#C. difficile and Home Care

[sanjay-chem]

Smart Vinyl Flooring Solutions Transforming Modern Interiors

Introduction: The Quiet Revolution in Vinyl Flooring

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The vinyl flooring market has experienced rapid expansion, with projections indicating a valuation of over USD 63.8 Billion by 2035, driven by increasing demand for luxury vinyl tiles (LVT), resilient flooring, and PVC-based planks. While much attention has been given to aesthetic appeal, cost-efficiency, and durability, a lesser-known but game-changing trend is the integration of antimicrobial technologies into vinyl flooring—particularly in healthcare and elder care environments.

This niche but crucial development is reshaping how institutions design their interiors, blending infection control with design flexibility.

Antimicrobial Vinyl Flooring: The Unseen Line of Defense

In high-risk environments such as hospitals, clinics, and long-term care homes, flooring plays a more vital role than most realize. These spaces are prone to the spread of pathogens, including MRSA, C. difficile, and norovirus. Traditional cleaning methods, though important, cannot offer 24/7 protection. This is where antimicrobial vinyl flooring steps in.

These flooring products are treated with built-in antimicrobial agents—such as silver ion technology or zinc-based additives—which actively inhibit bacterial growth on the surface. Unlike coatings that can wear off, these technologies are embedded during manufacturing, ensuring long-term effectiveness.

Key Takeaways from the Vinyl Flooring Market Study

South Korea market is projected to grow at a CAGR of around 6.5% over the forecast period, reflecting rapid infrastructure development and urban housing expansion.

The USA commanded approximately 6.8% CAGR of the global vinyl flooring market in 2035, driven by strong demand for luxury vinyl tile (LVT) and renovation activities.

Printed vinyl flooring segment is forecast to expand at a CAGR close to 7%, thanks to increasing adoption in residential and commercial interiors for design flexibility.

Why It Matters for Senior Care Facilities

While hospitals are an obvious application, elder care homes and assisted living centers are rapidly adopting antimicrobial vinyl flooring as part of infection control strategies. Seniors often have compromised immune systems, making them more vulnerable to infections.

Vinyl’s slip resistance, ease of wheelchair movement, and comfort underfoot already make it a popular choice, but adding pathogen resistance further elevates its value. For example, in Japan—where the aging population drives innovation in eldercare infrastructure—vinyl flooring products with antimicrobial and odor-neutralizing features are now standard in new facility construction.

Browse the Complete Report: https://www.futuremarketinsights.com/reports/vinyl-flooring-market

Product Innovation & Market Impact

This trend has triggered innovation from key players in the resilient flooring industry. Companies like Tarkett, Armstrong Flooring, and Gerflor have introduced LVT collections specifically targeting healthcare environments. These include advanced features like seamless installation, heat-welded joints, and UV-cured finishes, which enhance both hygiene and longevity.

Moreover, the Asia-Pacific region, with its growing medical tourism and hospital infrastructure boom, is emerging as a hotbed for antimicrobial vinyl flooring demand. By 2030, India and Southeast Asia are expected to account for over 25% of global demand for healthcare-grade LVT flooring.

From a regulatory perspective, antimicrobial flooring solutions are also aligning with hospital accreditation standards and infection control guidelines, which further fuels market demand.

Looking Ahead: A Market Shift Driven by Health and Safety

As healthcare and senior care continue to evolve, the role of surfaces—including floors—is becoming central to infection prevention design. Beyond visual appeal or durability, the market is seeing growing investment in function-first vinyl flooring, driven by health considerations.

In the near future, we may see antimicrobial vinyl flooring expand into schools, public transportation hubs, gyms, and restaurants, where hygiene is equally critical.

General & Advanced Materials Industry Analysis: https://www.futuremarketinsights.com/industry-analysis/general-and-advanced-materials

[pickingoutchinapatterns]

So, I just found out you’re a nurse. Thank you. 🙏 What is happening for you at the moment?

Ok, so I’m a nurse and admittedly I’m angry and frustrated.  This is gonna be a non-filtered rant (I may go into details about some points later). Also, before I get any shit bc I’m “just a nurse” (which happens), I’ll say that nursing is actually my third degree, my other 2 (undergrad and graduate) are also in the sciences.  Ok, let the rant begin.

First, when this is over, we need to fund education.  EVERYONE should have a basic knowledge of math and biology.  Seriously, have some of you ppl never heard of exponential growth? Let’s say an organism in a petri dish replicates once a day.  At the end of the first day, you’ll have 2, but at the end of the 14th day (I’m using that bc of the current “2 week isolation period” currently being advised right now), you don’t get 28 organisms in your dish (2x14), but 16,384 (2^14) organisms.  The growth of this organism will only slow down once it starts running out of resources (which is why you get an S shaped growth curve).  

WHY YOU SHOULD LISTEN TO WHAT PUBLIC HEALTH IS SAYING:  This is similar to disease spread.  If you infect one person, you’re literally making things exponentially worse.  And guess what, if you self-isolate you are GETTING RID OF THE VIRUS’ RESOURCES.  Viruses, unlike bacteria, cannot replicate on their own.  THEY NEED YOU TO GROW.  Plus, based on the data from the Japanese cruise ship, about half of those infected were ASYMPTOMATIC.  This means that we don’t know how many ppl are infected but we literally have THOUSANDS of Typhoid Mary’s out there.  Plus, given that it often takes about 2 weeks to develop symptoms of the virus,  so even if everyone is at home on lockdown, we won’t see how bad it actually is NOW for at least 2 WEEKS FROM NOW.  

STOP HOARDING AND STEALING MASKS AND PPE (personal protective equipement).  Yes, ppl are literally stealing PPE from hospitals.  JUST STAY THE FUCK HOME.

