Severe Staph Infections Linked to Unsafe Use of Single-Dose/Single-Use Vials

With certain drugs in short supply, some health care professionals may be tempted to use singledose/single-use medication vials for more than one patient, a practice that goes against US CDC’s 2007 Standard Precautions. New outbreak reports provide a frightening reminder of these critical recommendations: medications labeled “single-use” or “singledose” must be used for one—and only one—patient.

US CDC reported in the July 13 issue of MMWR that 10 patients in Arizona and Delaware contracted severe methicillin-susceptible Staphylococcus aureus (staph) or methicillin-resistant S. aureus (MRSA) infections at outpatient facilities where practitioners reused medication from single-dose/single-use medication vials for multiple patients.

In Arizona, three patients contracted invasive MRSA infections following injections from the same singledose/single-use vial at an outpatient pain management clinic. Patients were treated for acute mediastinitis, bacterial meningitis, epidural abscess and sepsis. A fourth patient who received an injection from the same vial was found dead at home six days after treatment at the clinic. Cause of death was reported as multiple drug overdose; however invasive MRSA could not be ruled out.

Seven patients in Delaware were diagnosed with severe staph infections after receiving joint injections at the same outpatient orthopedic practice. Staff at the clinic had recently started to use singledose/single-use vials for multiple patients after their supply of a smaller vial size (which they had previously dedicated for single-patient use), was disrupted as part of a national shortage. Two staff members who were responsible for preparing injections were found to be colonized with S. aureus, and one was an identical match to the strain that infected the seven patients.

Since 2007, the year that injection safety was included as part of Standard Precautions, there have been at least 20 outbreaks associated with the use of single-dose or single-use medication vials for more than one patient. Medication in single-dose/single-use vials is typically preservative-free, which makes it unsafe to use for more than one patient.

It is every provider’s responsibility to protect their patients. Refresh your knowledge of safe injection practices at the website, download the Healthcare Provider Toolkit, including an injection safety checklist and follow the campaign on Twitter and Facebook. Every patient deserves the protection of safe injections.

Tobacco prevention

The Cancer Action Network of the American Cancer Society recently released a report, Staying Well: Real Stories from the Prevention and Public Health Fund. The report includes a feature on the Maine Tobacco HelpLine and the Partnership for a Tobacco-Free Maine on pages 20-21.
Young tobacco prevention activists from Maine and throughout the United States are participating in a youth leadership training in Washington, DC, this week and meeting with members of Congress to urge them to support strong policies to reduce tobacco use.

In particular, the youth are calling attention to the marketing of cheap, sweet-flavored cigars that appeal to kids. Nearly 30 youth from across the country are participating in the training, which is organized by the Campaign for Tobacco-Free Kids and includes skill-building workshops on leadership, advocacy and communications.

In Maine, tobacco use kills 2,200 residents and costs the state $602 million in health care bills each year, and 15.2 percent of high school students smoke cigarettes.

For more information, visit http://www.tobaccofreekids.org/

Look forward To a Great Career With a Physical Therapy Assistant Degree

Becoming a physical therapy assistant is a challenging, yet very rewarding career choice for anyone interested in a much more hands on position in the medical services field.

It is a wonderful job for those who love working with the public on a one to one basis and offers an excellent salary as well. In order to secure this kind of job though, individuals are required to be titled, and (in most US states) to obtain licensure, which can be applied for after earning a physical therapy assistant degree.

How to Get a Associates Degree

First you will need to earn an Associates Degree of Science in Physical Therapy Assistance in order to obtain certification and licensure.

This involves a 2-year college education in a course that is accredited by the Commission on Accreditation in Physical Therapy Education (CAPTA), and the included, required externships.

Courses for an Associates Degree with emphasis on PTA include the basic courses of English, Maths and Algebra, Anatomy and Physiology, Kinesiology, Rehabilitation, Therapeutic exercise, Medical Terminology and others. After formal education and passing of all related exams, students earn their degree.

There are also some online, accredited Associates Degree programs which state they can prepare a student for PTA education and training; however, even though most of the coursework is done online, students will still need to fulfill externships and other required course work offline in order to graduate, and be prepared to take their certification exams.

A licensure is required individually by state, though currently 48 of fifty states require it (Colorado and Hawaii currently do not require licensure as long as someone has their PTA).

Once a PTA has passed their certification exam they are then eligible to take their state's licensure exam, making them eligible to work as a PTA in that state, only. PTAs who change location and wish to then work in a different state are required to take a new state exam in order to do so.

