By P. Pyran. Kutztown University of Pennsylvania.

Monitoring health in Europe: opportunities effective 8mg ondansetron, challenges purchase ondansetron 8 mg free shipping, and progress Eur J Public Health 13 (supplement 3): 1-4 buy 4mg ondansetron mastercard, 2003. The generic term for such indicators is health expectancies and they are summary measures of population health combining information on survival with the prevalence of a health measure (Robine 2006). The most common health measure used is disability, producing disability-free life expectancy. Background to health expectancies Research on health expectancies dates back to the 1960s. Being independent of the size of populations and of their age structure, health expectancies allow direct comparison of the different groups that make up populations: e. Since that time health expectancies have been increasingly used in developed countries to assess the evolution of a populations health status, in particular that of older people (Robine et al. However comparison between countries remained almost impossible due to national differences in the morbidity data collected, particularly in the study design, the health concepts used and the wording of questions. In total 10 instruments were proposed with their exact wording in English (Box 1). The set allows in theory the computation of many health expectancies covering the totality of the conceptual framework of the measurement of population health. Similar methodology was used in the development of the 10 health indicators: a systematic review of the literature on the concept and wording of questions and their previous use in surveys. Do you suffer from (have) any chronic (long-standing) illness or condition (health problem)? For the past 6 months or more have you been limited in activities people usually do because of a health problem? Ultimately 9 indicators were chosen: chronic morbidity (global and detailed); activity limitation (global); perceived health (global); physical and sensory functional limitations; personal care activities; household care activities; other activities; and mental health. Indeed it is crucial that even if existing 293 items are taken from current European Surveys, existing translations are not automatically taken but that new translations following a standard scientific protocol are undertaken. However 2003-2004 was a transitional period, during which data were provided by national sources with post- harmonisation giving a break in series. Considerable disparities are evident between the European Member States in the level of chronic morbidity reported by the population. The reported prevalence in women is higher than that for men within every Member State though the gender gap varies from 2. However men and women give the same picture of the diversity of chronic health problems reported in Europe. Briefly this entails applying the age and gender specific prevalence of chronic morbidity, presented in the previous section, to the life table for the corresponding years of the survey from which the prevalence data were obtained. The gender gap in life expectancy at age 65 within Member States in 2005 was only 2. There appeared to be little relationship between the increase over the period 1995 -2005 and life expectancy at age 65 in 1995 for either men or women. Thus there was no evidence that Member States with the highest life expectancies at the beginning of the period were showing signs of reaching a maximum value. On average increases in the later period were marginally greater than those in the early period. Increases in the two periods remained constant in Austria, Portugal, Sweden and United Kingdom in men and Austria in women. In Lithuania for both men and women life expectancy at age 65 declined in the period 2000-2005. Years with chronic morbidity at age 65 Applying the prevalence of chronic morbidity within age groups to the life tables gives the expected years spent with chronic morbidity. As with most health measures women spend a greater number of years but also a greater proportion of their remaining longer life with chronic morbidity. The evidence from Europe does not appear to support that Member States with longer life expectancy have longer healthier life expectancy or rather that they have less life expectancy with chronic morbidity. However there appears little evidence that Member States with the lowest proportion of unhealthy life (spent with chronic morbidity) are also those with the longest overall life expectancy at age 65. Health expectancies such as life expectancy with chronic morbidity offer the means to monitor that reducing the longevity gaps in Europe and increasing life expectancy will be accompanied by better health and quality of life. Gaps in life expectancy with chronic morbidity at age 65 are even greater than for life expectancy over 7 years for men and almost 9 years for women. Indeed after almost 20 years of research on health expectancies (Robine et al 2003b), on both sides of the North Atlantic governmental authorities request these simple and robust indicators to monitor the quality of life and support active ageing and employment in the context of lengthening of life. In addition greater care has been taken to ensure optimal translation to the underlying health concepts.

