By Rutland Herald | on February 11, 2017 By SUSAN SMALLHEER STAFF WRITER SPRINGFIELD

SPRINGFIELD Springfield Medical Care Systems is going solar.

The corporate parent of Springfield Hospital and the Springfield Health Center has completed its first solar project, with the installation of four solar panels in front of the entrance of the health center at One Hundred River Street.

Larry Kraft, a hospital spokesman, said the hospital will build a full solar array on land adjacent to the hospital later this year.

Kraft said Friday the two solar systems were different: One would produce hot water for use for the doctors and patients at the health center, and the larger system at the hospital would produce electricity to offset the hospitals usage.

He said the original intent of the project was to install a system on the rooftop, but the centers engineers determined the roof was not suitable.

But he said a portion of the building near the river is sheltered and receives what he called excellent sunlight, and the panels were installed there.

The four panels were installed before the onset of winter and have already started decreasing the centers use of fossil fuels, he said.

During the next 10 years, the hot water system will offset the use of 2,500 gallons of propane, which would ordinarily heat the 600,000 gallons of water used annually by staff members, patients and visitors to the health center. He said the total cost of the system was $30,000, and panels were installed by Springfield Heating and Ventilating Co. The system was paid for by donors, including a grant from the Jack and Dorothy Byrne Foundation. Kraft said that while a rooftop installation was originally considered, it was determined that the system would produce more electricity from the ground. He said the solar installation would be built on unbuildable ground farther up Ridgewood Road and across the road from the hospital. He said the site is currently wooded.

We will produce electricity, he said, with a netmetering project, rather than hot water at the health center system.

Under a net-metering project, the hospital will receive credits for the electricity it generates, and those credits will be used to offset its electric bill.

susan.smallheer @rutlandherald.com

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Medicine turns to solar energy - Rutland Herald

A D.C. surgeon who is credited with saving many lives through his pioneering work in organ transplant medicine says his story is one of faith and survival.

Dr. Clive Callender, a transplant surgeon and professor of surgery for Howard University Hospital, was born in New York City in 1936.

His mother had prayed for another son after two of her sons had passed away.

"She got pregnant again and low and behold, twin boys," Callender said.

But within 48 hours, Callender's mother died of complications from delivery, leaving he and his brother in foster care.

When their father, who worked on a railroad, couldn't care for them, his devoutly religious aunt took them in to raise them with her own family.

"I spent most of my early days in church, reading the bible and then ... decided I wanted to be a medical missionary," Callender said.

Hoping to realize his dream, Callender started high school. But at the age of 15 he contracted tuberculosis -- putting his high school education to a grinding halt.

He spent 18 months in the hospital and said despite that experience, he still wanted to do medicine.

"I had the opportunity to see people dying, people living," he said.

Without going to school since entering the hospital, the prospect of medical school appeared dim.

But Callender stuck with his goal.

"It was amazing to me and to the rest of my classmates, when ... I was the first person in the class to get accepted into medical school," he said. "How that miracle took place, I'll never know."

He went on to become a doctor and to make miracles happen for others by becoming a medical missionary and eventually he created the transplant center at Howard University Hospital.

"It's amazing how in my life I've had faith and would step out and the ground would be there," he said.

Callender just celebrated his 80th Birthday in November.

Published at 9:20 PM EST on Feb 10, 2017 | Updated at 9:22 PM EST on Feb 10, 2017

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DC Surgeon Says His Journey to Medicine is One of Survival - NBC4 Washington

More than 200kg of medicine destined for children undergoing treatment in the Tishreen University Hospital organized by the Fair Aid foundation was delivered to the Russian operated Khmeimim airbase in Latakia by a Russian Defense Ministry plane.

We delivered here humanitarian cargo for patients of the Tishreen University Hospital, for children who are undergoing treatment in the general medical division and the special care nursery, an aide to the organizations executive director, Natalya Avilova, said. We delivered 12 types of medicines weighting more than 200 kilograms in total.

The spokeswoman then emphasized that their is a critical shortage of medicine in Syria because of US-led sanctions on the country.

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We had to intervene because they have wonderful doctors and other specialists, they have enough equipment to perform basic surgeries, but they have no medicines. There are medicines that are not available to them because of sanctions, the official said. More children can be treated and more lives can be saved if medicines of vital importance are delivered here in time.

Meanwhile, a doctor in Syria explained that the only aid that arrives in the country comes from Russia.

As long as I work here, I see only Russian aid. No one else helps. A delegation from the UK arrived once, they came in, looked, smiled and left. Thats all, the Doctor Odai Joni said.

ALSO READ BREAKING: Al-Bab battle heat up as the Syrian Army reaches its southern gates

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Food and medicine shortages weren't bad enough. Now Venezuelans can't even get passports. Miami Herald After suffering months of merciless shortages of food and medicine, Venezuelans now face a new problem as a result of the economy's collapse: They can't even get the passports they need to leave the country. Venezuela's bankrupt government does not ... and more »

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Food and medicine shortages weren't bad enough. Now Venezuelans can't even get passports. - Miami Herald

MobiHealthNews, Healthcare IT News, and HIMSS are accepting speaker proposals for the inaugural Precision Medicine Summit, June 12-13 in Boston.

The deadline for submitting a proposal is 5 pm, Friday, Feb. 17, 2017.

Click here to submit a proposal and for more information.

This event will give attendees a valuable state of the industry for precision medicine. Over two days, speakers will discuss the current state of precision medicine, the ultimate goal, and what the healthcare industry must to do reach that goal.

Audience and speakers will include a mix of clinicians, health IT professionals and researchers at academic medical systems, hospitals, physician practices, government andacademic institutions.

Session proposals should focus on how healthcare organizations are using precision medicine to deliver targeted, personalized care. Specific topics could include: the vendor and reimbursement landscapes, ethical issues, building data bases, managing unstructured texts, privacy and security, data use and migration, among others.

Case studies are a priority for this event.

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Call for Presentations: HIMSS Precision Medicine Summit - MobiHealthNews

Strokes and heart attacks often strike without warning. But, a unique application of a medical camera could one day help physicians know who is at risk for a cardiovascular event by providing a better view of potential problem areas.

A new paper in Nature Biomedical Engineering reports proof-of-concept results for this new imaging platform for atherosclerosis.

The camera actually goes inside the vessels, says first author Luis Savastano, M.D., a Michigan Medicine resident neurosurgeon. We can see with very high resolution the surface of the vessels and any lesions, such as a ruptured plaque, that could cause a stroke. This technology could possibly find the smoking gun lesion in patients with strokes of unknown cause, and may even be able to show which silent, but at-risk, plaques may cause a cardiovascular event in the future.

The scanning fiber endoscope, or SFE, used in the study was invented and developed by co-author and University of Washington mechanical engineering research professor Eric Seibel, Ph.D. He originally designed it for early cancer detection by clearly imaging cancer cells that are currently invisible with clinical endoscopes.

