Showing posts with label preventative medicine. Show all posts
Showing posts with label preventative medicine. Show all posts
Peds immunization mnemonics
Wonder Me!

Source: https://youtu.be/WrlVbDmCVyw & Leik & Hollier

@Birth: B ---there's only one HepB vax

Visit every 2 months:
@2mo: 2 B DR. HIP (@ 2mo: HepB, DTaP, Rotavirus, Hib, IPV, PCV)
@4mo: 4 DR. HIP (@4mo: DTap, Rotavirus, IPV, PCV)
@6mo: B DR. HIP In 6mo (HepB, Dtap, Rotavirus, Influenza, PCV in 6mo)

12mo - 18mo: 1 MAD HPV (MMR, HepA, Dtap, Hib, PCV, Varicella)

2yo: n/a
3yo: n/a

4-6yo: VERY DIM between 4-6pm (Varicella, Dtap, IPV, MMR)

11-12yo: Tada! Human! Men! (TdaP, HPV, Meningoccocal)
16-18yo: Men get boosted!

Legend:
B: Hep B
D: DTaP
R: Rotavirus
H: Hib
I: IPV
P: PCV
M: MMR
A: HepA
V or Very: Varicella
Tada: TdaP
Human: HPV
Men: MCV

NOTE for California elementary school entry: (by Qt)

Hep B: needs 3 doses (Mnemonics: Hep B = B = Bday = given at Birth, then 2 mo. later, than 4 mo. later (@ birth, 2,6 = 3 doses)

DTaP: needs 5 doses (DR HIP, DR HIP, DR HIP, MAD HPV, & Very DIM)

IPV: needs 4 doses (DR HIP, DR HIP, DR HIP, & Very DIM)

Varicella & MMR:  needs 2 doses (Varicella & MMR: live vaccines = must be given after 1 yo (@12mo & @5yo generally speaking)

MCV & HPV: not given until middle school generally


Misc notes (Vax not required for school):
Influenze not given until 6mo and older
R = Rotavirus = only given at very young age, during first few initial visits (@2,4,6mo)
HepA = given @ 1 MAD HPV





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Family med. - preventative screening
Wonder Me!
Pap smear: @21 y/o up to 70 y/o unless clinically needed.
Colonoscopy: @50 y/o unless clinically nded
Mammogram: up to 70 y/o unless clinically needed

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cologuard
Wonder Me!
Cologuard - needs insurance to clear. Tests DNA. More expensive. Sent package straight to patients at home. Does not get sent to doctor's office. Used if patients don't want colonoscopy.

Directions: open bracket, put collect box in the toilet bowl, poop, collect swab sample (not a bunch of curds) then dip in the tube. Send the box of 'poop' :") to UPS only.

 http://cdn2.hubspot.net/hub/377740/file-1661056668-pdf/patient_guide_09SEP2014.pdf?t=1411156045251


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pap smear recommendations
Wonder Me!


Pap Smear Screening:
DO: Women 21 to 65 (Pap Smear q3years) or 30-65 (in combo with HPV testing q5years) or over65 and never had one
DO NOT:
-Women younger than 30 years, HPV testing
-Women younger than 21 (regardless of sexual history)
-Women older than 65, who have had adequate prior screening (=  3 consecutive negative cytology results OR 2 consecutive negative HPV results within 10 years before cessation of screening, with the most recent test occurring within 5 years)
-Women who have had a hysterectomy
~Wonder Me! 
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Cholesterol or lipid profile
Wonder Me!


Mini-Case*: Patient - My cholesterol is 295.... Don't remember what type of cholesterol. Aren't they all the same?

 Thinking: Cholesterol values include Total cholesterol, LDL, HDL, VLDL, which one? What is what?
=> Conclusion: most likely to be 'Total cholesterol' if pt only can only report 1 # but not any other #'s.


Case*: Pt is 50y/o with diabetes. Which Cholesterol level to start on Simvastatin?
Answer: Cholesterol level doesn't matter. No need to obtain lipid panel test. Just start them on Simvastatin.

Case*:  Pt asks How does Simvastatin affect HDL and LDL?
Answer: Lower LDL but very miniscule effects on HDL








Why it works?

Blurb:



  • Total cholesterol
  • LDL (bad) cholesterol--the main source of cholesterol buildup and blockage in the arteries
  • HDL (good) cholesterol--helps keep cholesterol from building up in the arteries
  • Triglycerides--another form of fat in your blood

    • What is total cholesterol?

    Total Cholesterol (done by enzymes, measured directly from blood):  Total cholesterol can be measured directly from blood. Enzyme (cholesterol oxidase) is added to produce reaction byproducts, H2O2.  Enzyme (Peroxidase) is then added to produce color. This color is electromagnetically analyzed at 500nm. The intensity of this color is directly proportional to cholesterol concentration.

    Triglycerides (done by enzymes, measured directly from blood) - must be fasting for correct level of triglycerides

    HDL (done by special agents, measured directly from blood, read by color intensity produced from electromagnet)

    LDL: very expensive to measure directly from blood via ultra-centrifuge. So, use Friedwald equation (only correct if pt is fasting)

    LDL-Cholesterol: Most of the circulating cholesterol is found in three major lipoprotein fractions: very low density lipoproteins (VLDL), LDL and HDL.
    [Total chol] = [VLDL-chol] + [LDL-chol] + [HDL-chol]

    LDL-cholesterol is calculated from measured values of total cholesterol, triglycerides and HDL cholesterol according to the relationship: 
                              [LDL-chol] = [total chol] - [HDL-chol] - [TG]/5
     where [TG]/5 is an estimate of VLDL-cholesterol and all values are expressed in mg/dL. 



    ~Miss Student

    *All cases are fictitious. No real patient encounters. Just my rich imagination! :)


    Read lab values:
    Mnemonics: High Healthy HDL; Low Let it down LDL ~Miss Student



    Nutrition:


    Diet restrictions: 
    1 - No Alcohol 24hrs before tests (elevate #)
    2 - No eating 12 hrs before tests (elevate triglycerides)
    3 - No water restrictions

    Clinical procedure:
    - Blood lab test (venipuncture)
    - Red tube (fasting)

    Who should be screened?:
    In priority order:

    1. - All men over 35 y/o even in absence of any risk factors for CHD
    2. - Men & women >20 y/o with increased risks for coronary heart disease (CHD)
    Increased risk, for the purposes of this recommendation, is defined by the presence of any one of the risk factors listed below. The greatest risk for CHD is conferred by a combination of multiple listed factors.
    • Diabetes.
    • Previous personal history of CHD or non-coronary atherosclerosis (e.g., abdominal aortic aneurysm, peripheral artery disease, carotid artery stenosis).
    • A family history of cardiovascular disease before age 50 in male relatives or age 60 in female relatives.
    • Tobacco use.
    • Hypertension.
    • Obesity (BMI ≥30).
    10-year CVD risk factors: http://cvdrisk.nhlbi.nih.gov/

    Helpful link:
    http://www.gpnotebook.co.uk/simplepage.cfm?ID=x20030114211535665170: short need-to-know details for lipid profile info.
    (2) http://www.cdc.gov/nchs/data/nhanes/nhanes_03_04/l13_c_met_lipids.pdf: how to calculate total cholesterol => not how total cholesterol is usu. obtained since you can do measure total cholesterol by hands
    http://www.wikihow.com/Calculate-Total-Cholesterol => how lipid panel is really measured
    http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/lipid-disorders-in-adults-cholesterol-dyslipidemia-screening#consider


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    dash diet
    Wonder Me!
    DASH = Dietary Approaches to Stop Hypertension. 

     Source: https://www.nhlbi.nih.gov/health/health-topics/topics/dash

    Description of the DASH Eating Plan 

    DASH is a flexible and balanced eating plan that helps creates a heart-healthy eating style for life.
    The DASH eating plan requires no special foods and instead provides daily and weekly nutritional goals. This plan recommends:
    • Eating vegetables, fruits, and whole grains
    • Including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils
    • Limiting foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils
    • Limiting sugar-sweetened beverages and sweets.
    Based on these recommendations, the following table shows examples of daily and weekly servings that meet DASH eating plan targets for a 2,000-calorie-a-day diet.
    Daily and Weekly DASH Eating Plan Goals for a 2,000-Calorie-a-Day Diet
    Food Group
    Daily Servings
    Grains
    6–8
    Meats, poultry, and fish
    6 or less
    Vegetables
    4–5
    Fruit
    4–5
    Low-fat or fat-free dairy products
    2–3
    Fats and oils
    2–3
    Sodium
    2,300 mg*
    Weekly Servings
    Nuts, seeds, dry beans, and peas
    4–5
    Sweets
    5 or less
    *1,500 milligrams (mg) sodium lowers blood pressure even further than 2,300 mg sodium daily.
    When following the DASH eating plan, it is important to choose foods that are:
    • Low in saturated and trans fats
    • Rich in potassium, calcium, magnesium, fiber, and protein
    • Lower in sodium
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    Screening recommendations
    Wonder Me!
    good for 1st clinical: http://www.uspreventiveservicestaskforce.org


    Blurb:
    HTN: screen all adults over 18 y/o
    Diabetes type 2: screen only for adults over 18 y/o w/ elevated BP >135/80
    Lipid disorder (Cholesterol, Dyslipidemia): screen all men over 35 y/o regardless of risks; in women over 20 y/o w/ increased risks only; also screen men 20-35 y/o if w/ increased risks
    Colorectal cancer: all over 50 y/o - 75 y/o; 75-85 y/o: maybe individual choices; over 85: do NOT screen
    Breast cancer:
    screen any women w/ family members w/ breast, ovarian, tubal, or peritoneal cancer
    screen women starting at 40 y/o if parent or sibling w/ breast cancer
    may not screen women starting at 40 y/o w/ no risk factors due to over-diagnosis problems.
    screen women starting at 50 y/o every 2 years
    Thyroid: not known






    ====
    Specific details:

    Summary of Recommendations for HTN 

    PopulationRecommendationGrade
    (What's This?)
    Adults with Elevated Blood Pressure 
    The USPSTF recommends screening for type 2 diabetes in asymptomatic adults with sustained blood pressure (either treated or untreated) greater than 135/80 mm Hg.
    		The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
    Asymptomatic Adults, Not Elevated Blood Pressure 
    The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for type 2 diabetes in asymptomatic adults with blood pressure of 135/80 mm Hg or lower.
    		The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

    Summary of Recommendations for Lipid disorders - Screening Men 

    PopulationRecommendationGrade
    (What's This?)
    Men 35 and Older 
    The USPSTF strongly recommends screening men aged 35 and older for lipid disorders. 
    		The USPSTF recommends the service. There is high certainty that the net benefit is substantial.
    Men 20-35 at Increased Risk for CHD
    The USPSTF recommends screening men aged 20-35 for lipid disorders if they are at increased risk for coronary heart disease. 
    		The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.

    Summary of Recommendations for Lipid disorders- Screening Women at Increased Risk 

    PopulationRecommendationGrade
    (What's This?)
    Women 45 and Older at Increased Risk for CHD 
    The USPSTF strongly recommends screening women aged 45 and older for lipid disorders if they are at increased risk for coronary heart disease. 
    		The USPSTF recommends the service. There is high certainty that the net benefit is substantial.
    Women 20-45 at Increased Risk for CHD
    The USPSTF recommends screening women aged 20-45 for lipid disorders if they are at increased risk for coronary heart disease. 
    		The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
    Go to the Clinical Considerations section for a discussion of "increased risk".

    Summary of Recommendations for colonoscopy

    PopulationRecommendationGrade
    (What's This?)
    Adults, beginning at age 50 years and continuing until age 75 years
    The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years. The risks and benefits of these screening methods vary. 
    		The USPSTF recommends the service. There is high certainty that the net benefit is substantial.
    Adults age 76 to 85 years
    The USPSTF recommends against routine screening for colorectal cancer in adults 76 to 85 years of age. There may be considerations that support colorectal cancer screening in an individual patient.
    		The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small.
    Adults older than age 85 years
    The USPSTF recommends against screening for colorectal cancer in adults older than age 85 years.
    		The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits
    Computed Tomographic Colonography and Fecal DNA testing as screening modalities
    The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic colonography and fecal DNA testing as screening modalities for colorectal cancer. 
    		The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.

    Summary of Recommendations and Evidence 

    PopulationRecommendationGrade
    (What's This?)
    Women who have Family Members with Breast, Ovarian, Tubal, or Peritoneal Cancer
    The USPSTF recommends that primary care providers screen women who have family members with breast, ovarian, tubal, or peritoneal cancer with 1 of several screening tools designed to identify a family history that may be associated with an increased risk for potentially harmful mutations in breast cancer susceptibility genes (BRCA1 or BRCA2). Women with positive screening results should receive genetic counseling and, if indicated after counseling, BRCA testing.
    		The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
    Women Whose Family History is not Associated with an Increased Risk 
    The USPSTF recommends against routine genetic counseling or BRCA testing for women whose family history is not associated with an increased risk for potentially harmful mutations in the BRCA1 or BRCA2 genes. 
    		The USPSTF recommends against the service. There is moderate or high certainty that the service has no net benefit or that the harms outweigh the benefits
    PopulationRecommendationGrade
    (What's This?)
    Women aged 50 to 74 years
    The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
    		The USPSTF recommends the service. There is high certainty that the net benefit is moderate or there is moderate certainty that the net benefit is moderate to substantial.
    Women aged 40 to 49 years
    The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years.
    •   For women who are at average risk for breast cancer, most of the benefit of mammography results from biennial screening during ages 50 to 74 years. Of all of the age groups, women aged 60 to 69 years are most likely to avoid breast cancer death through mammography screening. While screening mammography in women aged 40 to 49 years may reduce the risk for breast cancer death, the number of deaths averted is smaller than that in older women and the number of false-positive results and unnecessary biopsies is larger. The balance of benefits and harms is likely to improve as women move from their early to late 40s.
    •   In addition to false-positive results and unnecessary biopsies, all women undergoing regular screening mammography are at risk for the diagnosis and treatment of noninvasive and invasive breast cancer that would otherwise not have become a threat to their health, or even apparent, during their lifetime (known as “overdiagnosis”). Beginning mammography screening at a younger age and screening more frequently may increase the risk for overdiagnosis and subsequent overtreatment.
    •   Women with a parent, sibling, or child with breast cancer are at higher risk for breast cancer and thus may benefit more than average-risk women from beginning screening in their 40s.
    Go to the Clinical Considerations section for information on implementation of the C recommendation.
    		The USPSTF recommends against routinely providing the service. There may be considerations that support providing the service in an individual patient. There is at least moderate certainty that the net benefit is small.
    Women aged 75 years or older
    The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older.
    		The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
    All women 
    The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer.
    		The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
    Women with dense breasts
    The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram.
    		The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of the service. Evidence is lacking, of poor quality, or conflicting, and the balance of benefits and harms cannot be determined.
    These recommendations apply to asymptomatic women aged 40 years or older who do not have preexisting breast cancer or a previously diagnosed high-risk breast lesion and who are not at high risk for breast cancer because of a known underlying genetic mutation (such as a BRCA1 or BRCA2 gene mutation or other familial breast cancer syndrome) or a history of chest radiation at a young age.
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    HTN screening
    Wonder Me!
    Screening for all adults over >18y/o, but not

    http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/blood-pressure-in-adults-hypertension-screening


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