Repeat the radiograph if you have doubts about a If it is a tension pneumothorax 8 mg ondansetron with visa, this is a critical persisting or recurrent pneumothorax discount ondansetron 8 mg without prescription. So much air has filled the pleural space that the mediastinum is pushed to the opposite hemithorax buy discount ondansetron 8 mg line, If the pneumothorax is iatrogenic, (e. Immediately nd insertion of a central venous line), treat this initially with insert a large cannula or needle in the 2 intercostal space, puncture and aspiration alone. Keep the patient under in the mid-clavicular line, and as soon as you can, insert a th observation and repeat a chest radiograph after 24hrs. Or, insert drains simultaneously if via the chest drain into the pleural space using a wide bore someone can assist you. This causes an adhesive inflammation, and is often very painful; so use copious analgesics. Repeat the chest radiograph after 24hrs, and if chest wall) and there is no breathlessness, observe there is only minimal fluid and residual air, remove the the patient for 24hrs and repeat the chest radiograph. If this fails, wait a week, and if the pneumothorax If the rim has enlarged, aspirate as below. You should advise a patient to avoid non-pressurized air travel till the pneumothorax is Avoid positive pressure ventilation in anyone with a completely resolved, and to avoid smoking and deep sea pneumothorax: it may enlarge catastrophically! One of the first historical tasks of medicine was to comfort the dying and relieve their suffering. You can: unfortunately to preventable disease complicated by (1) Always alleviate intolerable pain with drugs. This usually needs only simple drugs, which are so often successful that they should be available to everyone. For example, them provide no terminal care whatever: its provision is a gastrostomy (13. He must feel welcomed by people who are determined to Usually, there is no further need for antihypertensive, help him. There is always something to be done to make diuretic or oral hypoglycaemic drugs in the final stages of his last days more bearable, even if he is dying. Assess carefully whether you should him back home immediately; he has come to you for help. A long family discussion may have taken place before he came, and if you send him back home without extensive Tell the patient, and his family, about his illness. Usually, you will have to tell his family, who may be induced also to reject him as a the full story to the patient and a responsible relative. Actively exclude any differential Many patients do not really understand what malignancy is diagnosis that may be curable. In contrast, many patients have thanked their doctors for Remember the stages of grief (according to the telling them the truth. It gives them time to prepare for Kbler-Ross model): denial, anger, opposition and finally their own end. You will have to decide whether to continue to treat him in Unfortunately, some patients cannot accept the whole truth hospital, or at home. How much of the (1),The extent of the suffering he will undergo at home truth is he really able to take at a time? Whatever you tell from bed sores, from malignant ulcers, and from difficulty him, it must be true. For example, if he needs once, but you must not minimize the problems by a catheter which must be changed every month, is there a obscuring the realities. Do not be drawn into telling a patient how long he has got to live because you may be hopelessly wrong, and many patients and their relatives may take your answer literally if you give a figure or a date! If one of the differential diagnoses is a curable condition, be sure to investigate sufficiently to exclude it. So do not accept a diagnosis of malignant disease until it is confirmed, preferably by biopsy. If you later try to tell them the diagnosis was wrong, they will be confused and lose confidence in you. Many patients have indeed been palliated for supposedly malignant disease, only to be shown at post mortem to have had some treatable condition. However, a conscientious doctor took a good history, examined her and did one relevant blood test: she was thyrotoxic! The perception of Remember palliative surgery may be very effective in pain pain is profoundly modified by his psychological state, relief especially in situations of obstruction: colostomy for and by spiritual, social, and financial factors. The effects of opioids and non-opioids are additive, and make a useful combination, in that non-opioids act peripherally, whereas opioids act centrally. Make sure you use them before the pain Prescribe a patient the right dose of the right drug at the right time. Use the oral route, where the gastro-intestinal tract is After Cancer pain relief and palliative care. Pain precipitated of strict controlled drug control policies within the by movement is likely to be less easily relieved than hospital.

