Cristina Chipriano says while Latinos aren’t monolithic “there are influences of Catholicism within the cultural values...a stigma exists because of the influence the church has on the cultural value of what happens after a suicide death.” She explains that for some Latino families after a suicide, when they finally share what happened, oftentimes blame is placed on a surviving family member.
hmmm..
He or she shall submit a report to the Board of Corrections, the person in charge of the jail or detention facility, and to the city governing body.
He or she shall submit a report to the Board of Corrections, the person in charge of the jail or detention facility, and to the city governing body.
He or she may make additional investigations of any city jail or detention facility as he or she determines necessary.
He or she may make additional investigations of any city jail or detention facility as he or she determines necessary.
In any city having a health officer, the city health officer shall investigate health and sanitary conditions in every city jail and other detention facility at least annually
In any city having a health officer, the city health officer shall investigate health and sanitary conditions in every city jail and other detention facility at least annually.
He or she may make additional investigations of any county jail or other detention facility of the county as he or she determines necessary.
He or she may make additional investigations of any county jail or other detention facility of the county as he or she determines necessary.
He or she shall submit a report to the Board of Corrections, the sheriff or other person in charge of the jail or detention facility, and to the board of supervisors.
"He or she shall submit a report to the Board of Corrections, the sheriff or other person in charge of the jail or detention facility, and to the board of supervisors."
He or she may make additional investigations of any city jail or detention facility as he or she determines necessary.
"He or she may make additional investigations of any city jail or detention facility as he or she determines necessary."
He or she may make additional investigations of any county jail or other detention facility of the county as he or she determines necessary.
While AB 263 was focused on the issues he raised, it was also intended to clarify that private detention facilities still fall under the purview of CDPH. In addition to AB 263 Health & Saf. Code, § 101045 notes that a country public health official "may make additional investigations of any county jail or other detention facility of the county as he or she determines necessary."
In any city having a health officer, the city health officer shall investigate health and sanitary conditions in every city jail and other detention facility at least annually
"In any city having a health officer, the city health officer shall investigate health and sanitary conditions in every city jail and other detention facility at least annually."
A recent analysis of churn rates among children found that while churn rates increased among children of all racial and ethnic groups, the increase was largest for Hispanic children, suggesting they face greater barriers to maintaining coverage. Additionally, people with LEP and people with disabilities are more likely to encounter challenges due to language and other barriers accessing information in needed formats. A recent analysis of state Medicaid websites found that while a majority of states translate their online application landing page or PDF application into other languages, most only provide Spanish translations (Figure 7). That same analysis revealed that a majority of states provide general information about reasonable modifications and teletypewriter (TTY) numbers on or within one click of their homepage or online application landing page (Figure 8), but fewer states provide information on how to access applications in large print or Braille or how to access American Sign Language interpreters.
A recent analysis of churn rates among children found that while churn rates increased among children of all racial and ethnic groups, the increase was largest for Hispanic children, suggesting they face greater barriers to maintaining coverage.
Additionally, people with LEP and people with disabilities are more likely to encounter challenges due to language and other barriers accessing information in needed formats. A recent analysis of state Medicaid websites found that while a majority of states translate their online application landing page or PDF application into other languages, most only provide Spanish translations (Figure 7).
That same analysis revealed that a majority of states provide general information about reasonable modifications and teletypewriter (TTY) numbers on or within one click of their homepage or online application landing page (Figure 8), but fewer states provide information on how to access applications in large print or Braille or how to access American Sign Language interpreters.
Organizations like Techqueria, which seek to improve the odds of Latinx in the tech labor market, have been popping up since 2014 among minorities and other marginalized social groups, with names like LGTBQ in Tech, Blacks in Technology, Latinas in Tech and Lesbians Who Tech. They’re free, fluid and informal, with members constantly exchanging information and support. While they offer many opportunities for face-to-face gatherings, they are powered by social media. Some of these collective efforts are no more than Slack workspaces. Others cross multiple platforms or even have web pages. Some have even incorporated. But all have the same goal: to make inroads into an industry where their members are grossly underrepresented.
Interesante.
Referral certification and authorization; health care claim status (inquiry and response)
unclear
Coordination of benefits
unclear.
A request that treatment or a referral be authorized, and a response to such a request;10
How do you envision making referrals if they have insurance? If I need to send someone to the ED, it would eventually be billed by insurance plan if they have insurance. Im thinking most millenials haveinsurance of some sort.
With enterprise-grade clinical data APIs, HIPAA-compliant user authentication, and an unparalleled master patient index, the Health Gorilla network makes it easy for providers to pull their patient's information from any clinical records system.
Good
Yearly HIPAA training is also required (which takes 2-4 hours).
Yearly HIPAA training is also required (which takes 2-4 hours).
To address this gap, MAs called patients after video visits to help with scheduling procedures and labs, and also conducted appropriate health maintenance screening for depression, tobacco cessation, and more. Positives screens in the after-visit setting triggered actions such as behavioral health follow-up.
To address this gap, MAs called patients after video visits to help with scheduling procedures and labs, and also conducted appropriate health maintenance screening for depression, tobacco cessation, and more. Positives screens in the after-visit setting triggered actions such as behavioral health follow-up.
As the role of technology expands in healthcare, so does the need to support its implementation and integration into the clinic. The concept of a new team member, the digital navigator, able to assume this role is introduced as a solution. With a digital navigator, any clinic today can take advantage of digital health and smartphone tools to augment and expand existing telehealth and face to face care. The role of a digital navigator is suitable as an entry level healthcare role, additional training for an experienced clinician, and well suited to peer specialists. To facilitate the training of digital navigators, we draw upon our experience in creating the role and across health education to introduce a 10-h curriculum designed to train digital navigators across 5 domains: (1) core smartphone skills, (2) basic technology troubleshooting, (3) app evaluation, (4) clinical terminology and data, and (5) engagement techniques. This paper outlines the curricular content, skills, and modules for this training and features a rich online supplementary Appendix with step by step instructions and resources.
Training of digital navigators. do you have a trainnig program in mind?
Consumers still want the benefits of in-person health care services—a personalized clinician-patient relationship As with in-person visits, consumers expect their virtual visits to be of high quality and with clinicians who listen, take their time, and treat them well. The Deloitte 2020 Survey of US Health Care Consumers found that among consumers who wouldn’t have another virtual care visit, a third said that quality of care was not as good as with their regular doctor and one out of five said they did not like the way the clinician treated them. We also found similar experiences during the pandemic. In the Deloitte April COVID-19 consumer survey, respondents reported holding on to traditional beliefs about the benefits of in-person health care services: Sixty-six percent of respondents believe that a doctor or nurse needs to physically examine them to understand their health needs Fifty-six percent don’t think they get the same quality of care/value from a virtual visit as from an in-person visit.
One of the advantages of video assited visits comparwed to telephone. You can exaimne a patient with video.
Nurture your online-presence to attract millennial patientsThe recent EBRI Research report (PDF) confirms millennials are very likely to factor in online ratings and reviews before choosing and visiting a healthcare provider. Millennials do their due diligence in vetting their options online, and they’ll choose one provider over another based on a strong online presence.
rewards fpr leaving good reviews?
