Always check expiration date when taking OTC

As a nursing student, I learned about the 5 rights that you must always check before giving a medication to a patient: right patient, right medication, right dose, right time, and right documentation.

Two additional rights that my Adult and Elder I simulation instructor emphasized was allergies and expiration dates.

Today, I rubbed on hydrocortisone 1% for my mosquito bite. Instead of soothing, my bites started to burn. I checked the expiration date after the fact (oops) and saw that it expired in 2007. Honestly, I don’t know how I still have medication from that long ago, but I threw it out right away. So the bottom line is: CHECK THE EXPIRATION DATE before applying, injecting, or ingesting any drug.

Asian American Health Portal

This website provides a wide variety of information on Asian American Health. It’s created by the United States National Library of Medicine.

It has health and diseases topics such as blood diseases, cancer, diabetes, the flu, heart diseases, hepatitis, HIV/AIDS, lung diseases, osteoporosis, and general topics.

There is also a complementary/alternative medicine section on acupuncture, herbal medicine, tai chi/qi gong, traditional medicine, and general topics.

http://asianamericanhealth.nlm.nih.gov/

Why it’s important for Asian Americans to get the Hepatitis B vaccine

“1 in 10 Asian Americans is living with chronic Hepatitis B.” via http://www.asianliver.com/en/

“Hepatitis B vaccination is the best protection. The vaccine can be given safely to infants, children, and adults and is usually given as three doses over about 6 months. Other flexible schedules are available. Pregnant women can be given this vaccine as well. Hepatitis B vaccine is very safe, and side effects are rare. This vaccine is the first vaccine that prevents cancer; it prevents liver cancer caused by HBV infection.” via http://www.immunize.org/catg.d/p4190.pdf

Hepatitis B can be prevented through the Hepatitis B vaccine. via http://liver.stanford.edu/Education/faq.html

Why are Asian Americans at a higher risk for Hepatitis B?

Since 1986, a hepatitis B vaccine has been available and should be given to newborns and children in the United States. The vaccine, however, is unavailable—or has only recently become available—in many parts of the world. You are at higher risk for hepatitis B if you or your mother was born in a region of the world where hepatitis B is common, meaning 2 percent or more of the population is chronically infected with the hepatitis B virus. In most Asian and Pacific Island nations, 8 to 16 percent of the population is chronically infected.

via NATIONAL DIGESTIVE DISEASES INFORMATION CLEARINGHOUSE (NDDIC)

AAP Updates Polio Vaccine Recommendations

I’m so glad that the number of cases of polio has decreased significantly, from 350,000 cases in 1988 to 1600 cases in 2009. However, wild polioviruses is still common in 4 countries: Afghanistan, India, Nigeria, and Pakistan. For those who travel there, it’s recommended to get an additional dose if they have already received when they were young, or to get the 3 doses at the minimum age.

September 26, 2011 — The American Academy of Pediatrics AAP has updated its recommendation for the administration of poliovirus vaccines, clarifying the standard schedule for immunization, as well as the minimal ages and minimal intervals between doses, according to a policy statement published online September 26 in Pediatrics.

Although the use of oral poliovirus vaccine OPV beginning in the early 1960s led to the elimination of polio in the United States, with the last reported outbreak seen in 1979, wild polioviruses still occur naturally in 4 countries: Afghanistan, India, Nigeria, and Pakistan. The fact that these 4 countries exported the virus to other countries that reported polio cases in 2009 points to the potential for the virus to be brought into the United States, the AAP policy statement says.

Twenty countries reported 1349 cases of polio in 2010, and 14 countries have reported 333 polio cases through August 23 of this year.

Inactivated poliovirus vaccine IPV replaced OPV as the vaccine of choice in the United States in 2000 in an effort to prevent rare but serious vaccine-associated paralytic polio. The current vaccination schedule, designed to produce immunity early in life, calls for 3 doses of IPV at 2, 4, and 6 through 18 months of age, and a fourth dose at 4 through 6 years of age. The AAP recommends that if risk for exposure is imminent, such as when a person travels to 1 of the 4 countries with wild polioviruses, then the doses should be administered at the minimum ages and intervals.

Within the United States, pockets of underimmunized children could lead to an outbreak if the wild viruses migrate to where those children are living, the AAP says.

