Middle East Respiratory Syndrome Coronavirus Infections in Health Care Workers

Today's post was shared by NEJM and comes from www.nejm.org

Correspondence

August 7, 2013DOI: 10.1056/NEJMc1308698

Article

To the Editor:

A majority of the 94 cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection that have been reported to date have occurred in Saudi Arabia. Patients with this infection have presented with serious respiratory disease and have required hospitalization.1,2 However, there have been case reports of less severe disease within family3,4 and hospital2 clusters, and the clinical spectrum of MERS-CoV infections may extend to asymptomatic and subclinical cases. Therefore, the epidemiologic and clinical characteristics of this infection need further definition. The patterns of the spread of MERs-CoV among family3,4 or hospital2 clusters suggest that transmission occurs through droplets or contact. We previously reported two cases of MERS-CoV infection in health care workers,2 one of which was fatal.

The presence of asymptomatic or subclinical MERS-CoV infections in the community or among health care workers could have important public health implications, since these infections may be sources of transmission to close contacts in the community or to patients with coexisting medical conditions. The close proximity of health care workers to patients and the handling of human biologic material (sputum, respiratory secretions, feces, urine, or blood) may increase the risk of transmission, and health care workers may be particularly at risk for MERS-CoV infections.

The Saudi Arabian Ministry of...

[Click here to see the rest of this article]

A 10 Step Guide To Your Independent Medical Examination

Follow these steps to ensure you get the most out of your independent medical examination.

Today's post comes from guest author Paul J. McAndrew, Jr. from Paul McAndrew Law Firm.

You will reach the stage in your worker’s compensation claim where you will be examined by a doctor of your choice. This exam may generate the most important evidence in your claim. I strongly recommend that you do the following:

1. Needless to say, always tell the truth. Never exaggerate or overstate your symptoms. On the other hand, do not understate your symptoms, either. This is your one chance to tell it all.
2. Be sure to write down the time and place of your independent medical examination (IME, for short). It is important that you make it to this appointment on time.
3. Before going to the IME, spend an hour or two writing down the history of your injury, your current complaints based on the injury, what things aggravate your injury, and what care and treatment you have been given for your injury. You will have only a limited amount of time to describe these things to the IME doctor. It is important that you have a well-organized statement to give to the doctor. Therefore, you should take your written statement to the IME and use it to make sure that you tell the doctor a complete statement of these things. Then, save the written statement and return it to me. If the things in your statement do not end up in the IME doctor’s record, this may be useful in the future.
4. Remember, although this is a doctor of our choosing who will be fair and impartial. The doctor is not in our pocket. He (or she) will be using the AMA Guides to the Evaluation of Permanent Impairment which has certain “tests” to determine if a patient is faking or exaggerating their symptoms.
5. The best way to go into the IME is to be alert, relaxed and polite. The IME is a fairly routine process. You are not being singled out. Don’t be defensive.
6. A major part of the IME will consist of you answering<!--more--> written or oral questions or giving a statement to the doctor. Answer all questions politely and truthfully. Don’t try to fake anything or unreasonably exaggerate any problem. Any experienced doctor will quickly discover this and it could ruin your case. Take your time in answering questions to make sure that you answer each question clearly and truthfully. Answer only the questions that are asked and don’t ramble on.
7. You will probably be asked to describe your pain. Paint is often difficult to describe. You might find it easiest to explain activities that worsen your pain. You should have a list of everyday activities that increase your pain.
8. When talking to the physician try to be as accurate as possible. Explain when and how you were hurt. Tell him your current symptoms in as neutral a way as possible.
9. Do not complain bitterly about your previous treatment. Don’t say things about the company doctor being in cahoots with the employer. The IME doctor’s evaluation won’t be made better by complaints.
10. After the IME, I am interested in knowing just what went on in the examination. Therefore, after the examination, take at least one half-hour to write down as much as you can remember of what the doctor said, what you answered, what the doctor did, and what, if anything, was dictated into a recorder. Note as accurately as possible the time that you arrived at the office, the time that you were placed in the examining room, when the doctor entered the room, and when the doctor left the room. It may be important to have an exact record of the time the doctor spent with you in the examination room.

If you follow these directions, you will provide the IME doctor with an accurate description of your work-injury condition. This will lead to a clear and reliable IME report that can held your claim. Of course, check with your attorney for more suggestions.

The Price of ‘Made in China’

Today's post was shared by Jon L Gelman and comes from www.nytimes.com

HERE is a symbol of China’s assault on the American economy: the Verrazano-Narrows Bridge, which connects Brooklyn and Staten Island. This landmark, which opened in 1964, is North America’s longest suspension bridge. It’s also in urgent need of renovation. Unfortunately, $34 million in steel production and fabrication work has been outsourced to China.

How did this happen? The Metropolitan Transportation Authority says a Chinese fabricator was picked because the two American companies approached for the project lacked the manufacturing space, special equipment and financial capacity to do the job. But the United Steelworkers claims it quickly found two other American bridge fabricators, within 100 miles of New York City, that could do the job.

The real problem with this deal is that it doesn’t take into account all of the additional costs that buying “Made in China” brings to the American table. In fact, this failure to consider all costs is the same problem we as consumers face every time we choose a Chinese-made product on price alone — a price that is invariably cheaper.

Consider the safety issue: a scary one, indeed, because China has a very well-deserved reputation for producing inferior and often dangerous products. Such products are as diverse as lead-filled toys, sulfurous drywall, pet food spiked with melamine and heparin tainted with oversulfated chondroitin sulfate.

In the specific case of bridges, six have collapsed across China since July 2011. The...