Digital Health-Enabled Community-Centered Care (D-CCC) represents a pioneering vision for the future of community-centered care. Utilizing an artificial intelligence-enabled closed-loop digital health platform designed for, and with, community health workers, D-CCC enables timely and individualized delivery of interventions by community health workers to the communities they serve. D-CCC has the potential to transform the current landscape of manual, episodic and restricted community health worker-delivered care and services into an expanded, digitally interconnected and collaborative community-centered health and social care ecosystem which centers around a digitally empowered community health workforce of the future.
Digital Health-Enabled Community-Centered Care (D-CCC)
Still confused? Here’s an example: A patient’s hospital bill is PHI because it reveals health information in combination with other information that identifies the patient. If the record shows only the health information and NOT the personal identifiers (name, address, phone, email, payment info, etc.), then it does not need to be protected under HIPAA.
Here’s an example:
Do Your Customers Need You To Be HIPAA-Compliant? In many cases, your customers will need your startup to comply with HIPAA in order to even consider working with you.HIPAA applies to two types of organizations: covered entities and business associates. Covered entities are health care providers, such as clinics, pharmacies, nursing homes, clearinghouses, health insurers, and government health programs, among others.Business associates are organizations or individuals who handle protected health information while working with a covered entity. HR startups like WageWorks and Greenhouse are considered business associates under HIPAA because they handle employee benefits information. If your startup handles PHI while working with other organizations, that makes you a business associate as far as HIPAA is concerned. That means you’ll need to sign a business associate agreement (BAA) in order to work with those customers.A BAA is a contract that defines how PHI will be used and protected by the business associate. It ensures that the business associate complies with HIPAA and that the covered entity reports and stops working with that vendor if any breaches or violations arise.But it gets more complicated than that.Say your SaaS startup provides a dashboard that helps health care providers manage their PHI. Because you handle PHI for the health care provider, you are a business associate. And because you work directly with a data hosting service, that makes the data host a business associate as well.In this scenario, think of your startup as the middle link in a chain of HIPAA compliance. You would need a BAA with the health care provider AND the data host. But the data host wouldn’t need a BAA with the health care provider.
Covered entities are health care providers, such as clinics, pharmacies, nursing homes, clearinghouses, health insurers, and government health programs, among others.
We don’t accept/bill insurances. Accepting insurance isn’t a prerequisite of HIPAA compliance.
We don’t accept/bill insurances. Accepting insurance isn’t a prerequisite of HIPAA compliance.
Ensure HIPAA Compliance If your medical startup or patient website will offer online accounts or online billing services, you will need to comply with all of the legal standards set out by HIPAA. This also applies if you will be maintaining patient information databases.
If your medical startup or patient website will offer online accounts or online billing services, you will need to comply with all of the legal standards set out by HIPAA.
List of 18 Identifiers 1. Names; 2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000. 3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older; 4. Phone numbers; 5. Fax numbers; 6. Electronic mail addresses; 7. Social Security numbers; 8. Medical record numbers; 9. Health plan beneficiary numbers; 10. Account numbers; 11. Certificate/license numbers; 12. Vehicle identifiers and serial numbers, including license plate numbers; 13. Device identifiers and serial numbers; 14. Web Universal Resource Locators (URLs); 15. Internet Protocol (IP) address numbers; 16. Biometric identifiers, including finger and voice prints; 17. Full face photographic images and any comparable images; and 18. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data) There are also additional standards and criteria to protect individuals from re-identification. Any code used to replace the identifiers in data sets cannot be derived from any information related to the individual and the master codes, nor can the method to derive the codes be disclosed. For example, a subject's initials cannot be used to code their data because the initials are derived from their name. Additionally, the researcher must not have actual knowledge that the research subject could be re-identified from the remaining identifiers in the PHI used in the research study. In other words, the information would still be considered identifiable if there was a way to identify the individual even though all of the 18 identifiers were removed.
What is PHI?
Healthcare Providers As healthcare providers are considered covered entities, they must ensure that they are in compliance with HIPAA regulations. For this reason, all hospitals, doctor’s offices, telehealth platforms, and software platforms that provide patient care must be in line with HIPAA requirements at all times.
all hospitals, doctor’s offices, telehealth platforms, and software platforms that provide patient care must be in line with HIPAA requirements at all times.
Who Is Required To Follow HIPAA Regulations? Startups and Software Development Companies Any startups and software development companies that receive protected health information from covered entities (CE), including health providers, hospitals, and insurance companies, must ensure that they are in compliance with HIPAA.
from covered entities (CE), including health providers,
(CEs being physicians, dentists, hospitals, pharmacies, insurance companies, etc.) and, consequently, has a hand in dealing with PHI. These folks are called Business Associates.
any business that works for or on behalf of CEs (CEs being physicians
Unlimited messaging with your Care Team
Unlimited messaging with your Care Team
Evaluations can occur in a medical asylum clinic, physician’s private office, or an attorney’s office. As the evaluation is not considered medical care, malpractice insurance and creating an electronic health record are not necessary, although standards may vary by institution.
FYI
10 272 (14%) were African American or Black, 233 (<1%) were Alaska Native or American Indian, 1540 (2%) were Asian, and 61 223 (81%) were White.
81 + 14 + 2 = 97%
The math does not add up. Latinos should make up 13%, but instead, the authors only looked at race and omitted ethnic origin, essentially removing all Latinos from the study.
https://go.djt.la/pew-hispanic-racial-identity https://go.djt.la/some-other-latino-ethnicity-hispanic
The population examined was limited to patients residing in the Midwest and receiving care at a single institution, although it was an institution covering academic and community settings as well as urban and rural patients; future studies should assess telemedicine failures throughout the United States.
I looked up the demographics. Latinos make up 13% of this part of Wisconsin.
This finding has implications for how multiracial Latinos are identified. For example, Latinos who identify themselves as one race (such as white or black) when asked to fit themselves into the country’s current standard racial categorization, but then say they consider being Latino as part of their racial background as well, have effectively indicated a multiracial background. That makes this group of Latinos potentially part of the mixed-race population. Taking this broader view of the multiracial population, including Latinos who give one census race and also consider their Latino background part of their race would raise the U.S. multiracial population share to 8.9% from 6.9%. This chapter incorporates this broader approach to Hispanic racial identity, exploring two possible ways to define and view definitions of mixed-race background among Hispanics: (1) those who say they are two census races (i.e., white and black) and are also Hispanic, a group consistently treated as multiracial throughout the report; and (2) those who name only one race (other than Hispanic), but also say they consider their Hispanic background to be part of their racial background. The chapter also explores other Hispanic racial identities, such as an Afro-Latino background and a background that includes roots among the indigenous peoples of the Americas, such as Native American, Maya, Taino or Quechua. These latter findings come from the Pew Research Center’s 2014 National Survey of Latinos.
Looked at another way, among the 34% of Latinos who self-identify as mixed race, mestizo or mulatto, only 13% also indicate a racial background with two or more races or volunteer that they were “mixed race” on the standard race question. About half (46%) of this group indicates their race or one of their races is white, and 24% volunteer that their race or one of their races is Hispanic or Latino. Fully 42% choose white as their only race, and 20% choose Hispanic as their only race.
