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When a day care worker reported to employee health at Dartmouth-Hitchcock Medical Center in Lebanon, NH, with a severe, spasmatic cough that had lasted more than two weeks, an employee health nurse immediately thought of pertussis.
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Tuberculosis has been reduced to record lows in the United States since the major hospital outbreaks in the 1980s and '90s, but there is growing concern that deadly strains of extensively drug-resistant (XDR) TB may arise at a point of U.S. disinterest and waning funding, the very trough of the so-called "U-shaped curve of concern" that historically precedes TB resurgence.
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The emergence of extensively drug-resistant tuberculosis (XDR-TB) has joined with the aftershocks of SARS and the threat of pandemic flu to put respiratory protection issues for health care workers back on the front burner.
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One of the harsh lessons of the "unforgiving" outbreak of severe acute respiratory syndrome (SARS) in Toronto was the infectious risk of the undiagnosed patient. While much has been made of the respiratory protection issues and fit-testing of N95 respirators, almost three-quarters of the health care workers infected in the 2003 Toronto outbreak were treating patients who had not been diagnosed with the emerging infection, said Allison McGeer, MD, infectious disease consultant at Mount Sinai Hospital in Toronto.
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In a group of smokers who were hospitalized with cardiac symptoms, a combination of 12 weeks of behavior modification counseling plus pharmacotherapy resulted in higher tobacco abstinence rates, lower re-hospitalization rates, and markedly reduced mortality rates compared with usual care over two years of follow-up.
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When compared to The Zone, Ornish, or LEARN diets, the very low carbohydrate diet (Atkins), showed that premenopausal, overweight, and obese women lost more weight and had the most beneficial metabolic effects at 12 months.
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The FDA has approved a new oral tyrosine kinase inhibitor with potent, reversible, selective dual inhibition of epidermal growth factor receptor (EGFR) and ErbB2 kinases.
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Recommended periodic preventive services are more likely to be performed through a scheduled screening physical examination or other dedicated preventive visits.
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Because of the high cardiovascular risk associated with prehypertension, both lifestyle and pharmacological interventions should be vigorously utilized to prevent its progression to full-blown hypertension with its associated higher rates of both morbidity and mortality.