The AAP statement says that after an individual receives the IPV series of doses, immunity is “long-term, possibly lifelong.” However, another recommendation in its statement is that even adults who completed immunization with OPV or IPV early in life get a single dose of IPV if they are at increased risk for exposure to wild poliovirus in 1 of the countries.

Three combination vaccines and 1 stand-alone vaccine are licensed in the United States. Diphtheria and tetanus toxoids and acellular pertussis adsorbed, hepatitis B DtaP-HepB-IPV; Pediarix, GlaxoSmithKline, is licensed for the first 3 doses and through 6 years of age. DtaP, IPV, and Haemophilus influenza type b DtaP-IPV/Hib; Pentacel, Sanofi Pasteur is licensed for all 4 doses through 4 years of age. DtaP-IPV Kinrix, GlaxoSmithKline is licensed for the last dose at ages 4 through 6. IPV Poliovax, Sanofi Pasteur, the stand-alone vaccine, is licensed for all doses in infants, children, and adults.

The World Health Assembly set a goal in 1988 of eradicating polio worldwide. At that time, an estimated 350,000 cases of polio existed in 125 countries. That number decreased to 1604 cases in 2009.

Pediatrics. Published online September 26, 2011.

via AAP Updates Polio Vaccine Recommendations.

2 out of 3 maternal deaths were due to maternal obesity :(

This is a sad article on obesity, moms and babies. Now it’s time to talk to people about how they can maintain a healthy weight.

http://www.nytimes.com/2010/06/06/health/06obese.html

As Americans have grown fatter over the last generation, inviting more heart disease, diabetes and premature deaths, all that extra weight has also become a burden in the maternity ward, where babies take their first breath of life.

About one in five women are obese when they become pregnant, meaning they have a body mass index of at least 30, as would a 5-foot-5 woman weighing 180 pounds, according to researchers with the federal Centers for Disease Control and Prevention. And medical evidence suggests thatobesity might be contributing to record-high rates of Caesarean sections and leading to more birth defects and deaths for mothers and babies.

Hospitals, especially in poor neighborhoods, have been forced to adjust. They are buying longer surgical instruments, more sophisticated fetal testing machines and bigger beds. They are holding sensitivity training for staff members and counseling women about losing weight, or even having bariatric surgery, before they become pregnant.

At Maimonides Medical Center in Brooklyn, where 38 percent of women giving birth are obese, Patricia Garcia had to be admitted after she had a stroke, part of a constellation of illnesses related to her weight, including diabetes and weak kidneys.

At seven months pregnant, she should have been feeling the thump of tiny feet against her belly. But as she lay flat in her hospital bed, doctors buzzing about, trying to stretch out her pregnancy day by precious day, Ms. Garcia, who had recently weighed in at 261 pounds, said she was too numb from water retention to feel anything.

On May 5, 11 weeks shy of her due date, a sonogram showed that the baby’s growth was lagging, and an emergency Caesarean was ordered.

She was given general anesthesia because her bulk made it hard to feel her spine to place a local anesthetic. Dr. Betsy Lantner, the obstetrician on call, stood on a stool so she could reach over Ms. Garcia’s belly. A flap of fat covered her bikini line, so the doctor had to make a higher incision. In an operation where every minute counted, it took four or five minutes, rather than the usual one or two, to pull out a 1-pound 11-ounce baby boy.

Studies have shown that babies born to obese women are nearly three times as likely to die within the first month of birth than women of normal weight, and that obese women are almost twice as likely to have a stillbirth.

About two out of three maternal deaths in New York State from 2003 to 2005 were associated with maternal obesity, according to the state-sponsored Safe Motherhood Initiative, which is analyzing more recent data.

Obese women are also more likely to have high blood pressure, diabetes, anesthesia complications, hemorrhage, blood clots and strokes during pregnancy and childbirth, data shows.

The problem has become so acute that five New York City hospitals — Beth Israel Medical Center and Mount Sinai Medical Center in Manhattan, Maimonides in Brooklyn andMontefiore Medical Center and Bronx-Lebanon Hospital Center in the Bronx — have formed a consortium to figure out how to handle it. They are supported by their malpractice insurer and the United Hospital Fund, a research group.

One possibility is to create specialized centers for obese women. The centers would counsel them on nutrition and weight loss, and would be staffed to provide emergency Caesarean sections and intensive care for newborns, said Dr. Adam P. Buckley, an obstetrician and patient safety expert at Beth Israel Hospital North who is leading the group.