To be successful in comprehending a basic food label requires three sets of skills including: numeracy (numbers) order ondansetron 8mg online, application of the written word (prose) and understanding of forms (documents) purchase ondansetron 4mg without a prescription. In essence discount ondansetron 4 mg overnight delivery, the comprehension of a food label mirrors the same analytical and conceptual skills necessary for following health care providers clinical instructions. The second instrument, The Dutch Heart Failure Knowledge Scale encompasses a wide knowledge base necessary for effective disease self-management of heart failure. Of significance, this instrument measures individual participants knowledge of heart failure, diet and fluid intake and recognition of early symptoms to report to their healthcare provider to avert potential complications and unnecessary hospital readmissions. Prior to widespread adoption of this instrument, van der Wal and colleagues assessed the face, content and construct validity of this scale amongst heart failure patients admitted to 19 different hospitals across the Netherlands. They found that this scale was able to differentiate between high and low levels of heart failure knowledge in this patient population (N=902) with a Cronbachs alpha of 0. In regard to ethnicity, 98% of the study participants reported being Caucasian, with only 2% being African American. Among the total of 136 heart failure patients who were screened for health literacy using the Newest Vital Sign: Health Literacy tool, 76% of the cases and 90% of the control group had a high probability of limited health literacy, as depicted in Table 1. The possibility of limited health literacy was noted in 13% of cases and 6% of the control group, with adequate health literacy noted in 11% of cases and 4% of the control group. Among the same patients screened post education, aggregate responses were correct 74. This reflects an overall 8% improvement between pre and post education on the Dutch Heart Failure Knowledge Scale. However, the statistical significance of the difference in these two proportions could not be tested at this time, due to the relatively small sample size of the cases. Yet these results do support the need for further evaluation with a larger sample size, to identify whether the application of the Dutch Heart Failure Knowledge Scale and subsequent tailoring of disease specific self-management patient education exerted a statistically significant reduction in overall 30-day hospital readmission rates. Through further research, we hope to enhance our understanding of the unique contribution of knowledge transfer and health literacy to more effective disease self-management, especially amongst heart failure patients and hospital readmission rates. More importantly, patients knowledge of their disease process can be strengthened through an inter- disciplinary approach to more effective knowledge transfer, more accurate assessment of patients level of health literacy and their ability to comprehend key aspects of their disease self-management, prior to hospital discharge. The heart failure nurse specialist is in a key position to evaluate heart failure patients knowledge prior to discharge and develop a transitional care plan that is patient, knowledge and level of health literacy specific. With considerable policy attention directed at reducing unnecessary hospital readmissions and associated costs, this intervention may play a significant role in improving clinical outcomes, quality of life and disease self- management for the heart failure population. Finally, a larger sample size to further evaluate the relationship between knowledge transfer and health literacy upon heart failure patients disease self-management and unnecessary hospital readmissions is currently under development. We believe this model may help strengthen our ability to achieve this future goal. Defining and Setting National Goals for Cardiovascular Health Promotion and Disease Reduction: The American Heart Associations Strategic Impact Goal through 2020 and Beyond. From 29 patients enrolled, male patients were dominant (25 patients) with age range from 39 to 74 years old with mean of age 58. Methodes The study was performed at the National Heart Center Harapan Kita, Jakarta, and was approved by the hospital ethics committee. A femoral venous puncture and insertion of electrode into the apex of the right ventricle was performed. The onset and slope were calculated 6 7 according to the methods explained by Schmidt et al. Statistical analysis Continuous variables were reported as mean and standard deviation while categorical variables were given as the number or the percentage of subjects with the characteristic of interest. Between-group comparisons of continuous variables were performed using independent t-test. Univariate relationships were tested using Chi- Square or Fischer, whichever appropriate. Result From March to June 2007, 34 patients were recruited; two subjects experienced episodes of atrial fibrillation prior to stimulation and three people had difficult vascular access, leaving 29 patients in the study. All medicine given routinely in the outpatient clinic were still taken during this study, including nitrates (72. Hemodynamic status were monitored prior to cardiac catheterization include measures of systolic blood pressure (142 +/- 26. Based on the results of coronary angiography, majority of patients showed stenosis in two coronary arteries (44. The condition causes high sympathetic activity in response to increased levels of epinephrine and 11 norepinephrine that weakens vagal activity at cardiac level. This difference is possibly attributed to the differences in stimulation methods or race. In obesity, excessive fat mobilization occurs due to increased sympathetic activity. High sympathetic activity is counterbalanced by vagal tone by directly inhibiting excitatory sympathetic innervation and adrenergic receptor inhibition. In sympathetic and parasympathetic coordination system, there is a mechanism known as accentuated antagonism in which the increased vagal activity will weaken sympathetic activity to target organs.

