The new guidelines recommend starting HAART therapy on asymptomatic HIV patients at any CD4 count!! This is a level BIII recommendation (meaning moderate recommendation based on expert opinion). This reflects the increasing evidence that HIV viremia leads to inflammation and non-AIDS related morbidity as well as decreasing transmission.
Panel’s Recommendations
1) Antiretroviral therapy (ART) is recommended for all HIV-infected individuals. The strength of this recommendation varies on the basis of pretreatment CD4 cell count:
CD4 count <350 cells/mm3 (AI)
CD4 count 350 to 500 cells/mm3 (AII)
CD4 count >500 cells/mm3 (BIII)
2) Regardless of CD4 count, initiation of ART is strongly recommended for individuals with the following conditions:
Pregnancy (AI) (see perinatal guidelines for more detailed discussion)
History of an AIDS-defining illness (AI)
HIV-associated nephropathy (HIVAN) (AII)
HIV/hepatitis B virus (HBV) coinfection (AII)
3) Effective ART also has been shown to prevent transmission of HIV from an infected individual to a sexual partner; therefore, ART should be offered to patients who are at risk of transmitting HIV to sexual partners (AI [heterosexuals] or AIII [other transmission risk groups]).
4) Patients starting ART should be willing and able to commit to treatment and should understand the benefits and risks of therapy and the importance of adherence (AIII). Patients may choose to postpone therapy, and providers, on a case-by-case basis, may elect to defer therapy on the basis of clinical and/or psychosocial factors.
Rating of Recommendations: A = Strong; B = Moderate; C = Optional
Rating of Evidence: I = data from randomized controlled trials; II = data from well-designed nonrandomized trials or observational cohort studies with long-term clinical outcomes; III = expert opinion
For more information, click on the link below:
DHHS HIV Guidelines
Friday, July 6, 2012
Thursday, June 28, 2012
Clinical Question of the Week
We're starting a Clinical Question of the Week, AKA COW. It will be posted early in the week with answers posted Friday afternoon. Please scroll to the bottom of the mobile homepage to see the question. Stacy Weinstein says "learning is the new pashmina!"
Wednesday, November 16, 2011
Housestaff Awards - Congrats!
Shipra Hingorany was awarded 2nd place in the DOM Research Day Poster Competition in the Clinical/Health Services Research, Trainee category - Management of Diabetes with Metformin in Patients with Chronic Heart Failure - $2000 honorarium!
Rena Shah won 3rd place in the poster competition at the ACP Regional Conference!
UCLA Jeopardy Team (Danny Kahn, Holly Thomas, Alex Viehman) won first place in the IM program regional competition and will compete in the National competition in New Orleans (paid trip by ACP)!!!!
Rena Shah won 3rd place in the poster competition at the ACP Regional Conference!
UCLA Jeopardy Team (Danny Kahn, Holly Thomas, Alex Viehman) won first place in the IM program regional competition and will compete in the National competition in New Orleans (paid trip by ACP)!!!!
Tuesday, September 6, 2011
Wanted: Defenders of the Evidence
We are looking for some motivated residents (PGY1-4) to become Defenders of the Evidence. We would like you to become the journal analysis experts in your respective classes. Over the coming months, we will occasionally be asking for people to submit articles for RAPID Journal Club. We would like for you to play an integral role in submitting and vetting the articles to decide what is important for your colleagues to know.
All you have to meet is the following criteria:
1. Be motivated.
2. Be willing to defend the evidence, no matter where it takes you.
If you would like to become a Defender of the Evidence, sign up on the main page of the mobile app.
All you have to meet is the following criteria:
1. Be motivated.
2. Be willing to defend the evidence, no matter where it takes you.
If you would like to become a Defender of the Evidence, sign up on the main page of the mobile app.
Thursday, September 1, 2011
New Discharge Button: What you Need to Know
As some of you may have noticed, we have a new discharge button on the medres homepage. The new discharge system has been thoroughly beta-tested in the past few weeks. Effective immediately, we ask you to please use the new button and to ignore the old WW and SMH Discharge Buttons. Why, you may ask?
