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Practice Guidelines
eliastheod:
δεν γνωρίζω αν υπάρχουν βιβλιογραφικές αναφορές για την ενδημικότητα της ν. Lyme στην Ελλάδα και θα είχε ενδιαφέρον αν κάποιος συνάδελφος γνώριζε κάτι για το θέμα αυτό.
Εργάζομαι στην περιοχή του β. Αιγαίου και αρκετά συχνά αντιμετωπίζω ασθενείς με πρόσφατο δήγμα τσιμπουριού. Συνήθως προσέρχονται λίγες μέρες μετά το δήγμα και συχνά εμφανίζουν σύστοιχη λεμφαδενίτιδα στην περιοχή, που είναι και το σύμπτωμα που συνήθως τους οδηγεί στο γιατρό. Σε όλους συνηθίζω να δίνω χημειοπροφύλαξη για ν.Lyme όπως περιγράφεται στις οδηγίες που έχω επισυνάψει
ManolisGP:
Δεν είναι ορατοί οι σύνδεσμοι (links).
Εγγραφή ή ΕίσοδοςGuidelines Issued for Acute Otitis Externa
Otolaryngol Head Neck Surg. 2006;134(suppl):24-48
--- Τέλος παράθεσης ---
Otitis Externa: Review and Clinical Update
Am Fam Physician 2006;74:1510-6.
Δεν είναι ορατοί οι σύνδεσμοι (links).
Εγγραφή ή Είσοδος
eliastheod:
Guidelines Issued for Early Detection of Colorectal Cancer
CA Cancer J Clin. Published online March 5, 2008
Gatekeeper:
The American Academy of Pediatrics (AAP)
Guidelines Updated for Influenza Immunization in Children
The revised guidelines recommend influenza immunization for the following groups:
Healthy children aged 6 through 59 months (evidence grade B).
High-risk children and adolescents with underlying medical conditions, including:
Asthma, cystic fibrosis, or other chronic pulmonary diseases (evidence grade B);
Hemodynamically significant cardiac disease;
Immunosuppressive disorders or treatment;
HIV infection;
Sickle cell anemia and other hemoglobinopathies;
Diseases treated with long-term aspirin therapy, including juvenile idiopathic arthritis or Kawasaki's disease (trivalent inactivated influenza vaccine [TIV] only);
Chronic renal dysfunction;
Diabetes mellitus or other chronic metabolic disease; and
Any condition that can reduce respiratory function or handling of secretions or can increase risk for aspiration, including cognitive dysfunction, spinal cord injury, seizures, or other neuromuscular disorders.
Study Highlights
Community outbreaks of influenza can last 4 to 8 weeks or longer.
Rates of infection are highest among children, but serious infection and mortality rates are higher among people older than 65 years, children younger than 2 years, and patients with medical conditions.
The influenza attack rate among children is 10% to 40% annually, with a 1% hospitalization rate.
Rates of emergency department visits and hospitalizations are higher in children younger than 5 years and highest in those younger than 2 years.
Outpatient visit rates for influenza are 80 to 150 per 1000 children among those aged 23 to 59 months.
Associated morbidity rates increased during the influenza season include acute otitis media with a 10% to 30% increase in antimicrobial use.
Deaths attributable to influenza are less common among children vs elderly people, with a rate of 0.4 per 1000 reported in the 1990s vs 98.3 per 100 among adults 65 years or older.
The annual number of influenza-related deaths among children that were reported to the CDC in the past 3 seasons ranged from 44 to 68.
TIV is administered intramuscularly to children 6 months or older and is indicated for healthy children and for those with chronic medical conditions.
LAIV is live attenuated, administered intranasally, and approved by the US Food and Drug Administration for those aged 2 to 49 years.
Both vaccines are contraindicated in those with egg or egg protein allergy.
Efficacy depends on the age and immunocompetence of the recipient.
LAIV has shown greater efficacy and safety than TIV for children between 12 and 59 months without a history of wheezing or asthma and is better than TIV against both strains of influenza.
Children and adolescents with influenza should not receive aspirin or salicylate-containing products because of the risk for Reye's syndrome.
Influenza vaccine is recommended for healthy children 6 to 59 months of age, children at high risk, and adolescents with underlying medical conditions.
The underlying medical conditions include asthma, chronic pulmonary diseases such as cystic fibrosis, significant cardiac disease, immunosuppression, HIV infection, hemoglobinopathies, chronic renal dysfunction, metabolic disease, and diseases requiring long-term therapy such as rheumatoid arthritis.
Others requiring immunization include household contacts and caregivers of children younger than 5 years and children of all ages who are at risk, children who require regular hospital follow-up because of prior disease, any girl or woman who will become pregnant during the influenza season (TIV only), all individuals aged 5 years or older, healthy contacts at risk for development of complications from influenza infection, close contacts of immunosuppressed individuals, and healthcare workers.
Children who received only 1 dose of influenza vaccine in the previous season should receive 2 doses given 1 month apart in the following season.
Children younger than 9 years and at least 6 months old who were previously unimmunized should receive 2 doses 1 month apart beginning as soon as possible.
Influenza vaccine should be offered throughout the influenza season even after influenza activity has been documented in the community.
Healthcare clinicians should not prescribe amantadine or rimantadine for influenza treatment or chemoprophylaxis because of widespread resistance among influenza A strains.
Oseltamivir and zanamivir can be prescribed for treatment or chemoprophylaxis because both influenza A and B remain susceptible.
Pearls for Practice
Influenza has a high rate of attack among children, and morbidity rate is highest among children younger than 2 years.
Influenza vaccine should be offered throughout the influenza season according to current indications, and amantadine and rimantadine should be avoided for treatment or prophylaxis of influenza.
Gatekeeper:
Clinical guidelines: Potential benefits, limitations,and harms.
Απο το BMJ.
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