You are currently browsing revere's articles.
by revere, cross-posted from Effect Measure
It’s being described as a “dramatic settlement” that will set a pattern for the nation. Let’s hope so, because the agreement reached yesterday by the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC) and hospital player Catholic Healthcare West (CHW) sounds like just what the doctor ordered. It covers 32 CHW facilities in California and Nevada, where CNA/NNOC represents 13,000 registered nurses.
Some details:
by revere, cross-posted from Effect Measure
Some people find posts like this tiresome. There are so many things that need doing and so little time and resources to do them. Adding to the list makes our eyes glaze over. I understand. But that doesn’t make this any less of a Big Deal.
by revere, cross-posted from Effect Measure
We’ve gotten the question here fairly frequently: If antivirals (Tamiflu, Relenza) for swine flu work best when given early but shouldn’t be given to people who aren’t really that sick, how do you balance waiting for them to get sick and have the drugs not work well with giving it when you don’t need to? There is no absolutely right answer to this difficult question. Early in the pandemic antivirals were being given prophylactically to stop spread, then they were being given only when a diagnosis of swine flu was confirmed. Then only to the sickest patients. We’re all on a learning curve. The latest recommendations from CDC try to walk the narrow line between over use and under use, taking into account that missing early treatment could endanger the lives of some patients who go on to serious illness. So the trick is to initiate early treatment for those at highest risk, even if some, or any, test results aren’t available or aren’t positive. For those patients, “empiric antiviral treatment” is indicated. Empiric treatment means use the drugs and ask questions later. From CDC’s Health Alert Network for health departments and clinicians:
by revere, cross-posted from Effect Measure
Monday morning, start of week three of the official flu season (which began October 4). CDC’s scientific spokeswoman on the flu, Dr. Anne Schuchat has said we are seeing “unprecedented” flu activity for this time of year, including an unusual toll in the pediatric age group. What does “unprecedented” mean? It’s not very specific on what precedents are included, but if we confine ourselves to the three years before this one, we can get a good idea of just how unusual this flu season is. This week CDC unveiled a new graphic for their Emerging Infections Program (EIP) (I liked the old one better; this one is not very legible), the component of the surveillance system that tracks laboratory-confirmed influenza-associated hospitalizations in children and adults. It collects data in 60 counties covering 12 metropolitan areas of 10 states (San Francisco CA, Denver CO, New Haven CT, Atlanta GA, Baltimore MD, Minneapolis/St. Paul MN, Albuquerque NM, Las Cruces, NM, Albany NY, Rochester NY, Portland OR, and Nashville TN). It appears CDC has added six new sites (in IA, ID, MI, ND, OK and SD), but the data here are for the original 10 so comparisons can be made. This is a passive surveillance system that reviews hospital laboratory, admissions and infection logs at sites chosen to allow calculation of rates per population in the hospital catchment areas. Here is what the graphic looks like as of last Friday:
by revere, cross-posted from Effect Measure
I’ve been asked a number of times why I am bothering to get both flu vaccines this year (the seasonal flu trivalent vaccine and the swine flu vaccine when it is my turn). I am in the older age group (last in line for swine flu vaccine) and it is my group that is hit the least hard from the swine flu virus. But there are a lot of us and we still being hit. I don’t know if I will be one of the unlucky few in my age group who draws the short straw or not, and I’d rather get vaccinated with an acceptably safe vaccine than take a chance in winding up having a machine breathe for me or not breathing at all. Moreover, we aren’t sure what’s going on with the relative lack of impact in my age group. It is possible (although truthfully I don’t think it is the most likely thing) that we are still being infected and shedding virus in reasonable numbers but some kind of cross-reactivity obtained in a past infection of a long history of yearly vaccinations is sparing us more serious clinical outcomes. After all, about a third of flu cases are asymptomatic under any conditions. So why care? Because it might mean I could still pass it on to family, friends and co-workers.
by revere, cross-posted from Effect Measure
If you are hesitating to be vaccinated for swine flu this year, perhaps this post will help you make up your mind. If it does, I hope it pushes you to get vaccinated, but whatever persuasion we attempt here will only be from a recital of what we know of the epidemiology of this pandemic. Because it is the different epidemiology that is the main feature, not the clinical characteristics or the virulence of the virus. So far this looks pretty much like a standard influenza A virus — except for the epidemiology. Since I’m an epidemiologist, you might expect me to think this is important, and I do. Epidemiology is the public health science that studies the patterns of illness in populations. One kind of pattern we study is who is getting sick. And it is a change in this pattern that is one of the big differences between a pandemic strain and a seasonal strain.
by revere, cross-posted from Effect Measure
A Catholic hospital system in Arkansas seems to have come up with an innovative solution to encouraging health care workers be vaccinated while allowing them the autonomy to make their own decision. When we last brought up this question one of our commenters said he’d like to see a button on health care workers that said, “I’m not vaccinated.” St. Vincent hospital system seems to have figured out a way to do this while still protecting both the worker and the patient. The idea is surprisingly simple:
by revere, cross-posted from Effect Measure
In an earlier post I said I opposed mandatory vaccination for adults (but not for children), the one exception being for health care workers because they come in contact with people at high risk. My view then was that if you work in a health care institution and won’t get vaccinated against flu, then you shouldn’t come to work. Now I am re-evaluating my position as a result of some cogent and pragmatic comments from lawyer-bioethicist George Annas, professor of health law, bioethics and human rights at Boston University School of Public Health, and author of “The Rights of Patients.” I know Annas to be pro-vaccination and unambiguous about mandatory vaccination for children. His (and my attitudes) about adults is that there is a primacy to the principle of autonomy, as bioethicists frame it, and that no one who is competent to decide for themselves should be legally forced to be vaccinated. But we differed on the matter of health care workers because I felt that while they might be able to decide for themselves, they had no right to put their patients at risk. But Annas has argued — I think persuasively — that legally requiring vaccination for health care workers would backfire:
by revere, cross-posted from Effect Measure
For the first time in medical history we may be seeing an influenza pandemic unfold in real time, but that doesn’t mean we know what we are seeing. There remains some uncertainty about virulence, both in terms of how often it kills and how it kills when it does kill. You’d think both would be easy to determine, but those who have been following along know the problem of how often infection with this virus kills is made almost impossible by not knowing how many people it is infecting. But what about the question of how it kills? There are mainly three scenarios of interest: primary viral pneumonia (the flu virus destroys the deep lung tissue on its own); primary viral pneumonia superimposed by a secondary bacterial infection; death by secondary bacterial invaders with the damage from the flu virus playing little part. In seasonal flu and previous pandemics bacterial infection has played a prominent part in the immediate cause of death. Two small series reporting clinical details of severe cases have been previously reported, 30 hospitalized cases from California and subsequently 10 critical care patients in Michigan. Neither showed evidence of bacterial co-infection. If this virus is acting differently we need to know it.
by revere, cross-posted from Effect Measure
A good story by the AP’s Lauran Neergaard yesterday highlighted the need for better public health surveillance and the efforts being made to improve it so as to keep track of possible rare side effects from the swine flu vaccine. This is an issue we’ve talked about a lot here, most recently in the context of not being able to fully test any vaccine for rare adverse outcomes prior to deployment. There’s more involved than that, but first here’s Neergaard’s lede:
