The Agenda for Familial Hypercholesterolemia
Click here to read a recent (October 2015) and detailed update from the American Heart Association on Familial Hypercholesterolemia.
Author: Skip
November News
Man the shots and mind the mist, November is here and the Flu has bliss! Guard your cells and do not kiss, meningitis can be missed!
Welcome November, your colds we do remember, but this year we’ll be well enough to last the winter!
What Should I be aware of this November?
Improve Mental Health this November
So many studies have shown how having an “attitude of gratitude” improves mental health! It improves sleep, grades, relationships, etc.
So how can you implement this attitude in your patients?
Simple! Just ask them what they’re thankful for.
You can phrase it in many different ways, just planting that seed of thought can have a large impact.
A few ways to ask or lead into the topic:
1. Bring up a material possession they’re wearing/holding: “Hey Sally! Wow those are great shoes, do you like them? I’m pretty thankful for my shoes, they’re important!”
2. Point out how healthy they are: “Woah, Tom! You are getting so big and strong, I bet you’re pretty thankful for that”
3. Tie it to the upcoming holiday: “Sarah, did you know it’s November? Thanksgiving is soon! What are you thankful for?”
4. In your waiting room have coloring pages prompting the patient to “Draw a picture of something they’re thankful for” then ask them if they drew anything while they were waiting and if so, what?
Tip: If you have a patient displaying signs of poor mental/behavioral health, an easy excersise for the guardians might be to have them write/draw a picture of one thing they’re thankful for every day.
Interested in reading more about how gratitude can improve health? Follow the links below for more articles:
http://www.healthline.com/health/depression/giving-thanks#2
http://www.huffingtonpost.com/2014/07/21/gratitude-healthy-benefits_n_2147182.html
https://www.psychologytoday.com/blog/prefrontal-nudity/201211/the-grateful-brain
Don’t Forget to Check!
Screening a healthcare employee or third party vendor includes an initial OIG background check of the List of Excluded Individuals and Entities (LEIE). This should be done prior to the hiring of or commencement of billing for the services or items purchased from a third party vendor.
How often should a healthcare organization check the exclusion list after hire or contracting with a third party?
To Read the Full Article from ProviderTrust Click here: NOTICE: OIG Background Check Requires OIG Exclusion Monthly Monitoring
Understand Smoking
Behavioral Health
Are your patients exposed to second hand smoke? Are your older patients showing signs of first hand smoke? This article explores the psychology of smoking and how there is probably a behavioral disorder to treat. Read more here
Did you know?
Approximately one-quarter of Tennesseans currently use tobacco products; the number of users of electronic nicotine delivery systems is not yet known. Those seeking help ending their nicotine addictions can find assistance at the toll-free Tennessee Tobacco QuitLine, 1-800-QUIT-NOW (1-800-784-8669).
Update on Pediatric Vision Screening
Miss the CME on Pediatric Vision Screening? Don’t worry! You can view a condensed version of the presentation here
Latest news from The IAC and SOCKS
This week’s CPF picks from the IAC News
CDC updates recommendation for timing of postvaccination serologic testing of infants born to HBsAg-positive women
An estimated 25,000 infants are born to HBV-positive mothers each year in the United States. However, post-exposure prophylaxis (PEP) is highly effective in preventing perinatal HBV transmission; only 1 percent of infants receiving PEP develop infection. Infants born to HBV-infected mothers should receive hepatitis B vaccine (consisting of a 3- or 4-dose series) and hepatitis B immune globulin within 12 hours of birth to prevent perinatal HBV transmission. In order to determine whether the infant requires revaccination, [postvaccination serologic testing] PVST was previously recommended at age 9–18 months. Because new evidence suggests that hepatitis B antibody levels decline following vaccination, CDC now recommends that PVST take place earlier—at age 9–12 months, or 1–2 months after the final dose of the hepatitis B vaccine series—in order to ensure antibodies are detected. Benefits to this shortened interval include a reduction in the time that non-responders are at risk for transmission from close contacts with HBV infection, opportunity for prompt revaccination when needed, and conservation of public health resources. Additionally, the authors note that a shortened interval might increase adherence with recommendations for timely completion of PVST.