The Michigan Medicine team used the instrument for a new application: acquiring high-quality images of possible stroke-causing regions of the carotid artery that may not be detected with conventional radiological techniques. The team worked with senior author Thomas Wang, M.D., Ph.D., who is at the forefront of novel imaging platforms. Wang is professor of internal medicine, biomedical engineering and mechanical engineering, and is the H Marvin Pollard Collegiate Professor of Endoscopy Research.

The team generated images of human arteries using the SFE, which illuminates tissues with multiple laser beams, and digitally reconstructs high-definition images to determine the severity of atherosclerosis and other qualities of the vessel wall.

In addition to discovering the cause of the stroke, the endoscope can also assist neurosurgeons with therapeutic interventions by guiding stent placement, releasing drugs and biomaterials and helping with surgeries, Seibel says.

In addition, the SFE uses fluorescence indicators to show key biological features associated with increased risk of stroke and heart attacks in the future.

The ability to identify and monitor the biological markers that render a plaque unstable and at risk for rupture could enable the detection of individuals within high-risk populations who are most likely to suffer from cardiovascular events, and therefore benefit the most from preventive treatment during the asymptomatic stage, says B. Gregory Thompson, M.D., professor of neurosurgery at the University of Michigan Medical School and a senior author on the new paper.

In addition, plaque-specific data could help physicians modulate treatment intensity of atherosclerosis, which is currently based on systemic surrogates such us cholesterol and blood sugar levels and occurrence of cardiovascular events such as stroke or myocardial infarction.

All research is in the pre-clinical phase.

Scanning fiber angioscopic images with red reflectance for structural images (left) and blue fluorescence for label-free biochemical contrast (right). Images demonstrate multiple atherosclerotic lesions with very low fluorescence in the blue spectrum in comparison to the surrounding healthy artery.

Additional authors: Quan Zhou, Arlene Smith, Karla Vega, Carlos Murga-Zamalloa,David Gordon, Jon McHugh, Lili Zhao, Michael M. Wang, Aditya Pandey, Jie Xu, Jifeng Zhang, Y. Eugene Chen and Thomas D. Wang.

Funding: Cerebrovascular Research Award, Joint Section on CerebrovascularSurgery of the American Association of Neurological Surgeons and Congress of Neurological Surgeons, and National Institutes of Health (U54 CA163059, R01 706 EB016457, R01 HL129778, R01 HL117491 and R01CA200007).

Disclosure: Seibel participates in royalty sharing with his employer, the University of Washington, which has ownership of patents that may gain or lose financially through this publication.

###

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Laser-based camera improves view of the carotid artery - University of Michigan Health System News (press release)

Updated: Feb 10, 2017 - 12:17 PM

Thousands of dog owners worldwide blame a popular flea killer for harming their pets.

Jim Strickland, a consumer investigator at our sister station in Atlanta, has obtained records showing dog owners believe the drug is connected to hundreds of pet deaths.

The medication is called Bravecto. It's a dog chew so powerful that one dose can kill fleas and ticks for three months. Pharmaceutical giant Merck says it's safe and effective, but the number of dog owners who think otherwise is growing.

"I believe that Bravecto killed my dog," Donna White of Buckhead, Georgia told Strickland.

When Strickland asked why, she said, "That's the only thing I changed his entire life."

In an email to Strickland, a Merck spokesperson said they've dispensed 34 million doses and that reports of serious adverse events are very rare, less than .01 percent.

We spoke with the FDA about how theyre handling the complaints and whether or not theyll take any action. Watch the story on KIRO7 News at 5 p.m. on Friday or online athttp://kiro.tv/LiveNews

2017 Cox Media Group.

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Dog owners blame popular flea medicine for pets' deaths - KIRO Seattle

Posted 10 February 2017 By Michael Mezher

The head of Japan's Pharmaceuticals and Medical Devices Agency (PMDA), Tatsuya Kondo, on Thursday released a paper discussing his vision for a patient-centric, regulatory science-driven and evidence-based system for medicine in Japan.

"'Rational Medicine' is the idea that a patient-centric system should be createda system under which optimal medical care from the patient's point of view, which is based on the latest scientific knowledge, is providedfrom the perinatal to the final stages of life," says Kondo, who has served as PMDA's Chief Executive since 2008.

To move toward that ideal, Kondo says PMDA will focus its efforts in four key areas:

After its founding in 2004, PMDA struggled to keep up with other major regulators, and was consistently behind the US Food and Drug Administration (FDA) and European Medicines Agency (EMA) in the time it took to review new drugs.

However, in recent years, PMDA has made significant strides toward reducing review times, and in 2014, following the introduction of its "Sakigake" designation system for accelerating access to innovative drugs, PMDA surpassed both FDA and EMA in median review times for new drugs.

"[PMDA] will strive to further shorten review times in 2017 through active use of the Sakigake designation system," Kondo says.

As part of its regulatory science efforts, Kondo says PMDA's Science Board will focus on three areas in 2017: better methods for assessing clinical studies for rare drugs, identifying areas of research that "bottleneck" drug development and looking into the use of artificial intelligence technologies in medicine.

Kondo also says PMDA is working to launch a dedicated Regulatory Science Center in 2018.

"This center will actively promote 'Rational Medicine' in collaboration with medical practitioners and academia, working on the basis of regulatory science. Its goal will include the formulation of guidelines to encourage the optimal use of novel medical products with innovative mechanisms of action," Kondo says.

Also in 2018, Kondo says PMDA hopes to make its database for real-world safety data fully operational. According to Kondo, once fully operational the Medical Information Database Network (MID-NET) will be made available to drugmakers and other third parties for use in postmarket surveillance activities.

PMDA

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PMDA Head Talks Priorities for 'Rational Medicine' - Regulatory Focus

On the health tech beat, you often meet, broadly, two types of people. First, there are lots of very smart people who think we have the know-how to achieve a kind of big-data, perpetual-monitoring, digital-health paradise or at least something better than we have now.

Then there are some other, equally smart folks whothink that particular vision is fueled bytoo muchSilicon Valley dreamin andtoo little attention tothe basics of health care access and smart policy.

Dr. Daniel Kraft is closer to the former category. Dr. Kraft put in an appearance on KQEDs Forum radio program recently to discuss cutting edge health tech. Kraft is the chair of medicine at Singularity University, a technology think tank,startup accelerator and educational organization that looks to leverage rapidly accelerating technologies to find solutions on a global scale.

Kraft and Forum host Michael Krasnytalked about the effects ofnew and prospective technologies,from virtual realitys impacton medical education to the Uberization of health care.Below are excerpts of Krafts answers, edited for length and clarity.

The Uberization of Health Care

Everyone is familiar with Uberas disruptive. But they couldnt have existed 10-plus years ago, without smartphones, GPS, online paymentsthey connected the dots.