I know that a lot of ppl have the attitude of “oh, it’s mild for most ppl” or “it just kills the elderly.” First, “it just kills the elderly” is NOT true.  The ppl it hits the hardest INCLUDE the elderly, but ALSO INCLUDES ppl with comorbidies like diabetes, cardiac conditions and high blood pressure (SOUND LIKE ANYONE YOU MIGHT FUCKING NOW???) and HEALTH CARE WORKERS.  No one knows why front line health care workers are hit so hard (my hypothesis is bc we are exposed to higher viral loads, plus we work in a stressful, germ infested place AND we do shift work…not exactly the best combinations for a healthy immune system.  Plus, many of us also suffer from comorbidities as well.)  The health care system was stretched tightly enough before this pandemic (cancer, flu season, infectious diseases and drug epidemics), so imagine us dealing with a pandemic AND our regular workload AND being SUPER SHORT STAFFED (which many of us are already before this began).  Italy has already announced a while ago that they’re just deciding that some ppl are not gonna get any treatment bc they HAVE NO MORE RESOURCES.

A note re the N95 (airborne) mask (these are not the basic surgical masks).   Did you know that we have to get trained on how to use them?  And then we have to do a test to make sure that each one of us is using the right brand and size?  (That’s right, it’s not a one size fits all.)  Plus, men have to shave before using one bc even a bit of stubble makes it ineffective?  Now imagine HCP’s are out of N95 masks (used for AIRBORNE precautions like TB, measles and shingles; surgical masks are used for droplet precautions, like the flu). We still have ppl in hospitals with TB, measles and shingles…what if these spread too now that we don’t have N95 masks?

Also, please stop using anti-bacterial soap.  First, COVID 19 is a virus, not a bacteria.  We already have A LOT of antibiotic resistant bacteria out there. (Ex. MRSA, VRE, C-difficile, literally called difficile bc it’s so hard to treat and kill).  Back when I was working in a microbiology lab, we were extra careful using vancomycin bc it was considered a last resort antibiotic and didn’t want to accidentally have bacteria develop and spread resistance to it. Now, I see vancomycin being used in hospitals daily.  (VRE literally stands for Vancomycin-Resistant Enterococci.)

This pandemic is gonna hit every health care system hard worldwide.  If we’re already full, how do you think we’ll handle you coming in needing emergency surgery?  What about during the high smog warnings in summer and ppl come in with heat stroke or a severe asthma exacerbation?  What if you’re going to deliver?  

I am a nurse and I do what I can to help ppl out.  I base my nursing practice on the fact that if I’m seeing you in hospital I’m likely seeing you during the worst time of your life.  This job is a roller coaster, both physically and emotionally.  I will say though, it is absolutely horrible treating ppl in respiratory distress.  It’s like you’re watching someone suffocate and drown at the same time. You see the panic in their eyes and in their families as they try to get enough air.  You do all that you can, and even if the intervention is successful, you still feel useless and shaken.  It is HORRIBLE.  Please, do all that you can to stop this spread and to keep yourself healthy so that my colleagues and I won’t see you anytime soon in any one of our facilities.

End of current rant.

[didanawisgi]

2020 Yale-G’s Monthly Clinical Updates According to www.uptodate.com

(As of 2020-11-12, updated in Yale-G’s 6th-Ed Kindle Version; will be emailed to buyers of Ed6 paper books)

       Chapter 1: Infectious Diseases

Special Viruses: Coronaviruses

     Coronaviruses are important human and animal pathogens, accounting for 5-10% community-acquired URIs in adults and probably also playing a role in severe LRIs, particularly in immunocompromised patients and primarily in the winter. Virology: Medium-sized enveloped positive-stranded RNA viruses as a family within the Nidovirales order, further classified into four genera (alpha, beta, gamma, delta), encoding 4-5 structural proteins, S, M, N, HE, and E; severe types: severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and novel coronavirus (2019-nCoV, which causes COVID-19). Routes of transmission: Similar to that of rhinoviruses, via direct contact with infected secretions or large aerosol droplets. Immunity develops soon after infection but wanes gradually over time. Reinfection is common. Clinical manifestations: 1. Coronaviruses mostly cause respiratory symptoms (nasal congestion, rhinorrhea, and cough) and influenza-like symptoms (fever, headache). 2. Severe types (2019-nCoV, MERS-CoV, and SARS-CoV): Typically with pneumonia–fever, cough, dyspnea, and bilateral infiltrates on chest imaging, and sometimes enterocolitis (diarrhea), particularly in immunocompromised hosts (HIV+, elders, children). 3. Most community-acquired coronavirus infections are diagnosed clinically, although RT-PCR applied to respiratory secretions is the diagnostic test of choice.              

Treatment: 1. Mainly consists of ensuring appropriate infection control and supportive care for sepsis and acute respiratory distress syndrome. 2. In study: Chloroquine showed activity against the SARS-CoV, HCoV-229E, and HCoV-OC43 and remdesivir against 2019-nCoV. Dexamethasone may have clinical benefit.

Prevention: 1. For most coronaviruses: The same as for rhinovirus infections, which consist of handwashing and the careful disposal of materials infected with nasal sec retions. 2. For novel coronavirus (2019-nCoV), MERS-CoV, and SARS-CoV: (1) Preventing exposure by diligent hand washing, respiratory hygiene, and avoiding close contact with live or dead animals and ill individuals. (2) Infection control for suspected or confirmed cases: Wear a medical mask to contain their respiratory secretions and seek medical attention; standard contact and airborne precautions, with eye protection.

      Hepatitis A: HAV vaccine is newly recommended to adults at increased risk for HAV infection (substance use treatment centers, group homes, and day care facilities for disabled persons), and to all children and adolescents aged 2 to 18 years who have not previously received HAV vaccine.