Patients must be capable self-advocates, accurately describing their symptoms to the physician, to facilitate the diagnosis of type 1 narcolepsy.
Always tell the doc everything.
The sudden onset of muscle weakness characterizes cataplexy.[1] Such episodes are transient, lasting seconds to minutes, and get precipitated by intense emotions.[1] Cataplectic attacks are more frequently incited by positive emotions (i.e., laughter, excitement, etc.) than negative emotions (i.e., anger, fear, frustration, etc.), with laughter being the most common precipitant.[13] It is the complete or partial paralysis of voluntary muscles that is responsible for the weakness associated with cataplexy; however, it bears noting that the muscles of eye movement and respiration get spared during these attacks.[1] The suppression of serotonergic and noradrenergic neuronal circuits permit the complete or partial paralysis of voluntary muscles.[14] Consciousness, however, is uncompromised during cataplectic attacks as wake-promoting histaminergic signaling is preserved.[14] Cataplectic attacks typically follow a crescendo pattern, first involving the muscles of the face and neck with progression to the muscles of the trunk and limbs.[1] Physical findings depend on the severity of each episode, ranging from facial drooping and slurring of speech (partial attacks) to collapse (complete attacks).[13][15] Episodes of cataplexy often resolve within two minutes, and those afflicted are without lingering effects.
Does this sound right to you?
Obtaining an accurate and detailed history is imperative in the diagnosis of narcolepsy. The clinician should perform an investigation of behavioral (i.e., caffeine use, insufficient sleep, poor sleep hygiene, tobacco use, etc.) and alternative diagnoses (i.e., anemia, hypothyroidism, obstructive sleep apnea, etc.) of excessive daytime sleepiness. It is essential to realize that patients with narcolepsy are well-rested following a brief nap or sufficient nights' sleep; however, the symptoms of excessive daytime sleepiness occur within hours of awakening.[1] In addition to excessive daytime sleepiness, patients with type 1 narcolepsy experience symptoms of disordered regulation of REM sleep (i.e., cataplexy, hypnagogic hallucinations, and sleep paralysis).
Boom
While one-third of patients present with the classic narcolepsy tetrad (cataplexy, excessive daytime sleepiness, hypnagogic hallucinations, and sleep paralysis), two-thirds of narcoleptic patients are affected by cataplexy.
Your sxs are more common.
Speed networking matches you with fellow-participants, speakers and hosts to have a one-on-one conversation with them. The time duration of each discussion is usually limited to make the experience quick and productive.Speed networking zone: The audience will be able to speed network only if they get into the speed networking zone. Encourage them to click on “Start speed networking.”Time duration: The ideal time slot for a speed networking meeting is between 2-5 minutes. Keep it as minimum as possible to make it more active and engaging.Set up speed networking →
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Airmeet has got one of the most engaging stage experiences with emojis, polls, Q&As and chats. Your first step is to get familiarized with the RHS and bottom navigation bar elements.Right-hand section(RHS)Chat: Airmeet offers a secured public and private chat box to boost uninterrupted communication.Q&A: A separate window, Q&A lets participants ask questions easily. Great questions need attention—the audience gets to upvote questions, and hosts will be able to sort them by popularity and get them answered.Invite to the stage: The feature allows you to invite attendees as speakers to the dais and help you stay on top of speaker management. Search for the attendee that you want to invite in the “Attendees” section in the RHS. Click on the three vertical dots on the attendee’s thumbnail and “invite to stage”.Videos: Stream pre-recorded video option on the Airmeet dashboard allows you to get pre-recorded videos from your speakers and stream it live. The videos that you upload on the Airmeet dashboard appears in the “Videos” tab on the RHS.Bottom navigation barReactions: Airmeet’s thumbs-up, clap, heart, and lots of other emojis make the experience lively and engaging.Polls: Polls let you gather some insightful feedback from the audience and are also a smart way to increase engagement in between sessions.Screen share: Screen share presentations and videos in a click of a button. Please make sure you don’t go on mute while playing videos from your laptop/desktop computer.
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Backstage is an exclusive space where hosts can sync up with speakers before going live. Hosts can help speakers get a quick dry run, test presentations and check audio and video quality before starting the session.Go Backstage: Only the speakers that have joined through the speaker link will be able to see the “Go Backstage” button on the top right corner of the social lounge window. Hosts and speakers will be able to enter the backstage, by clicking on this button.Start session: Once you are ready to go live, click on the “Start session” button on the top right corner of the backstage.Session countdown: After clicking on the “Start session”, you will be given a 15-seconds countdown with a starting soon message.
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Social Lounge is the signature feature of Airmeet where participants can network with fellow attendees, speakers, and hosts. It is a virtual ballroom with tables—participants can move between tables, join relevant conversations and meet more people. The social lounge area will be active and accessible before and after the event or sessions.Custom welcome message: You can edit the welcome message for your audience in the “Configure social lounge” tab on the top right corner of the social lounge.Take a seat: To join a table, you have to click on the “Take a seat” button below the table. Please make sure your participants make meaningful conversations at your event. Educate them that they can check the bio of the people in the table by hovering over their profile picture on the chairs.Leave table: The conversations that happen at the social lounge are not controlled or limited by anyone, unlike other platforms. Participants get absolute freedom to move between tables, leave the table and join new conversations that are happening in the social lounge.Table controls: Once you join a table, a window opens up where participants can video chat with each other in the table. The controls in the bottom bar of the window allow you to mute/unmute audio, turn on/off video, screen share with the audience on the table and a chat window(table chat) to share useful links and contact information.
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Gear up with top four things in an Airmeet
1
A new Kaiser Family Foundation poll finds that a general willingness to get vaccinated against COVID-19 has gone up since December. But there's still hesitancy, most notably among Blacks and Latinos. Garcia is not alone in being skeptical. The survey finds that more than half of Latino adults are in no rush to get vaccinated.
The survey finds that more than half of Latino adults are in no rush to get vaccinated.
Arroyo refers to the experiments in the 1940s where the U.S. Public Health service used sex workers to expose prisoners in Guatemalan jails with sexually transmitted diseases. Or in the 1950s, Puerto Rican women from low-income communities were given experimental birth control pills without being told they were part of a clinical trial.
prisoners in Guatemalan jails
Sadly, for me it's "don't go" And that's how my decision was made. My mother is a 90-year-old dynamo who lives independently — in the northwest of England. If she were closer I would put on a mask, give her a quick squeeze and relish her company from across the room.
I unfortunately will take the same position.
"Many people are seeing this as the door opening out of the locked room," says Schaffner. "If only we can get vaccinated, we will be free. It's not that easy."
Sad but true
Providers should not assume that a patient who refuses vaccination will not choose to be vaccinated at a later date. It is appropriate to continually encourage vaccination throughout pregnancy while taking care to respect patients' autonomy.
Agreed. But this study needs to be replicated with a larger Latino population.
Moreover, we found that more than one-fifth of those who were vaccinated initially refused vaccination, highlighting that patients' decisions regarding vaccination are dynamic.
This makes sense and is good to hear.
