were well trained and skilled in the full breadth of general surgery (see Figure 1). This led to a degree of complacency and little effort was made to change a system that produced experienced, well trained surgeons (even if some were a little jaded and embittered by the time they finally obtained a consultant post). More recently surgical training has been in a state of flux and standards have adapted to both market forces and European directives on doctors' hours. The Calman Report addressed these issues and has wide reaching implications. The prospect of a more focused and organised training that could produce consultants by the age of 32-33 was welcomed by most. The vagaries of an apprentice system needed to be addressed and tightly focused training programmes developed. Following endless committees the structure of general surgical training is now defined and will be dealt with in the first part of this paper. Having defined the structure we then need to assess the trainers'/ training programmes and finally the trainees.

Education, Medical, Graduate↗
PubMed1998

Guideline for the use of fresh-frozen plasma. Medical Directors Advisory Committee, National Blood Transfusion Council.

OBJECTIVE: To make recommendations regarding the rational use of fresh-frozen plasma (FFP), since there is evidence of excessive and uncritical use of this blood component. OPTIONS: Alternatives to the use of FFP are presented: (i) specific factor concentrates for the treatment of the haemophilias and related inherited bleeding disorders; (ii) cryoprecipitate for the management of fibrinogen deficiency; (iii) vitamin K, where bleeding is associated with a deficiency of this vitamin; and (iv) crystalloids, plasma and synthetic colloids, the indicated components in the management of hypovolaemia and appropriate replacement fluids in most plasma exchange procedures. EVIDENCE: There is a marked paucity of objective data regarding indications for the use of FFP. Evidence was therefore obtained from previously published guidelines from the USA and the UK. Three clinical studies of massive blood transfusion, cardiopulmonary bypass and patients with coagulation abnormalities undergoing minor invasive procedures were reviewed. BENEFITS, HARMS AND COSTS: By following this guideline unnecessary costs to hospitals and patients will be avoided and the well-known risks of blood transfusion will be decreased. Appropriate use will also result in the greater availability of plasma for fractionation into concentrates for the treatment of the haemophilias, of which there is usually a shortage. RECOMMENDATIONS: Definite indications for the use of FFP: (i) replacement of single factor deficiencies; (ii) immediate reversal of warfarin effect; (iii) vitamin K deficiency associated with active bleeding; (iv) acute disseminated intravascular coagulation; (v) thrombotic thrombocytopenic purpura; and (vi) inherited deficiencies of inhibitors of coagulation. Conditional uses (if there is bleeding and evidence of disturbed coagulation): (i) massive transfusion; (ii) liver disease; and (iii) cardiopulmonary bypass surgery. No justification for the use of FFP: (i) hypovolaemia; (ii) plasma exchange procedures; (iii) nutritional support and protein-losing states; and (iv) treatment of immunodeficiency states. VALIDATION: This guideline was circulated in draft form for review by clinical users or groups representing blood users in the regions served by the various blood transfusion services.

Blood Coagulation Disorders↗
PubMedDate not supplied

Partnerships in higher education: a model for joint degree nursing programs.

The purpose of this article is to outline specific strategies that were employed in the design and implementation of two joint baccalaureate nursing programs developed in New Jersey. Details regarding the academic contract, decision-making committees, advisory committees, lines of authority, and practical aspects of operational management are fully described. The authors also describe the broad assumptions and ingredients necessary to successful partnerships in higher education. Both the advantages and disadvantages to academic partnerships are discussed.

Curriculum↗
PubMed2003

Quality use of medicines in aged-care facilities in Australia.

Medication-related problems are most commonly reported in elderly patients. It is for this reason that the development of services supporting appropriate medication management in the elderly is paramount; particularly for those living in residential care facilities. In 1991, Australia had very limited services supporting the quality use of medicines for residents of aged-care facilities. Over 11 years, from 1991-2002, the range of services has expanded considerably. Federally funded medication review services are now available, with over 80% of residents provided with the service. Medication advisory committees, in accordance with national practice guidelines, have been established in many facilities to address issues concerning medication management. Fifty percent of Australian's pharmacies are registered to provide services, with over 10% of the country's pharmacists accredited to provide the service. National practice guidelines for medication management in aged-care facilities have been incorporated into accreditation standards for aged-care facilities, further integrating activity into the wider health system. The environment was created for these activities through the formation of the Pharmaceutical Health and Rational Use of Medicines (PHARM) Committee, an expert advisory committee, and the Australian Pharmaceutical Advisory Council (APAC), a representative council. Both groups had responsibility for advising the Federal Minister of Health. They both identified medication misadventure in residential aged care as a priority issue and through their recommendations the Government devoted funds to the development of best practice guidelines and research activity. Clinical pharmacy services in nursing-home and hostel settings were found to reduce the use of benzodiazepines, laxatives, NSAIDs and antacids leading to cost savings to the health system. Dose-administration aids were found to reduce error rates during medication administration, and the alteration of medications for administration to residents was found to be common practice and potentially problematic. Research in the Australian setting demonstrating effectiveness, as measured by changes in medication use or health outcomes, as well as actual or potential cost savings has been a critical success factor. In addition, prioritisation by government advisory committees, inquiries and policy documents, have assisted in the development of services from ideas in 1991 to nationally funded realities in 2002.

Aged↗