CDC study finds anaphylactic reactions rare after immunization
A recently published CDC-authored study based on a large population group that received currently used vaccines confirmed the rarity of anaphylaxis after vaccination. Risk of Anaphylaxis after Vaccination in Children and Adults was published online on October 7 in the Journal of Allergy and Clinical Immunology. The “Abstract” is reprinted below. Background Anaphylaxis is a potentially life-threatening allergic reaction. The risk of anaphylaxis after vaccination has not been well described in adults or with newer vaccines in children. Objective We sought to estimate the incidence of anaphylaxis after vaccines and describe the demographic and clinical characteristics of confirmed cases of anaphylaxis. Methods Using health care data from the Vaccine Safety Datalink, we determined rates of anaphylaxis after vaccination in children and adults. We first identified all patients with a vaccination record from January 2009 through December 2011 and used diagnostic and procedure codes to identify potential anaphylaxis cases. Medical records of potential cases were reviewed. Confirmed cases met the Brighton Collaboration definition for anaphylaxis and had to be determined to be vaccine triggered. We calculated the incidence of anaphylaxis after all vaccines combined and for selected individual vaccines. Results We identified 33 confirmed vaccine-triggered anaphylaxis cases that occurred after 25,173,965 vaccine doses. The rate of anaphylaxis was 1.31 (95% CI, 0.90–1.84) per million vaccine doses. The incidence did not vary significantly by age, and there was a nonsignificant female predominance. Vaccine-specific rates included 1.35 (95% CI, 0.65–2.47) per million doses for inactivated trivalent influenza vaccine (10 cases, 7,434,628 doses given alone) and 1.83 (95% CI, 0.22–6.63) per million doses for inactivated monovalent influenza vaccine (2 cases, 1,090,279 doses given alone). The onset of symptoms among cases was within 30 minutes (8 cases), 30 to less than 120 minutes (8 cases), 2 to less than 4 hours (10 cases), 4 to 8 hours (2 cases), the next day (1 case), and not documented (4 cases). Conclusion Anaphylaxis after vaccination is rare in all age groups. Despite its rarity, anaphylaxis is a potentially life-threatening medical emergency that vaccine providers need to be prepared to treat.
WHO announces recommended composition of influenza virus vaccines for use in the 2016 southern hemisphere influenza season
The World Health Organization (WHO) recently released information about the composition of the strains that will be used for seasonal influenza vaccination in the southern hemisphere in 2016. It is recommended that trivalent vaccines for use in the 2016 influenza season (southern hemisphere winter) contain the following:
An A/California/7/2009 (H1N1)pdm09-like virus
An A/Hong Kong/4801/2014 (H3N2)-like virus
A B/Brisbane/60/2008-like virus
It is recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/Phuket/3073/2013-like virus. Read WHO’s Recommended composition of influenza virus vaccines for use in the 2016 southern hemisphere influenza season.
Question of the Week
If a child only received a half dose of live attenuated influenza vaccine (LAIV, FluMist, MedImmune), I understand they are not considered immunized. Can the child receive inactivated influenza vaccine (IIV) on the same day?
You are correct that a half dose of LAIV (or any other vaccine) is a non-standard dose and should not be counted. If you weren’t able to give the second half of the LAIV at that same appointment, you will need to provide another full dose of influenza vaccine at another visit. If you want to try using a different type of vaccine, you can give IIV any time after the partial dose of LAIV. If you want to give LAIV again, you should wait four weeks because it is a live vaccine.
New Article from SOCKS!
Putting the Pieces Together: Endoscopic vs. Traditional Treatment of Craniosynostosis
The skull of the human brain is made of many bones that fit together like an anatomical jigsaw puzzle. Normally, the pieces gradually fuse together over stages of prenatal and childhood development. However, in approximately one out of every 2,200 live births, craniosynostosis occurs. Craniosynostosis is a premature fusion of bones in the skull, often before a baby is born. In this case, the remaining open sutures must compensate for the closed parts of the skull resulting in deformities of the head. If not treated in a timely manner, the closed portions of the skull can prevent the brain from developing properly, at times even affecting normal childhood maturing processes.