One other study supports our finding that race discordance is associated with influenza vaccine acceptance among non-Hispanic black patients.41 In this study and in our own analysis, the association observed was weak and may reflect statistical but not clinical significance.
Now you're making a little bit of sense.
Women who were race discordant with their provider were more likely to be vaccinated compared with those who were race concordant (57.9% vs. 52.9%, aOR: 1.16, 95% CI: 1.07–1.27).
I don’t believe it. Are there any Latin@ authors on this paper? Sounds like author-subject discordance to me.
We found that concordance of patient and provider race/ethnicity influenced the likelihood of vaccination, with patients being more likely to be vaccinated at race discordant visits. This was especially true for non-Hispanic black and Hispanic patients.
Mentirosos!
https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html.
Link to official announcement.
"We are empowering medical providers to serve patients wherever they are during this national public health emergency," said Roger Severino, OCR Director. "We are especially concerned about reaching those most at risk, including older persons and persons with disabilities," Severino added.
This should be common knowledge by all physicians. While some embraced this relaxing of the rules, not all health care systems took advantage of this to improve access to care.
Enforcement Discretion for Telehealth Remote Communications
Enforcement Discretion = Not enforced
Member List
AARP
American Civil Liberties Union (ACLU)
American College of Emergency Physicians (ACEP)
American Federation of State, County and Municipal Employees (AFSCME)
Alzheimer's Association
Asian Americans Advancing Justice – Los Angeles
Asian and Pacific Islander American Health Forum (APIAHF)
Association of California School Administrators (ACSA)
California Academy of Family Physicians (CAFP)
California Advocates for Nursing Home Reform (CANHR)
California Alliance of Child and Family Services
California Area Indian Health Service
California Assisted Living Association (CALA)
California Association of Area Agencies on Aging (C4A)
California Association of Health Facilities (CAHF)
California Association of Health Plans (CAHP)
California Association for Health Services at Home (CAHSAH)
California Association of Long-Term Care Medicine (CALTCM)
California Association of Public Hospitals and Health Systems (CAPH)
California Association of Rural Health Clinics (CARHC)
California Association of Veteran Service Agencies
California Behavioral Health Directors Association (CBHDA)
California Black Health Network
California Chamber of Commerce
California Conference of Local Health Officers (CCLHO)
California Consortium for Urban Indian Health, Inc. (CCUIH)
California Dental Association (CDA)
California Foundation for Independent Living Centers (CFILC)
California Grocers Association
California Hospital Association (CHA)
California Immigrant Policy Center (CIPC)
California Immunization Coalition
California Labor Federation
California LGBTQ Health and Human Services Network
California Long-Term Care Ombudsman Association (CLTCOA)
California Manufacturers & Technology Association (CMTA)
California Medical Association (CMA)
California Nurses Association (CNA)
California Pan-Ethnic Health Network (CPEHN)
California Pharmacists Association (CPHA)
California Primary Care Association (CPCA)
California Professional Firefighters
California Rural Indian Health Board (CRIHB)
California Rural Legal Assistance, Inc. (CRLA)
California School Boards Association (CSBA)
California School Nurses Organization (CSNO)
California Society of Health-System Pharmacists (CSHP)
California State Parent Teachers Association (CAPTA)
California Superintendent of Public Instruction
California Teachers Association (CTA)
Catholic Charities of California
Comite Civico del Valle
County Health Executives Association of California (CHEAC)
Disability Rights California (DRC)
Disability Rights Education and Defense Fund (DREDF)
Emergency Medical Services Administrators of California (EMSAC)
Faith in the Valley
First African Methodist Episcopal Church
First Five Association
Health Access
Housing California
Jakara Movement
Justice in Aging
Latino Coalition for a Healthy California (LCHC
Local Health Plans of California (LHPC)
Mixteco Indigena Community Organizing Project (MICOP) (Central Coast/Indigenous Farmworker population)
Planned Parenthood Affiliates of California (PPAC)
Service Employees International Union (SEIU) California State Council
Service Employees International Union Local 1000 (SEIU 1000) (Unit 17-Nurses)
State Council on Development Disabilities
The California Endowment
The Children's Partnership
UFW Foundation
United Domestic Workers (UDW/AFSCME)
United Food and Commercial Workers (UFCW) California
Vision y Compromiso
Western Center on Law and Poverty
MEETING MATERIALS: Written Public Comments to Community Vaccine Advisory Committee: 1/5/2021 - 1/18/2021 (PDF, 1.9MB)Meeting Agenda: Community Vaccine Advisory Committee - 1/20/2021 (PDF)
materials
Upcoming Meetings Date: Wednesday, January 20, 2021Time: 3:00 p.m.-6:00 p.m.
3 hour meeting
ensuring that the vaccine is distributed and allocated equitably, at first to those with the highest risk of becoming infected and spreading COVID-19; and transparency, by bringing in community stakeholders from the outset.
Question: Is this is enough? If not, why? What more can be done? Should more community orgs be invited? Should they play a more intricate role?
To ensure the vaccine is distributed and allocated equitably, California has created two related work groups: a Drafting Guidelines Workgroup charged with developing California-specific guidance for the prioritization and allocation of vaccine when supplies are limited, and a Community Advisory Vaccine Committee to provide input and feedback to the planning efforts and solve barriers of equitable vaccine implementation and decision-making.
Two groups have been created.
DB: There’s no chance it will just mysteriously disappear after the first or second wave? MO: We have no reason to think that that will happen. Put it in this context: If we drop 1000 books, we can pretty well predict moment after moment after moment in every instance, where each book is going to go when it hits the floor. And the same thing is true with viruses like this. There’s nothing in our past history that would suggests that it would just suddenly disappear and die off. While it does change genetically over time, it’s still a very stable virus. There’s no evidence that somehow it might just mutate itself away. That’s just not going to happen.
no
So, we’re really confronted with having this virus in our population for months to years ahead if we don’t get a successful vaccine. So to answer your question of how we are going to get to that 60 or 70%, that’s what we don’t know. We’ve never had a coronavirus pandemic infection like this. It may have happened centuries ago, but we didn’t see it. If it’s like influenza, of which there have been 10 such pandemics in the last 250 plus years, three started in our North American winter, two in our spring, three in our summer, and two in our fall. And in each instance when that happened, there was a wave that lasted several months, much like we’re seeing now around the world that seemed to disappear after several months. We don’t know what happens to the virus and it is not just based on season — it’s always just after a few months. In every instance the virus came back with a second wave. And when that happened, usually three to four months after that initial wave was over, it tended to be much, much more severe. This is not just the 1918 pandemic because even in 2009 with H1N1, we saw that same thing happening with a much less severe pandemic. We saw an early Spring peak of cases when it first emerged in March, April, and May. Then it disappeared and came back in late August / early September and then took off with a peak in October. So that’s one model that could happen. But because this is a coronavirus [not an influenza virus], we don’t know what might happen for sure. Our group has actually put a paper on our website and the scenarios for what this might look like. We said, well, maybe it’s not going to be like a flu virus, maybe it’ll just be a slow burn and just keep doing what it’s doing now for potentially months and months to come if we don’t get a vaccine. Or we could see more of these kinds of peaks and valleys where basically certain areas light up for anywhere from a month to six weeks, and we work hard to suppress it, and then it disappears, but then it lights up somewhere else. And any of these are still possibilities. But I can say with certainty, what I call the laws of virus physics, is that this is going to continue to transmit until we see a large part of the population infected. When you think about only 5% of this country’s been infected to date, and you understand the pain, the suffering, the death, and economic disruption that’s occurred with just 5%, then you can imagine what it’s going to take for us to get to 60 or 70%.