      Hepatitis C: 8-week glecaprevir-pibrentasvir is recommended for chronic HCV infection in treatment-naive patients. In addition to the new broad one-time HCV screening (17-79 y/a), a repeated screening in individuals with ongoing risk factors is suggested.

      New: Lefamulin is active against many common community-acquired pneumonia pathogens, including S. pneumoniae, Hib, M. catarrhalis, S. aureus, and atypical pathogens.  

      New: Cefiderocol is a novel parenteral cephalosporin that has activity against multidrug-resistant gram-negative bacteria, including carbapenemase-producing organisms and Pseudomonas aeruginosa resistant to other beta-lactams. It’s reserved for infections for which there are no alternative options.

      New: Novel macrolide fidaxomicin is reserved for treating the second or greater recurrence of C. difficile infection in children.       Vitamin C is not beneficial in adults with sepsis and ARDS.    

      Chapter 2: CVD

      AF: Catheter ablation is recommended to some drug-refractory, paroxysmal AF to decrease symptom burden. In study: Renal nerve denervation has been proposed as an adjunctive therapy to catheter ablation in hypertensive patients with AF. Alcohol abstinence lowers the risk of recurrent atrial fibrillation among regular drinkers.

VF: For nonshockable rhythms, epinephrine is given as soon as feasible during CPR, while for shockable rhythms epinephrine is given after initial defibrillation attempts are unsuccessful. Avoid vasopressin use.

All patients with an acute coronary syndrome (ACS) should receive a P2Y12 inhibitor. For patients undergoing an invasive approach, either prasugrel or ticagrelor has been preferred to clopidogrel. Long-term antithrombotic therapy in patients with stable CAD and AF has newly been modified as either anticoagulant (AC) monotherapy or AC plus a single antiplatelet agent.

      Long-term antithrombotic therapy (rivaroxaban +/- aspirin) is recommended for patients with AF and stable CAD. Ticagrelor plus aspirin is recommended for some patients with CAD and diabetes.

VTE (venous thromboembolism): LMW heparin or oral anticoagulant edoxaban is the first-line anticoagulants in patients with cancer-associated VTE.

Dosing of warfarin for VTE prophylaxis in patients undergoing total hip or total knee arthroplasty should continue to target an INR of 2.5.

     Chapter 3: Resp. Disorders

Asthma: Benralizumab is an IL-5 receptor antibody that is used as add-on therapy for patients with severe asthma and high blood eosinophil counts.

Recombinant GM-CSF is still reserved for patients who cannot undergo, or who have failed, whole lung lavage.

Pulmonary embolism (PE): PE response teams (PERT, with specialists from vascular surgery, critical care, interventional radiology, emergency medicine, cardiac surgery, and cardiology) are being increasingly used in management of patients with intermediate and high-risk PE.

Although high-sensitivity D-dimer testing is preferred, protocols that use D-dimer levels adjusted for pretest probability may be an alternative to unadjusted D-dimer in patients with a low pretest probability for PE.

     Non-small cell lung cancer (NSCLC): Newly approved capmatinib is for advanced NSCLC associated with a MET mutation, and selpercatinib for those with advanced RET fusion-positive. Atezolizumab was newly approved for PD-L1 high NSCLC.

Circulating tumor DNA tests for cancers such as NSCLC are increasingly used as “liquid biopsy”. Due to its limited sensitivity, NSCLC patients who test (-) for the biomarkers should undergo tissue biopsy.

Cystic Fibrosis (CF): Tx: CFTR modulator therapy (elexacaftor-tezacaftor-ivacaftor) is recommended for patients ≥12 years with the F508del variant.

Vitamin E acetate has been implicated in the development of electronic-cigarette, or vaping, product use associated lung injury.

     Chapter 4: Digestive and Nutritional Disorders

     Comparison of Primary Biliary Cholangitis (PBC) and Primary Sclerosing Cholangitis (PSC):

     Common: They are two major types of chronic cholestatic liver disease, with fatigue, pruritus, obstructive jaundice, similar biochemical tests of copper metabolism, overlapped histology (which is not diagnostic), destructive cholangitis, and both ultimately result in cirrhosis and hepatic failure. (1) PBC: Mainly in middle-aged women, with keratoconjunctivitis sicca, hyperpigmentation, and high titer of antimitochondrial Ab (which is negative for PSC). (2) PSC: Primarily in middle-aged men, with chronic ulcerative colitis (80%), irregular intra- and extra-hepatic bile ducts, and anti-centromere Ab (+).

      CRC: Patients with colorectal adenomas at high risk for subsequent colorectal cancer (CRC) (≥3 adenomas, villous type with high-grade dysplasia, or ≥10 mm in diameter) are advised short follow-up intervals for CRC surveillance. Pembrolizumab was approved for the first-line treatment of patients with unresectable or metastatic DNA mismatch repair (dMMR) CRC.

      UC and CRC: Patients with extensive colitis (not proctitis or left-sided colitis) have increased CRC risk.

      Eradication of H. pylori: adding bismuth to clarithromycin-based triple therapy for patients with risk factors for macrolide resistance.

      Thromboelastography and rotational thromboelastometry are bedside tests recommended for patients with cirrhosis and bleeding.

      Pancreatic cancer: Screening for patients at risk for hereditary pancreatic cancer (PC): Individuals with mutations in the ataxia-telangiectasia mutated gene and one first-degree relative with PC can be screened with endoscopic ultrasound and/or MRI/magnetic retrograde cholangiopancreatography.

      Olaparib is recommended for BRCA-mutated advanced pancreatic cancer after 16 weeks of initial platinum-containing therapy.

      HCC (unresectable): New first-line therapy is a TKI (sorafenib or sunitinib) or immune checkpoint inhibitor atezolizumab plus bevacizumab, +/- doxorubicin. Monitor kidney toxicity for these drugs.