Previously, the main method of treatment was to make an incision from ear to ear on an infant’s scalp, totally or partially removing skull pieces, and placing them back together using additional prosthetic materials as necessary. Typically taking three to seven hours with a three to five day recovery, postoperative swelling and discomfort was present. Although the surgery produced good results, another goal of physicians was to reduce pain, hospitalization time, and blood loss.
With that goal in mind, an endoscopic assisted repair for craniosynostosis treatment has now become more prevalent in patients less than 6 months old. Utilizing a small endoscope, doctors now use one or two small incisions, approximately 1.5 inches long. Instead of physically re-structuring the skull with additional materials, the endoscopic surgery removes small pieces of fused bone, leaves space for the brain to grow, and uses a post-operative, custom-made helmet to ensure the protection and correct growth of an infant’s head. The patient wears this helmet for up to a year in order for the skull to grow according to the structure of the helmet.
As both procedures offer positive results with the intention of giving the brain room to grow and restoring a patient’s head to a normal shape, researchers were compelled to measure the effectiveness of both surgeries. In a retrospective studies published in the Journal of Craniofacial Surgery in 2013 and Journal of Neurosurgery: Pediatrics in 2014, patients underwent the craniosynostosis repair either by traditional or endoscopic means, comparing operating room times, blood loss, volume of transfused blood, length of hospital stay, and overall costs. Outcomes showed that the endoscopic procedure resulted in shorter operating room times, lower estimated blood loss, less transfused blood, shorter hospital stays, and decreased costs. The studies also recognized issues with compliance in wearing the molded helmet as well as minor skin breakdown after extended helmet use. Therefore, the research concluded that, with compliant patients, the endoscopic procedure was a viable option for craniosynostosis repair. These studies also illustrate the importance of recognizing craniosynostosis early, as the endoscopic repair is only considered in patients less than 6 months old.
Overall, both procedures have produced positive results. However, the endoscopic procedure seems to fit all the pieces together for a cost-effective, safe surgery to ensure a better future for a patient’s neurological development.
Vision Study Wrap Up
CPF joined the Welch-Allyn PediaVision study with Dr. Donahue when the need for more effective vision screening was noticed. The purpose of the study was to be the first large scale, multi-center evaluation of photoscreening in the medical home.
CPF members were very eager to participate in this study; 12 CPF community sites participated and worked very hard to record their referrals and to promote the need for vision screening.
A huge thank you to Dr. Sean Donahue, the Vanderbilt Eye Institute, Sandy Owings, Janet Cates, Jana Bregman, and the following participating practices:
Nurture Pediatrics
The Pediatric Center of Tullahoma
The Children’s Clinic of Nashville
Rivergate Pediatrics
Children’s Clinic East-Mt. Juliet, Hermitage, Lebanon
Brentwood Pediatrics
Capstone Pediatrics-Southern Hills, Centennial, Lebanon
Meharry Pediatric Group
We are so delighted to have been a part of this ground-breaking study and look forward to following how it impacts our community!
Guess What’s Coming!
Something big is coming!
Submit your guesses in the comment field below-MUST BE LOGGED IN TO COMMENT! The first person to guess the right answer wins a CPF gift bag!
Hint #1: We have recently had surveys and brief announcements on this program
Hint #2: It is launching before March 2016
MGMA Special Alert
Oct. 6, 2015 – Special Alert
CMS releases final meaningful use Stage 2 modifications and Stage 3 rules
Today, the Centers for Medicare & Medicaid Services (CMS) released a long-awaited final regulation that includes modifications to Stage 2 of the EHR Incentive (meaningful use) Program and outlines the requirements for Stage 3 of the program. The rule also specifies EHR certification standards and finalizes the government’s “interoperability roadmap.” For meaningful use in 2015 through 2017, major provisions include:
- Shortened 2015 reporting period (from all year to any 90 consecutive days in 2015);
- Ten objectives for eligible professionals including one public health reporting objective, down from 18 total objectives;
- Reduced number of measures that are required to be reported;
- Reduced measure threshold for View, Download or Transmit (from 5% to just one patient in 2015); and
- Reduced measure threshold for Secure Messaging (from 5% to simply having the capability in 2015).
MGMA will develop a member benefit overview of the regulation.
Read the CMS fact sheet.