Monkeypox & Smallpox Vaccine Guidance

Image via Non-Human Primate Models of Orthopoxvirus Infections via Veterinary Sciences.

Vaccine Effectiveness
“Because monkeypox virus is closely related to the virus that causes smallpox, the smallpox vaccine can protect people from getting monkeypox. Past data from Africa suggests that the smallpox vaccine is at least 85% effective in preventing monkeypox. The effectiveness of JYNNEOSTM against monkeypox was concluded from a clinical study on the immunogenicity of JYNNEOS and efficacy data from animal studies.

Smallpox and monkeypox vaccines are effective at protecting people against monkeypox when given before exposure to monkeypox. Experts also believe that vaccination after a monkeypox exposure may help prevent the disease or make it less severe.”

More on Monkeypox and Smallpox Vaccine Guidance via the CDC.

Upcoming Webinar

Quality Improvement in Family Medicine Education – Plan It, Do It, Teach It! A collaboration between the Section of Teachers and Section of Researchers

May 24, 2022
12:00 p.m. – 1:00 p.m. (ET)

Join your fellow teachers, preceptors, and educational leaders for a conversation about incorporating quality improvement (QI) in your family medicine teaching role. This webinar is an opportunity to consider how QI can better inform and support your teaching practice. Our panelists will share their experiences, challenges, and expertise implementing QI in diverse education and practice settings. We hope the webinar will be of broad interest, and particularly for those who are developing QI teaching capacity. No pre-registration is required, simply join us via YouTube.

Mercury, Selenium, and Arsenic Concentrations in Canadian Freshwater Fish

“Mercury (Hg) and arsenic (As) contamination of fish can be toxic and limit safe human consumption, whereas selenium (Se) can potentially protect fish and consumers from the adverse effects of Hg and As. We assembled datasets of the above-mentioned elements in Canadian freshwater fish and compare them with risk assessment thresholds.

We further assessed linkages between the elemental concentrations and anthropogenic activities and ecozones. Mercury concentrations exceeded the retail fish Canadian threshold (0.5 µg/g wet weight) in 31% of all Walleye; this proportion rose to 64% in reservoirs. Reservoirs and lakes impacted by logging and urbanization had higher fish [Hg] than other types of impacted systems. Se and As concentrations exceeded Canadian guidelines in 5% (aquatic life) and 0.2% of all fish, respectively. In mining areas, fish [Hg] were low and negatively correlated with [Se], and fish [Se] were positively correlated with [As].

In all areas, we observed an important overall and previously unpublished negative relationship between mean fish [As] and [Hg], suggesting an inverse consumption risk for these two elements. The ratio Se/Hg was lower than the protective value of 1 for 14% of all fish and was negatively correlated with fish length. However, the benefit-risk value (BRV) threshold, which accounts for the Se intake from other food products, did not suggest any fish consumption limitations, except for few very contaminated top predators (> 2 µg/g ww). More studies need to assess the role of Se against Hg toxicity and adjust fish consumption guidelines accordingly.”

More on Mercury, selenium and arsenic concentrations in Canadian freshwater fish and a perspective on human consumption intake and risk via Journal of Hazardous Materials Advances.

Increased Bleeding with Apixaban & Systemic Fluconazole

“Direct oral anticoagulants (DOACs) have fewer drug interactions than warfarin, but interactions do occur. In a large series involving nearly 100,000 individuals receiving a DOAC, individuals receiving apixaban plus fluconazole, a moderate inhibitor of the P450 cytochrome CYP3A4, had a 3.5-fold increased risk of bleeding compared with periods when they were receiving apixaban without fluconazole [1]. The increase was greatest in gastrointestinal bleeding requiring hospitalization. The risk was only seen with systemic fluconazole plus apixaban; it did not occur with topical fluconazole plus apixaban or systemic fluconazole plus another DOAC.

This study highlights the importance of possible drug interactions and of considering alternatives that might be equally effective, such as topical therapy. (See “Direct oral anticoagulants (DOACs) and parenteral direct-acting anticoagulants: Dosing and adverse effects”, section on ‘Dosing, monitoring, risks (apixaban)’.)”

What’s New in Family Medicine via UpToDate.