Well, first of all, the old buttons will disappear in the next 1-2 weeks. The new discharge system fixes a number of problems (some of which are highlighted below). And lastly, there are some new features built into the discharge system.
What's fixed?
- WW and SMH d/c summaries don't require separate buttons
- Typing in the MRN and clicking the Find Patient button actually works at RR now. It used to only work at SMH.
- The "patient was not previously on warfarin" box actually saves when you click "Save Form"
- The time-out period until it logs you out has been extended to 30 minutes (tell us if this isn't the case -- it was implemented earlier today)
- The Save Form feature works -- if you save a form, anyone else who is logged in will be able to see it. There is no reason now to finalize discharge summaries until the patient is actually discharged!
- When you click "Create cView Note," the resulting note actually looks readable and nicely formatted. No more ********s. Literally. The QI measures still appear at the bottom and need to be included in the d/c summary to help the hospital track quality outcomes. Because of this, if you choose to verbally dictate the discharge summary, you still need to added your dictation with the QI measures from this section.
- The delete icon under your "Saved Notes" will no longer automatically delete the note -- it will ask you to confirm before proceeding with deleting.
What's new?
- Medications can be printed right from within a discharge form without even saving it. There's a new button that says "Print Medications" at the very bottom of the page. It does require some basic info to be plugged in (patient's MRN, name, allergies) but it should help with those times when you need to quickly print the meds without dealing with the rest of the discharge.
- If you are changing the dose of someone's medication and need to write them a script for it, you do not need to enter the medication twice under Old and New Meds (as you did with the old system). All you need to do is write the medication with how much you want to dispense (i.e. Lisinopril 10mg 1 tab po daily DISP#30, no refills) under the "Old Medications with New Instructions" box. ANY MEDICATION WITH THE WORD "DISP" AFTER IT WILL AUTOMATICALLY BE ADDED TO THE LIST OF PRESCRIPTION MEDS.
- The discharge paperwork that goes to the patient has been dramatically shortened, down to 2 pages. It contains only what the patient needs to know, with a reason for hospitalization in lay terms. It is formatted as a PDF
- There's a new "Upload Discharge PDF to cView" button -- this will actually send the patient's discharge paperwork directly into cView. Note that the discharge instructions do not contain a physical exam. Therefore, please include the physical exam in the discharge summary. If you upload the PDF and make a dramatic change afterwards to the discharge plan or meds, please re-upload the PDF. It's okay for more than one set of discharge instructions to be in the chart. The important thing is for the instructions in cView to be accurate.
- You MUST list a PMD. If it's a PMD at UCLA, simply start typing in their name and the new auto-suggest feature should find their name for you. Let us know if a name is missing. If it's an outside physician, there is an "NPI Search" link to figure out the physician's address. If you select no PMD -- guess what. There will be ASSIGNED a PMD. If are a PMD and you have availability (and the insurance is right), that PMD may be you. Otherwise they will be assigned someone else at UCLA. What if they can't remember their PMD's name? This probably means that the need a new PMD!
Why doesn't __________ work?
- The discharge button is still new. If you find a bug, let us know. We'll try our best to fix it. However, in 2 weeks, the old discharge buttons will disappear so please tell us before then if you can.
Well, first of all, the old buttons will disappear in the next 1-2 weeks. The new discharge system fixes a number of problems (some of which are highlighted below). And lastly, there are some new features built into the discharge system.
What's fixed?
- WW and SMH d/c summaries don't require separate buttons
- Typing in the MRN and clicking the Find Patient button actually works at RR now. It used to only work at SMH.
- The "patient was not previously on warfarin" box actually saves when you click "Save Form"
- The time-out period until it logs you out has been extended to 30 minutes (tell us if this isn't the case -- it was implemented earlier today)
- The Save Form feature works -- if you save a form, anyone else who is logged in will be able to see it. There is no reason now to finalize discharge summaries until the patient is actually discharged!