Information about state licensure and the National Physical Therapy Exams (NPTE) for PTs and PTAs can be found on the Federation of State Board of Physical Therapy website at http://www.fsbpt.org

Jobs Available with a Degree

Once certification and licensure is complete, PTAs are able to apply for jobs in a variety of medical settings including in hospitals, rehabilitation centers, sports medicine practices, skilled nursing facilities, home health aide services, schools and with individual companies as on-staff physical therapy providers.

Licensed PTAs can also continue their education and obtain specialty training to become qualified to work in specific fields such as post-surgical, orthopedic and cardiopulmonary. Many PTAs also continue their college education and work toward becoming an actual Physical Therapist, too.

Salary After Getting a Degree

Depending on the location, job experience and the type of position, physical therapy assistant salaries range between $31,000 and as high as $68,000 (upper 10 percent) as of May, 2010 according to the US Bureau of Labor Statistics.

This range is expected to rise in the coming 5 to ten years, too, as the physical therapy field grows. Job numbers are also expected to grow as much as 46 percent during this time, so it seems that becoming a PTA is a position with a good future and a lot of promise in both opportunity and salary.

Physical therapy aides (non-licensed, non-schooled) on the other hand earn a salary of between $17,000 and $34,000.

With these kind of statistics, anyone interested in a medical profession where they will assist with actual patient care and other hands on duties is likely to be a very satisfying one, personally, professionally and financially.

Those looking to become PTAs are recommended to find the best accredited program available in order to be well prepared for physical therapy assistant degree and licensing exams.

It should also be noted, currently there is discussion of changing the course curriculum for a PTA from a 2 year Associates Degree to a 4 year Bachelors Degree, the same as there have been discussions in other medical areas of raising the schooling requirements.

Getting a degree finished now will enable someone to get into the field faster if these changes do come about in the near future.

Food safety

One confirmed case in Maine is included in a multistate outbreak of Salmonella Enteritidis infections linked to ground beef. A second suspected case is undergoing testing.


Consumers should check their refrigerators and freezers for recalled products and not eat them; retailers and food service operators should not serve them.

Salmonella Enteriditis causes abdominal pain, diarrhea, cramps, and fevers. It usually lasts 3-10 days.

One in six Americans will get sick from food poisoning this year alone. FoodSafety.gov has a number of helpful at-a-glance food safety charts available as well as other food safety information.
If you’ll be grilling outdoors this summer, check out this video from the Grill Sergeants with safety guidelines for safe grilling.

Pertussis (whooping cough) update 7/26/12

Pertussis is endemic in the United States. Although cyclical in nature, a gradual and sustained increase has been observed in the United States after reaching historic lows in the 1970s. In 2010, 27,550 pertussis cases were reported. Year-to-date case counts from 2012 have surpassed those from the previous 5 years for the same period.


To date, 300 cases of pertussis have been reported in Maine this calendar year, compared with 75 cases at the same time last year. The majority of cases have been in Cumberland, Somerset, and Penobscot counties, with most cases in children ages 7 to 19. Weekly pertussis updates are available on the Maine CDC website (http://www.mainepublichealth.gov/), updated every Thursday. This week's update is available at: http://go.usa.gov/fMC

US CDC recently issued a MMWR about the pertussis epidemic in Washington state, which suggests early waning of immunity from acellular pertussis vaccines.

For more information, visit http://go.usa.gov/dCO

HIV updates

The XIX Annual International AIDS Conference is currently underway in Washington, D.C., and several recent developments have occurred in the fight against HIV/AIDS:


Home Testing

The US Food and Drug Administration (FDA) approved the first over-the-counter home-use rapid HIV test on July 3. The OraQuick In-Home HIV Test is designed to allow individuals to collect an oral fluid sample and obtain test results within 20 to 40 minutes.


A positive result with this test does not mean that an individual is definitely infected with HIV, but rather that additional testing should be done in a medical setting to confirm the test result. Similarly, a negative test result does not mean that an individual is definitely not infected with HIV, particularly when exposure may have been within the previous three months. The test has the potential to identify large numbers of previously undiagnosed HIV infections especially if used by those unlikely to use standard screening methods.


Pre-Exposure Prophylaxis

On July 16, FDA approved Truvada (a fixed dose combination of two antiretrovirals used to treat HIV) to reduce the risk of HIV infection in uninfected individuals who are at high risk of HIV infection and who may engage in sexual activity with HIV-infected partners. Truvada is to be used for pre-exposure prophylaxis (PrEP) in combination with safer sex practices to prevent sexually-acquired HIV infection in adults at high risk. Truvada is the first drug approved for this indication.

