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Last Build Date: Sat, 20 Jan 2018 10:40:34 GMT

 



Seasonal influenza

Fri, 19 Jan 2018 08:37:57 GMT

more detail

← Older revision Revision as of 08:37, 19 January 2018
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Seasonal [[influenza]] tends to be about 75% [[influenza A]] and 25% [[influenza B]] with usually one or two strains causing most morbidity. As shown on the time graph seasonal influenza is winter associated in most of the world. [[Pandemic influenza]] is driven by a single strain.
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Seasonal [[influenza]] tends to be about 75% [[influenza A]] and 25% [[influenza B]] with usually one or two strains causing most morbidity. It can be regarded to be consequential of population density and globalisation but probably these same two factors now ensure fair herd immunity to the virus. [[Influenza vaccination]] also helps considerably at a population level. As shown on the time graph seasonal influenza is winter associated in most of the world. [[Pandemic influenza]] is driven by a single strain. The severity varies from year to year. Since air travel became widely available there is often a correlation between Northern and Southern hemisphere winter outbreaks, so a bad seasonal influenza year in one hemisphere tends to be predictive of a bad year in the other hemisphere. Thus the 2017 Australasian season which was about half as bad as the [[2009]] seasonal pandemic was remarkably predictive of the strain in health services felt as far apart as California and UK. Further the 2009 Australasian severity was predicted from the 2008/9 season and it took another year in the Northern hemisphere for immunity to catch up.
[[Image:FluLikeIllnessEnglandandWales.png|Incidence during year of influenza like illness in England and Wales 1967-2016]]
[[Image:FluLikeIllnessEnglandandWales.png|Incidence during year of influenza like illness in England and Wales 1967-2016]]
[[Category:Influenza]]
[[Category:Influenza]]
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Influenza

Fri, 19 Jan 2018 08:23:14 GMT

links to surveillance reports ← Older revision Revision as of 08:23, 19 January 2018 Line 87: Line 87: An indirect but suggestive measure of significant influenza is weekly death rate data. In the case of [http://www.euromomo.eu/ European weekly mortality] initial data from a few countries can be suggestive of the seasonal outbreak that follows. Such data also suggests the variation, due to vaccination rates and other factors in herd immunity. Seasonal influenza epidemiology in the Southern Hemisphere can be relevant to the epidemiology 6 months later in the Northern Hemisphere. International comparisons can also be very suggestive as to the most effective public health strategies for vaccination and where the design of the social/health care system might be impairing effective vaccine delivery.   An indirect but suggestive measure of significant influenza is weekly death rate data. In the case of [http://www.euromomo.eu/ European weekly mortality] initial data from a few countries can be suggestive of the seasonal outbreak that follows. Such data also suggests the variation, due to vaccination rates and other factors in herd immunity. Seasonal influenza epidemiology in the Southern Hemisphere can be relevant to the epidemiology 6 months later in the Northern Hemisphere. International comparisons can also be very suggestive as to the most effective public health strategies for vaccination and where the design of the social/health care system might be impairing effective vaccine delivery.    +====Links to surveillance reports====  +*[http://www.who.int/influenza/surveillance_monitoring/updates/en/ WHO influenza reports]  +*[https://ecdc.europa.eu/en/seasonal-influenza EU weekly influenza reports]  +*[https://www.gov.uk/government/statistics/weekly-national-flu-reports UK weekly influenza reports]  +*[https://www.cdc.gov/flu/weekly/index.htm USA weekly influenza reports]  +*[https://www.canada.ca/en/public-health/services/diseases/flu-influenza/influenza-surveillance/weekly-influenza-reports.html Canada weekly influenza reports]  +*[http://www.chp.gov.hk/en/resources/29/304.html Hong Kong weekly influenza reports]  +*[https://www.moh.gov.sg/content/moh_web/home/statistics/infectiousDiseasesStatistics/weekly_infectiousdiseasesbulletin.html Singapore weekly infectious disease reports]  +*[http://www.health.gov.au/flureport Australia weekly influenza reports]  +*[https://surv.esr.cri.nz/virology/influenza_weekly_update.php New Zealand weekly influenza reports]  + === Mutation of the influenza [[Virus|virus]] === === Mutation of the influenza [[Virus|virus]] === [...]