      UC: Ustekinumab (-umab) anti-interleukin 12/23 antibody, is newly approved for the treatment of UC.

      Crohn disease: The combination of partial enteral nutrition with the specific Crohn disease exclusion diet is a valuable alternative to exclusive enteral nutrition for induction of remission.

      Obesity: Lorcaserin, a 5HT2C agonist that can reduce food intake, has been discontinued in the treatment of obesity due to increased malignancies (including colorectal, pancreatic, and lung cancers).

      Diet and cancer deaths: A low-fat diet rich in vegetables, fruits, and grains experienced fewer deaths resulted from many types of cancer.

      Note that H2-blockers (-tidines) are no longer recommended due to the associated carcinogenic N-nitrosodimethylamine.

      Gastrointestinal Stromal Tumors (GIST):

      GIST is a rare type of tumor that occurs in the GI tract, mostly in the stomach (50%) or small intestine. As a sarcoma, it’s the #1 common in the GI tract. It is considered to grow from specialized cells in the GI tract called interstitial cells of Cajal, associated with high rates of malignant transformation.

Clinical features and diagnosis: Most GISTs are asymptomatic. Nausea, early satiety, bloating, weight loss, and signs of anemia may develop, depending on the location, size, and pattern of growth of the tumor. They are best diagnosed by CT scan and mostly positive staining for CD117 (C-Kit), CD34, and/or DOG-1.

Treatment: Approaches include resection of primary low-risk tumors, resection of high-risk primary or metastatic tumors with a tyrosine kinase inhibitor (TKI) imatinib for 12 months, or if the tumor is unresectable, neoadjuvant imatinib followed by resection. Radiofrequency ablation has shown to be effective when surgery is not suitable. Newer therapies of ipilimumab, nivolumab, and endoscopic ultrasound alcohol ablation have shown promising results. Avapritinib or ripretinib (new TKI) is recommended for advanced unresectable or metastatic GIST with PDGFRA mutations.

      Anal Cancer:

Anal cancer is uncommon and more similar to a genital cancer than it is to a GI malignancy by etiology. By histology, it is divided into SCC (#1 common) and adenocarcinoma. Anal cancer (particularly SCC among women) has increased fast over the last 30 years and may surpass cervical cancer to become the leading HPV-linked cancer in older women. A higher incidence has been associated with HPV/HIV infection, multiple sexual partners, genital warts, receptive anal intercourse, and cigarette smoking. SCCs that arise in the rectum are treated as anal canal SCCs.

Clinical features and diagnosis: 1. Bleeding (#1) and itching (often mistaken as hemorrhoids). Later on, patients may develop focal pain or pressure, unusual discharges, and lump near the anus, and changes in bowel habits. 2. Diagnosis is made by a routine digital rectal exam, anoscopy/proctoscopy plus biopsy, +/- endorectal ultrasound.

Treatment: Anal cancer is primarily treated with a combination of radiation, chemotherapy, and surgery—especially for patients failing the above therapy or for true perianal skin cancers.

     Chapter 5: Endocrinology

      Diabetes (DM):       Liraglutide can be added as a second agent for type-2 DM patients who fail monotherapy with metformin or as a third agent for those who fail combination therapy with metformin and insulin.       Metformin is suggested to prevent type 2 DM in high-risk patients in whom lifestyle interventions fail to improve glycemic indices.       Metabolic (bariatric) surgery improves glucose control in obese patients with type 2 DM and also reduce diabetes-related complications, such as CVD.       Teprotumumab, an insulin-like growth factor 1 receptor inhibitor, can be used for Graves’ orbitopathy if corticosteroids are not effective. Subclinical hypothyroidism should not be routinely treated (with T4) in older adults with TSH <10 mU/L.

        Chapter 6: Hematology & Immunology

       Anticoagulants: Apixaban is preferred to warfarin for atrial fibrillation with osteoporosis because it lowers the risk of fracture. Rivaroxaban is inferior to warfarin for antiphospholipid syndrome.

      Cancer-associated VTE: LMW heparin or oral edoxaban is the first-line anticoagulant prophylaxis.

      NH-Lymphoma Tx: New suggestion is four cycles of R(rituximab)-CHOP for limited stage (stage I or II) diffuse large B cell non-Hodgkin lymphoma (DLBCL) without adverse features. New suggestions: selinexor is for patients with ≥2 relapses of DLBCL, and tafasitamab plus lenalidomide is for patients with r/r DLBCL who are not eligible for autologous HCT.

      Chimeric antigen receptor (CAR)-T (NK) immunotherapy is newly suggested for refractory lymphoid malignancies, with less toxicity than CAR-T therapy. Polatuzumab + bendamustine + rituximab (PBR) is an alternative to CAR-T, allogeneic HCT, etc. for multiply relapsed diffuse large B-C NHL.

      Refractory classic Hodgkin lymphoma (r/r cHL) is responsive to immune checkpoint inhibition with pembrolizumab or nivolumab, including those previously treated with brentuximab vedotin or autologous transplantation.

      Mantle cell lymphoma: Induction therapy is bendamustine + rituximab or other conventional chemoimmunotherapy rather than more intensive approaches. CAR-T cell therapy is for refractory mantle cell lymphoma.

      AML: Gilteritinib is a new alternative to intensive chemotherapy for patients with FLT3-mutated r/r AML.

      Oral decitabine plus cedazuridine is suggested for MDS and chronic myelomonocytic leukemia.  

      Multiple myeloma (MM): Levofloxacin prophylaxis is suggested for patients with newly diagnosed MM during the first three months of treatment. For relapsed MM: Three-drug regimens (daratumumab, carfilzomib, and dexamethasone) are newly recommended.