Inject 50ml sterile water or saline into the This is very unlikely to happen purchase ondansetron 8mg amex, if you routinely excise a bladder and immediately aspirate it purchase ondansetron 8 mg overnight delivery. If you find bladder diverticula buy ondansetron 8 mg on line, leave them: they will become smaller now that you have relieved the If this fails to dislodge the clot, try using heparinized obstruction, unless they were very large. Do not pull the If there is an inguinal hernia present, you may repair catheter out: it may be impossible to re-insert without a this (18. If bleeding does not stop, re-insert a urethral catheter, Between 5-10% of cases of supposed prostatic obstruction making sure (by ultrasound if possible) that the balloon is are like this. Leave the catheter in situ some days and repeat bladder wash-outs till the urine stays clear. Instead, the posterior lip of the urinary meatus is unduly prominent (difficult to see with an ordinary cystoscope). A normal prostate feels -blocker and may cause postural hypotension) smooth, symmetrical, and firm, usually with a median groove and mobile rectal mucosa. Put a self-retaining retractor into the bladder, open it, and tilt the head of the table downwards slightly. Use a Langenbeck retractor, or a bent copper retractor, to draw the anterior wall of the bladder against the pubis, so that you can see the internal urinary meatus. The cuts must go deep enough to divide the circular fibres of the neck of the bladder. If schistosomiasis is the cause, there will be more fibrosis, and you will be cutting fibrous tissue rather than muscle. A, holding the sheathed (or Trucut biopsy) needle along the palmar Prostate carcinoma is the commonest male cancer >65yrs. Using your right hand, push the needle 05cm through Perineal pain suggests extensive local disease, the rectal mucosa, towards one of the prostatic lobes. Remove your finger, D, advance the outer sheath far enough to cover the biopsy jaws. Finger-guided transrectal biopsy of the prostate: a because of its oestrogen effects. Look for lytic and sclerotic (typical but There is an 80% chance that there will be a good response. It falls in response to treatment, and rises when An alternative hormonal treatment is a subcapsular the disease reactivates. If you take it immediately object to castration, but they may accept a reduction in size afterwards, you will get an abnormally high reading. This is not difficult but you may miss the least 3wks, before trying to remove it, and if then there is malignancy unless it is quite advanced. Ultrasound will still urinary retention, consider leaving it in for a further help you guide the needle, but unless you have a rectal 3wks. Hormonal treatment will usually make the prostate ultrasound probe, you will need to use a perineal route. You may feel a grating antibiotics; in itself infection will not influence the sensation, as you pass the cystoscope through the outcome of the carcinoma. A few cases are (3) bladder carcinoma infiltrating the prostate, viral: the important viral cause is mumps which occurs in (4) bladder-neck fibrosis (27. If the disease is still confined to the prostatic capsule at age <65yrs, there might be benefit from radical Chronic epididymo-orchitis is common in the sexually radiotherapy if available. Previous untreated or imperfectly treated attacks of localized radiotherapy may give much relief. If the disease is advanced or you cannot access (2) Non-specific urinary infection (usually due to E. The cause of many hydrocoeles is unknown; they may be Suggesting testicular torsion (27. A hydrocoele in an pain in the groin or lower abdomen, associated with an adult is different from one in a child, which is almost exquisitely tender testis lying horizontally in the scrotum. You must be able to differentiate a hydrocoele from an inguinoscrotal Suggesting acute epididymo-orchitis: a history of hernia by being able to get above the hydrocoele. If possible, culture hydrocoeles every 3-6months is popular with many the urine and use an appropriate antibiotic. As an alternative, sclerotherapy is useful, Suggesting schistosomiasis: small 3-5mm nodules in the but may also result in septic complications. The vas deferens is usually recurrence, insert 1ml 2% phenol with 10ml lidocaine into palpable. A continuous locking absorbable suture over Suggesting mumps orchitis: the testis is affected but the cut edge of the tunica is more reliable than interrupted the epididymis appears normal. The sac may be tense, enlarged and tender if there is a The boy will settle without treatment, but if both testes are scrotal abscess (6.

