scholarly journals P005 Diphtheria treatment

2019 ◽  
Vol 104 (7) ◽  
pp. e2.7-e2
Author(s):  
Claire Hannah
Keyword(s):  
Public Health ◽  
Qt Interval ◽  
Kidney Injury ◽  
Test Dose ◽  
Left Ventricular ◽  
Lessons Learned ◽  
List Type ◽  
Staff Members ◽  
Diphtheria Antitoxin ◽  
Corynebacterium Diphtheria

BackgroundDiphtheria is a life threatening but vaccine preventable disease. 5 cases were identified by Public Health England (PHE) in 2017.1 Respiratory diphtheria is characterised by a pseudomembrane which obstructs the airways. Corynebacterium diphtheria produces an exotoxin that causes local tissue necrosis, myocarditis, polyneuropathy, paralysis, respiratory failure and death.Clinical caseA 4 year old boy was admitted via A&E with suspected croup requiring intubation and ventilation on intensive care unit (ICU). Throat swabs confirmed diphtheria diagnosis, PHE was contacted and diphtheria antitoxin was obtained. The patient received two subcutaneous doses of diphtheria-antitoxin. He developed myocarditis, Acute Kidney Injury (AKI), impaired left ventricular function and polyneuropathy. He was treated with 14 days intravenous vancomycin and clindamycin following multiple antibiotic changes.Pharmacy contributionAnti-toxin: Diphtheria anti- toxin was obtained and advice was provided regarding an appropriate dose and route of administration. Ward staff were reluctant to give a subcutaneous infusion. A pharmacist provided reassurance that this was the only way to treat the infection and a subcutaneous cannula was inserted. He was given 0.2 ml subcutaneously as a test dose followed by the remaining 40,000 units. His second dose was given as a test dose of 0.2 ml followed by 60,000 units between two sites due to multi-organ involvement. Chemoprophylaxis: The patient’s family and 34 staff members required prophylactic antibiotics. They received azithromycin 500 mg once daily for 3 days. Staff members had throat swabs and were to remain off work until these swabs were negative which resulted in the Trust cancelling elective operations and admissions. Pharmacy confirmed azithromycin was safe for 34 adult patients and checked for interactions with currently prescribed medicines and advised appropriately.Critical careCreatinine doubled and the pharmacist reviewed drugs to account for renal impairment. The pharmacist highlighted that clarithromycin can prolong QT interval. An echocardiogram revealed the patient had prolonged QT interval and clarithromycin was switched to an alternative after discussion with the microbiologist.Vancomycin therapeutic levels were reached on day 5. The dose remained unchanged for the remainder of the course and levels taken every 3 days were appropriate. The pharmacist prepared a weaning plan for morphine and clonidine. The pharmacist advised reducing dexamethasone and stopping when no longer required due to raised blood glucose measurements.Lessons learnedHow to obtain and administer diphtheria antitoxin. What chemoprophylaxis to provide to family and staff, the difficulties of supplying this to so many adults in a children’s hospital and the pressure the hospital faced having 34 staff members excluded for 48 hours while cultures were taken The importance of personal protective equipment to protect staff and other patients Monitoring parameters: vancomycin levels, renal function, cardiac function, blood sugars Importance of encouraging parents to have their children vaccinated with all the primary immunisations to protect their children and othersReferencePublic health England: Diphtheria in England 2017. Accessed via: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/711453/hpr1818_dphthr17.pdf

A Functional Needs Approach to Emergency Planning

2014 ◽  
Vol 8 (4) ◽  
pp. 301-309 ◽  
Author(s):  
Rebecca Zod ◽  
Robin Fick-Osborne ◽  
Eleanor B. Peters
Keyword(s):  
Public Health ◽  
Lessons Learned ◽  
Emergency Planning ◽  
Verbal Cues ◽  
Staff Members ◽  
Emergency Situations ◽  
Department Of Health ◽  
Response Measures ◽  
Emergency Actions ◽  
New Guidelines