We all want that ease and transparency of use that were used to with Uber. And were seeing that kind of mindset come not just to millennials but to older folks who want access to their clinical data and doctor. There are several companies that have launched apps where you press a button and a doctor will come to you within three hours. Uber itself did a pilot in New Yorkwhere you press a button and a nurse will come and give you a flu shot. This ease-of-access mindset is coming across in many parts of health care, including delivering your drugs, whether its by Uber, Lyft or drone.

The Potential of Digital Health Data

Were in this age of exponential data, but how do you make it useful to you as a consumer, patientand physician? A lot of digital devices get left in a drawer after a month or so; the trick is to make themengaging.

We practice sick care today, spending most of our time and money on folks who already have disease. But we can really move to more proactive, continuoushealth care using some of these tools.

In the future well have individualized check engine lights. Your information will be synthesized so that a warning light can say, Hey, time to come in for a checkup before you blow a gasket.

Digital Mental Health Tools

With some wearables and other technologieswe can now get a pulse on our behaviors. Right now Im wearing a couple of devices that track my sleep. I have a ring that can do this; I have a sensor on my mattress. Just getting insight into how you sleep can have a huge impact on health and wellness over the long term.

Its the same thing for depression and anxiety. Were seeing companies that can be a platform for mental health progression. For example, for bipolar patients, if youre depressed and not moving much and staying in the house, some of these new platforms allow you to access your care team and your family, so you can get a digital hug when you might need one.

Virtual and Augmented Reality

Physicians today spend twice as much time typing in their medical records than they do with patients. So one of the best applications is using Google Glass or a similar product sophysicians can see their patients and viewdata but have someone else act as a virtual scribe.

Were seeing now how Oculus Rift can help medical students learn anatomy, allowing them to fly through the heart or the brain. Were seeing ways to use VR to treat burn patients who have undergonepainful surgeries; theyre put into a cold environment where they get to throw snowballs, and it diminishestheir pain and their need for opiates. And kids with autism can now put on Google Glass and learn to recognize facial emotions.

Health Screening Tools

Part of the future will beto use new screening tools: app-based eye-tracking devices, blood-based diagnostics, brain scans that might pick up dementia 10 or 15 years early. There are drugs in development that might stop or reverse plaques when youre at stage 0, before you have symptoms.

Even with your 23andme data, primary care doctors could gain some insightswhen to screen you or what statin drugs may workbest for you, based on your pharmacogenomics. The challenge is a lot of this information doesnt flow to your physicians; theyre not incentivized to use it, and in some cases theyre dis-incentivized.

Health Care vs. Technology Care

Folks talk about robot physicians or the app taking over your medical care. I think its going to be more of a blend, not just AI but IA, intelligence augmentation. So in fields like radiology or dermatology or pathology, where clinicians are trained to see patterns, now machine learning can arguablydo that faster and better, and that can augment a primary care doctor in screening you for melanoma, for example.

Were seeing the ability to do triage with chatbots, whichyou might access from your phone and help you do the first steps. Ive got a few medical tricorders, inspired by Star Trek,with me. So at home or in yourpocket you can literally pull down advanced vital signs that synch up with your phone and connect to your clinicians, and AI agents can help you understand where you are in your baseline and the way things are moving.

We dont need to replace doctors, but maybe every visit doesnt need to require you to take off half a day of work, sit in the waiting room and fill out the same form. You might use your smartphone for a follow-up appointment to look at a wound from surgery, or to check on a suspicious skin lesion. As cost pressures go, well be seeing more and more payment for some of these telehealth platforms.

Pediatrics and Technology

Theres a lot of new tech coming for pregnant women and children. A connected otoscope can enable you to track kids with ear infections athome, so you dont have to drag them back to the doctor. Were seeing sensored cribs or infant ankle bracelets, sort of a Fitbit for babies, which can help reassure worried parents or enable a physician to send a child home earlier when theyre at risk of SIDS or asthma.

More onSingularity University and what it calls exponential medicine here.

Jon Brooks is the host and editor of KQEDs health and technology blog, Future of You. He is the former editor of KQEDs daily news blog, News Fix. A veteran blogger, he previously worked for Yahoo! in various news writing and editing roles. He was also the editor of EconomyBeat.org, which documented user-generated content about the financial crisis and recession. Jon is also a playwright whose work has been produced in San Francisco, New York, Italy, and around the U.S. He has written about film for his own blog and studied film at Boston University. He has an MFA in Creative Writing from Brooklyn College.

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What Will Next-Stage Digital Medicine Look Like? - KQED

Summa emergency medicine residency loses accreditation, health system put on probation Crain's Cleveland Business The emergency medicine residency program at Summa Health will lose its accreditation, and the system has been put on probation by the Accreditation Council on Graduate Medical Education (ACGME). The program's accreditation withdrawal is effective ... Summa Health emergency medicine residency program put on probationBecker's Hospital Review all 2 news articles »

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Summa emergency medicine residency loses accreditation, health system put on probation - Crain's Cleveland Business

At least five people have been accidentally infected with HIV at a hospital in China after a doctorreused dirtyneedles during treatment.

The doctor at the Chinese medicine hospital inthe eastern city ofHangzhouisunder criminal investigation,according tothe local health authority.

The government statement said a"serious medical incident" had occurred at the Zhejiang Provincial Hospital of Traditional Chinese Medicine, reported the South China Morning Post.

TheAIDS-causingvirus is believed to havespread when the doctor violated procedure by failing to dispose of syringes after use, transferring the infection from one HIV positive patient to at least five others.

Internet users in Chinareacted with shock to the news, stoking long-standingfears HIV could be spread by poor medical practice.

However,most media reports and social media postspublished in Chinese about the incident were swiftlycensored, according to AFP.

The health authority said it had learned of the five infections on 26 January, but did not disclose how many people might havebeen exposed to the virus in total, or what the original treatments were for.

The Independent has contacted the large hospital, whose websiteclaims it is "well known nationwide for its longest history and largest scale with the best technical capacity in Zhejiang Province", for comment.

Hangzhou, in Zhejiang province, is around 100 miles from Shanghai.

China had around 500,000 cases of HIV and AIDS at the end of 2014, according to a 2015 UN report, and the Chinese government has announced new efforts to contain the spread of the virus with a five-year plan.

In 1990,thousands of people contracted HIV amid an infected blood-selling scandal in the central Henan province.

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At least five patients accidentally infected with HIV at traditional Chinese medicine hospital - The Independent

Dr. Lin H. Chen consults a patient in her office at Mt. Auburn Hospital, where she is the director of the Travel Medicine Clinic.

Bitten by a spider in Peru? Suffering from high altitude sickness in Tanzania? Contracted a virus during a mass gathering like the Hajj? As globetrotters go to increasingly far-flung destinations, travel physicians like Dr. Lin H. Chen need to keep their pulse on remote destinations and the unique health risks they present. Travel medicine today is a lot more than just jabs from a needle for vaccinations its consulting with patients about health and safety measures, and taking precautions that cant always be neatly packed into a suitcase, says Chen, 56, director of the Travel Medicine Center at Mount Auburn Hospital in Cambridge. Chen never knows what types of cases she will see when she walks into the exam room last year, the infectious disease specialist discovered one of the first cases of Zika in New England. The Globe spoke with Chen about this rapidly evolving field of medicine.

When I discovered one of the first Zika cases in the state, it was a patient who arrived at the travel clinic after a trip to Costa Rica. He showed symptoms of fever, joint pain, and a dramatic rash. A test came back confirming Zika. Shortly after the diagnosis, the countrys health minister recognized that Zika was indeed spreading throughout the local population. This case was interesting because the traveler was a sentinel for the disease not yet confirmed for that location.

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Travelers go to such exotic places and do fascinating things, whether backpacking, volunteering or working. Our patients might be running a marathon on every continent, participating in car rallies on the Silk Road, locating human trafficking victims, or observing elections abroad. Its fascinating to see the global connections, and its very satisfying when I confirm a diagnosis sometimes exotic, sometimes not in an ill traveler, and they improve with treatment.

Our travel medicine center is one of the GeoSentinel sites worldwide that participate in surveillance and monitoring of travel-related illnesses. My work is really interesting, intersecting so many different disciplines. Many questions arise that do not have clear-cut answers, and I enjoy the challenge of pulling scientific evidence from the different specialties to synthesize into practical clinical guidance.

I got involved with this field because I love to travel and I live vicariously through the travels of my patients. Ive been to all continents except for Africa and Antarctica. But even a travel physicians family can have inadvertent injuries and illness. We still have come down with the ubiquitous travel diarrhea, and one of my children even once fractured his elbow in Mexico. He tripped over a swimming noodle by the pool. So accidents can happen anywhere. Its good to always be prepared.

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This travel medicine doctor is always on the go - The Boston Globe

FLORENCE, SC Whether older, younger, active, or not-so-active, everyone has unique movement imbalances and limitations that can lead to decreased performance and even injury. To provide useful tools for staying active while also decreasing risk of injury, McLeod Sports Medicine will host a Performance Clinic on Saturday, February 18, 2017 at the McLeod Health and Fitness Center located at 2437 Willwood Drive, Florence. The one day drop-in clinic, is from 9:00 a.m. until 11:00 a.m.

The Performance Clinic is designed to be very interactive and will be staffed by Certified Athletic Trainers, Physical Therapists, and Physical Therapy Assistants. Attendees will have the opportunity to participate in 3D video gait analysis (Dartfish), Kineseotaping, Lower and Upper Extremity testing with corrective exercise strategies, strength training, injury screenings and injury prevention, and obtain dry needling information, nutrition advice, and tactics to personalize training while minimizing the risk of injury.

For more information on the McLeod Sports Medicine Performance Clinic, please call Dave Stoklosa at (843) 616-8235.

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McLeod Sports Medicine offers free Performance Clinic - WBTW - Myrtle Beach and Florence SC

A junior doctor in Sydney writes about the crushing pressure experienced by doctors in training.

In the year it has taken for me to complete my training as a junior doctor three of my colleagues have killed themselves.

These are just the ones I've heard about.

I've read articles that refer to suicide among doctors as "the profession's grubby little secret" but I'd rather call it exactly how it is the profession's shameful and disgusting open secret.

Medical training has long had its culture rooted in ideals of suffering. Not so much for the patients which is often sadly a given but for the doctors training inside it. Every generation always looks down on the generation training after it:no one ever had it as hard as them, and thus deserve to suffer just as much, if not more.

This dubious school of thought has long been acknowledged as standard practice. To be a good doctor you must work harder, stay later, know more, and never falter. Weakness in medicine is a failing and if you admit to struggling it's thought that you simply couldn't hack it. In the cut-throat, brutal culture of medicine,many junior doctors stay stoically mute in the face of daily, soul-destroying adversity. Inthese worst cases, their loudest gesture is deafeningly silent. The thought of years of knowledge and training being used for such purposes is not only sickening, it is heartbreakingly sad.

Extremely long hours, little financial remuneration (particularly while training), discouragement to claim overtime, and extreme shortage of training places leave many doctors of my generation feeling as if we don't have many options.

Colleagues compete with one another because it's how we have been conditioned to behave we all know one bad mistake or disagreement with an important superior is all that it takes to end a career you've already devoted seven-plus years of your life to,and you haven't even really started yet.

To not "specialise" is seen as a cop-out anyone who openly admits to wanting a more lifestyle-friendly medical career path is more often than not looked down upon. You're left feeling much of the time that whatever you do it's simply never going to be quite good enough.

When I asked my friends who are not doctors whether three people in their cohort had killed themselves in the past year, they looked horrified. There would be some kind of inquiry, they said, an investigation, some action. Some kind of introspective analysis into their workplace that tried to find some kind of answer for what had occurred. Doctors tend to receive an email from our management with a link to a counselling service, and then we go to work and pretend as if nothing has happened.

No doctor I know, particularly juniors trying to pass exams and get into training programs, would ever voluntarily seek help, because they are afraid of being labelled as weak or not coping.

Junior doctors are called the backbone of the medical profession, but at the same time it feels all too often as if we are its collective punching bag. We are told from day one we must always be extremely polite to nursing staff whom I have witnessed belittling interns and residents without consequence. We are expected to work well beyond our rostered hours. We are told we must pay thousands of dollars for courses and exams and further our knowledge but we are all too often humiliated by our seniors in high-stress environments because, for all the things we know, we can never know enough.

When I think about all the things I have learnt at the end of my training, one stands out very clearly. There is something rotten inside the medical profession that has been festering for a long time. There isno realistic cure. The statistics about doctor suicide and mental health have been clear for yearsand yet our responses and solutions feel perfunctory at best and shameful at worst.

Most junior doctors feel the same as me that things won't change and that there's no point in really trying.

I don't want to get "doctor suicide fatigue" where another death is not a tragedy but rather an unpleasant expectation. When a patient dies unexpectedly at my work there is an investigation and a debrief and somebody writes a report and steps are put in place to ensure this doesn't happen again. Where is this investigation when a doctor dies?

Junior doctors deserve better than what we are being given. It is time for the medical profession to look deep inside itself and fix the cancer that has been growing for far too long. If they don't, the cost is simply too high.

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Three of my colleagues have killed themselves. Medicine's dark secret can't go on - The Sydney Morning Herald

by Sunpreet Singh | 2/9/17 2:00am

H. Gilbert Welch is an academic physician and cancer researcher at the College. He is a professor of medicine at The Dartmouth Institute for Health Policy and Clinical Practice and an internist at the White River Junction Veterans Affairs Medical Center. He focuses on studying issues in early detection efforts for cancer, including over-testing and the harmful effects of false positives, and is the author of three books on the subject. Welch also teaches an undergraduate course every spring called Public Policy 26, Health Policy and Clinical Practice.

What made you decide to study medicine?