This is a highly malignant tumor with 5-year disease free survival less than 10% B ondansetron 8mg sale. This is considered a low grade tumor and when treated with complete resection has a good prognosis C order ondansetron 8mg with mastercard. Neoadjuvant chemoradiation should be administered first with surgery being reserved for nonresponders D cheap ondansetron 8mg amex. This tends to present at a slightly older age than other salivary tumors so 51 is unusual Answer 27 B. Question 28 A 75 year old man who underwent a total parotidectomy with wide resection for a malignant tumor 1 year ago presents with a new mass in his lung that is suspicious for metastatic disease. You review the pathology and operative report from his record and it states that there was perineural infiltration and skip lesions along the facial nerve. Question 29 You perform a total parotidectomy on this patient from which he seems to progress from well initially. At a 3 month follow up, he states that he experiences redness and sweating over his cheek and near his ear when he eats or even thinks about food. If the symptoms easily replicate by having him eat a lemon slice, you can consider Botox injection to see if that relieves the symptoms D. It is most likely secondary to injury and inappropriate regeneration of the auriculotemporal branch of the trigeminal nerve E. He states that he experiences nausea, occasional nonbilious emesis, and dizziness about 2 hours after he eats. If you were to check his glucose when the symptoms occur, it would most likely be high B. This usually does not improve with conservative treatment so you should anticipate converting him to a Roux-en-Y C. This is most likely due to retained antrum so you will need to consider repeat resection Answer 30 C. He experiences frequent epigastric pain after meals with subsequent bilious vomiting that does not relieve the pain. This is most likely due to retained antrum so you will need to consider repeat resection D. On postoperative day 1 he is experiencing severe abdominal pain and nonbilious emesis. You obtain imaging which is concerning for a markedly dilated bowel limb proximal to the anastomosis. You would be less likely to have this complication if you did an antecolic gastrojejunostomy C. In the chronic form (from partial obstruction) patients may develop microcytic anemia E. This picture is concerning for afferent limb obstruction- the patient needs intervention as he is high risk for duodenal stump blowout. Preoperative multiagent chemotherapy and radiation followed by resection 6 weeks after treatment B. Alpha-ketoglutarate Question 2 (of 3) The primary fuel source for small bowel is: A. Alpha-ketoglutarate Question 3 The primary fuel source for cancer cells is: A. It is thought that tube feeds with glutamine may help decrease gut translocation in patients with sepsis, trauma, etc. Question 4 During prolonged starvation the brain switches from using glucose to using: A. The brain switched from glucose to ketones after prolonged starvation Question 5 The p53 tumor suppresor gene is primarily involved in A. P53 is primarily involved in cell cycle regulation and apoptosis Question 6 Hyperacute rejection following organ transplantation is most often due to: A. New proteinuria is most consistent with renal vein thrombosis Question 9 The maximum amount of collagen in a wound occurs at: A. After that the amount of collagen stays the same but continued cross-linking improves strength Question 10 Diaphragm injuries are: A. Diaphragm injuries are more common with blunt trauma and on the left as the liver protects the right side. Question 12 You perform a laparotomy in the previous pt and find a large left sided retroperitoneal hematoma that extends above the celiac artery. Because the hematoma extends above the celiac artery a Mattox maneuver is not going to give you proper exposure. Replace the infradiaphragmatic clamp with a suprarenal clamp, perform primary repair C. The left renal vein has the adrenal vein and gonadal vein collaterals making ligation of the left renal vein safe. This effectively causes more water reabsorption Question 15 All of the following are true about nitric oxide except: A.