      Transplantation: As the transplant waitlist continues to grow, there may be an increasing need of HIV-positive to HIV-positive transplants.

      Porphyria:       Porphyria is a group of disorders (mostly inherited) caused by an overaccumulation of porphyrin, which results in hemoglobin and neurovisceral dysfunctions, and skin lesions.       Clinical types, features, and diagnosis:  I. Acute porphyrias: 1. Acute intermittent porphyria: Increased porphobilinogen (PBG) causes attacks of abdominal pain (90%), neurologic dysfunction (tetraparesis, limb pain and weakness), psychosis, and constipation, but no rash. Discolored urine is common. 2. ALA (aminolevulinic acid) dehydratase deficiency porphyria (Doss porphyria): Sensorimotor neuropathy and cutaneous photosensitivity. 3. Hereditary coproporphyria: Abdominal pain, constipation, neuropathies, and skin rash. 4. Variegate porphyria: Cutaneous photosensitivity and neuropathies.  II. Chronic porphyrias: 1. Erythropoietic porphyria: Deficient uroporphyrinogen III synthase leads to cutaneous photosensitivity characterized by blisters, erosions, and scarring of light-exposed skin. Hemolytic anemia, splenomegaly, and osseous fragility may occur. 2. Cutaneous porphyrias–porphyria cutanea tarda: Skin fragility, photosensitivity, and blistering; the liver and nervous system may or may not be involved.  III. Lab diagnosis: Significantly increased ALA and PBG levels in urine have 100% specificity for most acute porphyrias. Normal PBG levels in urine can exclude acute porphyria.       Treatment: 1. Acute episodes: Parenteral narcotics are indicated for pain relief. Hemin (plasma-derived intravenous heme) is the definitive treatment and mainstay of management. 2. Avoidance of sunlight is the key in treating cutaneous porphyrias. Afamelanotide may permit increased duration of sun exposure in patients with erythropoietic protoporphyria.

 Chapter 7: Renal & UG

Membranous nephropathy (MN): Rituximab is a first-line therapy in patients with high or moderate risk of progressive disease and requiring immunosuppressive therapy.

      Diabetes Insipidus (DI): Arginine-stimulated plasma copeptin assays are newly used to diagnose central DI and primary polydipsia, often alleviating the need for water restriction, hypertonic saline, and exogenous desmopressin.

      Prostate cancer: Enzalutamide (new androgen blocker) is available for metastatic castration-sensitive prostate cancer. Cabazitaxel, despite its great toxicity, is suggested as third-line agent for metastatic prostate cancer. Either early salvage RT or adjuvant RT is acceptable after radical prostatectomy for high-risk disease.

      UG cancers: Nivolumab plus ipilimumab is suggested in metastatic renal cell carcinoma for long-term survival.

      Enfortumab vedotin is suggested in locally advanced or metastatic urothelial carcinoma. Maintenance avelumab is recommended with other chemotherapy in advanced urothelial bladder cancer. Pyelocalyceal mitomycin is suggested for low-grade upper tract urothelial carcinomas.

Chapter 8: Rheumatology

Janus kinase (JAK) inhibitors (upadacitinib, filgotinib) are new options for active, resistant RA and ankylosing spondylitis.

Graves’ orbitopathy: new therapy–teprotumumab, an insulin-like growth factor 1 receptor inhibitor.

Chapter 9: Neurology & Special Senses

Epilepsy: Cenobamate, a novel tetrazole alkyl carbamate derivative that inhibits Na-channels, provides a new treatment option for patients with drug-resistant focal epilepsy. A benzodiazepine plus either fosphenytoin, valproate, or levetiracetam is recommended as the initial treatment of generalized convulsive status epilepticus.

Migraine: Lasmiditan is a selective 5H1F receptor agonist that lacks vasoconstrictor activity, new therapy for patients with relative contraindications to triptans due to cardiovascular risk factors.

      Stroke: New recommendation for cerebellar hemorrhages >3 cm in diameter is surgical evacuation.       TBI: Antifibrolytic agent tranexamic acid is newly recommended for moderate and severe acute traumatic brain injury (TBI).

      Ofatumumab is a new agent that may delay progression of MS.

 Chapter 10: Dermatology

 Minocycline foam is a new topical drug option for moderate to severe acne vulgaris.

       Melanloma: Nivolumab plus ipilimumab in metastatic melanoma has confirmed long-term survival. With sun-protective behavior, melanoma incidence is decreasing.

       New: Tazemetostat is suggested in patients with locally advanced or metastatic epithelioid sarcoma (rare and aggressive) ineligible for complete surgical resection.

       Psoriasis: New therapies for severe psoriasis and psoriatic arthritis: a TNF-alpha inhibitor (infliximab or adalimumab, golimumab) or IL-inhibitor (etanercept or ustekinumab) is effective. Ixekizumab is a newly approved monoclonal antibody against IL-17A. Clinical data support vigilance for signs of symptoms of malignancy in patients with psoriasis.

     Chapter 11: GYH

      Breast cancer:        Although combined CDK 4/6 and aromatase inhibition is an effective strategy in older adults with advanced receptor-positive, HER2-negative breast cancer, toxicities (myelosuppression, diarrhea, and increased creatinine) should be carefully monitored. SC trastuzumab and pertuzumab is newly recommended for HER2-positive breast cancer.

      Whole breast irradiation is suggested for most early-stage breast cancers treated with lumpectomy. Accelerated partial breast irradiation can be an alternative for women ≥50 years old with small (≤2 cm), hormone receptor-positive, node-negative tumors.

      Endocrine therapy is recommended for breast cancer prevention in high-risk postmenopausal women.

      Uterine fibroids: Elagolix (oral gonadotropin-releasing hormone antagonist) in combination with estradiol and norethindrone is for treatment of heavy menstrual bleeding (HMB) due to uterine fibroids.