Influenza/prevention

Fri, 19 Jan 2018 08:09:06 GMT

update

← Older revision Revision as of 08:09, 19 January 2018
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==Effectiveness==
==Effectiveness==
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Vaccination is only about 60% effective. Efficacy varies from year to year as a result of prior immunity (from natural exposure and to vaccines), and the quality of the "match" between the vaccine strain and circulating strains of influenza.
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[[image:FluLikeIllnessEnglandandWales.png|thumb|Reduction in seasonal influenza like illness in England and Wales. This is likely to be due to herd immunity from repeated vaccination of those most at risk]]
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Vaccination is only about 60% effective. Efficacy varies from year to year as a result of prior immunity (from natural exposure and to vaccines), and the quality of the "match" between the vaccine strain and circulating strains of influenza. At a population level however repeated influenza vaccination is very effective. This is illustrated by the sustained reduction in the severity of [[seasonal influenza]] outbreaks.  
This means that standard treatment must be offered in high risk groups such as pregnant women on first clinical suspicion, whatever their immunisation status[http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=25295498  Rasmussen SA, Jamieson DJ. 2009 H1N1 Influenza and Pregnancy - 5 Years Later. The New England journal of medicine. 2014 Oct 9; 371(15):1373-1375.]([http://dx.doi.org/10.1056/NEJMp1403496 Link to article] – subscription may be required.).
This means that standard treatment must be offered in high risk groups such as pregnant women on first clinical suspicion, whatever their immunisation status[http://www.ncbi.nlm.nih.gov/sites/entrez?itool=abstractplus&db=pubmed&cmd=Retrieve&dopt=abstractplus&list_uids=25295498  Rasmussen SA, Jamieson DJ. 2009 H1N1 Influenza and Pregnancy - 5 Years Later. The New England journal of medicine. 2014 Oct 9; 371(15):1373-1375.]([http://dx.doi.org/10.1056/NEJMp1403496 Link to article] – subscription may be required.).



Influenza/prevention

Tue, 16 Jan 2018 16:47:26 GMT

Vaccination against influenza: ← Older revision Revision as of 16:47, 16 January 2018 (One intermediate revision not shown)Line 24: Line 24: "It is recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/Phuket/3073/2013-like virus." "It is recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/Phuket/3073/2013-like virus."  +  +Note that live attenuated influenza vaccine (LAIV) routinely offered to children is a quadrivalent vaccine.  +  +During the 2017-18 there were a higher than usual number of flu B cases; and a high proportion of these were B(Yamagata) lineage strains. There is some cross-protection against these strains from the trivalent vaccines used this year; but the quadrivalent vaccine provides much better protection - suggesting that the burden of influenza related disease this season may have been lower if a higher proportion of patients had received the (slightly more expensive, but still cost-effective) quadrivalent vaccine. =====Types of influenza vaccine===== =====Types of influenza vaccine===== Line 35: Line 39: If a vaccine is to be effective, it needs to generate immunity to antigens present on flu in a way which prevents illness (and, ideally, infection and infectiousness). Immunity to these antigens can be generated by presenting the antibodies to the immune system with more or less other parts of the virus, or in other ways.   If a vaccine is to be effective, it needs to generate immunity to antigens present on flu in a way which prevents illness (and, ideally, infection and infectiousness). Immunity to these antigens can be generated by presenting the antibodies to the immune system with more or less other parts of the virus, or in other ways.    +  +The vaccines are broadly categorised as comprising:  +  +*Live attenuated influenza vaccine (LAIV) - offered to children, and administered as a nasal spray. From 2017 onwards (perhaps earlier) LAIV vaccines used in the UK are quadrivalent vaccines.  +*Trivalent [[#Inactivated influenza vaccines|inactivated influenza vaccine]] (TIV) (not adjuvanted).  +*Quadrivalent [[#Inactivated influenza vaccines|inactivated influenza vaccine]] (QIV) (not adjuvanted).  +*Adjuvanted trivalent [[#Inactivated influenza vaccines|inactivated influenza vaccine]] (aTIV). The first such vaccine to be available in the UK was licensed in August [[2017]].http://www.seqirus.com/newsroom/New-influenza-vaccine-offers-improved-protection-for-older-adults Seqirus. New influenza vaccine offers improved protection for older adults. Maidenhead, UK: Seqirus, 2017(22 August); 1-3.]  +*Adjuvanted quadrivalent inactivated influenza vaccine (aTIV) - mentioned for hypothetical completeness, although in practice no such vaccine has been licensed in the UK. ======Inactivated influenza vaccines====== ======Inactivated influenza vaccines====== Line 41: Line 53: In the UK at present we use a range of inactivated vaccines.   In the UK at present we use a range of inactivated vaccines.   -In August [[2017]] an [[Adjuvant|adjuvanted]] inactivated influenza vaccine was licensed in the UK and Europe. The manufacturers claim that this vaccine is more effective in older people (who are at increased risk of complications associated with influenza, and in whom influenza vaccines are generally less effective).[http://www.seqirus.com/newsroom/New-influenza-vaccine-offers-improved-protection-for-older-adults New influenza vaccine offers improved protection for older adults. Maidenhead, UK: Seqirus, 2017 (22 August); 1-3.] This vaccine will be available for the 2018-9 Northern hemisphere influenza season (and presumably for the 2018 Southern hemisphere season).+In August [[2017]] an [[Adjuvant|adjuv[...]



