Kaitlynn Ely

Schnuck Markets Inc., a Midwestern grocery chain, has teamed up with Centene Corp. and Betty Jean Kerr People’s Health Centers to create a full-service clinic inside a Schunck supermarket in Ferguson, MO.

The supermarket chain has donated space in its Ferguson store for family care clinicians from People’s Health. Centene has agreed to support the health center’s operations, as an estimated 8,000 patients are expected to visit the clinic annually.

Services offered to patients include low-acuity primary care, vaccinations, lab work, dental services, x-ray and mammography screening, gynecological services, and social services.

The health clinic is scheduled to open this November with the Centene’s investment of more than $1.3 million.  This investment is sponsored by the People’s Healthcare Services Clinic by Home State Health.

Centene has been active in the Ferguson community over the past few years by opening a 45,000 square-foot service center, which created 250 jobs.  The center includes a fitness center, child development center, and a community room for clubs and job-training seminars.

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Schnuck Markets Inc., a Midwestern grocery chain, has teamed up with Centene Corp. and Betty Jean Kerr Peopleâ€™s Health Centers to create a full-service clinic inside a Schunck supermarket in Ferguson, MO.

Grocery Store Chain Teams up to Create Full-Service Clinic

MinuteClinic, the retail medical clinic arm of CVS Health, has announced that it is now a part of the Alere eScreen Occupational Health Network (EOHN), a comprehensive alliance of clinics.

The retail medical clinic arm can now benefit from the thousands of business employees using Alere eScreen’s services when searching for mandatory occupational health screenings. These employees can receive health services like biometric screenings, vaccinations, and drug testing at any of the 1,100 MinuteClinic locations nationwide.

Employees need only to visit the Alere eScreen website to choose their MinuteClinic location for testing and enter personal demographic data. After, the patient will print out an “e-passport” which they will show their health professional to confirm what tests and vaccinations are requested by the employer.

Open 7 days a week, MinuteClinics are staffed with nurse practitioners and physician assistants.

Sanjay Malkani, Global President of Toxicology at Alere, said in a prepared statement, “Alere is excited to be an enabling partner for MinuteClinic in their desire to dramatically improve the accessibility of workplace testing services. With the Alere eScreen system already in place, and access to a broad services menu including biometric screening, DOT physicals, vaccinations, and drug testing, MinuteClinic is poised to become a valuable workplace health destination for employers nationwide.”

MinuteClinic Partners with Alere eScreen to Expand Workplace Health Service Access

Scientists have developed an efficient way of distinguishing between acute rhinosinusitis and acute bacterial rhinosinusitis to reduce the inappropriate prescribing of antibiotics.

For the study, investigators used a multivariate analysis and a classification and regression tree (CART) analysis to develop proposed clinical decision rules for the diagnosis of acute rhinosinusitis. Included in the study were 175 Danish adults aged 18 to 65 years who were seeking treatment for suspected cases of acute rhinosinusitis. The investigators prospectively recorded signs, symptoms, C-reactive protein (CRP), and reference standard tests.

Point scores based on logistic regression models, and algorithms based on classification and CART were used to develop the clinical decision rules, which were used for each of the 3 reference standards used to diagnose patients: an abnormal finding on a CT scan; purulent or mucopurulent fluid detected by an antral puncture of the maxillary sinus; and a positive bacterial culture from the antral puncture fluid. Using these diagnostic rules, patients were placed in either low, moderate, or high-risk groups for acute rhinosinusitis or acute bacterial rhinosinusitis.

According to the study, point scores based on logistic regression was the most common approach to developing clinical decision rules. Patients who received more points were more likely to have a correct diagnosis. Furthermore, the ease of this approach makes it more appealing to physicians.

The CART algorithm uses the predictor variable to distinguish symptoms between patients, creating a tree. Each terminus, or leaf, of the tree shows the probability of the outcome of interest. Three CART models were developed for each of the 3 reference standards. The accuracy of each model correctly categorizes patients in the low, moderate, or high-risk classifications based on the probability of acute rhinosinusitis and acute bacterial rhinosinusitis in each group.

diagnosis is defined by the presence of purulent or mucopurulent antral puncture fluid. Signs and symptoms include preceding upper respiratory tract infection, previous diagnosis of sinusitis, toothache, purulent nasal discharge, and any unilateral tenderness of the maxillary sinus.

The results of the study, published in the Annals of Family Medicine, showed that the CRP and ESR tests were the strongest predictors of acute rhinosinusitis and bacterial rhinosinusitis. However, researchers believe that the best reference standard is the positive bacterial culture of antral puncture fluid, with the point score system classifying patients into the 3 categories. Patients with a positive bacterial culture as the reference standard for low, moderate, and high had a 16%, 49%, and 73% likelihood of acute bacterial rhinosinusitis. The authors noted that CT scans are not recommended for clinical use because they place a minimal number of people in the low-risk group.

Overall, about 70% of patients are prescribed antibiotics when only 30% are suffering from acute bacterial rhinosinusitis. The sinus scores placed almost half of the participants in the low-risk group for acute bacterial rhinosinusitis, indicating that antibiotics should not be prescribed to these individuals.

Patients categorized as high-risk should be offered antibiotics, while moderate-risk patients should seek further testing.

“We have developed a point score and a CART-derived algorithm for diagnosing acute bacterial rhinosinusitis,” the authors wrote. “Use of such a score can help patients and physicians more confidently avoid antibiotics if patients are at low risk for a bacterial infection, reducing overuse of antibiotics.”

Proposed rules increase accuracy of acute rhinosinusitis and acute bacterial rhinosinusitis diagnoses. 

