26 April, 2019

Measles


Measles is a childhood infection caused by a virus. Once quite common, measles can now almost always be prevented with a vaccine.
Also called rubeola, measles can be serious and even fatal for small children. While death rates have been falling worldwide as more children receive the measles vaccine, the disease still kills more than 100,000 people a year, most under the age of 5.
As a result of high vaccination rates in general, measles hasn't been widespread in the United States for more than a decade. The United States averaged about 60 cases of measles a year from 2000 to 2010, but the average number of cases jumped to 205 a year in recent years. Most of these cases originate outside the country and occurred in people who were unvaccinated or who didn't know whether or not they had been vaccinated.

Symptoms

Measles signs and symptoms appear around 10 to 14 days after exposure to the virus. Signs and symptoms of measles typically include:
  • Fever
  • Dry cough
  • Runny nose
  • Sore throat
  • Inflamed eyes (conjunctivitis)
  • Tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek — also called Koplik's spots
  • A skin rash made up of large, flat blotches that often flow into one another
The infection occurs in sequential stages over a period of two to three weeks.
  • Infection and incubation. For the first 10 to 14 days after you're infected, the measles virus incubates. You have no signs or symptoms of measles during this time.
  • Nonspecific signs and symptoms. Measles typically begins with a mild to moderate fever, often accompanied by a persistent cough, runny nose, inflamed eyes (conjunctivitis) and sore throat. This relatively mild illness may last two or three days.
  • Acute illness and rash. The rash consists of small red spots, some of which are slightly raised. Spots and bumps in tight clusters give the skin a splotchy red appearance. The face breaks out first.
    Over the next few days, the rash spreads down the arms and trunk, then over the thighs, lower legs and feet. At the same time, the fever rises sharply, often as high as 104 to 105.8 F (40 to 41 C). The measles rash gradually recedes, fading first from the face and last from the thighs and feet.
  • Communicable period. A person with measles can spread the virus to others for about eight days, starting four days before the rash appears and ending when the rash has been present for four days.

When to see a doctor

Call your doctor if you think you or your child may have been exposed to measles or if you or your child has a rash resembling measles.
Review your family's immunization records with your doctor, especially before starting elementary school, before college and before international travel.

Causes

Measles is a highly contagious illness caused by a virus that replicates in the nose and throat of an infected child or adult. Then, when someone with measles coughs, sneezes or talks, infected droplets spray into the air, where other people can inhale them.
The infected droplets may also land on a surface, where they remain active and contagious for several hours. You can contract the virus by putting your fingers in your mouth or nose or rubbing your eyes after touching the infected surface.
About 90 percent of susceptible people who are exposed to someone with the virus will be infected.

Risk factors

Risk factors for measles include:
  • Being unvaccinated. If you haven't received the vaccine for measles, you're much more likely to develop the disease.
  • Traveling internationally. If you travel to developing countries, where measles is more common, you're at higher risk of catching the disease.
  • Having a vitamin A deficiency. If you don't have enough vitamin A in your diet, you're more likely to have more-severe symptoms and complications.

Complications

Complications of measles may include:
  • Ear infection. One of the most common complications of measles is a bacterial ear infection.
  • Bronchitis, laryngitis or croup. Measles may lead to inflammation of your voice box (larynx) or inflammation of the inner walls that line the main air passageways of your lungs (bronchial tubes).
  • Pneumonia. Pneumonia is a common complication of measles. People with compromised immune systems can develop an especially dangerous variety of pneumonia that is sometimes fatal.
  • Encephalitis. About 1 in 1,000 people with measles develop a complication called encephalitis. Encephalitis may occur right after measles, or it might not occur until months later.
  • Pregnancy problems. If you're pregnant, you need to take special care to avoid measles because the disease can cause preterm labor, low birth weight, and maternal death.

Prevention

If someone in your household has measles, take these precautions to protect vulnerable family and friends:
  • Isolation. Because measles is highly contagious from about four days before to four days after the rash breaks out, people with measles shouldn't return to activities in which they interact with other people during this period.
    It may also be necessary to keep nonimmunized people — siblings, for example — away from the infected person.
  • Vaccinate. Be sure that anyone who's at risk of getting the measles who hasn't been fully vaccinated receives the measles vaccine as soon as possible. This includes anyone born after 1957 who hasn't been vaccinated, as well as infants older than 6 months.
    The first dose for infants is usually given between 12 and 15 months, with the second dose typically given between ages four and six years. If you'll be traveling abroad before your child is a year old, talk with your child's doctor about getting the measles vaccine earlier.