Truvada for PrEP is meant to be used as part of a comprehensive HIV prevention plan that includes risk reduction counseling consistent and correct condom use, regular HIV testing, and screening for and treatment of other sexually-transmitted infections. Truvada is not a substitute for safer sex practices. As part of PrEP, HIV-uninfected individuals who are at high risk will need to take Truvada daily to lower their chances of becoming infected with HIV should they be exposed to the virus.

For more information about PrEP, visit http://www.cdc.gov/hiv/prep/


Prevention with Positives

Earlier this week, US CDC launched the first ever Prevention with Positives website to help address the prevention needs of people living with HIV/AIDS.

Trends in HIV-related Risk Behaviors Among High School Students

An early release MMWR article “Trends in HIV-Related Risk Behaviors Among High School Students — United States, 1991–2011” describes the analysis of data from the biennial national Youth Risk Behavior Survey (YRBS) with results that suggest that progress in reducing some HIV-related risk behaviors among high school students overall and in certain populations stalled in the past decade. The article suggests that renewed educational efforts and other risk reduction interventions are warranted to reduce the number of young persons who become infected with HIV.


Maine Reports

Maine's May 2012 HIV/STD update and 2011 HIV/STD Surveillance Report are now both posted on the Maine CDC website.

Medical Education Vs Chiropractic Education

After working within the chiropractic field for a few years now, I occasionally come upon interested patients who question the number of years of training it requires to get a degree in chiropractic. A fair amount of these folks seem to have the idea that it's merely a two-year education. I'm not necessarily astonished at this kind of belief, nonetheless I do think this is a general indication of our society's view of chiropractic care. In fact some of my pals will occasionally jest about visiting a 'real doctor'.

Given the history between the medical industry and the chiropractic industry, this type of perspective of the general population should not be surprising. The American Medical Association (AMA) went to great effort to attempt to discredit chiropractic for quite a while, and it wasn't until the lawsuit Wilkes v. American Medical Association in 1983, which decided against the AMA, that it was revealed that their purpose had been to eliminate chiropractic as a discipline. Of course the AMA made an effort to appeal the verdict up to 1990. Ever since that point in time, attitudes between medical doctors and chiropractic professionals have begun to change, but remnants of that former feud still linger.

As a consequence of years of propaganda from the AMA seeking to depict chiropractors in a damaging light, it's unsurprising that the general public doesn't have a more favorable view of the profession. The primary distinction between chiropractic doctors and medical doctors boils down to their philosophy and approach to treatment. Normally, chiropractors start conservatively with their treatment plan, and only proceed to more intrusive procedures when there is no improvement with initial methods. DC's are generally focused on the nervous system, muscles, and joints within the body. Medical doctors put a greater emphasis on medications and the way those medications act in the human body, and they also deal considerably more with things like infections, and internal issue.

So just how do the educations of medical doctors and chiropractic doctors compare to each other? They are in reality pretty much equivalent. Each of them needs very similar undergrad education to be accepted to the school. A few colleges in both disciplines need a bachelor's degree, however others only require 3 years of undergraduate instruction to be accepted into the doctoral program. On the whole a chiropractor gets to spend roughly 4485 hours in class and clinic time, whereas a medical practitioner spends 4248 hours in order to acquire their diploma. Although the majority of the schooling is similar, a couple of differences consist of chiropractors have more class hours on neurology and fewer on such things as gynecology, and psychiatry. Doctors of chiropractic also have more class time focused on manipulation, and allopathic doctors have more class time focused on pharmacology. Needless to say this makes sense once you understand the sort of treatment options each one utilizes.

As you have seen, the education involving the two occupations is just the same. I would like to mention that medical professionals are required to do a minimum of a 3-year post degree residency after med school. If you ask me, this is just smart due to the degree of associated risk included in the form of treatments they use. The risk of chiropractic treatments are comparatively low, particularly when compared to risks of some medications. Medical doctors must be familiar with a great variety of prescription drugs, and not merely the side-effects of those medications, but any plausible interactions they can have with other drugs. Spending time in residency where they're supervised by more knowledgeable MD's is just a good idea.

In ending, I think that you do not have to make a choice between a medical doctor or a chiropractic doctor. Both strategies have their merits, and the one that is the most suitable depends upon your personal beliefs, and the problems you are suffering from. If you're managing a problem with the muscles, nervous system, or the bodies articulations, and you also have faith in conservative health care, go visit a chiropractor. If you don't improve while under their care, they should recommend you to somebody else. However, if you're managing some other sort of illness, or you only desire to receive some drugs to help you feel better, you may want to visit an allopathic doctor.

Are Vitamin B12 Shots Necessary?