Very obese women, or those with a B.M.I. of 35 or higher, are three to four times as likely to deliver their first baby by Caesarean section as first-time mothers of normal weight, according to a study by the Consortium on Safe Labor of the National Institutes of Health.

While doctors are often on the defensive about whether Caesarean sections, which carry all the risks of surgery, are justified, Dr. Howard L. Minkoff, the chairman of obstetrics at Maimonides, said doctors must weigh those concerns against the potential complications from vaginal delivery in obese women. Typically, these include failing to progress in labor; diabetes in the mother, which can lead to birth complications; and difficulty monitoring fetal distress. “With obese women we are stuck between Scylla and Charybdis,” Dr. Minkoff said.

But even routine care, like finding a vein to take blood, can be harder through layers of fatty tissue.

And equipment can be a problem. Dr. Janice Henderson, an obstetrician for high-risk pregnancies at Johns Hopkins in Baltimore, described a recent meeting where doctors worried that the delivery room table might collapse under the weight of an obese patient.

At Maimonides, the perinatal unit threw away its old examining tables and replaced them with wider, sturdier ones. It bought ultrasound machines that make lifelike three-dimensional images early in pregnancy, when the fetus is still low in the uterus and less obscured by fat, but also less developed and thus harder to diagnose clearly. “You really need to use the best equipment, which is more expensive,” said Dr. Shoshana Haberman, the director of perinatal services.

Many experienced obstetricians complain that as Americans have grown larger, the perception of what constitutes obesity has shifted, leading to some complacency among doctors. At UMass Memorial Medical Center in Worcester, Mass., Dr. Tiffany A. Moore Simas, the associate director of the residency program in obstetrics, demands that residents calculate B.M.I. as a routine part of prenatal treatment. “It’s one of my siren songs,” Dr. Moore Simas said, “because we are very bad at eyeballing people.”

Dr. Haberman said there was obesity in her own family, and she had seen how hurtful even professionals could be. “We as a society have issues with the perception of obesity; anatomically, you get turned off,” she said.

So she was sympathetic to Ms. Garcia, making sure she got a room with a window, and calling to check on her after hours.

Ms. Garcia, 38, a former school bus dispatcher, is 5 feet tall. She said she had tried diets, weight-watching groups and joining a gym. She was 195 pounds before her pregnancy (B.M.I., 38) and ballooned to 261 pounds, which she attributed to water weight and inactivity.

“I’m the smallest one in my family,” she said. Her older brother weighed more than 700 pounds before having gastric bypass surgery.

She wiped tears away as she confessed that she worried that she might die and leave her baby without a mother.

At Ms. Garcia’s stage of pregnancy, every day in the womb was good for the baby but bad for the mother, Dr. Minkoff said. “She’s making a heroic decision to put her own self in peril for the sake of the child,” he said.

She survived, but was dismayed by the size of her son, Josiah Patrick, who had to be put on a breathing machine. At first she could see him only by remote video. But after a month, Josiah was off the ventilator, taking 15 milliliters of formula and had smiled at his mother, and doctors said he was where he should be developmentally for a preemie his age.

The hospital estimated that the cost of caring for the mother and baby would be more than $200,000, compared with $13,000 for a normal delivery.

Ms. Garcia promised Dr. Minkoff that she would lose weight and see her baby graduate from college. “I’m going on a strict, strict, strict diet,” she said. “I’m not going through this again.”

API Medical Traditions

Asian medical tradition centers on a belief in the interconnectedness of the mind, body, and spirit and the need for balance and a holistic approach to the treatment of illness. In this session, you will look at some of the traditional beliefs that shape Asian medicine. Understanding and acknowledging these beliefs can help you provide a better foundation for helping your patients make intelligent health care decisions.

Many Asian patients must reconcile traditional beliefs with Western concepts of health and illness. Patients subscribe more firmly to traditional or western beliefs based on their age, education, language proficiency, length of time in the US, and general assimilation into Western culture. An awareness of AAPI medical tradition will permit you to ask appropriate questions regarding health beliefs, demonstrate respect and sensitivity for your patient’s culture, and ultimately strengthen your relationships with your AAPI patients.

via Providers Guide.