HGW: I was an ambulance attendant, EMT, in college. I was very interested in emergency care and saving lives, stuff like that. I also liked science, and I thought it would be really fun to learn about the biology of the human body, the biology of yourself. Those were my motivations that drew me to medical school. I didnt know that I ultimately wanted to be a member of medical school faculty. My father was a faculty member at the University of Colorado. I didnt know I would be involved in research because I thought I would be involved in political research and medicine.

What made you come to Dartmouth?

HGW: I have been at Dartmouth since 1990. I came and started as an employee at the [Veteran Affairs division] in White River Junction, where I worked for 20 years. I was also involved in research at the forerunner of The Dartmouth Institute. I came here to work with TDI founder Jack Wennberg, who put Dartmouth on the map for medicine.

He started The Dartmouth Atlas of Healthcare by doing analyses of the epidemiology of the practice of medical care, how it is practiced in different places and how it has evolved over time. Epidemiology is all about patterns in health that vary across geography and across time. He made observations that what was a homogeneous and white middle-class place [New Hampshire] had wildly different medical care across towns. I did my fellowship at the University of Washington, and my adviser told me they were looking for someone at Dartmouth, so I applied and have stayed since.

How have you seen Dartmouths role in medicine change over time?

HGW: Over the course of my 27 years here, the stature of the ideas coming from Dartmouth counter cultural ideas has gained a lot of traction. There are a lot of people elsewhere in the country that look to Dartmouth to help explicate some of the unusual features of medical care that we can create demand for. Dartmouth has offered counters to the whole idea that if you build more hospitals, more people will come, and more people will then be treated. The phenomenon is that if you build it, they will come, where you build more hospitals and more people are in the hospitals.

If you start looking for early forms of disease, you are going to find a lot, more than you would expect. These are somewhat revolutionary ideas in medicine because it wasnt all about patients needs. The current system has some very powerful influence over how much medical care people get. We have long been concerned about people not getting enough medical care, and in more recent years we realized we have to worry about the other side of the equation where people are getting too much medical care. Some people are not getting enough, but some people are getting too much, and it is not good for their health.

What is your research regarding medical testing about?

HGW: My role in research has been dealing with this assumption that sooner is always better. This is a very powerful assumption in healthcare, particularly for feared diseases like cancer, because we think that the best way to deal with it is to look for it early.

It seems to make so much sense on the face of it, but it is not right. At least, it is not always right. The truth is whenever we look for early forms of disease, we find a lot more than we would ever expect. Ironically, because of our interest in early cancer detection, where I have focused a lot of my energy, there is an incredible heterogeneity in what we call cancer.

That brings me to the barnyard pen of cancers, which is a way to think about the heterogeneity of cancer. The barnyard pen has three animals: the birds, the rabbits and the turtles the goal of early detection is to catch those animals early and fence them in. The bird cant be fenced. It has already flown away they represent the fastest growing and most aggressive cancers that have already spread. Screening wont help the bird; they are already missed and out of there. The rabbits are hopping around. You can catch them if you build the fence early. Detection has the potential to benefit slow growing cancers the turtles are the cancers that arent going anywhere anyway. You dont need any fences, but unfortunately our early detection efforts are really good at finding turtles. However, doctors cant separate turtles from rabbits, and they treat everybody, which creates harmful early detection results. Breast, prostate and thyroid are all glands that have cellular abnormality in them. If we look really hard, we start finding that abnormality.

What have been the effects of this early screening issue in specific cases and for the medical community in general?

HGW: The poster child for the problem is South Korea. 15 years ago, doctors started doing ultrasound screening for thyroid cancer. Then 15 years later, there was a 15-fold increase in the incidence of thyroid cancer. Some people say that is an epidemic of disease. But, the death rate from thyroid cancer is totally stable. It doesnt look like an epidemic of disease it looks to me like an epidemic of diagnosis. In fact, the thyroid gland is known to harbor lots of small cancers, and yet pathologists also recognized that thyroid cancer was also an extremely rare form of cancer. You have all this reservoir of abnormalities that could be called cancer, but most of them could never go on to cause death. The end result is if you start looking for thyroid cancer, you find a lot of thyroid cancer, you scare a lot of people, take out a lot of thyroids, people need lifelong thyroid replacement and you dont change their death rate. You are then treating them unnecessarily, which happened in South Korea.

More important broadly, there is a lot of interest right now in the biotechnology community in testing people. Whether its biomarkers, immunosignatures, liquid biopsies, nanositiology, they got all these various technologies to test people, to try to predict or find early forms of disease. And I think everyone needs to understand that that is a double edged sword, that we all harbor abnormalities and increasingly our tests are able to find those abnormalities. That does not tell us what to do and creates a cycle of increasing anxiety and intervention that can harm patients. This is a general thing we all need to inoculate ourselves on. Theres this idea that you can test yourself to help, and we need to recognize first that over-testing may distract us from things that are more important and can start a chain of events that we wished had never started.

What impact has your research had on medical practices and screening procedures and perceptions regarding early screening?

HGW: We are getting to be more balanced now. More and more physicians and an increasing portion of the public understand that this is not as simple as it seems, that it is not always the right thing to do, looking hard for things to be wrong. It can be a recipe for turning people into patients unnecessarily. This is kind of a new idea. It started with the best of intentions where we said, Wow, people have really bad diseases and bad things happen and the way to deal with it is to look for early forms of disease. We didnt anticipate that there are more forms than expected of those diseases. The first thing is that everybody needs to have a more healthy skepticism about the value of testing. For too long we think that we can decide later what we do after getting tested, but instead we need to decide upfront whether you want to do this testing. Once you have an abnormal test result, you are set back, which happens so much since we use so much testing.

A lot of people are beginning to recognize that abnormalities occur due to increased testing, and that may start affecting both patients and physicians feelings about how much to test people and how to be tested. I dont think a law about this is necessary, but I think that direct to consumer advertising of this stuff simply promotes its use and invariably over-promises and oversimplifies the full effects of what can happen. This is a very important point, that the use of these tests is typically associated with very misleading feedback.

Going back to South Korea the minute you look hard for thyroid cancer, there appears to be more out there, and you get a sense of epidemic. This feeds back to get people to test more and not look and see that theres more to cancer. Now the typical thyroid cancer patient does better, their survival rate is higher, and they are less likely to have metastatic disease. They think that is great, but it is only because you told everyone they have thyroid cancer. If you told everyone they had cancer, survival rates would go through the roof, but that doesnt mean youre helping anyone. That is misleading because it is hard for people to wrap their head around. The problem is the measure because it can be biased by the addition of cases that are never going to matter.

What is your class, Public Policy 26, Health Policy and Clinical Practice, all about?

HGW: My class is a 10, and it is offered in the spring, and I have been teaching it for 7 years to cross the boundaries between health care and public policy. It is open to everybody, and every year it is about a quarter freshmen, quarter sophomores, etc. Honestly, sometimes the freshmen do better than the seniors.

In the course we stress statistics and analyzing data because everyone needs to be able to understand numbers, i.e. what is big, what is small, what is being affected, what is this really measuring and what do I want to know. The course is really about critical thinking in the context of health care. The goals are to understand policy context and population perspective, develop skills such as management and quantitative analysis and to evaluate info and thinking about what the measures of something really are.

A big part of it is to question underlying assumptions, since you are willing to ask, Is that central belief, is that really right? and it requires a bit of healthy skepticism. Some students have told me that the first two weeks of the class is a boot camp, and it is really focused on interpreting graphs and then playing with numbers in a spreadsheet to do simple things with it. This is the groundwork that allows us to go forward in the rest of the class to analyze different models and assess clinical practices based on data using simple algebra.

This interview has been edited and condensed for clarity and length.

Link:

Q&A with professor of medicine H. Gilbert Welch - The Dartmouth

Last nights CNN duel between Senators Bernie Sanders and Ted Cruz on the future of Obamacare was pretty illuminating for a recent arrival to the United States, with Senator Sanders playbook all-too-familiar to those of us from the UK.

Sanders wants a single-payer socialized healthcare system in the United States, just as we have in Britain. Any objection to that is met with the claim that you are leaving people to die. The only alternatives on offer, you would think, are the U.S. system as it exists now, or the UK system. Sanders did not once acknowledge that the UK structure, which is free at the point of use, inevitably means rationed care, with a lack of pre-screening. He also failed to acknowledge that lower health spending levels (indeed, even public spending on health is lower in the UK than the United States now) are not the same as efficiencywhich is about outputs per input.

In the face of anecdote after anecdote about those saved by Obamacare and the virtues of a government-run health system, Cruz countered with some anecdotes from the UK showing the consequences of rationed care: a Scottish hospital turning away pregnant women, a woman in Wales waiting eight hours on the floor for an ambulance to arriveafter a fall, and a hospital in Essex canceling life-saving cancer treatment because there were no free beds in intensive care. He could also have talked about the Mid-Staffs scandal, or a recent documentary showing doctors deciding between saving a cancer patient or a pensioner bleeding to death.

Anecdotes are powerful in helping to persuade people, and there are good reasons to use them in debates. Yet they are always susceptible to the charge that all health systems have extreme failures. Perhaps more powerfully then, the inadequacies of the UK system show up systematically in the data about how well conditions are dealt with (data from my former colleague Kristian Niemietzs reports here and here):

I could go on. All of which is to show that your probability of dying from a range of common conditions is much higher in the UK than here. Perhaps thats why (with no hint of irony) The Guardians write-up of a Commonwealth Fund Report suggesting the UKs health system was the best in the world said the only serious black mark against the NHS was its poor record on keeping people alive.

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Socialized Medicine: From Anecdote to Data - Cato Institute (blog)

From tiny startups to global giants, the companies that sustain the $324 billion U.S. biotech industry are increasingly alarmed as President Donald Trump considers following his controversial travel ban with restrictions on skilled foreign immigrants.

To crank out discoveries, U.S. biotech firms such as Amgen Inc. and Gilead Sciences Inc., as well as overseas companies with stateside operations, rely on the worlds best scientists and lower-level researchers with scarce expertise.

A crackdown on visas for these workers could set back research, including the treatment of cancer, executives said. It also comes as companies, hospitals and universities struggle with the aftermath of Trumps immigration ban from seven Muslim-majority countries, which has for now been blocked in court.

Theres a real crisis of science going on in this country, said Cedric Francois, chief executive officer of Apellis Pharmaceuticals, a startup based in Crestwood, Kentucky, that is working on immune-therapy drugs. About half of Apelliss staff come from abroad, largely brought in on the kind of visas, called H-1B, that allow temporary residence for skilled foreign workers.

Most, if not all of our people who are on a green card started off on an H-1B, said Francois, who is Belgian. Including me.

The Trump administration is considering changes to the scope of the H-1B program, one of the main routes through which U.S. employers sponsor skilled staff for immigration, White House spokesman Sean Spicer told reporters last week.

The administration may push to require companies to try to hire Americans first, and make it more difficult for lower-paid roles to qualify for the visas, in order to serve, first and foremost, the U.S. national interest, according to a draft executive order seen by Bloomberg. So far, no such changes have been announced, and the White House hasnt confirmed any details. Broader changes might require an act of Congress.

Politicians in both parties, as well as labor unions, have criticized the H-1B program because they say it lets companies undercut American wages. Some Democrats have also sought to restrict H-1B visas, including through a bill introduced by U.S. Representative Zoe Lofgren of California that would raise the minimum pay for such visa holders to $130,000.

Read More: Why H-1B Tech-Worker Visas Press Trumps Buttons

India-based outsourcing firms, such as Infosys Ltd. and Wipro Ltd., are among their largest users. Silicon Valley giants including Google Inc. and Facebook Inc. are also major H-1B sponsors, and have lobbied for years to make the category more flexible.

The Trump administration didnt respond to requests for comment. Trump has said its necessary to restrict travel from the seven countries because of the risk of terrorism.

U.S. bioscience firms employ about 1.7 million people, according to an industry-backed study, including a rising number of foreigners. Fewer than half of biomedical scientists in the U.S. in 2014 were native-born citizens, according to the journal Nature, and a third were non-citizens. Meanwhile, thousands of foreign scientists travel to the U.S. every year for specific projects.

The chief executives of two companies with U.S. operations, Roche Holding AG, Europes largest drug-maker, and Londons AstraZeneca Plc,assailed the restrictions.

Science doesnt have any borders, so anything that gets in the way of a borderless science exchange doesnt help, said Pascal Soriot,CEO of AstraZeneca, which has U.S. headquarters in Wilmington, Delaware, and research and manufacturing sites in Massachusetts and Maryland. We want to be able to move our people and our scientists around the world.

Trumps first executive order on immigration gave companies an early hint of what could become broader struggles. At Monrovia, California-based Xencor Inc., which works on drugs for immune diseases and cancer, one employee had to cancel a trip for fear of being stranded and another abandoned hope of a visit from an elderly relative overseas, according to CEO Bassil Dahiyat.

Xencor relies on its non-American staff, Dahiyat said: I can think of several off the top of my head who are absolutely pivotal.

Olivier Elemento, a computational biologist at Weill Cornell Medical College in New York, runs a cancer systems lab where two researchers have H-1B visas. The lab works on computational biology, where researchers analyze complex patient gene data to help find targets for new precision drugs -- an approach that has led to recent breakthroughs.

Our research would suffer without a doubt, Elemento said. A lot of discoveries we would make maybe wouldnt happen.

The immigration battle marks the second between drugmakers and the president. Last month, Trump accused the companies of getting away with murder by charging high prices for medicine and threatened to use the purchasing muscle of the federal government to drive costs down.

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On Tuesday, more than 160 industry executives, scientists, and investors signed a letter to the journal Nature Biotechnology condemning Trumps earlier travel ban as a misguided threat to both liberty and innovation.