Recently, I was "assaulted" by an advertisement urging people to get routine vitamin B12 injections because "B12 can naturally increase energy and stamina, improve sleep and immune support, reduce stress and anxiety, assist with weight loss, enhance sports performance and much more!" Enhance sports performance? Essentially, the only thing not included was "spice up your love life." There's an old saying... "Never try to pull one over a scientist."

Vitamin B12, otherwise known as cobalamin, plays a critical role in the central nervous system (CNS), blood cell maturation, and DNA replication. Ubiquitously involved in cellular metabolic function, cobalamin is the most structurally complex of vitamins, bearing some resemblance to hemoglobin. Instead of iron as the center of a porphyrin ring, B12 contains cobalt at the center of a corrin ring. Present in the body (blood, plasma, kidney, spleen, pancreas) in the range of 80-300 micrograms (mcg), cobalt is conservatively utilized biochemical element. Vitamin B12 is the human body's primary source of cobalt.

Deficiency in stored and/or systemic cobalt may be caused by alcoholism, Chron's disease, intestinal surgery, pernicious anemia, and certain autoimmune disorders such as systemic lupus erythematosus. It might also result from a vegan diet, as the most abundant sources of B12 derived cobalt are animal products (meat, seafood, poultry, eggs, and milk).

There are a variety of symptoms of cobalt deficiency, amongst which are fatigue, pale skin (indication of anemia), neurological disorders, and easy bruising. In fact, fatigue is the most common reason why medical practitioners administer bolus injections of cobalamin. Such injections range from $25-75 in patient cost. The fundamental question is, "Are vitamin B12 injections necessary?"

Once B12 rich foods are consumed, they are digested in the stomach. All of the cobalamin present in food sources is protein bound (not immediately available), requiring enzymatic liberation for human metabolism. Absorbtion is facilitated by a protein known as "intrinsic factor," otherwise known as gastric intrinsic factor (GIF). Binding of food-derived B12 to GIF is required for transport to the ileum. Only those who have compromised ability to produce GIF are incapable of absorbing B12 via consumption of food. When consumed at high doses in supplements, however, cobalamin can effectively overcome GIF defects via passive diffusion.

Bearing highly polar peripheral amide groups and a charged phosphoribose moiety, cobalamin is one of the most water-soluble vitamins known. Unlike other water-soluble vitamins that are rapidly eliminated via excretion, B12 is stored in the liver. The amount of cobalamin in a typical B-100 supplement is 100 mcg, 0.043 mcg of which is metallic cobalt. This is more than forty times the FDA's Recommended Daily Allowance (RDA). Readily absorbed in the ileum, B12 experiences a very high level of binding to plasma proteins, and has a half-life of approximately 6 days. The half-life of cobalamin in the liver is 400 days. Barring hepatic disease or IF dysfunction, the human body quickly absorbs and stores what B12 it needs in plasma proteins and the liver.

Most B12 shots are administered subcutaneously in a quantity of 1000 mcg or 1 milligram (mg). A structural analog, methylcobalamin delivers a 10 mg equivalent of cobalamin. Hence the most common injection of B12 on the market may be absorbed via the orally consumable equivalent of 10 B-100 tablets. The typical wholesale cost of B-100 tablets from popular distributors is approximately 8 cents each. Hence, the equivalent of a $25-75 cobalamin shot from a nurse practitioner or physician may be taken and absorbed orally for only 80 cents.

There is a common myth perpetuated by certain magazines and websites - B12 shots can be part of a regimen of "medical weight loss." To date, there is absolutely no peer-reviewed evidence published in medical journals supporting such claims. In all likelihood the placebo effect of the injection imparts elevated mood leading to increased levels of activity, thereby increasing metabolism. The bottom line is this. If there is an unusual disorder which impedes food-derived or supplemental B12 absorption, then there is need for bolus injection of B12 to maintain health. In lack of corroborating evidence for such a disorder, then there is no perceptible advantage in getting B12 subcutaneous injections.

Mostly unknown to the public is the potential for dangerous side effects of "B12 abuse," including diarrhea, confusion, dizziness and breathing difficulty. The Mayo clinic reports in rare cases, excessive intake of cobalamin via supplements and injection can lead to "peripheral vascular thrombosis, an arterial blockage in the arms and legs that causes pain, numbness and ulcers."

On a finishing note, one strategically and effectively superior use of an injectible B12 analog, hydroxycobalamin, is for the treatment of cyanide poisoning. Hydroxycobalamin binds cyanide to form cyanocobalamin, a harmless acid-base adduct, which is eliminated via urination. This treatment is far less complex and invasive than the traditional inhalation of amyl nitrite, i.v. administration of sodium nitrite, followed by i.v. administration of sodium thiosulfate.