Acute Rhinosinusitis Clinical Decision Rules Seek to Reduce Overuse of Antibiotics

Home-based medication errors are becoming more common, according to a report from The Center for Injury Research and Policy and the Central Ohio Poison Center at Nationwide Children’s Hospital and published a study in Clinical Toxicology.

Researchers noted that the rate of medication errors, which occurred outside of health facilities and occurred mainly in homes, was 1.09 for every 100,000 Americans in 2000, and rose to 2.28 in 2012. All age groups, except children under 6 years of age, experienced an increase in medication error frequency and rates. In children 6 years or younger, medication error rates decreased after 2005. The researchers noted that this was likely attributable to decreased the use of cough and cold medicines in this age group.

According to the study, the most common errors were associated with cardiovascular drugs (21%), analgesics (12%), and hormones/hormone antagonists (11%). Cardiovascular and analgesic drugs were the cause of most fatalities due to drug errors.

Reasons for medication errors varied from being prescribed the wrong medication to having the incorrect dosage measurement. Consuming someone else’s medication by accident was the most common error among children. About 30% of these medication errors caused patients to receive hospital treatment.

Nationwide Children’s Hospital suggested writing down medication information for other caregivers to avoid dosage error and emphasized the importance of the pharmacists’ role in teaching parents, patients, and caregivers how to take or give medications. Using child-proof containers and pill planners is also recommended, as well as keeping pills in cabinets that children cannot reach.

“Drug manufacturers and pharmacists have a role to play when it comes to reducing medication errors,” Henry Spiller, MD, D.ABAT, and director of the Central Ohio Poison Center said in a press release.

“There is room for improvement in product packaging and labeling. Dosing instructions could be made clearer, especially for patients and caregivers with limited literacy or numeracy.”

1. Hodges NL, Spiller HA, Casavant MJ, et al. Non-health care facility medication errors resulting in serious medical outcomes. Clinical Toxicology. July 10, 2017. http://dx.doi.org/10.1080/15563650.2017.1337908

2. Study finds rate of medication errors resulting in serious medical outcomes rising [news release]. Columbus, OH. Nationwide Children’s Hospital’s website. July 10, 2017. http://www.nationwidechildrens.org/news-room-articles/study-finds-rate-of-medication-errors-resulting-in-serious-medical-outcomes-rising?contentid=164068. Accessed July 11, 2017.

Home-based medication errors are becoming more common, according to a report from The Center for Injury Research and Policy and the Central Ohio Poison Center at Nationwide Childrenâ€™s Hospital and  published a study in Clinical Toxicology.

Home-based Medication Errors Rose Between 2000 and 2012

The CDC has released trends on influenza activity in the United States during the 2016-2017 flu season. This data is updated yearly to consider new strains of the virus circulating in society and the overall length of the season.

The season lasted from October 2, 2016, to May 20, 2017, with activity that remained low through November and increased in December. The number of patients infected with the virus peaked in February. The data were obtained from public health and clinical laboratories located in all 50 states, Puerto Rico, and the District of Columbia.

Approximately 70% of patients tested positive for influenza A viruses and 30% tested positive for influenza B viruses.

Influenza A was the predominant virus among all age groups; however, influenza B cases were highest among individuals aged 5 to 24 years and accounted for 28% of reported viruses for that age group, according to the report. Three novel influenza A viruses were reported to the CDC, however, none of these patients were hospitalized and all recovered.

Several medical conditions can increase an individuals risk for contracting influenza. These include cardiovascular disease, metabolic disorders, obesity, asthma, neurologic disorders, and chronic lung disease. Many children hospitalized had at least 1 of these underlying medical conditions.

A total of 98 laboratory-confirmed influenza-influenced deaths occurred among children, 46 of which were associated with influenza A, 34 with influenza B, 3 with influenza A(H1N1)pdm09 virus, and 14 with influenza A for which no subtyping was done. Death among adults also peaked twice this year during the weeks ending January 21, 2017, and February 25, 2017.

The US Influenza Vaccine Effectiveness network collected data that showed a 42% decrease in risk for contracting the virus.

https://www.cdc.gov/mmwr/volumes/66/wr/mm6625a3.htm?s_cid=mm6625a3_w

Overall, influenza activity in the United States was moderate.

CDC Releases Update on Influenza Activity During 2016-2017 Season

After receiving complaints, Novo Nordisk has voluntarily recalled insulin cartridge holders due to cracks or breaks in the NovoPen Echo when exposed to some chemicals, including cleaning agents.

The device is used by patients with diabetes for insulin treatment. According to a press release, only a small number of NovoPen Echo batches were affected by this recall.

The company thinks that using cracked devices increases the risk of an inaccurate dosing of insulin delivered to patients, which can lead to high blood sugar. The affected pens were produced between August 1, 2016, and June 22, 2017, and were distributed to health care providers, pharmacies, and patients in the United States.

Faulty batch numbers for the NovoPen Echo include: EVG1221, EVG1226, FVG7149, FVG7458, FVG8134, and FVG8135. All devices produced after June 22, 2017, are deemed safe, according to the release.

According to the FDA, a person who is experiencing high blood sugar, or hyperglycemia, usually appears to have flushed skin, feels tired, has dry mouth and is thirsty, and/or feels nauseous. Patients with diabetes should contact their physician or a health care provider if hyperglycemia is suspected.

Any individuals using a recalled pen should check their blood sugar levels consistently to confirm they are not experiencing hyperglycemia or going into diabetic shock, and should also call Novo Nordisk at 1-855-419-8827 to receive a replacement insulin cartridge holder.

Using a broken or cracked cartridge holder may result in an inaccurate dosage of insulin.