Medical leaders point to the central role of foreign doctors in the kinds of crises Americans fear. When the Boston Marathon bombings tore the city apart almost four years ago, a Greek doctor led Massachusetts Generals response: George Velmahos, chief of trauma surgery.

Mass General and its affiliated Brigham and Womens Hospital have 100 people with visas from the seven countries targeted by Trumps order, according to Katrina Armstrong, Massachusetts Generals physician-in-chief.

We brought them here because we thought they had the talent to make the country a better place, Armstrong said. These are people who couldnt be more dedicated to preventing violence and saving lives.

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Trump's H-1B Visa Crackdown Threatens Cutting-Edge US Medicine - Bloomberg

Precision medicine promises to change the healthcare paradigm and create a powerful new model of care designed specifically for each individual, offering a much greater likelihood of effectiveness. But to realize much of this vision requires eliminating data silos and aggregating information from all sources Internet of Things, patient surveys, genomic data, EHRs and more into a central repository that gives clinicians worldwide access to this data.

Many believe the cloud will become the primary platform for data aggregation and harmonization. And thats the direction Nephi Walton, MD, informaticist and clinical geneticist at Washington University School of Medicine, is heading.

People are misled a bit by the benefits of cloud computing in this domain, Walton said. A lot of people are touting the advantage of data anywhere, which indeed is an advantage of cloud computing. But that is not the major role that the cloud will play in precision medicine. Its more related to the size of the data and the ability to analyze and access data quickly. And the ability to plug into cloud services of different types. There are certain things that lend themselves to cloud computing more than others, and in precision medicine it is more the large data sets involved.

A caregiver may have huge data sets, entire genomes, gigabytes on an individual. Historically, healthcare has placed all this data on huge servers; but when one has this large a data set on each patient, one really needs to use distributed computing, Walton explained.

Learn more at theCloud Computing ForumHIMSS17.Register here. University of Mississippi Medical Center finds big analytics gains in the cloud Intermountain exec: Cloud changes breadth and depth of innovation

When you think about who is doing it and allowing huge sets of analysis, you think of someone like Google; it is using database cloud computing technology, he explained. The advantage is setting up all of these large data sets in something similar to Google Big Table a database structure different from standard relational databases as it allows one to use a distributed model that enables rapid access to large amounts of data. Here you can quickly access lots of information and process it quickly.

That is where the power will be in terms of cloud computing and precision medicine, he added.

You will have someones genomic data in an accessible database where you can access all the people with certain conditions to do real-time analysis and apply new knowledge to large data sets quickly, he said.

Walton will be speaking on the benefits and challenges of using cloud computing with precision medicine at the HIMSS and Healthcare IT News Cloud Computing Forum in Orlando, Florida, on February 19, during the 2017 HIMSS Conference & Exhibition. Waltons session is entitled Precision Medicine and the Cloud.

One of the big challenges with cloud computing and precision medicine is peoples fear of data security, Walton said.

The thing people do not realize is that the cloud is probably in some ways more secure than what a lot of people are doing now, he said. I know of some organizations that are fearful of the security of putting the data out there in the cloud but that actually have serious gaping security holes that expose them to far more risk than would happen with cloud computing. Anytime you allow remote access to data your weakest link in security is your employees passwords. If you have any reasonable security, the weakest spot will be at the employee level.

Walton said most companies that provide cloud computing services have excellent reliability and security and can provide these things on a scale that would be difficult for smaller organizations and even challenging for larger organizations.

The issue is it is not cheap, he added. But when you look at all the people you employ for security and backup and maintenance and so forth, for smaller organizations it makes sense to turn to the cloud; for larger organizations, it depends.

In the end, healthcare organizations must understand why they wish to get into cloud computing before they actually do so, Walton advised.

Understand if you are doing it for the right reasons, that you have done a good analysis of not just the real obvious things and are not just jumping into the ring without fully understanding why, he said. If you do it from the perspective of you do not want to be the person who manages servers and worry about backups and data security, essentially what you are doing is putting off a lot of your IT expenses to someone else. You can build a cloud in-house. The question is can you do it more efficiently than someone who's job and mission it is to do that. You have to make sure you know why you are doing it and the benefits you will get from it.

HIMSS17runs from Feb. 19-23, 2017 at the Orange County Convention Center.

This article is part of our ongoing coverage of HIMSS17. VisitDestination HIMSS17for previews, reporting live from the show floor and after the conference.

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Cloud computing key to precision medicine but security concerns persist - Healthcare IT News

It seems like debates over vaccines are fairly recent phenomenon, but in truth, medical progress has always been fraught with controversy, competition, and ethical conundrums. In her new book The Vaccine Race: Science, Politics, and the Human Costs of Defeating Disease, author Meredith Wadman explores the story behind the creation of rubella vaccine a medical breakthrough that has helped generations of Americans have healthier childhoods. It also led to the development of numerous other important vaccines including ones for rabies, Hepatitis A and chicken pox.

Yet what many people may not know, Wadman explains, is that A good number of our modern day vaccines actually are made in two cells lines, both of them from legally aborted fetuses originating from Europe back in the early sixties. It was the development of these vaccines that established the fact you could use human cells as safe, clean mini vaccine factories a welcome alternative to previous, riskier work with animal cells. But it also created brand new questions about ownership of cells and what happens when human tissue is turned into profitable invention.

Today, nearly every person born in America since 1979 has been vaccinated against rubella with these cells roughly 140 million individuals. And Wadman says that that number is only a starting point. There are also all of the other people like all of our military recruits who additionally receive vaccines for different reasons. So if youre never worried about getting German measles, its because of a few cell lines, and a scientific race that played out nearly sixty years ago.

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WATCH: How abortion ushered in modern medicine - Salon

In October 2016, the Advisory Committee on Immunization Practices (ACIP) voted to approve the Recommended Adult Immunization Schedule for Adults Aged 19 Years or Older, United States, 2017. The 2017 adult immunization schedule summarizes ACIP recommendations in 2 figures, footnotes for the figures, and a table of contraindications and precautions for vaccines recommended for adults (Figure). These documents can also be found at http://www.cdc.gov/vaccines/schedules. The full ACIP recommendations for each vaccine can be found at http://www.cdc.gov/vaccines/hcp/acip-recs/index.html. The 2017 adult immunization schedule was also reviewed and approved by the American College of Physicians, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists, and the American College of Nurse-Midwives. Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2017.

Recommended Immunization Schedule for Adults Aged 19 Years or Older, United States, 2017.