Advantages of BSc Adoption for Information Security

Information Security is an integral part of any IT system that should not be overlooked. However, sometimes it can be rather difficult to justify the budget spent on this IT component. In order to estimate the value of the security control methods executives traditionally use ROI (Return on Investment) and ROSI (Return on Security Investment) frameworks. However, these systems don't always reflect the actual efficiency of the security means. Because of the varying degrees of ROI and ROSI success many organizations opt for the Balanced Scorecard approach for their IT security performance evaluation. In this brief post we are going to define the basic principles of the BSc evaluation framework, as well as give examples of the Information Security key performance indicators.

Scorecard in Brief

Balanced business evaluation framework has been around for about 15 years. It was initially introduced in 1992 as a way to demonstrate the implementation of non-material, intangible business goals. Ever since the first publication, the framework has become tremendously popular with organizations of different nature: military units, schools, manufacturing, and non-profit companies. This business strategy evaluation system gives a holistic picture of the company's well-being from four viewpoints or Perspectives (three non-financial, and one financial). Such a scorecard helps answer the most crucial questions of any business entity:

What do our customers think about us? - Customer Perspective.

What are the underlying drivers of our success? - Internal Processes Perspective.

Do we work on improvement of our product? - Learning and Growth Perspective.

What do our shareholders think about our financial health? - Financial Perspective.

The presence of different perspectives allows business owners not only evaluate their company's performance, but identify the aspects that influence on the firm's success the most.

Balanced Scorecard in Information Security

In fact, the BSc approach to Information Security evaluation serves as a bridge between employees and senior executives, since it can represent complicated IT data in a way that is comprehensible by people who has nothing to do with Information Technology. Moreover, this framework can encompass and monetize aspects which seem to be intangible at first sight. This is where key performance indicators come into play.

Identifying Key Performance Indicators for Information Security

These measures make the core of any strategy evaluation system. Creating metrics for Information Technology needs doesn't have to be daunting. Information Security consists of the following levels: Information Availability, Information Integrity, Information Authenticity, and Personnel Protection (this level is often argued). Thus, when you have these categories in your evaluating system, you can measure the number of failure events for each level. By doing this you will create measurable entities for your business evaluation framework.

However, identifying the right KPIs is only half the battle. Another half is creating an effective system of data mining. Without gathering actual information on each KPI it is impossible to get a holistic picture of your business entity operation. The number of metrics should not be great. Too much metrics result in numerous reports and application forms for your employees, and these can be very distractive.

Best 5 Weight Loss Exercise Tips Ever

If you find it frustrating or difficult to lose weight, I have some food for thought for you. Losing weight and losing it fast is not as difficult as people make it out to be. One thing for sure, you have to be determined and willing to lose weight or burn your belly fat or wherever you may have the problem.

The thing is... You don't have to stress a lot when trying to lose weight,. It can be as natural as ever. I'm going to show you a few simple steps that you can follow and be on your way to losing weight the best way.

1. You need a plan. Not Just any plan. A good weight loss plan. Start slowly by cutting down things you can do without. Don't get discouraged when you see no results instantly, losing weight can take time and effort. Many people do this mistake by quitting their program after a few days because they think losing a lot of weight can happen overnight.

2. Get all the help you can get. No man is an Island and we need some sort of guidance in whatever we do. Find people who are also going through the same problem and link up with them. Join support groups and health clubs. When going through something this big. You will need a shoulder to cry on, someone to motivate you because as human beings we have little faith. It is normal to want to give up, especially after some hard weeks of exercise or diet routine.

3. Start things slow. Learn something new. Replace old habits with something new. Because weight loss can be challenging for most, what better way to replace a bad habit with a new one. A good hobby is always advisable because not only will you burn fat easy and fast. You will be gaining new experiences and skills that can make your body move in amazing ways. Try jazz, ballet or dancing lessons.etc. Do this at least 3 times a week.

4. Have amazing weekends, always do something physical on weekends, go hiking, bike riding or walks or just keep busy aground the house, don't do the same thing over and over or else you will get bored and lose interest. Check your weight at most once a week or at least once every two weeks. Don't check your weight regularly as this will not be exciting for the first few weeks because weight loss takes time.

5. Remember. Always do the things you will enjoy while losing weight. When you lose some weight. Reward yourself. Not with food. You can go shopping for the smaller size dresses or shirts you always wanted to wear, just go out and look good in public. The more you lose weight is the more you will need to exercise and the happier you will be.

Remember. Only you can make this happen for yourself. A determined body and a positive mindset is all you need to burn all that fat. You are now a step closer to achieving your goal. Just take the first step and the rest is history.