Preventing new infections

If you've already had measles, your body has built up its immune system to fight the infection, and you can't get measles again. Most people born or living in the United States before 1957 are immune to measles, simply because they've already had it.
For everyone else, there's the measles vaccine, which is important for:
  • Promoting and preserving widespread immunity. Since the introduction of the measles vaccine, measles has virtually been eliminated in the United States, even though not everyone has been vaccinated. This effect is called herd immunity.
    But herd immunity may now be weakening a bit, likely due to a drop in vaccination rates. The rate of measles in the U.S. recently jumped from an average of 60 cases a year to 205 cases annually.
  • Preventing a resurgence of measles. Steady vaccination rates are important because soon after vaccination rates decline, measles begins to come back. In 1998, a now-discredited study was published erroneously linking autism to the measles, mumps, and rubella (MMR) vaccine.
    In the United Kingdom, where the study originated, the rate of vaccination dropped to an all-time low of about 80 percent of all children in 2003-2004. In 2008, there were nearly 1,400 lab-confirmed cases of measles in England and Wales.

Diagnosis

Your doctor can usually diagnose measles based on the disease's characteristic rash as well as a small, bluish-white spot on bright red background — Koplik's spot — on the inside lining of the cheek. However, many doctors have never seen measles, and the rash can be confused with a number of other illnesses. If necessary, a blood test can confirm whether the rash is truly measles.

Treatment

There's no specific treatment for established measles infection. However, some measures can be taken to protect vulnerable individuals who have been exposed to the virus.
  • Post-exposure vaccination. Nonimmunized people, including infants, may be given the measles vaccination within 72 hours of exposure to the measles virus to provide protection against the disease. If measles still develops, the illness usually has milder symptoms and lasts for a shorter time.
  • Immune serum globulin. Pregnant women, infants and people with weakened immune systems who are exposed to the virus may receive an injection of proteins (antibodies) called immune serum globulin. When given within six days of exposure to the virus, these antibodies can prevent measles or make symptoms less severe.

Medications

  • Fever reducers. You or your child may also take over-the-counter medications such as acetaminophen (Tylenol, others), ibuprofen (Advil, Children's Motrin, others) or naproxen (Aleve) to help relieve the fever that accompanies measles.
    Don't give aspirin to children or teenagers who have measles symptoms. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children.
  • Antibiotics. If a bacterial infection, such as pneumonia or an ear infection, develops while you or your child has measles, your doctor may prescribe an antibiotic.
  • Vitamin A. Children with low levels of vitamin A are more likely to have a more severe case of measles. Giving vitamin A may lessen the severity of the measles. It's generally given as a large dose of 200,000 international units (IU) for children older than a year.

If you or your child has measles, keep in touch with your doctor as you monitor the progress of the disease and watch for complications. Also, try these comfort measures:
  • Take it easy. Get rest and avoid busy activities.
  • Sip something. Drink plenty of water, fruit juice, and herbal tea to replace fluids lost by fever and sweating.
  • Seek respiratory relief. Use a humidifier to relieve a cough and sore throat.
  • Rest your eyes. If you or your child finds bright light bothersome, as do many people with measles, keep the lights low or wear sunglasses. Also, avoid reading or watching television if the light from a reading lamp or from the television is bothersome.

Preparing for your appointment

If you suspect that you or your child has measles, you need to see your child's doctor.

What you can do

  • Write down any symptoms you or your child is experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
  • Write down key personal information, including any recent travel.
  • Make a list of all medications, vitamins or supplements that you or your child is taking.
  • Write down questions to ask your doctor.
For measles, some basic questions to ask your doctor include:
  • What's the most likely cause of my or my child's symptoms?
  • Are there other possible causes?
  • What treatments are available, and which do you recommend?
  • Is there anything I can do to make my child more comfortable?
  • Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?

What to expect from your doctor

The doctor may ask that you come in before or after office hours to reduce the risk of exposing others to the measles. In addition, if the doctor believes that you or your child has the measles, he or she must report those findings to the local health department.
Your doctor is likely to ask you a number of questions, such as:
  • Have you or your child been vaccinated for the measles? If so, do you know when?
  • Have you traveled out of the country recently?
  • Does anyone else live in your household? If yes, have they been vaccinated for measles?

What you can do in the meantime

While you're waiting to see the doctor:
  • Be sure you or your child stays well-hydrated. Pediatric electrolyte solutions, such as Pedialyte, or sports drinks, such as Gatorade or Powerade, can help you stay hydrated and maintain your electrolyte balance.
  • Bring a fever down safely. If a fever is making you or your child uncomfortable, medications such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Children's Motrin, others) can help bring the fever down.
    Don't give aspirin to children or teenagers who have symptoms of measles. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye's syndrome, a rare but potentially life-threatening condition, in such children.