AbstractObjectiveThis study was conducted to test the ability of the St Louis County Department of Health to efficiently dispense medication to individuals with functional needs during a public health emergency and develop new guidelines for future emergency planning. Historically, people with functional needs have been vulnerable in emergency situations, and emergency planners are responsible for creating equal access for mass prophylaxis events.MethodsMeasures to create access for individuals with functional needs were tested in a countywide exercise in which 40 volunteers with functional needs walked through an open point of dispensing location to collect medication as if it were a real emergency. Actions were informed by representatives from the functional needs community in the St Louis area.ResultsDuring the exercise, medications were successfully dispensed to all participants. Many participants offered feedback for future program design.ConclusionsOutcomes indicated the importance of working closely with the community organizations that serve people with functional needs in designing appropriate response measures, providing sensitivity training to staff members, employing useful technology, and using visual and verbal cues. The lessons learned from this exercise apply to emergency planning nationwide, as planning efforts for persons with functional needs still lag significantly.(Disaster Med Public Health Preparedness. 2014;0:1–9)

scholarly journals Myositis, rhabdomyolysis and severe hypercalcaemia in a body builder

2020 ◽  
Vol 2020 ◽  
Author(s):  
Ravikumar Ravindran ◽  
Justyna Witczak ◽  
Suhani Bahl ◽  
Lakdasa D K E Premawardhana ◽  
Mohamed Adlan
Keyword(s):  
Calcium Release ◽  
Urine Analysis ◽  
Anabolic Steroids ◽  
Kidney Injury ◽  
Renal Stones ◽  
Left Ventricular ◽  
List Type ◽  
Hypervitaminosis A ◽  
Renal Deterioration ◽  
Significant Family History

Summary A 53-year-old man who used growth hormone (GH), anabolic steroids and testosterone (T) for over 20 years presented with severe constipation and hypercalcaemia. He had benign prostatic hyperplasia and renal stones but no significant family history. Investigations showed – (1) corrected calcium (reference range) 3.66 mmol/L (2.2–2.6), phosphate 1.39 mmol/L (0.80–1.50), and PTH 2 pmol/L (1.6–7.2); (2) urea 21.9 mmol/L (2.5–7.8), creatinine 319 mmol/L (58–110), eGFR 18 mL/min (>90), and urine analysis (protein 4+, glucose 4+, red cells 2+); (3) creatine kinase 7952 U/L (40–320), positive anti Jo-1, and Ro-52 antibodies; (4) vitamin D 46 nmol/L (30–50), vitamin D3 29 pmol/L (55–139), vitamin A 4.65 mmol/L (1.10–2.60), and normal protein electrophoresis; (5) normal CT thorax, abdomen and pelvis and MRI of muscles showed ‘inflammation’, myositis and calcification; (6) biopsy of thigh muscles showed active myositis, chronic myopathic changes and mineral deposition and of the kidneys showed positive CD3 and CD45, focal segmental glomerulosclerosis and hypercalcaemic tubular changes; and (7) echocardiography showed left ventricular hypertrophy (likely medications and myositis contributing), aortic stenosis and an ejection fraction of 44%, and MRI confirmed these with possible right coronary artery disease. Hypercalcaemia was possibly multifactorial – (1) calcium release following myositis, rhabdomyolysis and acute kidney injury; (2) possible primary hyperparathyroidism (a low but detectable PTH); and (3) hypervitaminosis A. He was hydrated and given pamidronate, mycophenolate and prednisolone. Following initial biochemical and clinical improvement, he had multiple subsequent admissions for hypercalcaemia and renal deterioration. He continued taking GH and T despite counselling but died suddenly of a myocardial infarction. Learning points: The differential diagnosis of hypercalcaemia is sometimes a challenge. Diagnosis may require multidisciplinary expertise and multiple and invasive investigations. There may be several disparate causes for hypercalcaemia, although one usually predominates. Maintaining ‘body image’ even with the use of harmful drugs may be an overpowering emotion despite counselling about their dangers.

scholarly journals P025 Clinical pearl; treating infant botulism on a paediatric intensive care unit (PICU)

2019 ◽  
Vol 104 (7) ◽  
pp. e2.29-e2
Author(s):  
Caroline Dalton
Keyword(s):  
Public Health ◽  
Medicinal Product ◽  
Prevention Program ◽  
Communicable Disease ◽  
Lessons Learned ◽  
List Type ◽  
California Department ◽  
Out Of Hours ◽  
Treatment And Prevention ◽  
Infant Botulism