- When you click "Create cView Note," the resulting note actually looks readable and nicely formatted. No more ********s. Literally. The QI measures still appear at the bottom and need to be included in the d/c summary to help the hospital track quality outcomes. Because of this, if you choose to verbally dictate the discharge summary, you still need to added your dictation with the QI measures from this section.
- The delete icon under your "Saved Notes" will no longer automatically delete the note -- it will ask you to confirm before proceeding with deleting.
What's new?
- Medications can be printed right from within a discharge form without even saving it. There's a new button that says "Print Medications" at the very bottom of the page. It does require some basic info to be plugged in (patient's MRN, name, allergies) but it should help with those times when you need to quickly print the meds without dealing with the rest of the discharge.
- If you are changing the dose of someone's medication and need to write them a script for it, you do not need to enter the medication twice under Old and New Meds (as you did with the old system). All you need to do is write the medication with how much you want to dispense (i.e. Lisinopril 10mg 1 tab po daily DISP#30, no refills) under the "Old Medications with New Instructions" box. ANY MEDICATION WITH THE WORD "DISP" AFTER IT WILL AUTOMATICALLY BE ADDED TO THE LIST OF PRESCRIPTION MEDS.
- The discharge paperwork that goes to the patient has been dramatically shortened, down to 2 pages. It contains only what the patient needs to know, with a reason for hospitalization in lay terms. It is formatted as a PDF
- There's a new "Upload Discharge PDF to cView" button -- this will actually send the patient's discharge paperwork directly into cView. Note that the discharge instructions do not contain a physical exam. Therefore, please include the physical exam in the discharge summary. If you upload the PDF and make a dramatic change afterwards to the discharge plan or meds, please re-upload the PDF. It's okay for more than one set of discharge instructions to be in the chart. The important thing is for the instructions in cView to be accurate.
- You MUST list a PMD. If it's a PMD at UCLA, simply start typing in their name and the new auto-suggest feature should find their name for you. Let us know if a name is missing. If it's an outside physician, there is an "NPI Search" link to figure out the physician's address. If you select no PMD -- guess what. There will be ASSIGNED a PMD. If are a PMD and you have availability (and the insurance is right), that PMD may be you. Otherwise they will be assigned someone else at UCLA. What if they can't remember their PMD's name? This probably means that the need a new PMD!
Why doesn't __________ work?
- The discharge button is still new. If you find a bug, let us know. We'll try our best to fix it. However, in 2 weeks, the old discharge buttons will disappear so please tell us before then if you can.
Thursday, August 11, 2011
New Antibiotic Dosing Guide!
Hello all,
Hot off the presses from the pharmacy, the new antibiotic dosing guide has been posted to the Notes section of the mobile app. Enjoy!
The dosing guide is an embedded pdf file. It loads appropriately on iPhone but let us know if it doesn't work correctly on your mobile device.
~ Chiefs
Hot off the presses from the pharmacy, the new antibiotic dosing guide has been posted to the Notes section of the mobile app. Enjoy!
The dosing guide is an embedded pdf file. It loads appropriately on iPhone but let us know if it doesn't work correctly on your mobile device.
~ Chiefs
Thursday, August 4, 2011
Podcasts are Up and Running
Check out Dr. Lazarus' talk on an evidence-based approach to the pre-operative evaluation.
1. Go to the Calendar
2. Click on the date at the very top. Change it to August 3rd.
3. Click on Didactics.
4. Click on Podcast.
OR, since it's the first one: you can click HERE to load the podcast.
Tell us if it doesn't work on your device!
~ Chiefs
1. Go to the Calendar
2. Click on the date at the very top. Change it to August 3rd.
3. Click on Didactics.
4. Click on Podcast.
OR, since it's the first one: you can click HERE to load the podcast.
Tell us if it doesn't work on your device!
~ Chiefs
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