04 March, 2019

HIPAA 2



Be careful when mailing documents:

•        A patient received an appointment reminder for another patient.

•        A patient received another patient’s medical records in with their requested medical records.

Double check your mailings before enclosing the document in the envelope.  Also, seal the envelope before it leaves your office.

Be careful what you say:

•        Making a comment about an employee and their recent doctor’s visits to another employee.

•        Asking an employee why they were at an appointment.  If someone wants to voluntarily share their information that’s okay.  But it is never okay to ask.

•        Mentioning to someone that you saw a mutual friend at the clinic.

•        Confirming for a caller that a patient had an appointment.

•        Sharing with outsiders that a patient was at the clinic and giving out their diagnosis.

•        Advising a school whether a student had an appointment at the clinic.  The school was trying to verify if an excuse for absence is legitimate.  The correct answer would be to tell them if the excuse is legitimate.  Do not verify if there was an appointment.

•        Verifying for a parent of a patient that is over the age of 18 whether there was an office visit.  The parent may cover the student under their health insurance but that does not grant them rights to the medical records.

HIPAA is see something, say nothing.

Be careful when printing out medical records for patients:

•        Printing out chart information for an adult that advises they are a parent but not verify that this is actually a parent.

•        Printing out medical records for the spouse of one of your patients.  Without a written release from the patient.

Before we give any records out we must verify the identity of the person seeking the records and their right to the records.  Make copies of their ID for the file.  Also, they should sign the Medical Records request form for our records.

Accessing records that aren’t for a patient being treated by your provider:

•        Reading your lab/x-ray results in your or a family members medical chart.

•        Looking up the reason an acquaintance was in for a visit.

•        Printing out information from your child’s medical record.

•        Printing out information from your own personal medical record.

•        Printing out information from other family members file.

•        Printing out information for another employee at their request.

You should never access a record that isn’t a patient being treated by your provider.  If you need a copy of an item in your file or a family member’s file, then complete the Medical Records request form and get the records from Medical Records just like other patients.  This allows for proper documentation of the release of the records.

Sharing your login with others:

•        Accessing a medical record using someone else’s login.

•        Allowing someone to complete a record using your login.

•        Placing your login and password information on your desk or computer so you won’t forget.

Your login information is your fingerprint in the Electronic Medical Records.  Don’t allow anyone to use the login and don’t leave it out for someone to take.

Remember Allscripts records every touch from login to log out.  An audit of an account shows the person that touched the file with date, time and what was viewed, changed, and/or printed.  It keeps up with the total time spent on each area.  If someone questions whether their chart has been viewed.

Thank you.


25 February, 2019

Professional Email



Email takes up a significant portion of our workday.  While we all try to multitask and work more efficiently, we must remember to keep our emails professional.  The following are some rules/tips to help you use your Email professionally and efficiently.

•        Always have a clearly defined SUBJECT line.  The Subject line should be clear and applicable to the email.  Don’t reply to an email with a subject line that has nothing to do with your reply message.  A blank subject line makes it easy for the recipient to miss.

•        Include a professional Signature.  An email without a signature can make it difficult to identify the sender.  A signature should give information to the recipient that would allow them to contact you directly by phone or location.


•        Use a professional salutation.  Use the person’s name and a salutation.  This helps to set the tone of the email.


•        Remember an email doesn’t include your vocal tone and facial expressions.  Make sure that your email expresses the issue as you intended.


•        Proofread your message before hitting send.  Look for misspelled words, grammatical errors, etc.  Don’t count on spell check to catch your errors.


•        Don’t assume the recipient knows what you are talking about.  It can be frustrating and time-consuming to look back at a chain of emails to get to the real context of the email.


•        Never send an angry reply to an email or give quick, flip responses.  If you feel angry, give yourself time before you respond.  Emails seem to make us respond differently than if we were face to face with the sender.



•        Don’t use texting abbreviations and acronyms.  Save the abbreviations and acronyms for your personal email or text messages.


•        Don’t type in all caps and use punctuation.  Take the time to make your email look professional.  Remember it is a reflection of your professional behavior.


•        Use extreme caution with attachments or links.  Remember these could be Phishing attempts.  Phishing emails can be designed to look like an email from someone you work with or know personally.  


•        When replying,  Close your email letting the recipient know if you need a response, if you are available to assist with questions or concerns, or if this email is just for informational purpose.  If there is a deadline, be sure to include this information.


•        When replying be sure to check how you are replying:

•        When replying be sure to check how you are replying:

  Reply  (this replies to the individual that sent the original email)

  Reply All (this replies to everyone that received the email)


  Forward   (you must choose the email addresses that will receive your email)


When sending an email make sure that you choose the correct name.  Verify which address applies to the person you are contacting.

Thank you.

Source: