vol. 4 issue 1 | September/October 2010
COLON CANCER SCREENING
Elizabeth Carter, MD
Prior to the inception of this initiative, colorectal cancer screening at JPS Health Network relied on physician discretion and no system supported an age-specific tickler or reminder process for the appropriate age or high-risk population. At JPS less than 25% of age appropriate patients obtained colorectal cancer screening.
In 2007, JPS developed a disease case management pilot to enhance community health through colon cancer screening. During the study period, 73% of the unique patients were appointed to see their Primary Care Physicians or attend an educational class for appropriate colon cancer screening evaluation, education and counseling. The proportion of fecal occult blood tests (FOBT) in the targeted population was estimated to have increased by 15% in colon cancer screening. The pilot study supported the model of disease state case management for colon cancer screening evaluation, education and counseling. Each year the program has increased the recommended and appropriate colon cancer screening through an FOBT mail out with survey questions to identify high risk patients. Those high risk patients are then offered appropriate endoscopic or imaging evaluation.
In 2009, 5,877 kits were mailed to JPS patients born between 1957 and 1960. Close to 16% of the FOBT cards and 10% of the surveys were returned. The results were compelling with 241 patients (23 positive FOBT and 218 positive surveys) placing in the high risk category and 136 patients in general were found to either be unable to complete further workup or were thought not to need further evaluation. In addition, 105 colonoscopies were scheduled as a result of the program. The remainder of the patients had errors in either FOBT or survey responses or were duplicated patients. Of the 81 colonoscopies completed, 37 patients had pathology requests and 53 of those pathologic specimens indicated polyps with malignant potential. No colon cancer was found.
For 2010, 9,489 patients have been identified who will meet the criteria for participation and 4,490 kits and surveys have
been mailed thus far.
by Jay Haynes, MD, MSc
The 2010 − 2011 flu season is upon us, and there are some significant changes in this flu season’s recommendations that healthcare providers and clinicians should be aware of before beginning flu vaccination efforts.
This season’s flu vaccine is made in the same way as past flu vaccines. Over the years, hundreds of millions of people in the U.S. have safely received seasonal flu vaccines. This year’s vaccine will protect against the three main viruses that research indicates will cause the most illness − 2009 H1N1, an A- H3N2 virus, and a B virus.
Since the seasonal vaccine will protect against the 2009 H1N1 virus, two different flu vaccines will not be necessary this season.
On July 29, the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) issued recommendations for everyone six months of age and older who do not have any contraindications to vaccination, to
receive a flu vaccine each year, beginning this flu season. ACIP recommends that children six months through eight years of age receive two doses of this season’s flu vaccine with a minimal interval of four weeks unless they have received:
•At least one dose of 2009 H1N1 flu vaccine last season, and
•At least one dose of seasonal flu vaccine prior to the 2009 − 2010 flu season or two doses of 2009 − 2010 seasonal flu vaccine. If a child has fulfilled both of these requirements, they only need one flu vaccine.
Also important to note in the new recommendations is information about a newly approved vaccine, Fluzone High-Dose, for those 65 years of age and older, which simply adds another vaccine option for this group. That population can choose a standard-dose trivalent flu vaccine (15 mcg per strain) or the Fluzone High-Dose vaccine (60 mcg hemagglutinin antigen per strain).
Other new recommendations include information about newly approved flu vaccines, as well as previously approved vaccines with expanded age indications.
While everyone should get a flu vaccine each flu season, it’s especially important that certain groups get vaccinated either because they are at high risk of developing serious flu-related complications or because they live with or care for people at high risk of developing flu-related complications including:
•Children younger than 5, and especially children younger than 2 years;
•People 50 years of age and older;
•People of any age with certain chronic medical conditions such as asthma and diabetes;
•People with immunosuppression, whether due to illness or medications;
•People who live in nursing homes and other long-term care facilities; and
•People who live with or care for those at high risk for complications from flu, including:
– Healthcare workers
– Household contacts of people at high risk for complications from the flu; and
– Household contacts and out of home caregivers of children less than six months of age (no vaccine is approved for children younger than six months, as these children are too young to be vaccinated).
Flu vaccine shipments have begun with expectations of a plentiful enough supply to ensure that everyone recommended is able to be vaccinated. Health care providers and clinicians are recommended to begin flu vaccination as soon as shipments arrive at their
location and should continue vaccination throughout the remainder of the flu season.
Throughout the influenza season, health care providers and clinicians should check www.flu.gov or www.cdc.gov/flu for flu information, updates, and access to free materials to assist with educating staff and patients about the impact of influenza and the benefits of vaccination.