Thursday, April 27, 2017

10 Things to Know During National STD Awareness Month

By Junda Woo, MD, MPH
San Antonio obstetrician gynecologist 
Medical Director, San Antonio Metropolitan Health District
  1. Syphilis is back. Rates of this ancient scourge jumped 19 percent from 2014 to 2015, more than any other reportable STD, according to the Centers for Disease Control and Prevention (CDC). Most cases are among men who have sex with men. Men who have sex with men should get tested annually for syphilis, chlamydia, gonorrhea, and HIV.

  2. Rates of chlamydia rose too — 1.5 million people were diagnosed with this infection in 2015. Since most women with chlamydia show no symptoms, the CDC says all sexually active women should be tested every year until age 25. Yet fewer than half of insured, eligible women under 25 were tested for chlamydia in 2015, according to data collected from U.S. health plans.

  3. In 2009, Texas made it legal for doctors treating STD patients to provide an extra antibiotic prescription for the patient’s partner. This practice is called Expedited Partner Therapy. While it is better if every partner sees a doctor, that doesn’t always happen. When doctors provide partner prescriptions, re-infections of chlamydia drop 20 percent, and re-infections of gonorrhea drop 50 percent.

  4. Anyone who is treated for chlamydia, gonorrhea, or trichomoniasis — all easily curable STDs — should be retested in three months to catch re-infections, according to the CDC.

  5. About 1 in 6 sexually active people have herpes, but only one-tenth of infected people know they are infected. The CDC does not recommend routine blood tests for herpes, in part because the tests are not that accurate, and false positive tests cause emotional distress.

  6. Everyone between the ages of 13 and 64 should be tested for HIV at least once in their lives.

  7. There is now a daily pill that prevents HIV. If you are HIV-negative but your partner is HIV-positive, or you are man who has sex with men and you have multiple partners, ask your doctor about pre-exposure prophylaxis (PrEP). 
… And for physicians:
  1. Patients say they want their doctors to ask about sexual health. Doctors may feel uncomfortable asking intimate questions. The CDC offers this guide: https://www.cdc.gov/std/treatment/sexualhistory.pdf.

  2. Many people in the LGBT community are reluctant to “come out” to doctors because of previous negative experiences. For free continuing medical education (CME) on LGBT health and tips on creating an LGBT-friendly office, go to LGBThealtheducation.org.

  3. Doctors can brush up their knowledge about syphilis (“The Great Imitator”) and get free CME with the National STD Training Curriculum: https://www.std.uw.edu/.

Monday, April 10, 2017

With Throat Cancer Increasing, Doctors Urge Vaccination to Prevent It

Doctors are diagnosing more throat cancers caused by the human papillomavirus (HPV). HPV also causes other cancers, such as cervical, but throat cancer is quickly becoming the most common. The good news: the HPV vaccination, if people receive it early enough, can prevent most of these cancers, which are found in the tonsils and base of the tongue.

Four percent of U.S. adults aged 18 to 69 have a type of HPV that puts them at high risk for throat, or oropharyngeal, cancers, according to a new report from the Centers for Disease Control and Prevention. Nearly 16,000 oropharyngeal cancers are diagnosed in the U.S. each year, according to the CDC.

The cancer’s prevalence has pushed it into the spotlight this month, which has been designated Oral, Head and Neck Cancer Awareness Month. During April, Texas physicians urge parents to vaccinate their children against HPV to prevent cancer later in life.

“The vaccine is nearly 100 percent effective if it’s given before someone is exposed to HPV,” said Texas Medical Association member Erich Sturgis, MD, a head and neck surgeon at the MD Anderson Cancer Center in Houston. “Taking this preventive action during adolescence can mean better health down the road.”

Physicians and other health experts recommend the HPV vaccination for preteen boys and girls, aged 11 and 12 years, but youths can receive it as early as age 9. A second dose of HPV vaccine should be given six to 12 months after the first dose.

HPV is the most common infection in the nation spread through intimate skin-to-skin or sexual contact. Almost all — eight in 10 — sexually active people will have the virus sometime in their lives.

HPV infections can cause healthy cells to become abnormal. Typically, the body can clear the infection. But when it can’t, the infection can cause cells to become cancerous years later.

Dr. Sturgis says the HPV vaccination is important for both boys and girls, but stresses its importance for boys. Doctors can diagnose cervical cancer early through screening (the Pap test), he said, but currently no screening is available for throat cancers, so they usually are advanced when diagnosed. And while HPV-related throat cancers are expected to surpass cervical cancer by 2020, Dr. Sturgis said experts say that may occur sooner.

Men are three to five times as likely to get throat cancer as women, with most cases occurring in white, middle-aged males. Smoking and alcohol use previously caused most oropharyngeal cancers, but HPV now accounts for at least 70 percent of these cancers.