      Chapter 12: OB

      Table 12-6: Active labor can start after OS > 4cm, and 6cm is relatively more acceptable but not a strict number.

      Table 12-7: Preeclampsia is a multisystem progressive disorder characterized by the new onset of hypertension and proteinuria, or of hypertension and significant end-organ dysfunction with or without proteinuria, in the last half of pregnancy or postpartum. Once a diagnosis of preeclampsia is established, testing for proteinuria is no longerdiagnostic or prognostic. “proteinuria>5g/24hours” may only indicate the severity.

      Mole: For partial moles, obtain a confirmatory hCG level one month after normalization; for complete moles, reduce monitoring from 6 to 3 months post-normalization.

      Chapter 14: EM

SHOCK RESUSCITATION

Emergency treatment—critical care!

“A-B-C”: Breathing: …In mechanically ventilated adults with critical illness in ICU, intermittent sedative-analgesic medications (morphine, propofol, midazolam) are recommended.

 Chapter 15: Surgery

      Surgery and Geriatrics: Hemiarthroplasty is a suitable option for patients who sustain a displaced femoral neck fracture.

    Chapter 16: Psychiatry

     Depression: Both short-term and maintenance therapies with esketamine are beneficial for treatment-resistant depression.

Schizophrenia: Long-term antipsychotics may decrease long-term suicide mortality.

Narcolepsy: Pitolisant is a novel oral histamine H3 receptor inverse agonist used in narcolepsy patients with poor response or tolerate to other medications. Oxybate salts, a lower sodium mixed-salt formulation of gamma hydroxybutyrate is for treatment of narcolepsy with cataplexy.

     Chapter 17: Last Chapter

PEARLS—Table 17-9:  Important Immunization Schedules for All (2020, USA)

Vaccine                 Birth       2M          4M          6M          12-15M                 2Y          4-6Y       11-12Y       Sum

HAV                                                                                       1st                          2nd (2-18Y)                            2 doses

HBV                      1st           2nd                        3rd (6-12M)                                                                             3 doses

DTaP                                    1st            2nd         3rd          4th (15-18M)                        5th                             + Td per 10Y

IPV                                       1st           2nd         3rd (6-18M)                                         4th                             4 doses

Rotavirus                            1st           2nd                                                                                                         2 doses

Hib                                       1st           2nd         (3rd)       (3-4th)                                                                    3-4 doses

MMR                                                                                    1st                                         2nd                              2 doses

Varicella                                                                              1st                                         2nd                        + Shingles at 60Y

Influenza                                                            1st (IIV: 6-12Y; LAIV: >2Y                (2nd dose)               1-2 doses annually

PCV                                     1st           2nd         3rd          4th                                                                        PCV13+PPSV at 65Y

MCV (Men A, B)                                                                                                                                1st         Booster at 16Y

HPV                      9-12Y starting: <15Y: 2 doses (0, 6-12M); >15Y or immunosuppression: 3 doses (0, 2, 6M).

Chapter 17 HYQ answer 22: No routine prostate cancer screening (including PSA) is recommended and answer “G” is still correct–PSA

screening among healthy men is not routinely done but should be indicated in a patient with two risk factors.

[fullcirclehealthsalesreps88]

2018 BC Health Care Awards Recipients Revealed

VANCOUVER - Recipients of the 12th annual BC Health Care Awards were announced today at a gala luncheon in Vancouver. Twelve Gold Apple and six Award of Merit recipients were honoured.

Presented by the Health Employers Association of British Columbia (HEABC), the awards recognize British Columbians who are providing outstanding care and support. Awards are given in 11 categories to projects improving delivery through innovative and collaborative approaches and to people making a positive impact and inspiring those around them.

"BC's medical professionals - including support staff - genuinely care about delivering quality care to British Columbians," said Michael McMillan, HEABC's President and CEO. "The BCHC Awards are an opportunity to recognize and celebrate the individual and team contributions made by these individuals."

New this year - Dianna Mah-Jones Award of Excellence in Person-Centred Care

Named in honour of Dianna Mah-Jones, this award is for a team or project that makes use of leading practices to improve care for patients, residents or clients by focusing on the needs of the person rather than the needs of the system or service. Dianna Mah-Jones, an occupational therapist at GF Strong Rehabilitation Centre, was tragically killed, along with her husband Richard Jones, just three months after being named Provincial HC Hero at the 2017 awards. Our hope is that this ward will help to keep her memory and legacy alive by recognizing others who strive to deliver care that is respectful of the needs, values and preferences of individuals.

2018 Gold Apple winners

Provincial HC Hero & HC Hero - Provincial Health Services Authority

Glenn Braithwaite - District Supervisor, Emergency Coordinator, BCEHS

Glenn Jay Braithwaite is a Paramedic and District Supervisor at BC Ambulance Service, recognized for providing exceptional emergency response and for his clinical leadership abilities. He's received several professional accolades for his heroic actions, and his outstanding commitment to patients, colleagues and the broader community.

Provincial HC Hero & HC Hero - Island Health

Dr. Ramm Hering - Physician Lead, Primary Care Substance Use, Island Health

By passionately and effectively advocating for improved services for patients dealing with substance use and addiction, Dr. Hering has inspired his colleagues to work together to develop new programs and create an efficient, client-centred system of addiction services.