Recommended immunization schedule for adults aged 19 years or older by age group, United States, 2017

Recommended immunization schedule for adults aged 19 years or older by medical condition and other indications, United States, 2017

Contraindications and precautions for vaccines recommended for adults aged 19 years or older*

Newly added to the 2017 adult immunization schedule is a cover page that contains information on select general principles pertinent to the adult immunization schedule, additional CDC resources, instructions for reporting adverse events related to vaccination and suspected cases of reportable vaccine-preventable diseases, and an ACIP-approved list of standardized acronyms for vaccines recommended for adults. In addition, the table of contraindications and precautions for vaccines routinely recommended for adults that was formerly a standalone document has been incorporated into the adult immunization schedule. Changes in the 2017 adult immunization schedule from the previous year's schedule include new or revised ACIP recommendations on influenza, human papillomavirus, hepatitis B, and meningococcal vaccinations.

LAIV should not be used during the 20162017 influenza season.

Adults with a history of egg allergy who have only hives after exposure to egg should receive age-appropriate inactivated influenza vaccine (IIV) or recombinant influenza vaccine (RIV).

Adults with a history of egg allergy with symptoms other than hives (e.g., angioedema, respiratory distress, lightheadedness, or recurrent emesis, or who required epinephrine or another emergency medical intervention) may receive age-appropriate IIV or RIV. The selected vaccine should be administered in an inpatient or outpatient medical setting and supervised by a health care provider who is able to recognize and manage severe allergic conditions.

Women through age 26 years and men through age 21 years who have not received any HPV should receive a 3-dose series of HPV at 0, 1-2, and 6 months. Men aged 22 through 26 years may be vaccinated with a 3-dose series of HPV at 0, 1-2, and 6 months.

Women through age 26 years and men through age 21 years (and men aged 22 through 26 years who may receive HPV) who initiated HPV series before age 15 years and received 2 doses at least 5 months apart are considered adequately vaccinated and do not need an additional dose of HPV.

Women through age 26 years and adult males through age 21 years (and men aged 22 through 26 years who may receive HPV) who initiated HPV series before age 15 years and received only 1 dose, or 2 doses less than 5 months apart, are not considered adequately vaccinated and should receive 1 additional dose of HPV.

Adults with chronic liver disease, including, but not limited to, hepatitis C virus infection, cirrhosis, fatty liver disease, alcoholic liver disease, autoimmune hepatitis, and an alanine aminotransferase (ALT) or aspartate aminotransferase (AST) level greater than twice the upper limit of normal, should receive a HepB series.

Adults with anatomical or functional asplenia or persistent complement component deficiencies should receive a 2-dose primary series of MenACWY at least 2 months apart and revaccinate every 5 years. They should also receive a series of MenB with either a 2-dose series of MenB-4C at least 1 month apart or a 3-dose series of MenB-FHbp at 0, 1-2, and 6 months.

Adults with HIV infection who have not been previously vaccinated should receive a 2-dose primary series of MenACWY at least 2 months apart and revaccinate every 5 years. Those who previously received 1 dose of MenACWY should receive a second dose at least 2 months after the first dose. Adults with HIV infection are not routinely recommended to receive MenB because meningococcal disease in this population is caused primarily by serogroups C, W, and Y.

Microbiologists who are routinely exposed to isolates of Neisseria meningitidis should receive 1 dose of MenACWY and revaccinate every 5 years if the risk for infection remains, and either a 2-dose series of MenB-4C at least 1 month apart or a 3-dose series of MenB-FHbp at 0, 1-2, and 6 months.

Adults at risk because of a meningococcal disease outbreak should receive 1 dose of MenACWY if the outbreak is attributable to serogroup A, C, W, or Y, or either a 2-dose series of MenB-4C at least 1 month apart or a 3-dose series of MenB-FHbp at 0, 1-2, and 6 months if the outbreak is attributable to serogroup B.

Young adults aged 16 through 23 years (preferred age range is 16 through 18 years) who are healthy and not at increased risk for serogroup B meningococcal disease may receive either a 2-dose series of MenB-4C at least 1 month apart or a 2-dose series of MenB-FHbp at 0 and 6 months for short-term protection against most strains of serogroup B meningococcal disease.

Significant changes in the 2017 adult immunization schedule footnotes include the following:

The format for the footnotes has been condensed, simplified, and standardized. The format for pneumococcal; human papillomavirus; meningococcal; varicella; and measles, mumps, and rubella vaccination footnotes have undergone significant revision.

Lastly, the table of contraindications and precautions for vaccines routinely recommended for adults, previously a standalone document, has been incorporated into the adult immunization schedule. The content of the table has been consolidated and simplified.

Work Group Chair: Laura E. Riley, MD, Cambridge, Massachusetts.

Work Group Members: John Epling, MD, MSEd, Syracuse, New York; Stephan Foster, Nashville, Tennessee; Sandra Fryhofer, MD, Atlanta, Georgia; Robert H. Hopkins Jr., MD, Little Rock, Arkansas; Paul Hunter, MD, Milwaukee, WI; Jane Kim, MD, Durham, North Carolina; Laura Pinkston Koenigs, MD, Springfield, Massachusetts; Maria Lanzi, ANP, MPH, Hamilton, New Jersey; Marie-Michele Leger, MPH, PA-C, Alexandria, Virginia; Susan M. Lett, MD, Boston, Massachusetts; Robert Palinkas, MD, Urbana, Illinois; Gregory Poland, MD, Rochester, Minnesota; Joni Reynolds, MPH, Denver, Colorado; Charles Rittle, DNP, MPH, RN, Pittsburgh, Pennsylvania; William Schaffner, MD, Nashville, Tennessee; Kenneth Schmader, MD, Durham, North Carolina; Angela Shen, PhD, Washington, DC; Rhoda Sperling, MD, New York, New York.

Work Group Contributors: Carolyn B. Bridges, MD, Atlanta, Georgia; Elizabeth Briere, MD, MPH, Atlanta, Georgia; Lisa Grohskopf, MD, MPH, Atlanta, Georgia; Rafael Harpaz, MD, MPH, Atlanta, Georgia; Charles LeBaron, MD, Atlanta, Georgia; Jennifer L. Liang, DVM, MPVM, Atlanta, Georgia; Jessica MacNeil, MPH, Atlanta, Georgia; Mona Marin, MD, Atlanta, Georgia; Lauri Markowitz, MD, Atlanta, Georgia; Noele Nelson, MD, PhD, Atlanta, Georgia; Tamara Pilishvili, MPH, Atlanta, Georgia; Mona Saraiya, MD, MPH, Atlanta, Georgia; Sarah Schillie, MD, Atlanta, Georgia; Raymond A. Strikas, MD, MPH, Atlanta, Georgia; Walter W. Williams, MD, MPH, Atlanta, Georgia.

Work Group Consultants: Tamera Coyne-Beasley, MD, MPH, Chapel Hill, North Carolina; Kathleen H. Harriman, PhD, MPH, RN, Richmond, California; Molly Howell, MPH, Bismarck, North Dakota; Linda Kinsinger, MD, MPH, Durham, North Carolina; Diane Peterson, St. Paul, Minnesota; Litjen Tan, PhD, Chicago, Illinois.

Work Group Secretariat: David K. Kim, MD, MA, Atlanta, Georgia.

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