“Unfortunately, the generation of people getting HPV-related throat cancers didn’t have the benefit of vaccination,” said Dr. Sturgis. “Now we have the opportunity to protect the next generation from a very devastating disease.”

Older teens and young adults who weren’t vaccinated in adolescence also can benefit from HPV vaccination. Both males and females can get the shots until age 26. For those over age 15, however, the CDC recommends three shots for full protection. People should ask their physician about how many doses are needed and when.

TMA has published an infographic and fact sheet about the importance of HPV vaccination, both in English and Spanish.

Tuesday, March 28, 2017

New Vaccine Recommendation Cuts Number Of HPV Shots Children Need

By Michelle Andrews
Kaiser Health News

Content provided by Kaiser Health News

You’d think that a vaccine that protects people against more than a half-dozen types of cancer would have people lining up to get it. But the human papillomavirus (HPV) vaccine, which can prevent roughly 90 percent of all cervical cancers as well as other cancers and sexually transmitted infections caused by the virus, has faced an uphill climb since its introduction more than a decade ago.

Now, with a new dosing schedule that requires fewer shots and a more effective vaccine, clinicians and public health advocates hope they may move the needle on preventing these virus-related cancers.

In December, the Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommended reducing the number of shots in the HPV vaccine from three to two for girls and boys between the ages of 9 and 14. The recommendation was based on clinical trial data that showed two doses was just as effective as a three-dose regimen for this age group.

The study was conducted using Gardasil 9, a version of the vaccine approved by the Food and Drug Administration in late 2014. It protects against nine types of HPV: seven that are responsible for 90 percent of cervical cancers and two that account for 90 percent of genital warts.

In addition, the new version of Gardasil improved protection against HPV-related cancers in the vagina, vulva, penis, anus, rectum and oropharynx — the tongue and tonsil area at the back of the throat.

An earlier version protected against four types of HPV.

From the start, clinicians have run into some parental and political roadblocks because the vaccine, which is recommended for preteens, protects against genital human papillomavirus — a virus transmitted through sexual contact. Many physicians are also reluctant about discussing the need for the vaccine, and for many parents, the vaccine’s cancer-prevention benefits were overshadowed by concerns about discussing sexual matters with such young kids. Yet for maximum protection, the immunizations should be given before girls and boys become sexually active.

The focus should not have been on sexually transmitted infections, some say. “You only get one chance to make a first impression,” said Dr. H. Cody Meissner, a professor of pediatrics at Tufts University School of Medicine and a member of the American Academy of Pediatrics’ committee on infectious diseases. “This vaccine should have been introduced as a vaccine that will prevent cancer, not sexually transmitted infections.”

The HPV virus is incredibly common. At any given time, nearly 80 million Americans are infected, and most people can expect to contract HPV at some point in their lives. Most never know they’ve been infected and have no symptoms. Some develop genital warts, but the infection generally goes away on its own and many people never have health problems.

However, others may develop problems years later. There are approximately 39,000 HPV-related cancers every year, nearly two-thirds of them in women. In addition to cervical cancer, more than 90 percent of anal cancers and 70 percent of vaginal and vulvar cancers are thought to be caused by the HPV virus. Recent studies show that about 70 percent of cancers in the oropharynx may also be linked to HPV.

A 2015 study published in the Journal of the National Cancer Institute estimated that earlier versions of the HPV vaccine could reduce the number of HPV-related cancers by nearly 25,000 annually, and the new version of the vaccine could further reduce the number of such cancers by about 4,000.

The vaccine is estimated to prevent 5,000 cancer deaths annually, said Dr. Paul Offit, professor of pediatrics and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

But compliance is an ongoing problem. “They’re not getting the one vaccine that protects against diseases from which they’re most likely to suffer and die,” Offit said, noting that deaths from pertussis and meningococcal disease, for which adolescents are also vaccinated at that age, are minuscule compared with HPV-related cancers.

In 2015, 87 percent of 13-year-olds were up-to-date with the Tdap vaccine that protects against tetanus, diphtheria and pertussis, and 80 percent had received the meningococcal vaccine, according to the Centers for Disease Control and Prevention. But just 30 percent of girls and 25 percent of boys at that age had received all three doses of the HPV vaccine. In contrast to other vaccines, however, the HPV vaccine is required only in a few states for secondary school.

Public health advocates say they think the shift to a two-dose regimen could make a big difference in the number of adolescents who get all the necessary doses of the HPV vaccine. For one thing, the fewer shots the better, in general, they say.

In addition, because the second HPV shot is supposed to be given anywhere from six months to a year after the first one, “parents can fit it into a routine regimen when people go in for their 12-year-old’s regularly scheduled visit,” said Dr. Joseph Bocchini Jr., chairman of pediatrics at Louisiana State University Health in Shreveport who is president-elect at the National Foundation for Infectious Diseases.