HC Hero - Affiliate

Dr. David Agulnik- Emergency Physician, St. Paul's Hospital

HC Hero - Fraser Health

Mits Miyata - Pharmacy Manager, Lower Mainland Pharmacy Services

HC Hero - Interior Health

Lynda Martyn - Registered Speech-Language Pathologist, Coordinator Kelowna Cleft Lip/Palate Clinic

HC Hero - Northern Health

Debbie Strang - Health Services Administrator, Quesnel

HC Hero - Provincial Health Services Authority

Dr. Faisal Khosa - Associate Professor, Radiology, Vancouver General Hospital

Dianna Mah-Jones Award of Excellence in Person-Centred Care

International Seating Symposium - Sunny Hill Health Centre for Children, Provincial Health Services Authority

The International Seating Symposium has created an international forum that fosters an exchange of ideas and a network of consumers, rehabilitation therapists, physicians, designers, and manufacturers of positioning and mobility equipment. This has inspired improvements in rehabilitation equipment and technology that have improved mobility, comfort and quality of life for people with disabilities.

Dianna Mah-Jones Award of Excellence in Person-Centred Care

Residential Care for Me: Megamorphosis - Seniors Care and Palliative Services, Providence

The goal of Residential Care for Me: Megamorphosis is to change the residential care culture from an institutional to a social model of care, and improve quality of life for residents by rapidly testing and implementing changes that focus on emotional connections, allow residents to direct each moment, and create the feeling of home.  Get More Info Full Circle Health Sales Reps

Top Innovation

SNIFF: C. Difficile Canine Scent Detection Program - Vancouver Coastal Health

An innovative and dedicated team of people and a growing roster of pups known as the C. Difficile Scent Detection Program is pioneering a cost-effective method to improve and enhance C. Difficile surveillance and improve infection control and prevention practices.

Workplace Health Innovation

VGH Emergency Department Healthy Workplace Initiative - Vancouver Coastal Health

Vancouver General Hospital's emergency department formed a multi-disciplinary team with the goal of working together to improve workplace health and safety, leading to an improved working climate where staff report feeling engaged and better able to provide the type of quality care that emergency patients deserve.

Collaborative Solutions

Improving Indigenous Cancer Journeys: A Road Map - BC Association of Aboriginal Friendship Centres, BC Cancer (Provincial Health Services Authority), First Nations Health Authority, Métis Nation BC

The Indigenous Cancer Strategy is a collaborative strategy that will improve indigenous cancer outcomes by addressing all steps of the cancer journey, from prevention and treatment, through to survivorship and end-of-life care.

This year's Awards of Merit recipients are:

Dianna Mah-Jones Award of Excellence in Person-Centred Care

• Resources and Needs Review - Nanaimo Regional General Hospital, Island Health

Top Innovation

• Symphony QuickCall - Workforce Management Solutions, Provincial Health Services Authority

• Fall-unteers: A Volunteer-Based Falls Prevention Strategy in Residential Care - Holy Family Hospital Residential Care, Providence

Workplace Health Innovation

• Reducing Workplace Injuries through Leading Practices - Menno Place

Collaborative Solutions

• Regional Strategy for Reducing Ambulance Turnaround Times - BC Emergency Health Services, Provincial Health Services Authority, Fraser Health

• Vancouver Shared Care Team - Doctors of BC, Providence, Vancouver Coastal Health

Since the awards launched in 2007, more than 200 Gold Apples and Awards of Merit have been awarded to health employees who are improving BC's healthcare system and patient care.

The 2018 BCHC Awards are generously supported by Great-West Life, Healthcare Benefit Trust, and Pacific Blue Cross.

Visit BCHealthCareAwards.ca,to learn more about the 2018 awards winners.

The Health Employers Association of British Columbia (HEABC) is the accredited bargaining agent for most publicly funded health employers in the province, representing denominational, proprietary and affiliate health employers, as well as the province's six health authorities. HEABC coordinates the labour relations interests of 250 publicly funded healthcare employers and negotiates five major provincial agreements covering more than 120,000 unionized employees.

[kevsteen]

I don’t even know what to do anymore.

I feel like I owe everyone a million apologies. 

I have two different chronic pain conditions, and chronic fatigue, and I work full time.

I have a cat who thankfully doesn’t seem to have cancer, but she is sick and doesn’t walk properly any more and needs help with cleaning herself and stretching out her back legs and she is on expensive prescription food for her blood condition and needs extra attention.

My spouse lost their job a month ago and we are in the process of suing the former employer, so not only is there no income there, we have to pay a lawyer.

I am the only emotional support for my mother, who lives across the country, as my grandmother (her mother) is literally wasting away in front of her. Grandma, who was more like a second mother to me, has been sick and hospitalized the bulk of the time since the new year. She is down to 108 lbs and looks skeletal, can’t keep food down, has chronic c. difficile, and asked her doctors last week what would happen if she stopped taking the antibiotics that are killing her colon but keeping the infection halfway at bay, and they told her that she would go septic and her organs would shut down. To which her only concern was how painful dying was, and they told her she wasn’t allowed to make that decision but it’s very painful. As a result of the rampant dehydration and starvation and her age, she is more and more confused as the days go on, and she isn’t being allowed palliative care as an option. So not only is she dying, it’s in one of the worst ways possible. She’s arthritic and spends 90% of her day on the toilet so she is in agony. It’s not okay, and I’m not there and there’s nothing I can do about it and it’s killing me.

My workplace is overloading me. Even if all the above wasn’t a concern, I work for two lawyers and both are giving me enough work to keep me busy all day... so every day I end up behind by a full day. It’s stressing me out so bad. It’s making my insomnia worse than usual, plus the pain conditions I have mean sleep isn’t very restful anyway.

On top of all that, I also have very severe endometriosis. Enough that I have full cramping for a week before I even begin my period and all through it. I’m already being treated with a hormonal solution, but it isn’t enough to keep my insides from gluing themselves together so they want me to start on Visanne. That drug is more of the same hormones I already take, and I already have cycle-related suicidal ideations. I think if I take it I will actually end up killing myself. Other side effects include brain fog and loss of short-term memory, and those things will cost me my job. I need my job. Especially as it’s the only income right now, and what I bring home is only half of what we need to keep our house (we are banking on getting a settlement from the lawsuit, but after the mandatory minimum severance runs out in 2 months we might need to sell our home). The average experience on Visanne is feeling like you’re two months pregnant the entire time you’re on it - including awful nausea and sore and swollen breasts. Also acne and excessive sweating with severe B.O. Did I mention this drug isn’t covered by insurance and is $80 out of pocket every month? So my options are all those wonderful side effects or all the extra pain I’ve been dealing with. 