boom
Here are the highlights of our conversation. But if you really want to understand this disease, read the whole interview. This disease may be the biggest event of our lifetimes. 3 months ago, COVID-19 was not even in the top 75 causes of death in this country. Much of the last month, it was the #1 cause of death in this country. This is more remarkable than the 1918 Flu pandemic. There is no scientific indication Covid-19 will disappear of its own accord. If you’re under age 55, obesity is the #1 risk factor. So, eating the right diet, getting physical activity, and managing stress are some of the most important things you can do to protect yourself from the disease. One of the best things we can do for our aging parents is to get them out into the fresh air, while maintaining physical (not social) distancing. Wearing a cloth mask does not protect you much if you’re in close contact with someone who is COVID-19 contagious. It may give you 20 minutes, instead of 10, to avoid contracting the disease. We can expect COVID-19 to infect 60% – 70% of Americans. That’s around 200 million Americans. We can expect between 800,000 and 1.6 million Americans to die in the next 18 months if we don’t have a successful vaccine. There is no guarantee of an effective vaccination and even if we find one, it may only give short term protection. Speeding a vaccination into production carries its own risks. The darkest days are still ahead of us. We need moral leadership, the command leadership that doesn’t minimize what’s before us but allows everyone to see that we’re going to get through it.
key
Last year, Colombian technology companies received more than $1.2 billion of investment capital. I am impressed with the new headlines my generation and Colombian colleagues across technology have achieved in only 20 years. But I can assure you that Colombia’s headlines in the 21st century will be stunted if Colombian politicians and authorities do not address the underlying need to improve regulation that embraces technology and new mobility, including Picap. We have room to grow and show the world how our tenacity and resilience will help address not just Colombian or Latin American challenges, but global challenges.
The ghostwriter sounds like a CEO!
“You know we don’t drive down that road,” my father said.I had asked him why we never took the shortest path to the beach. Just eight years old, I was fascinated by maps and was questioning my father’s choice. Years later I would learn the route I suggested was mired with armed groups of all stripes whose interests didn’t align with mine or that of other Colombian families.
nice intro
If a positive case is identified in the workplace, the employer is encouraged to investigate the exposure of others in the workplace without disclosing the name of the individual or any personally identifiable information about the person.
private info
The key to coping during this, or any, time of upheaval is to quickly establish new routines so that, even if the world is uncertain, there are still things you can count on.
Time for new routines.
When there are discrepancies between expectations and reality, all kinds of distress signals go off in the brain. It doesn’t matter if it’s a holiday ritual or more mundane habit like how you tie your shoes; if you can’t do it the way you normally do it, you’re biologically engineered to get upset.
So true.
People who acquired influenza during the herald wave were quite lucky. The authors estimate that these people were 56% to 89% less likely to die in the fall, effectively "vaccinating" these survivors against the deadlier autumn wave. The most compelling explanation for the unusual lethality pattern of the 1918 Spanish flu is known as the "recycling hypothesis." According to this hypothesis, older people were spared because decades earlier, they had been exposed to an influenza virus similar to the one that circled the globe in 1918. This hypothesis is supported by the fact that older people in isolated populations -- such as the native populations in Alaska and the Pacific Islands -- were not spared. Beware the Herald Wave In 2009, the world experienced another influenza pandemic, albeit far less lethal than the one in 1918. It is estimated that up to 203,000 people died, with most deaths occurring in younger people (i.e., people under the age of 65). The authors conclude that "early pandemic waves of mild nature may in fact be the rule rather than exceptions." That may be useful information for predicting the next pandemic, a notoriously tricky task for epidemiologists. Those who come down with a mild case of the flu in the spring or summer may serve as a warning to the rest of us. Beware the herald wave.
Beware The Herald Wave
None of the 12 patients had known exposures to staff members with COVID-19 or shared rooms with patients with confirmed COVID-19.
Once again... HCWs aren't being screened so we dont know if they could nhave been exposed.
Among 8370 patients who were hospitalized with non–COVID-19–related conditions and were discharged through June 17, 2020, 11 (0.1%) tested positive in our health care system within 14 days of discharge (median time to diagnosis, 6 days; range 1-14 days) (cases are summarized in eTable 2 in the Supplement). Only 1 case was deemed to be likely hospital acquired, albeit with no known exposures inside the hospital.
This is where the money is. Asymptomatic health care workers are the likley culprits but only patients are screened. Would be interesting to do a similar study but with screening of all healthcare workers to see how many test positive and could potentially be spreading it.
In this cohort study of 9149 patients admitted to a large US academic medical center over a 12-week period, 697 were diagnosed with COVID-19. In the context of a comprehensive and progressive infection control program, only 2 hospital-acquired cases were detected: 1 patient was likely infected by a presymptomatic spouse before visitor restrictions were implemented, and 1 patient developed symptoms 4 days after a 16-day hospitalization but without known exposures in the hospital.
With the incubation period being so long. Tough to determine if it was iatrogenic, no?
Some of My favorite dishes here are: fried fish fillet with garlic and peppers, Kung Pao Chicken, Braised Beef Hot Pot and Fried Rice. Their noodles are ready as well.
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My favorites:1. Spicy salt shrimp (with head on of course). So good. 2. Three ingredient taste. Like kung pao but not spicy and with vegetables. (my wife's go to dish)3. Spicy salt squid. Junior's favorite. Just wish they would use whole squid with tentacles but it's still good.4. House special chow mein (crispy style). Huge dish full of shrimp, chicken, beef, veggies....5. Spicy salt pork chops. An impressive mountatin of pork chops. I laugh everytime it comes out bc of the sheer amount of pork chops. Only dish I didnt care for was the Royal Chicken. Really expensive for basically boiled chicken with ginger-green onion dipping sauce. Hard pass.
🎉
Our favorite dishes are the honey walnut shrimp, house pan fried noodles, salt and pepper pork chops, as well as the orange chicken. The beef chow fun is also super good.
🙌
My favorite Chinese food. This is actually the only Chinese place that I will eat. My favorite is the orange chicken. The salt and pepper pork chops are to die for and the shrimp fried rice
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We ordered:1. Xiao Long Baos (comes in a order of 10): These were delicious! Very hot and juicy and the pork inside was on point! The love was very happy! 2. Egg Flower Soup - A little bland, but usually you add in your own pepper and such to work to your taste. I love that at chinese restaurants they pour your first bowl for you. I feel that's so generous. 3. Beef with Broccoli - Love this dish! It wasn't too salty or over sauced. Beef was tender and juicy and broccoli was cooked to perfection!4. Chicken Chow Mein - This one was a little oily, but other than that flavor was pretty there. A little bland but not bad overall.5. Chicken Lettuce Wraps - OH MAN, this dish was massive! It was a little on the saltier side, but it was so good! Love the blend that they mixed with the chicken and the lettuce was fresh. They also serve you wonton chips as an appetizer, along with peanuts! As you guys can see, we ordered so much food for only two people. We were eating Chinese for the next two days and decided we were good with Chinese for a while. hahah.