These indices are sometimes used to assess protein and muscle status buy ondansetron 4mg with amex, but they are rather nonspecific (12 buy 4mg ondansetron free shipping,13) buy ondansetron 4mg with visa. Many of the acute- and negative-phase reactants are used to assess the short-term visceral protein status in individuals. This section focuses on albumin and transthyretin because they are the most common biomarkers for protein used in clinical practice. Serum albumin is commonly used in clinical settings to assess protein status in individuals, although it is of only limited utility because it is affected by many other factors, including the presence of inflammation. Although it is true that serum albumin decreases with protein restriction, it changes little with energy restriction (12). It has a relatively long half-life of about 20 days and it changes only slowly (12). Low levels of serum albumin are associated with liver disease, pregnancy, increased capillary permeability, and overhydration. Transthyretin is a transport protein that binds with thyroxin and retinol-binding protein (12). It is another negative acute-phase reactant, and decreases in response to stress and infection, but it is also altered by zinc status (12). The advantages to using transthyretin are its short half-life, which is about 2 days (12,13), making it more sensitive to changes. However, it also has all of the disadvantages that have been described for serum albumin, including lack of specificity and high cost (12). Creatinine is found primarily in the muscles and is sometimes used as an indicator of muscle mass and adequate energy status. Serum creatinine is 22 Part I / Introduction to Rheumatic Diseases and Related Topics affected by disease and diet. A high consumption of muscle meats that contain creatine in the diet may give rise to high serum creatinine. A complete 24-hour urine collection is best, but collecting 24-hour urine samples may be difficult for ambulatory patients. The skeletal muscle mass (in kilograms) is sometimes very roughly estimated with this equation: the 24-hour urinary creatinine (grams per day) is multiplied by 18. Urinary creatinine levels are increased with exercise and with high meat intake (13). Urinary 3-methylhistidine is found only in muscle and is associated with muscle mass. A complete 24-hour urine 3-methylhistidine collection is required to obtain estimates of muscle mass. Calcium Serum calcium levels may be measured using total calcium or ionized calcium tests, but both are tightly controlled and change little in response to diet; hence, they are rarely used for nutritional status assessment. Calcium is primarily transported in the blood either freely or bound with albumin, and it is involved in muscle contraction and blood clotting (13). The regulation of calcium and phosphorus levels in the blood is influenced by vitamin D, calcitonin, and parathyroid hormone (15). Iron There are many types of nutrition-related alterations to red blood cell and hemoglobin synthesis, including iron-deficiency anemia, folate-related anemia, and vitamin B12- deficiency anemia. Other non-nutritional conditions may contribute to microcytic or macrocytic anemias and should be considered when evalu- ating the biomarkers. If anemia of chronic disease is present, increased ferritin levels are not representative of iron-deficient status. For example, individuals with arthritis who are truly iron-deficient may have elevated or normal serum ferritin levels. It is important to evaluate each biochemical test and disease state to determine if iron supplementation is warranted. Hyperglycemia Fasting blood glucose helps to identify abnormal glucose metabolism owing to diabetes or drugs. These tests are particularly important for those with obesity, a family history of heart disease, atherosclerosis, or diabetes. It is important to ensure that individuals fast for 12 hours before the blood draw. Markers of Inammation Many of the acute-phase proteins are used to assess the presence of inflammation. A common medication and nutri- tional interaction is between the anticoagulant, warfarin, and vitamin K, which compete with each other for the same binding site in the coagulation cascade (17). Clinical manifestations occur late and are nonspecific, and may also be related to other conditions or multiple nutrient deficiencies. These signs and symptoms may be caused by a disease, medication, or nutritional deficiency.