And that’s all on top of the other strains that come with being married, having other family problems, my dad popping up out of nowhere with a phone call that sent me spiraling (I cut him off because he’s a crack addict who tried to get me to pay his lawyer’s fees after he robbed some banks and was caught and then tried to open up a credit card in my name). 

I am just so tired and worn out and I don’t have any resources left. I keep being told I have to be the strong one, but I don’t feel like anyone is there for me. I have friends who have cut me off because it’s too much drama. I feel like I am making everyone mad by not being myself lately. Believe me, I wish things were different, and I can’t blame anyone because I wouldn’t want to deal with me either. I just don’t know what to do anymore. Every day is something I dread because what ELSE could happen? I just don’t see the good in life because there’s no room for anything else. Even wrestling, which has always been my refuge, has been awful lately. 

I just want to go to sleep and not wake up. I’m so very tired.

[npr]

Named from the Greek kloster, for spindle, a class of bacteria known as Clostridia abounds in nature.

Staining deep violet under the microscope, they appear as slender rods with a bulge at one end, like a tadpole or maple seed. They thrive in soil, marine sediments and humans. They live on our skin and in our intestines.

And sometimes, they can kill you.

Most strains are harmless, but tetanus, botulism and gangrene are caused by clostridial species. Vaccination, sanitation and improved medical care have made these infections less common, but one variety has been difficult to contain.

Clostridium difficile, or C. diff, can cause diarrhea and a life-threatening infection of the intestines. The bug was associated with nearly 30,000 deaths in 2011.

First seen as a problem mainly confined to hospitals and nursing homes, research suggests C. diff rates in the community are on the rise, and that traditional risk factors may no longer tell the whole story.

Dangerous Infection Tied To Hospitals Now Becoming Common Outside Them

Image: BSIP/UIG via Getty Images

[teknohocam]

How do We Protect Ourselves From Gastrointestinal Infection?

There are several steps you can take to protect yourself from gastrointestinal infections: - Practice good hygiene: Wash your hands frequently and thoroughly with soap and warm water, especially before eating or preparing food, after using the bathroom, and after being in contact with someone who is sick. - Cook food properly: Make sure that meat, poultry, fish, and eggs are cooked thoroughly before eating them. Use a meat thermometer to ensure that the internal temperature of the food reaches a safe level. - Store food properly: Keep food at safe temperatures, either refrigerated or frozen, and make sure that raw meats are stored separately from other foods to avoid cross-contamination. - Avoid raw or undercooked foods: Raw or undercooked meats, seafood, and eggs can contain harmful bacteria and viruses that can cause gastrointestinal infections. - Drink clean water: Drink water from a clean and reliable source. If you are unsure about the safety of the water, boil it or use a water filter. - Be careful when traveling: If you are traveling to a developing country, be careful about what you eat and drink. Avoid street food and only drink bottled water or water that has been boiled or treated with purification tablets. - Practice safe sex: Some gastrointestinal infections, such as hepatitis A, can be transmitted sexually. Use condoms to reduce the risk of infection. By following these steps, you can reduce your risk of gastrointestinal infections and stay healthy. Gastrointestinal infections are caused by various pathogens such as viruses, bacteria, and parasites. These pathogens can enter the body through contaminated food, water, or contact with infected individuals.

What causes gastrointestinal infection?

Some common causes of gastrointestinal infections include: - Viruses: Norovirus, rotavirus, and adenovirus are examples of viruses that can cause gastrointestinal infections. These viruses are highly contagious and can be easily spread from person to person, especially in places where people are in close contact with each other, such as schools, hospitals, and cruise ships. - Bacteria: Escherichia coli (E. coli), Salmonella, Campylobacter, and Shigella are examples of bacteria that can cause gastrointestinal infections. These bacteria are usually found in contaminated food or water, and they can cause severe symptoms, such as diarrhea, vomiting, and abdominal pain. - Parasites: Parasites such as Giardia and Cryptosporidium can cause gastrointestinal infections when they are ingested through contaminated water or food. These parasites can survive for long periods in the environment and can be difficult to eliminate. - Toxins: Some types of bacteria produce toxins that can cause gastrointestinal infections. For example, Clostridium difficile (C. difficile) can cause severe diarrhea and inflammation of the colon. In general, good hygiene practices such as washing hands frequently and properly cooking food can help reduce the risk of gastrointestinal infections.

Do these against gastrointestinal infection

Here are some general actions that can help prevent gastrointestinal infections: - Wash your hands: Washing your hands frequently with soap and water, especially after using the bathroom and before handling food, can help prevent the spread of bacteria and viruses. - Cook food properly: Cook food, especially meat, poultry, and fish, thoroughly to kill any bacteria or parasites that may be present. - Store food safely: Store food properly in the refrigerator or freezer to prevent the growth of harmful bacteria. - Drink clean water: Drink water from a safe and reliable source. If you are traveling to an area where the water may not be safe, use bottled water or water that has been properly treated. - Practice good personal hygiene: Avoid sharing personal items such as towels, toothbrushes, and utensils. If you are sick, stay home to avoid spreading the infection to others. - Avoid close contact with sick people: Gastrointestinal infections can be highly contagious, so it's important to avoid close contact with people who are sick. By taking these steps, you can help prevent gastrointestinal infections and stay healthy. Read the full article