Tuesday, March 14, 2017

Vaccines, Medical Homes, and Cancer Prevention

An Updated Immunization Schedule


The 2017 update of recommended immunization schedules for children and adults were published recently by the Centers for Disease Control and Prevention’s (CDC’s) Advisory Committee on Immunization Practices (ACIP). These recommendations represent agreement among professional societies and ACIP. Physicians use the schedules to ensure patients receive the right vaccinations for their age and medical condition. This year’s schedules came with a few changes worth noting.

  • ACIP now recommends boys and girls between 9 and 14 years of age only receive two doses of the human papillomavirus (HPV) vaccine, instead of the previously recommended three doses, because of the better response at the younger ages; those who begin the series at 15 years of age or older will require three doses. 
  • People with egg allergies can now take any age-appropriate flu vaccine instead of relying solely on an egg-free flu vaccine. 
  • The nasal flu vaccine is no longer recommended, as it is deemed too ineffective. 
  • The hepatitis B vaccine is now recommended for adults with chronic liver diseases like hepatitis C and cirrhosis. 
  • And the meningococcal B vaccine may be given to certain high-risk groups, like individuals between 16 and 23 years old who will be attending college.

Check out the child and adult schedules, and talk with your doctor to make sure you and your family are receiving the right vaccinations at the right time.

Medical Homes Improve Vaccination Rates


Dr. Siegel
Jane Siegel, MD, a Corpus Christi pediatric infectious disease physician, knows how essential vaccines are to both public health and individual patient health. She says one of the best ways to guarantee patients stay on top of their vaccinations is through a medical home ― a physician-led health care team that looks after a patient’s comprehensive and continuous medical care.

“Visits to a medical home provide opportunities to counsel patients on a variety of wellness topics, including vaccinations,” said Dr. Siegel. “It is a time to ensure our patients live in a safe environment in their home and that patients and families are fully informed about preventive practices like vaccines. It is important to remember: Every health care encounter is an opportunity to vaccinate.”

Medical home visits also “provide opportunities for vaccine-hesitant families to develop trust in the physician and provider team and learn the facts about vaccination,” added Dr. Siegel. “This is especially important in Texas, where the number of children getting school vaccine exemptions continues to increase yearly.”

And when it comes to maintaining accurate vaccination records for schools, a medical home can’t be beat, said Dr. Siegel: “The medical home is the best in position to maintain complete records so adolescents will have their immunization records required for higher education and jobs in areas where vaccinations are required.”

Vaccines Can Prevent Cancer


It can’t be said enough: In addition to preventing infection, some vaccines can even prevent certain cancers, stressed Dr. Siegel.

Specifically, “the HPV vaccine reduces the risk of cervical, vulvar, anal, penile, and head and neck cancers,” she said.  ”And the hepatitis B virus (HBV) vaccine reduces the risk of hepatocellular (liver) cancer. If parents and patients understand a safe vaccine can prevent cancer, who would not want to accept that vaccine?”

Wednesday, March 8, 2017

Code What? Improving Hospital Communication in an Emergency

By Scott Robins, MD
Chair, Texas Hospital Association Hospital Physician Executive Council
Division Chief Medical Officer, Medical City Healthcare

Anyone who has ever been in a hospital has probably heard over the public address system the cryptic words, “Code Pink” or “Code Black” or, more commonly, “Code Blue.” These color-based alert codes are intended to notify hospital staff and physicians and sometimes the public to an emergency of some kind.

The color-based alert codes typically are unique to each hospital. This means they lack standardization across facilities. When an emergency occurs and time is of the essence, this variation can create confusion and delay or uncertainty in response. This is particularly true for physicians who work in multiple hospitals and for new employees who have come from different hospitals.
The Texas Hospital Association has a solution.

It recommends that hospitals use standardized, plain-language emergency alerts instead of the color-based codes. The alerts are intended to allow hospitals to personalize the information to their facilities and provide site-specific details.

For example, instead of announcing “Code Pink” for a missing person alert, a hospital could instead announce “Security Alert. Missing female child, age 2. Last seen first-floor lobby.” Hospitals could choose to add additional information as warranted, such as instructions on contacting hospital security.
 
The intent of using plain-language alerts is to:

  • Promote the safety of patients, visitors, physicians, and hospital staff;
  • Reduce errors;
  • Increase transparency of communications and safety protocols; 
  • Align with national safety recommendations; and
  • Reduce confusion for staff or physicians who work in more than one facility. 

The initiative is completely voluntary, but THA hopes that every Texas hospital adopts all of the standardized, plain-language codes as part of the industry’s work to improve and provide higher quality, safer care.

Complete information about the initiative is available on www.tha.org/plainlanguagecodes.