👍
Shrimp Lettuce wrap amount was good for two meals and they gave plenty of lettuce. Fried fish did not get soggy or condensation on the way home due to ample breathing room they created for the to go order. Salt and pepper shrimp could have been two meals worth but my tummy was craving lots of shrimp that day. Fresh shrimp, no ammonia smelling meat.
😊
"Be a part of your communities beyond your own workplace. Join friends and neighbors in the activities of schools, churches, synagogues and mosques. Let your children see that you care about the community you reside in and help them learn to exercise their gifts and skills as you do to the betterment of the world." Dr. Joseph Martin Brown University, Alpert Medical School, 2012
community
To get the message across, Casillas has spoken with community groups and health care workers, at conferences such as Google's "Salud con Tech" and more to advocate for more user-friendly solutions and relevant digital health applications for these populations.
SaludConTech y UCLA Health!
DEFINITION — The term "reactive arthritis" was introduced in 1969 as "an arthritis which developed soon after or during an infection elsewhere in the body, but in which the microorganisms cannot be recovered from the joint" [1]. The original definition did not specify the pathogens that were accepted as causes of reactive arthritis, and, in 1999, a panel of experts determined a specific list of gastrointestinal and urogenital pathogens that could be considered causative [2]. These included Chlamydia trachomatis, Yersinia, Salmonella, Shigella, and Campylobacter [2]. Escherichia coli, Clostridioides (formerly Clostridium) difficile, and Chlamydia pneumoniae have since been added to the list [3-7]. Reactive arthritis triggered by a sexually transmitted infection is also referred to as sexually acquired reactive arthritis (SARA) [8].Additional causative pathogens, alternative terms, and diagnostic and therapeutic strategies for reactive arthritis have subsequently been proposed [9]. However, none of the newer diagnostic or therapeutic approaches or alternate names has been adequately validated. Another problem is that many of the studies generating these approaches involved patients seen in rheumatology clinics or followed outbreaks of disease after exposure to a common pathogen; such patients are not likely to be representative of the affected patients in the general community. Thus, the definition of reactive arthritis is still evolving.Two major clinical features that characterize reactive arthritis were identified [2]:●An interval ranging from several days to weeks between the antecedent infection and arthritis●A typically mono- or oligoarticular pattern of the arthritis, often involving the lower extremities, and sometimes associated with dactylitis and enthesitisBy convention, reactive arthritis of more than six months' duration was regarded as being chronic instead of acute.The term "reactive arthritis" has sometimes been used historically to refer to the clinical triad of postinfectious arthritis, urethritis, and conjunctivitis, which was formerly called Reiter syndrome [10,11]. However, these patients represent only a subset of patients with reactive arthritis [10,12].
Definition
Evidence of preceding extraarticular infection – The presence of a preceding extraarticular infection may be indicated simply by a history of urethritis or diarrhea. In the case of urethritis, or suspected silent urethritis, chlamydia can usually be identified, if present, by nucleic acid amplification. Stool cultures are usually not done in patients in whom the preceding episode of diarrhea has resolved. (See "Clinical manifestations and diagnosis of Chlamydia trachomatis infections", section on 'Nucleic acid amplification testing (test of choice)'.)Inability to identify the causative pathogen does not exclude the diagnosis of reactive arthritis. Even in well-controlled studies, pathogens can be identified in only about 50 percent of the patients. In those cases, the diagnosis of infections would depend entirely upon the history
Inability to identify the causative pathogen does not exclude the diagnosis of reactive arthritis.
Characteristic musculoskeletal findings – Such findings include a combination of oligoarthritis of peripheral joints, most often with asymmetric involvement of the lower extremity, enthesitis, dactylitis, or inflammatory back pain.
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DIAGNOSIS — The diagnosis of reactive arthritis is a clinical diagnosis based upon the pattern of findings and exclusion of other diseases. There is no single definitive diagnostic test, nor are there validated diagnostic criteria. The diagnosis can generally be suspected in patients who exhibit all three of the following:
Dx
The mean age of diagnosis was 66 years.
Age
EvaluationReactive Arthritis falls within the subclass of seronegative spondyloarthropathies that affect the axial skeleton. Other members of that group are Ankylosing spondylitis and Psoriatic arthritis. Joint involvement is oligoarticular and asymmetrical. American College of Rheumatology came up with diagnostic guidelines for Reactive arthritis in 1999. The criteria were divided into MAJORAsymmetric oligo or monoarthritis involving lower extremitiesEither enteritis or urethritis symptoms preceding the onset of arthritis by a time interval of 3 days to 6 weeksMINORPresence of a triggering infection as evidenced by culture positivityPresence of persistent synovial involvementA combination of genitourinary symptoms, metatarsophalangeal joint involvement, elevated C reactive protein and Positive HLA- B27 renders a 69% sensitivity and 93.5% specificity to the diagnosis of reactive arthritis.[12]
Evaluation
So configure Radarr: Under settings, Connect create a new connection:Name: Trailer DownloadOn Grab: NoOn Download: YesOn Upgrade: NoOn Rename: YesFilter Movie Tags: BlankPath: c:\path\to\script.bat
yes
IV-4.3 ENTRY WITH VICTIMS RECEIVING EMERGENCY TREATMENT Often, officers respond to the Emergency Department with individuals who need emergency medical treatment due to being victims of violent crime (e.g., shootings, stabbings, etc.). The timely collection of evidence and statements in these cases is extremely important. An officer may enter the Emergency Department in these circumstances without notifying the House Supervisor. Normal protocol of letting Emergency Department personnel and/or the University Police Officer know of the officer’s presence and purpose will be followed. If the victim needs to be moved to another area of the hospital for treatment, the officer shall stay with that individual as safety, legal, and evidentiary circumstances require. In such situations, Emergency Department personnel or the University Police Officer will notify the House Supervisor of the movement. The House Supervisor may check in with the officer who has stayed with the victim.
Worrisome
Every four years, without fail, the two mainstream political parties try to win over Latino voters for their respective presidential candidates. The reason is clear: There is no route to the White House without the support of Latinos.This wooing is carried out with cynicism and fueled by the political ambitions of all concerned. Republicans and Democrats alike seem to rediscover us every four years, then forget about us until the next election. It’s such an open and flagrant display of opportunism that some people have called it the Christopher Columbus syndrome.
Like clockwork.
There Is No Route to the White House Without Latino Voters
Confirmed
Republicans and Democrats alike seem to rediscover us every four years, then forget about us. It is called the Christopher Columbus syndrome.
Not to be confused with Montezuma's revenge.
