5th Annual Advocacy Project: ImmuneWise Section on Medical Students, Residents, and Fellowship Trainees 2009-2010 - PowerPoint PPT Presentation

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5th Annual Advocacy Project: ImmuneWise Section on Medical Students, Residents, and Fellowship Trainees 2009-2010

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Title: 5th Annual Advocacy Project: ImmuneWise Section on Medical Students, Residents, and Fellowship Trainees 2009-2010


1
5th Annual Advocacy Project ImmuneWiseSection
on Medical Students, Residents, and Fellowship
Trainees2009-2010
2
(No Transcript)
3
Case Presentation
4
Case Presentation
  • 4 year old female is on the illness clinic
    schedule
  • Her mom reports 2 days of fever and decreased
    energy level

5
Case Presentation
  • Review of Systems
  • Temp to 102F
  • Mild headache
  • Eye redness
  • Mild congestion
  • Non-productive cough
  • No GI complaints
  • No rash
  • PMHx
  • Healthy
  • Due for 4-5 year old immunizations
  • SHx
  • Lives with parents
  • No known sick contacts
  • Recent travel to Disney World (about 10 days ago)

6
Case Presentation - Exam
  • General Cooperative, NAD but appears ill
  • HEENT PERRL, bilateral conjunctival erythema and
    watery eyes, nares patent, MMM without lesions,
    neck supple, no lymphadenopathy
  • Chest CTA bilaterally, no wheeze/rales/rhonchi
    RRR, no murmur/rub/gallop
  • Abd Active BS, soft, non-tender, no HSM
  • Skin No rash or lesions noted

7
Case Presentation
  • Diagnosed with a viral upper respiratory
    infection
  • Supportive care was discussed with the patients
    mother

8
Case Presentation
  • The 4 year old returns the next day with a new
    rash
  • Exam is unchanged except for a blotchy, blanching
    erythematous maculopapular rash on her face and
    neck

9
Differential Diagnosis
- Discussion
10
Management
11
MeaslesEpidemiology
  • Humans are the only natural host
  • Transmitted by direct contact with droplets
  • may contract from airborne droplets too
  • Most common in preschool and early school-aged
    children with a late winter peak
  • Vaccine licensed in 1963
  • Vaccine failure rate of 5 in those with only a
    single dose

12
MeaslesEpidemiology
13
Measles Epidemiology
14
Measles Clinical Presentation
  • Incubation period of 8-12 days
  • Symptoms and signs include
  • Fever, malaise, cough
  • Conjunctivitis, coryza, /- photophobia
  • Koplik spots on soft palate (often occur before
    the rash and are diagnostic)
  • Rash, usually day 2-3 of illness
  • Contagious for 1-2 days before onset of symptoms
    until 4 days after rash appears

15
Measles Clinical Presentation
16
Measles Diagnosis
  • Serum sample positive for measles IgM antibody on
    initial presentation
  • Sensitivity varies - low in first 72 hours of
    rash
  • If the initial test is negative, consider
    repeating after the rash is present gt 72 hours
  • Significant rise in measles IgG in paired acute
    convalescent samples
  • Measles RNA in blood, throat, nasopharyngeal or
    urine samples (by PCR)

17
MeaslesComplications
  • Complications include
  • Otitis media
  • Croup or bronchopneumonia
  • Diarrhea
  • Severe complications
  • Acute encephalitis in 1/1000 cases
  • Death in 1-3/1000 cases
  • Usually due to respiratory or neuro complications
  • Subacute sclerosing panencephalitis (SSPE)
  • Degenerative CNS disease

18
Measles Treatment
  • Supportive care
  • Vitamin A
  • Give if vitamin A deficiency is endemic
  • Give in the U.S under certain conditions Consult
    Red Book
  • Ribavirin
  • Not FDA approved, but may help those severely
    affected and immunocompromised

19
Measles Infection Control
  • Vaccine given within 72 hrs of exposure my
    provide protection in susceptible individuals
  • Immune globulin given within 6 days of exposure
    may prevent or modify measles

20
ImmuneWise Advocacy
21
ImmuneWise
  • 5th Annual Advocacy Project
  • SOMSRFT partnered with Section for Seniors
    Members
  • Goal Educate providers and parents
  • Goal Improve immunization rates
  • Goal Foster advocacy interest among SOMSRFT
    members