Friday, March 3, 2017

Hard Hats for Little Heads: A Community Affair in Odessa

By Christine Wan
Odessa family physician
Hard Hats for Little Heads Physician Advisory Panel member


Editor’s Note: March is Brain Injury Awareness Month, and physicians encourage children and adults to wear the correct helmet for every wheeled sport to prevent brain injury or death in case of an accident.

As physicians, we love helping others. We are privileged to be in a position to help individuals in a meaningful way on a daily basis, but how can we help our community in a larger way?

For me, that opportunity came through a TMA program and a local organization. A few years ago, I joined Pilot Club of Odessa, a community service organization whose core membership is mostly professional women who want to bring positive things to our community. At a regional meeting in Lubbock, the Pilot Club of Alpine shared a presentation about how its club and a local physician, Adrian Billings, MD, cohosted a TMA Hard Hats for Little Heads event to give bike helmets to kids at a bike fair.

I knew Dr. Billings (also a Hard Hats advisory panel member) from our medical school days at The University of Texas Medical Branch, and I had heard about the Hard Hats program a few years earlier. I thought about doing Hard Hats then but didn’t know how I, as one doctor, would pull this off. After hearing about this collaboration between Pilot Club of Alpine and Hard Hats for Little Heads, I suggested our Odessa Pilot club bring the program to our community with me as the TMA physician sponsor. Everyone was in enthusiastic agreement.

Seven years later, we have given out more than 3,500 helmets to our kids. We hosted events at schools and bike fairs in our city, as well as rural areas around us in Crane and Fort Stockton. Our big yearly event is the Odessa Fall Festival, put on by the City of Odessa Parks and Recreation Department. The city began Fall Festival the same year we started our Hard Hats for Little Heads project, and organizers contacted Pilot Club about volunteering. We told them we could bring volunteers AND free bike helmets to give away. Every year, children come out early to line up for the helmets at the festival.

One year we had about 20 helmets left over, and we sent those to an orphanage in Guatemala via an Odessa church’s mission trip. Bike riding is vital in Guatemala as a form of transportation and employment. So our helmets have even gone international!

Pilot Club has a puppet presentation called “Brain Minders” that pairs nicely with the helmet giveaway when we do school presentations. The TMA Hard Hats program staff were great in helping us get started, providing resources and excellent communication. I and others have presented our Hard Hats project at local, regional, and state Pilot Club meetings and at Texas Tech School of Medicine to spread the word. So my story is one that began with a thought about how I, as one busy physician, could help my city and beyond in a bigger way. The answer to my question was to reach out to my professional and community organizations for help.

Wednesday, March 1, 2017

AMA Honors Texas Senator with Distinguished Service Award



WASHINGTON, D.C. – The American Medical Association (AMA) presented Texas State Sen. Kirk Watson with the Dr. Nathan Davis Award for Outstanding Government Service. Watson was selected for the AMA’s top government service award for asserting his community vision for health care and economic prosperity, most notably for leading the successful effort at the University of Texas Austin to build a new medical school from the ground up.

“Sen. Watson laid out a groundbreaking ‘10 Goals in 10 Years’ initiative for Austin, which included a comprehensive plan to bring a state-of-the-art medical school to the University of Texas in Austin,” said AMA Board Chair Patrice A. Harris, M.D. “Just five years later, the Dell Medical School opened its doors to the first class of 50 students in 2016. Through his bold vision and hard work, Sen. Watson is not just inspiring great change in Austin, but helping shape the landscape of medicine and medical schools well into the future.”

As part of his “10 Goals in 10 Years” initiative, Sen. Watson also put forth a vision to develop laboratories and other facilities for public and private research, provide needed psychiatric care and facilities, make Austin a center for comprehensive cancer care, and build a modern teaching hospital. The hospital – the Dell Seton Medical Center at The University of Texas – will open this year.

Watson is one of 10 honorees chosen this year to receive the Dr. Nathan Davis Award for Outstanding Government Service. The award, named for the founding father of the AMA, recognizes elected and career officials in federal, state or municipal service whose outstanding contributions have promoted the art and science of medicine and the betterment of public health.

“For more than a quarter century of the Nathan Davis Awards, the AMA has sought to salute government officials who go above and beyond the call of duty to improve public health,” said Dr. Harris. “Award winners have come from every branch of government service and are a testament to the important role public officials play in creating and implementing health policy that benefits Americans.”

Sen. Watson was presented with the award last night at a ceremony in Washington, D.C. as part of the AMA’s National Advocacy Conference.

The American Medical Association is the premier national organization dedicated to empowering the nation’s physicians to continually provide safer, higher quality, and more efficient care to patients and communities. For more than 165 years the AMA has been unwavering in its commitment to using its unique position and knowledge to shape a healthier future for America. For more information, visit ama-assn.org 

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