ProblemA call was received out of hours by the specialist PICU pharmacist (SP). A five month old baby with rapidly spreading paralysis of unknown cause had been admitted to the unit. A toxin had been extracted from the stool culture and tested on mice. Within hours all mice had died, confirming a positive result for Botulism toxin. The SP was asked to obtain an urgent supply of Human Botulism Anti-Toxin however the only worldwide manufacturer/supplier, the Infant Botulism Treatment and Prevention Program (IBTPP), is based in California.1 BabyBIG, Botulism Immune Globulin Intravenous (Human) (BIG-IV), is an orphan drug that consists of human-derived anti-botulism toxin antibodies that is approved by the U.S. Food and Drug Administration for the treatment of infant botulism types A and B in patients <1 year old.Pharmacist contributionsDay 1: After confirmation with PHE (Public Health England) that the use of their heptavalent horse botulisum anti-toxin would be inappropriate, it was suggested that a supply should be obtained from the USA. SP phoned the IBTPP on call consultant and discussed need for an urgent supply.Consequently SP ensured the appropriate provision and recording of required information and the seamless transition of relevant paperwork.Day 2: SP liaised with the Clinical Director for Children’s Services, the PHE consultant on call and the Trust Silver on call manager to authorise large out of hours drug expenditure. Prompt authorised signature of contract between the above parties was arranged by SP via email. SP contacted the MHRA duty officer on call to obtain an import permit authorisation letter (Notification of Intent to Import an Unlicensed Medicinal Product) to allow for this unlicensed import of a human medicinal product from outside the EEA, re-affirming this was of urgent clinical need.Trust Chief Pharmacist was alerted to the situation by SP, and access to the to the Trust import/specials licence required by the MHRA was granted to the SP to finalise the MHRA import licence. A courier from California was organised by SP liaising with the on call IBTPP consultant, ensuring all paperwork was accurately completed. Dosing, administration and reconstitution advice was given by SP to PICU medical and nursing staff via email. SP immediately confirmed receipt via phone and provided clarification of this when required. SP remained contactable throughout the weekend to resolve any queries the staff had with regards to BabyBIG.Day 3: The SP attempted contact with border control at Heathrow airport to ensure a timely transition through customs and liaised with the courier in the UK to ensure rapid delivery once BabyBIG had been cleared. Allowing sufficient transit time from Heathrow, the SP then called to confirm receipt of BabyBIG on PICU.Outcome and lessons learnedBabyBIG obtained and patient treated successfully, avoiding potential for serious complications and dramatically reducing PICU and overall inpatient stay. A cost analysis done by SP confirmed treatment with BabyBIG reduced overall Trust spend on this admission by half; accounting for average expected PICU stay for infant botulism cases(∼6 weeks) versus this patient’s stay (∼1.5 weeks).ReferencesDivision of Communicable Disease Control, California Department of Public Health. Infant Botulism Treatment and Prevention Program [online] California Department of Public Health, 2010. (accessed 02 Aug 2018) Available from: http://www.infantbotulism.org/general/babybig.phpSave

Collecting Data During the COVID-19 Pandemic: Lessons From an In-Person Survey of People Who Use Opioids

2022 ◽  
pp. 003335492110634
Author(s):  
Lauren Jessell ◽  
Izza Zaidi ◽  
Leonardo Dominguez-Gomez ◽  
Alex Harocopos
Keyword(s):  
Public Health ◽  
New York ◽  
Data Collection ◽  
Service Use ◽  
Lessons Learned ◽  
People Who Use Drugs ◽  
Staff Members ◽  
Service Programs ◽  
Department Of Health ◽  
Control And Prevention

Objectives: In response to the COVID-19 pandemic, much in-person data collection has been suspended or become tele-remote. However, tele-remote methods often exclude marginalized groups, including people who use drugs, many of whom lack the technology to participate. To inform future surveillance and research during the pandemic and other public health disasters, we report methods and lessons learned from an in-person survey of people who use opioids conducted by the New York City Department of Health and Mental Hygiene (DOHMH) during the COVID-19 pandemic. Materials and Methods: This public health surveillance was a component of the Centers for Disease Control and Prevention Overdose Data to Action initiative and aimed to inform overdose prevention efforts. Survey domains inquired about participants’ drug use patterns, risk behaviors, overdose history, and service use. Results: From June 16 through September 9, 2020, DOHMH staff members conducted 329 surveys with participants from 4 syringe service programs (n = 148, 44.9%) and via street intercept (n = 81, 55.1%). To survey participants safely and effectively, it was important to build rapport upfront so that requests to maintain distance were not perceived as stigmatizing. DOHMH staff members offered all participants, regardless of survey eligibility, Narcan and hygiene products, including face masks and soap. Practice Implications: Surveys administered outdoors during the COVID-19 pandemic should be limited to 30 minutes. Although conducting in-person surveys poses unique challenges, this method should be considered so marginalized populations are included in data collection and public health responses.

scholarly journals California’s Prisoner Protections for Family and Community Health Act