22
Why?
23
Who Else?
  • Within the AAP, many are concerned

Paul Offit, M.D.
24
What about You?
  • Many levels of advocacy
  • Individual level
  • Residency program / Clinic level
  • State level
  • Federal level

25
Individual Level
26
Individual Advocacy
  • Talk to the Press
  • Write a letter to the editor
  • Make yourself available to the media
  • Contact your state legislators
  • Write a letter or an email
  • Provide them with information
  • Discuss the issue with parents
  • Provide parents with info on Myths vs. Facts
  • Answer questions about vaccine components, side
    effects, and alternate schedules

27
Myths vs. Facts
28
Program / Clinic Level
29
Program-Wide Advocacy
  • Implement a quality improvement project focused
    on improving immunization rates
  • Implement an immunization education curriculum

30
Quality Improvement
  • ACGME Program Requirement on Practice Based
    Learning and Improvement states, systematically
    analyze practice using quality improvement
    methods, and implement changes with the goal of
    practice improvement- Residents are expected to
    participate in a quality improvement project.

31
QI ProjectImmunization Rates
  • QI projects focused on improving immunization
    rates can target
  • Particular vaccine (eg, influenza)
  • Target population (eg, 2-24 month olds)
  • Entire population served
  • An example of how to
  • do QI for immunization
  • rates comes from TIDE Teaching
  • Immunization Delivery and Evaluation

32
Designing QI Step 1
  • Assess Immunization Rates (Plan)
  • Assessment methods
  • Chart method
  • Active method
  • Consecutive method
  • Record the assessment data collected
  • There is a sample to download

33
Designing QI Step 2
  • Implement Change (Do)
  • Describe and analyze key office routines related
    to immunizations using an office immunization
    practices questionnaire
  • There is a sample to download
  • Based on findings
  • Select an intervention likely to improve
    immunization rates
  • Focus on the vital few interventions rather
    than the useful many

34
Office Immunization Practices Questionnaire
35
Designing QI Step 3
  • Assess the Effects of Change (Study)
  • Assess the immunization rates again (after a set
    period of time)
  • Continue to improve your effort after noting
    barriers / set-backs
  • Celebrate successes

36
Community Level
37
Community Advocacy
  • Find community supporters and leaders
  • Speak to parent groups
  • Post ImmuneWise posters in key locations
  • Utilize national PSAs at the local level

38
PSA Every Child By Two
39
State Level
40
State Advocacy
  • Each state has their own reimbursement issues

41
State Advocacy
  • Statewide campaigns are an opportunity to partner
    with AAP Chapters
  • The activities available/needed vary by state, so
    for more information turn to
  • ImmuneWise CD-ROM
  • AAP Committee on State
  • Government Affairs

42
National / Federal Level
43
national Advocacy
  • National media campaigns underway
  • Every Child by Two
  • The Vaccinate
  • Your Baby Web site

www.vaccinateyourbaby.org
44
Federal Advocacy
  • Other opportunities for involvement
  • Attend AAP Advocacy Institute
  • March 10-12, 2010 in Chicago
  • Familiarize yourself with AAP position papers
  • Become a Key Contact for the AAP Federal Affairs
    Advocacy Network (FAAN)

45
You Can Make a Difference!
  • Find out the special needs of your clinic or
    community
  • Develop a project YOU have a passion for
  • Return the Project Outcome Report for ImmuneWise.
    This will help us improve future advocacy
    projects!
  • Let us know what you have accomplished. We want
    to recognize you in district newsletters and
    !

46
Brought to You By
  • SOMSRFT Executive Committee Advocacy Subcommittee
  • Co-Chairs
  • Drs. Katie Snyder and Jennifer Williams
  • Members
  • Drs. Shawn Batlivala, Clara Filice, Jenni
    Linebarger, Christina Robinson, Sara Slovin, Josh
    Smith, Amy Starmer, David Tayloe
  • Other Contributors/Supporters
  • Lucy Crain, MD, FAAP, Buz Harlor, MD, FAAP,
    Michael Warren, MD, FAAP, Julie Raymond, Ian
    Van Dinther
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