[Click here to see the rest of this article]

Healthcare Workers: Protect Yourselves!

Today's post was shared by Safe Healthy Workers and comes from www.cdc.gov

Healthcare workers may be at risk for exposure to vaccine-preventable diseases. Getting vaccinated is an important step to keep yourself, coworkers, patients, and family safe.

Healthcare workers (HCWs) are at risk for exposure to serious, and sometimes deadly, diseases. If you work directly with patients or handle material that could spread infection, you should get appropriate vaccines to reduce the chance that you will get or spread vaccine-preventable diseases. Protect yourself, your patients, and your family members. Make sure you are up-to-date with recommended vaccines.

The term "healthcare workers" includes physicians, nurses, emergency medical personnel, dental professionals and students, medical and nursing students, laboratory technicians, pharmacists, hospital volunteers, and administrative staff.

Recommended Vaccines for Healthcare Workers:

Hepatitis B Vaccine

If you don't have documented evidence of a complete hepatitis B vaccine series, or if you don't have an up-to-date blood test that shows you are immune to hepatitis B (i.e., no serologic evidence of immunity or prior vaccination) then you should:

• Get the 3-dose series (dose #1 now, #2 in 1 month, #3 approximately 5 months after #2).
• Get anti-HBs serologic tested 1–2 months after dose #3.

Flu (Influenza) Vaccine

Get 1 dose of influenza vaccine annually.

MMR (Measles, Mumps, & Rubella) Vaccine

If you were born in 1957 or later and have not had the MMR vaccine, or if you don't have an up-to-date blood test...

[Click here to see the rest of this article]

Truck Drivers Not Revved Up About New Safety Rules

Today's post was shared by NIOSH Transportation and comes from www.cnbc.com

The federal government thinks long-haul truckers like Bryan Spoon need more rest.

But with the Department of Transportation's new rules forcing drivers to take longer breaks and cut back on hours behind the wheel, Spoon thinks the government has created a solution looking for a problem.

"I wish the government would just quit trying to fix something that's not broken," he said on a recent rest stop in Columbia, Mo., after hauling a load of construction materials on the 48-foot Great Dane flatbed behind his 2009 Volvo 780.

"If I get any more breaks out here I won't be able to make a living," he said.

Starting Monday, drivers like Spooner will have to stick to a schedule that requires taking a 30-minute break in the first eight hours of driving, cut the maximum workweek to 70 hours from 82, and "restart" those 70 hours with a 34-hour break once a week.

The rules are part of a program by the Obama administration to make U.S. highways safer by reducing the number of truck accidents and fatalities. The program also includes a safety rating system that shippers can review when they chose a new carrier, with the goal of prodding the trucking industry to further improve the safety of its drivers and equipment.

"The updated hours of service rule makes three common sense, data-driven changes to increase safety on our roadways and reduce driver fatigue, a leading factor in large truck crashes," said Anne Ferro administrator of the Federal Motor Carrier Safety Administration,...

[Click here to see the rest of this article]

At Too Many Hospitals, a Revolving Door

Today's post was shared by The New Old Age and comes from newoldage.blogs.nytimes.com

Jessie Gruman can’t remember the number of times she’s been hospitalized for cancer. The list of the conditions she’s had over almost 40 years is daunting: from Hodgkin’s lymphoma to cancers of the cervix and lung.

But Ms. Gruman, 59, can’t forget her experience three years ago, when it was time to leave the hospital after having her stomach removed, a consequence of gastric cancer.

Ms. Gruman was alone; her husband was on his way to this hospital but hadn’t yet arrived. This is all she remembers a nurse saying before she was shown the door.

Here is a prescription for pain medication. Don’t drive if you take it. Call your surgeon if you have a temperature or are worried about anything. Go see your doctor in two weeks. Do you want a flu shot? I can give you one before you leave. If you need a wheel chair to take you to the door, I’ll call for one. If not, you can go home. Take care of yourself. You are going to do great!

What wasn’t communicated to Ms. Gruman: Here’s a number to call if you have any questions. Here’s the medical expert who’s in charge of your follow-up care and how to reach him or her. Here’s the plan for your care over the next month, and here’s the plan for the next six months.



Or this: You’re going to experience a lot of challenges when you get home. Here are the three or four concerns that should be your priorities. Here’s what your caregiver needs to know to...

[Click here to see the rest of this article]

The Unanticipated Consequences of Postponing the Employer Mandate

Today's post was shared by NEJM and comes from www.nejm.org

The Obama administration's decision to postpone implementation of the employer mandate is the latest in a series of delays and alterations of the Affordable Care Act (ACA). But postponing the mandate — which requires larger employers to offer lower-income workers health insurance coverage similar to that available in the new insurance exchanges, on equal and affordable financial terms — may create large ripple effects. The good news is that as compared with instituting the mandate as planned, postponing it should barely increase the number of uninsured Americans after ACA implementation. But it affects other provisions, particularly the individual subsidies for purchasing insurance, and creates distorted incentives that may leave the government paying significantly more than planned.

More than 90% of Americans who obtain private health insurance today receive it through employers, but the centerpiece of the ACA's effort to make coverage more attractive to the uninsured focuses on insurance exchanges for individuals purchasing coverage directly. However, because both consumers and employers can in principle finance or obtain private health insurance in either setting, ACA provisions had to be compatible with both coverage channels. Moreover, the legislation created tax-financed subsidies for buying insurance only through the exchanges while relying largely on regulations and mandates to deal with employment-based coverage. Inevitably, this grafting of a new...

[Click here to see the rest of this article]