Here are some examples of what the safety/infection control and prevention offcers will ensure ondansetron 4mg sale. August 2007 Student Manual 5-25 International Association Infectious Diseases of Fire Fighers Unit 5 Avian & Pandemic Infuenza Page left blank intentionally buy ondansetron 4mg cheap. Infuenza is spread from person to person by contact with respiratory secretions from an infected person order ondansetron 8mg fast delivery. When an infected person coughs or sneezes, large droplets carrying the virus land on the surfaces of the upper respiratory tracts of persons who are within three feet of the infected person. The virus can also spread by direct or indirect contact with respiratory secretions touching contaminated surfaces and then touching the eyes, nose, or mouth. Respiratory Protection During the class discussion, use the space below to take notes on respiratory protection. Surgical mask N-95 P-100 August 2007 Student Manual 5-27 International Association Infectious Diseases of Fire Fighers Unit 5 Avian & Pandemic Infuenza Page left blank intentionally. If you taste or smell the agent, you will test another disposable mask size (or type). Immediately after activities involving contact with a patients body fuids, gloves should be removed and discarded and hands should be cleaned. Do not rub eyes after using eyewear, or after handling patients or equipment until you have thoroughly washed your hands. You are dispatched as part of Ladder Company to West Point Drive where a -year-old male complains of shortness of breath. As you talk to him, he reveals that he works as a consultant to a company that produces down comforters and has spent a great deal of time in factories that house ducks. If the turnout gear is visibly contaminated by bodily fuid, it should be placed in a biohazard bag at the scene and washed, following prescribed laundry procedures. The vaccine could be used in the event the current H5N avian virus were to develop the capability to effciently spread from human to human, resulting in the rapid spread of the disease across the globe. Should such an infuenza pandemic emerge, the vaccine may provide early limited protection in the months before a vaccine tailored to the pandemic strain of the virus could be developed and produced. The vaccine was obtained from a human strain and is intended for immunizing people 18 through 64 years of age who could be at increased risk of exposure to the H5N1 infuenza virus contained in the vaccine. H5N1 infuenza vaccine immunization consists of two intramuscular injections, given approximately one month apart. The vaccine has been purchased by the federal government for inclusion within the National Stockpile for distribution by public health offcials if needed. The study showed that 5 percent of individuals who received the 0 microgram, two-dose regimen developed antibodies at a level that is expected to reduce the risk of getting infuenza. Although the level of antibodies seen in the remaining individuals did not reach that level, current scientifc information on other infuenza vaccines suggests that less than optimal antibody levels may still have the potential to help reduce disease severity and infuenza-related hospitalizations and deaths. National Institutes of Health and other government agencies and manufacturers are working to develop a next generation of infuenza vaccines for enhanced immune responses at lower doses, using technologies intended to boost the immune response. Meanwhile, the approval and availability of this vaccine will enhance national readiness and the nations ability to protect those at increased risk of exposure. Work individually to describe how you will prepare for an outbreak of pandemic fu. A5- 2 Unit 5 Appendices August 2007 Infectious Diseases International Association Unit 5 Avian & Pandemic Infuenza of Fire Fighters Appendix 5-A Facilitators Guide to Preparing for a Pandemic Flu: What First Responders Need to Know A Shift-Based Training Program August 2007 Unit 5 Appendices A5- International Association Infectious Diseases of Fire Fighers Unit 5 Avian & Pandemic Infuenza Page left blank intentionally. A5- Unit 5 Appendices August 2007 Infectious Diseases International Association Unit 5 Avian & Pandemic Infuenza of Fire Fighters Facilitators Guide to Preparing for a Pandemic Flu: What First Responders Need to Know A Shift-Based Training Program Overview Many health experts believe that the next outbreak of a pandemic fu isnt a question of if, but when. This training program is for frst responders who play a vital role in outbreak response. It is crucial that rank and fle fre fghters learn basic information about the pandemic fu to protect themselves, their families, their department and their community. This program provides hands-on activities and discussion questions to teach frst responders to prepare for a major emergency, such as a pandemic fu outbreak. Learning objectives Predict and summarize effects of a pandemic fu on the individual, family, the department, the community and nation. Materials needed White board, chalk board, easel w/ pad or white paper taped to wall Markers Facilitator Instructions 1. Guided Discussion on the Pandemic Flu (10 minutes) To understand bigger picture of a pandemic fu outbreak, start with basic facts about the pandemic fu. Suggested responses : A pandemic is an outbreak that spreads across a region There is the potential for a current strain of the avian fu (the H5N1 strain) to begin to infect humans. Several cases have been reported, but only from bird to human transmission (not human to human).