Hypnosis

Tue, 16 Jan 2018 14:25:46 GMT

Created page with "{{stub}} Until ganfyd has content this topic, please see the Wikipedia pages on hypnosis and hypnotherapy"

New page

{{stub}}
Until ganfyd has content this topic, please see the Wikipedia pages on [[Wikipedia:hypnosis|hypnosis]] and [[Wikipedia:hypnotherapy|hypnotherapy]]



Hypnotherapy

Tue, 16 Jan 2018 14:25:23 GMT

Redirected page to Hypnosis

New page

#REDIRECT [[Hypnosis]]



Sedation

Tue, 16 Jan 2018 14:20:56 GMT

Applications: ← Older revision Revision as of 14:20, 16 January 2018 (2 intermediate revisions not shown)Line 3: Line 3: ==Sedation for Procedures== ==Sedation for Procedures== -Shorting acting agents used. Mainly given intravenously for rapid action, but other routes available. Examples: [[midazolam]], [[propofol]], [[ketamine]].+Ideally, before considering sedative drugs - with all the risks associated with them - non-pharmaceutical methods such as [[meditation]], [[mindfulness]], and [[hypnotherapy]] should be considered.  +   +Where medication is provided, short acting agents such as [[midazolam]], [[propofol]], and [[ketamine]] are generally used. Alcohol They are mainly given intravenously for rapid action, but other routes are available.    +   +The use of [[alcohol]] (prescribed, advised, or as self-medication) is deprecated because of its side-effects. ===Principles=== ===Principles=== Line 21: Line 25: *Orthopaedic reductions, e.g. fractures or dislocations *Orthopaedic reductions, e.g. fractures or dislocations *Adjunct to local anaesthetic procedures, e.g. anxious patients undergoing local anaesthetic hernia repair *Adjunct to local anaesthetic procedures, e.g. anxious patients undergoing local anaesthetic hernia repair  +*Dental procedures (NB - when it is clinically appropriate to provide sedation for dental procedures, dentists can and should prescribe - diazepam is on the [https://bnf.nice.org.uk/dental-practitioners-formulary/ Dental Practitioners’ Formulary] for this purpose).  +  +==Other external links==  +In addition to those mentioned above, the following may be of interest:  +*[https://www.rcoa.ac.uk/system/files/PUB-SafeSedPrac2013.pdf Safe Sedation Practice for Healthcare Procedures (2013)] from the [[Academy of Medical Royal Colleges]][https://www.rcoa.ac.uk/system/files/PUB-SafeSedPrac2013.pdf Academy of Medical Royal Colleges. ''Safe Sedation Practice for Healthcare Procedures''. London: Academy of Medical Royal Colleges, 2013(October); 1-37.] {{refsec}} {{refsec}} [...]