One-third of all patients with Parkinson’s disease visit an emergency department or hospital each year, making it a surprisingly common occurrence.1
Common
In general, treatment of a type 2 MI does not include antithrombotic therapy or urgent coronary angiography (as these may cause bleeding in medically complex patients), but rather should focus on resolving the underlying cause(s) of supply-demand mismatch. Accordingly, a type 2 MI should always be documented as a secondary diagnosis in the discharge summary, as it stems from an underlying (primary) cause (Figure).1
1
n contrast, a type 2 MI results from imbalance between myocardial oxygen supply and demand that is unrelated to acute coronary thrombosis or plaque rupture.4
1
Type 1 MI (STEMI and NSTEMI) is generally a primary reason for a patient's presentation to a hospital, and accordingly should be documented as the principal diagnosis in the discharge summary.
2
Documentation of a type 1 MI (acute STEMI and NSTEMI) is supported by the presence of acute coronary thrombus (STEMI) or plaque rupture/erosion (NSTEMI) on coronary angiography,4 or a strong suspicion for acute thrombus or plaque rupture when angiography is unavailable or contraindicated.
1
Evidence in support of using virtual telerounding to decrease transmission among frontline workers.
Our study has 2 limitations. First, the results of the nucleic acid test do not indicate the amount of viable virus. Second, for the unknown minimal infectious dose, the aerosol transmission distance cannot be strictly determined.
Meaningful limitations
As of March 30, no staff members at Huoshenshan Hospital had been infected with SARS-CoV-2, indicating that appropriate precautions could effectively prevent infection. In addition, our findings suggest that home isolation of persons with suspected COVID-19 might not be a good control strategy. Family members usually do not have personal protective equipment and lack professional training, which easily leads to familial cluster infections (6). During the outbreak, the government of China strove to the fullest extent possible to isolate all patients with suspected COVID-19 by actions such as constructing mobile cabin hospitals in Wuhan (7), which ensured that all patients with suspected disease were cared for by professional medical staff and that virus transmission was effectively cut off. As of the end of March, the SARS-COV-2 epidemic in China had been well controlled.
I doubt this would be implemented in the US.
Chronic Pancreatitis: Indications for SurgeryBiliary or pancreatic strictureDuodenal stenosisFistulas (peritoneal or pleural effusion)HemorrhageIntractable chronic abdominal painPseudocystsSuspected pancreatic neoplasmVascular complications
surgery?
Chronic Pancreatitis Treatment OptionsMedicalAnalgesics (stepwise approach)Antidepressants (treatment of concurrent depression)Cessation of alcohol and tobacco useDenervation (celiac nerve blocks, transthoracic splanchnicectomy)Insulin (for pancreatic diabetes)Low-fat diet and small mealsPancreatic enzymes with proton pump inhibitors or his-tamine H2 blockersSteroid therapy (in autoimmune pancreatitis)Vitamin supplementation (A, D, E, K, and B12) EndoscopicExtracorporeal shock wave lithotripsy with or without endoscopyPancreatic sphincterotomy and stent placement for pain reliefTransampullary or transgastric drainage of pseudocystSurgicalDecompressionCystenterostomyLateral pancreaticojejunostomy (most common)Sphincterotomy or sphincteroplastyResectionDistal or total pancreatectomyPancreatoduodenectomy (Whipple procedure, pylorus-preserving, duodenum-preserving)Not recommendedAllopurinol Antioxidant therapy (vitamin C, vitamin E, selenium, methionine [no longer available in the United States])Octreotide (Sandostatin)Prokinetic agents (erythromycin)Adapted with permission from Nair RJ, Lawler L, Miller MR. Chronic pancreatitis. Am Fam Physician. 2007;76(11):1684
tx
Laboratory Tests Used in the Evaluation of Patients with Suspected Chronic PancreatitisTe s t s CommentsComplete blood countElevated with infection, abscessSerum amylase and lipaseNonspecific for chronic pancreatitisTotal bilirubin, alkaline phospha-tase, and hepatic transaminaseElevated in biliary pancreatitis and ductal obstruction by strictures or massFasting serum glucoseElevation suggests pancreatic diabetes mellitusPancreatic function testsSometimes useful in early chronic pancreatitis with normal computed tomography or magnetic resonance imaging findingsFecal elastase< 200 mcg per g of stool is abnormal; noninvasive, exogenous pancreatic supplementation will not alter results, requires only 20 g of stoolFecal fat estimation> 7 g of fat per day is abnormal; quantitative, requires 72 hours, should be on a diet of 100 g of fat per daySecretin stimulationPeak bicarbonate concentration < 80 mEq per L (80 mmol per L) in duodenal secretion, best test for diagnosing pancreatic exocrine insufficiencySerum trypsinogen< 20 ng per mL is abnormalLipid panelSignificantly elevated triglycerides are a rare cause of chronic pancreatitisCalciumHyperparathyroidism is a rare cause of chronic pancreatitisImmunoglobulin G4 serum antibody, antinuclear antibody, rheumatoid factor, erythrocyte sedimentation rateAbnormality may indicate autoimmune pancreatitisNote: Tests are listed in order of most to least commonly performed.Adapted with permission from Nair RJ, Lawler L, Miller MR. Chronic pancreatitis. Am Fam Physician. 2007;76(11):1681
tests
Differential Diagnosis of Chronic PancreatitisMore commonAcute cholecystitisAcute pancreatitisIntestinal ischemia or infarctionObstruction of common bile ductPancreatic tumorsPeptic ulcer diseaseRenal insufficiencyLess commonAcute appendicitisAcute salpingitisCrohn diseaseEctopic pregnancyGastroparesisIntestinal obstructionIrritable bowel syndromeMalabsorptionOvarian cystPapillary cystadenocarcinoma of the ovaryThoracic radiculopathy
ddx
TIGAR-O Classification of Risk Factors Associated with Chronic PancreatitisToxic-metabolicAlcoholChronic renal failureHypercalcemia (hyperparathyroidism)Hyperlipidemia (rare)Medications*TobaccoToxinsIdiopathicEarly and late onsetTropical pancreatitis (tropical calcifying pancreatitis and fibrocalculous pancreatic diabetes)GeneticAutosomal dominant (cationic trypsinogen [codon 29 and 122 mutations])Autosomal recessive modifier genes (CFTR and SPINK1mutations, cationic trypsinogen [codon 16, 22, and 23 mutations], alpha1-antitrypsin deficiency)AutoimmuneAutoimmune chronic pancreatitis associated with inflammatory bowel disease, Sjögren syndrome, primary biliary cirrhosisIsolated autoimmune chronic pancreatitisRecurrent and severe acute pancreatitisPostirradiationPostnecrotic (severe acute pancreatitis)Recurrent acute pancreatitisVascular ischemiaObstructiveDuct obstruction (pancreatic or ampullary tumors) posttraumatic pancreatic duct fibrosis)Pancreas divisumSphincter of Oddi disorders*—Drug-induced pancreatitis is mostly acute or recurrent acute pancreatitis, specifically in high-risk populations (e.g., older per-sons; patients with human immunodeficiency virus infection, cancer, or other immunocompromising condition). Common drugs that may induce chronic pancreatitis include angiotensin-converting enzyme inhibitors, statins, didanosine (Videx), azathi-oprine (Imuran), steroids, lamivudine (Epivir), hydrochlorothiazide, valproic acid (Depakene), oral contraceptives, and interferon.Adapted with permission from Etemad B, Whitcomb DC. Chronic pancreatitis: diagnosis, classification, and new genetic develop-ments. Gastroenterology. 2001;120(3):691, with additional infor-mation from reference 5
who
Glucose intolerance occurs with some frequency in chronic pancreatitis, but overt diabetes mellitus usually occurs late in the course of disease. A trial of oral hypoglycemic agents followed by insulin therapy when the need arises has been the line of management in these patients.