2020 ◽  
Vol 135 (1_suppl) ◽  
pp. 50S-56S
Author(s):  
Kimberley D. Lucas ◽  
Joseph Bick ◽  
Janet C. Mohle-Boetani
Keyword(s):  
Public Health ◽  
Transmitted Disease ◽  
Lessons Learned ◽  
California Department ◽  
Prison Staff ◽  
Sexually Transmitted ◽  
Correctional Health ◽  
Staff Members ◽  
Incarcerated Men ◽  
Condom Access

In 2014, California passed Assembly Bill 966, which required condom access for persons incarcerated in all 35 California state prisons (33 men’s and 2 women’s prisons). The California Correctional Health Care Services and the Sexually Transmitted Disease Control Branch and the Office of AIDS of the California Department of Public Health collaborated in a prison administration–led multidisciplinary implementation workgroup. Our workgroup, representing public health, correctional health, legal and legislative affairs, labor relations, and prison staff members, participated in 4 planning meetings during May–September 2015. We surveyed prison staff members and incarcerated men to identify and address potential challenges; conceptualized a tamper-resistant condom dispenser; developed educational materials, frequently asked questions for staff members, and fact sheets for the public; and conducted forums for custody and medical staff members at each prison. Key lessons learned included the need for high-level custody support, engagement of labor unions early in the decision-making process, and flexibility within defined parameters for sites to determine best practices given their unique institutional population, culture, and physical layout. Condom access was initiated at 4 prisons in July 2015 and expanded incrementally to the remaining 29 men’s prisons through July 2016. A total of 243 563 condoms were accessed in the men’s prisons, for an average of 354 condoms per 1000 population per month. The start-up dispenser cost was $69 825 (735 dispensers at $95 each). We estimated an annual condom cost of $0.60 per person. Although staff members and incarcerated men expressed concern that this legislation would condone sex and provide repositories for contraband, no serious adverse incidents involving condoms were reported. California demonstrated that condom access is a safe, low-cost intervention with high uptake for a large correctional system and provided a replicable implementation model for other states. Prison condom programs have the potential to decrease transmission of sexually transmitted infections (STIs) among incarcerated persons and their communities, which are often disproportionately affected by STIs, HIV, and other chronic diseases.

Dealing with COVID-19: lessons learned from the Italian experience

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Silvana Mirella Aliberti ◽  
Francesco De Caro ◽  
Giovanni Boccia ◽  
Rosario Caruso ◽  
Mario Capunzo
Keyword(s):  
Public Health ◽  
Risk Assessment ◽  
Lessons Learned ◽  
Coherent System ◽  
Effective Response ◽  
Medical Practitioners ◽  
Italian Experience ◽  
Rapid Spread ◽  
Public Health Officials ◽  
Future Plans

: Italy was the first western nation affected by the pandemic and was observed as a pilot case in the management of the new coronavirus epidemic. The outbreak of COVID-19 disease has been very difficult in Italy, on June 25, 2020 there are 239,821 total cases of which 33,592 deaths nationwide. Three lessons emerged from this experience that can serve as a blueprint to improve future plans for the outbreak of viruses. First, early reports on the spread of COVID-19 can help inform public health officials and medical practitioners in effort to combat its progression; second, inadequate risk assessment related to the urgency of the situation and limited reporting to the virus has led the rapid spread of COVID-19; third, an effective response to the virus had to be undertaken with coherent system of actions and simultaneously.

scholarly journals Review of Irish patients meeting ST elevation criteria during the COVID-19 pandemic

Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001716
Author(s):  
Luke Byrne ◽  
Roisin Gardiner ◽  
Patrick Devitt ◽  
Caleb Powell ◽  
Richard Armstrong ◽  
...  
Keyword(s):  
Public Health ◽  
Public Perception ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Control Group ◽  
Ventricular Ejection Fraction ◽  
St Elevation ◽  
The Impact ◽  
Transfer Times