Vintage Medical Drawings

A man with a large pendant face tumour. In 1835, the American physician Peter Parker opened a hospital in the Chinese city of Canton. For five years he commissioned gouache paintings of patients by the painter Lam Qua. Photograph: Wellcome Library, London
A 13-year-old boy with severe untreated leprosy. Photograph: Wellcome Library, London
The hands of a patient with paronychia, an infection of the nails associated with tertiary syphilis. Photograph: Wellcome Library, London
Hand-drawn and textured pages from a rare Japanese treatise on smallpox called The Essentials of Smallpox written in the late 17th or early 18th century by the Japanese doctor Kanda Gensen. Photograph: Wellcome Library, London

The Little Things That Make Employees Feel Appreciated

Ernest L. Blumenschein, The Gift, 1922, oil on canvas, Smithsonian American Art Museum, Bequest of Henry Ward Ranger through the National Academy of Design, 1975.86

“While most companies run employee-recognition programs of some sort, all too often they produce reactions like Rowen’s. Instead of giving people a meaningful sense of appreciation, they become just another box for managers to check and are completely disconnected from employees’ accomplishments. Some companies try to make programs more relevant by giving specific awards to individuals who’ve, say, created and led an important new initiative, “embodied” the organization’s values in their behavior, or had a significant impact. Yet that approach has problems too: Awards can be seen as an elite opportunity for a chosen few — and leave the majority of the workforce feeling left out and overlooked.

If managers could make a far broader group of employees feel appreciated, the benefits would be considerable. Adam Grant and Francesca Gino have found that when people experience gratitude from their manager, they’re more productive. Another researcher recently found that teams perform tasks better when their members believe that their colleagues respect and appreciate them.

But in our combined 50-plus years of working to improve organizations, we’ve observed that many managers struggle to make employees feel that their talents and contributions are noticed and valued. To explore this problem, we recently took a deep dive within an organization to see how organizational efforts to show appreciation and gratitude were perceived. In that project we engaged with both employees and managers through focus groups, survey questions, and learning sessions. And what we discovered was that even though bosses feel it’s challenging to show their staff appreciation, the employees think it’s actually pretty simple.”

More on The Little Things That Make Employees Feel Appreciated via Harvard Business Review.

Firearm Homicide and Suicide During the COVID-19 Pandemic

“Health care professionals and systems have an essential role in comprehensive strategies to reduce violence and suicide and corresponding inequities in communities. However, medical school curricula do not consistently incorporate firearm safety, violence prevention, or social determinants of health in training. Many clinicians are not comfortable asking patients about firearm injury risk factors2 and are not trained in trauma-informed care. At the health system level, financial incentives prioritize rapid visits and higher volume that leave less time for patient counseling and prevention; yet the financial costs to systems from caring for individuals who experience firearm-related trauma is substantial.

Many clinicians may not have the experience or be aware of the opportunities to prevent firearm-related morbidity and mortality. For example, in a survey of 1015 family physicians, 46% reported no training in firearm safety counseling and 68% did not feel knowledgeable discussing safe storage devices for firearms. Family physicians who had received formal training about firearm safety counseling were more likely to report a higher level of comfort with asking patients about firearm ownership.3 Physicians and other health care professionals can enhance the safety of their patients, improve data to inform community efforts, and support system changes to prevent violence and reduce inequities. Examples include pediatricians asking parents about safe storage of firearms at home, emergency physicians and surgeons engaging in hospital-based violence intervention programs and referring injured patients to wraparound services (such as counseling and job training), and behavioral health practitioners assessing suicidality and counseling about access to lethal means. Clinicians also can work with health departments and community partners to share their medical and health care–related expertise in regard to policies and programs that increase economic and household stability and enhance access to care, services, and support (e.g., tax credits, housing policies, mentoring, and after-school programs).4

More on Firearm Homicide and Suicide During the COVID-19 Pandemic Implications for Clinicians and Health Care Systems via JAMA.

Delivery models, efficacy, safety, and cost reduction of outpatient parenteral antimicrobial therapy

ABSTRACT: Outpatient parenteral antimicrobial therapy is an important medical service that allows for the treatment of complex infections outside acute care hospitals. In BC, the practice has evolved over many decades to include both hospital-based and outpatient infusion centres, as well as home intravenous programs. Numerous publications demonstrate the safety, efficacy, and cost reduction of outpatient parenteral antimicrobial therapy, while reducing congestion in emergency departments. With increasing strain on inpatient facilities due to increased numbers of drug-resistant organisms and high-risk immunosuppressed patients with complex infections, outpatient parenteral antimicrobial therapy is a treatment modality that improves patient care and flow through the health care system.

More on Delivery models, efficacy, safety, and cost reduction of outpatient parenteral antimicrobial therapy in British Columbia via BCMJ.