dm
Steatorrhea (fat malabsorption) may develop in patients with severe pancreatic exocrine dysfunction. Treatment depends upon the severity of disease.•Dietary modification should begin with restriction of fat intake (to less than 20 g per day). (See 'Dietary modification' above.)•For patients who do not respond to dietary restriction, we suggest lipase supplementation (table 1) (Grade 2C). As a general rule, 30,000 international units (IU) of pancreatic lipase (90,000 United States Pharmacopeia units [USP]) swallowed during each meal should suffice in reducing steatorrhea and preventing weight loss. Fat soluble vitamin replacement may be required. (See 'Lipase supplementation' above.)•Medium chain triglycerides (MCTs) can provide extra calories in patients with weight loss and a poor response to diet and pancreatic enzyme therapy.
fat
Chronic pancreatitis typically presents as chronic unrelenting pain with episodic flares. The goals of treatment include pain management, correction of pancreatic insufficiency, and management of complications. (See 'Introduction' above.)
def
Pain management should proceed in a stepwise approach. (See 'Pain management' above.)•Initial treatment begins with recommendations to stop alcohol and tobacco and to eat small meals that are low in fat. (See 'General recommendations' above.)•We suggest the use of pancreatic enzyme supplements in patients with pain persisting after the above interventions (Grade 2C). These relieve pain in some patients and are generally safe. (See 'Pancreatic enzyme supplements' above.)•Treatment with acid suppression (either with an H2 receptor blocker or a proton pump inhibitor) should be given along with pancreatic enzyme supplements to reduce inactivation from gastric acid.•Analgesics with opiates and/or nonsteroidal antiinflammatory agents can be considered if pancreatic enzyme therapy fails to control pain. Adjuvant therapy with pregabalin can be considered in patients whose pain is not adequately controlled with opiates and/or nonsteroidal antiinflammatory agents. (See 'Analgesics' above.)•Other specialized approaches for patients who continue to have pain include endoscopic therapy, extracorporeal shock wave lithotripsy, celiac nerve block, and surgery. (See 'Specialized approaches' above.)•Surgery has generally been considered for patients who fail medical therapy. Three surgical approaches have been described: decompression/drainage operations, pancreatic resections, and denervation procedures. The choice of procedure is made based upon the size of the pancreatic ducts and the regions of pancreas that are involved. (See 'Surgery' above.)
pain
SUMMARY AND RECOMMENDATIONS●Elevations in pancreatic enzymes are not specific for acute pancreatitis. Between 11 and 13 percent of patients admitted to the hospital with non-pancreatic abdominal pain have elevated pancreatic enzymes. (See 'Epidemiology' above.)●Elevated amylase and lipase may be due to increase in pancreatic or extrapancreatic production or a decrease in clearance (table 1 and table 2). However, in some cases pancreatic enzymes can be elevated in the absence of an identifiable disease. (See 'Causes' above.)●Patients with acute pancreatitis typically have a threefold elevation of amylase and/or lipase. However, patients with acute on chronic pancreatitis, hypertriglyceridemia-induced pancreatitis, and alcoholic pancreatitis may only have elevations in lipase. Isolated elevations in amylase may be due to salivary disease, and in rare cases, due to macroamylasemia. (See 'Isolated amylase elevation' above and 'Isolated/predominant lipase elevation' above.)●The approach to the patient with abdominal pain and elevated amylase and/or lipase is based on whether the clinical presentation is consistent with acute pancreatitis. (See 'Initial approach' above.)•In patients with characteristic abdominal pain and elevation in serum lipase or amylase up to three times or greater than the upper limit of normal, no imaging is required to establish the diagnosis of acute pancreatitis. (See 'Presentation consistent with acute pancreatitis' above.)•In patients whose clinical presentation is not consistent with acute pancreatitis, we obtain a detailed clinical history that includes medications, laboratory evaluation, and abdominal imaging to determine the cause of abdominal pain and elevated pancreatic enzymes. (See 'Presentation inconsistent with acute pancreatitis' above.)●Subsequent management in patients with a negative initial evaluation depends on the presence of continued abdominal pain. (See 'Subsequent approach' above.)•In patients in whom abdominal pain has resolved, we do not pursue additional evaluation. (See 'Patients without persistent abdominal pain' above.)•Patients with persistent abdominal pain with negative initial imaging should be evaluated for other causes of abdominal pain. Repeating amylase and/or lipase in such patients is not clinically useful. Additional evaluation with endoscopic ultrasound can be helpful in the diagnosis of chronic pancreatitis, and in patients suspected of having an occult pancreatic malignancy. (See 'Patients with continued abdominal pain' above.)
3x
SUMMARY AND RECOMMENDATIONS●Endoscopic ultrasound (EUS) detects changes of mild chronic pancreatitis (CP) that may not be detectable with other imaging modalities or functional testing but can be confirmed by histology. However, controversy remains regarding the diagnosis of "early" chronic pancreatitis based upon EUS changes alone. (See 'Reference standards' above.)●There are multiple sonographic features that may indicate the presence of chronic pancreatitis. The threshold for diagnosing chronic pancreatitis based on EUS can be varied (eg, ≥3, ≥4, or ≥5 criteria). Criteria for diagnosing chronic pancreatitis based on EUS include. (See 'Threshold to diagnose or exclude CP by EUS' above.):Parenchyma abnormalities:•Hyperechoic foci•Hyperechoic strands•Lobular contour•CystsDuctal abnormalities:•Main duct dilation•Duct irregularity•Hyperechoic margins•Visible side branches•Stones●Chronic pancreatitis shares clinical and radiologic features with pancreatic cancer. As a result, there may be diagnostic confusion, which can lead to unnecessary resection in those with chronic pancreatitis. While no test has proven to be consistently accurate in making this distinction, a potential role for EUS has been suggested in several studies. (See 'Discrimination from pancreatic cancer' above.)
EUS
Wir nennen uns selbst Homo sapiens – der weise Mensch. Erste Versuche, diese Weisheit zu beschreiben, zu verstehen, abzubilden und in Gesetzmäßig-keiten zu verwandeln, reichen bis in die Antike zurück und haben eine lange Tradition in der Philosophie, Mathematik, Psychologie, Neurowissenschaft und Informatik. Vielfach wurde versucht, den Begriff der Intelligenz – also die kog-nitive Leistungsfähigkeit des Menschen – besser zu verstehen und zu definie-ren. Als KI bezeichnet man traditionell e
yo
One alcohol misuse screening covered per year. Up to four counseling sessions may be covered if positive screening results. Must be delivered in a primary care setting.SBIRT may be provided via telehealth
interesting
Clinical features of acute pericarditis
x zx xz