IntroductionThe COVID-19 pandemic has seen the introduction of important public health measures to minimise the spread of the virus. We aim to identify the impact government restrictions and hospital-based infection control procedures on ST elevation myocardial infarction (STEMI) care during the COVID-19 pandemic.MethodsPatients meeting ST elevation criteria and undergoing primary percutaneous coronary intervention from 27 March 2020, the day initial national lockdown measures were announced in Ireland, were included in the study. Patients presenting after the lockdown period, from 18 May to 31 June 2020, were also examined. Time from symptom onset to first medical contact (FMC), transfer time and time of wire cross was noted. Additionally, patient characteristics, left ventricular ejection fraction, mortality and biochemical parameters were documented. Outcomes and characteristics were compared against a control group of patients meeting ST elevation criteria during the month of January.ResultsA total of 42 patients presented with STEMI during the lockdown period. A significant increase in total ischaemic time (TIT) was noted versus controls (8.81 hours (±16.4) vs 2.99 hours (±1.39), p=0.03), with increases driven largely by delays in seeking FMC (7.13 hours (±16.4) vs 1.98 hours (±1.46), p=0.049). TIT remained significantly elevated during the postlockdown period (6.1 hours (±5.3), p=0.05), however, an improvement in patient delays was seen versus the control group (3.99 hours (±4.5), p=0.06). There was no difference seen in transfer times and door to wire cross time during lockdown, however, a significant increase in transfer times was seen postlockdown versus controls (1.81 hours (±1.0) vs 1.1 hours (±0.87), p=0.004).ConclusionA significant increase in TIT was seen during the lockdown period driven mainly by patient factors highlighting the significance of public health messages on public perception. Additionally, a significant delay in transfer times to our centre was seen postlockdown.

scholarly journals A public health perspective on mental health: lessons for population health in the 21st century

2021 ◽  
pp. 1-4
Author(s):  
James V. Lucey
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Population Health ◽  
Royal College ◽  
Public Support ◽  
Healthcare Systems ◽  
Lessons Learned ◽  
Public Health Perspective ◽  
The World ◽  
Shared Commitment

In December 2019, clinicians and academics from the disciplines of public health and psychiatry met in Dublin at the Royal College of Surgeons in Ireland (RCSI), to restate their shared commitment to population health. The purpose of this review is to bring our discussion to a wider audience. The meeting could not have been more timely. Six weeks later, the COVID-19 emergency emerged in China and within 12 months it had swept the world. This paper, the contents of which were presented at that meeting in December recommended that future healthcare would be guided more by public health perspectives and informed by an understanding of health economics, population health and the lessons learned by psychiatry in the 20th century. Ultimately two issues are at stake in 21st century healthcare: the sustainability of our healthcare systems and the maintenance of public support for population health. We must plan for the next generation of healthcare. We need to do this now since it is clear that COVID-19 marks the beginning of 21st century medicine.

PP159 Telemedicine In Paraguay: Contributions Of The Institute Of Health Sciences Research, National University Of Asunción

2020 ◽  
Vol 36 (S1) ◽  
pp. 18-18
Author(s):  
Ronald Rivas ◽  
Pedro Galván
Keyword(s):  
Public Health ◽  
Biomedical Engineering ◽  
List Type ◽  
Telemedicine System ◽  
Cellular Telephony ◽  
Imaging Department ◽  
Number Of Patients ◽  
Computed Tomography Scans ◽  
National University ◽  
Development And Validation

IntroductionThe modalities of telemedicine that have been developed and applied so far by the Department of Biomedical Engineering and Imaging at the National University of Asunción (IICS-UNA) are as follows: (i) telediagnosis: the remote sending of data, signals, and images for diagnostic purposes; (ii) general telediagnostic imaging; (iii) telemonitoring (including telemetry): remote monitoring of vital parameters to provide automatic or semi-automatic surveillance or alarm services in emergencies, epidemiology, or tele-public health; and (iv) tele-education: the use of telematic networks to provide virtual platforms for educating and training health professionals.MethodsWe conducted a comprehensive review of the scientific works developed by the IICS-UNA in order to evaluate the systematic implementation of Telemedicine in Paraguay. Documents, pilot projects (satellite telegraphy), telediagnostic research, telematics, tele-education, published articles, and statistical data (number of patients attending or studies performed, etcetera) relating to the implementation of the National Telemedicine System by the Ministry of Public Health and Social Welfare since 1999 were reviewed.ResultsImplementation of the telemedicine system has meant that 472,038 patients have attended referral centers nationwide, with 297,999 electrocardiographs, 165,323 computed tomography scans, and 8,697 electroencephalograms being conducted. Projects developed within the framework of the Telemedicine Research Line have included the following: (i)Development and validation of a clinical telemicroscopy system based on cellular telephony;(ii)Implementation of a telemetry system for temperature monitoring of the collection of biological samples from a biomedical research center; and(iii)Production and development of a virtual campus at the National University of Asunción.ConclusionsGiven the current healthcare environment, developing a line of research based on telemedicine is a proactive step, since telemedicine provides an alternative solution to the problem of access to the health system. That is why the IICS-UNA Biomedical Engineering and Imaging Department has developed telemedicine as one of its main lines of research.

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