Immunizations

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Immunizations

• Monica Scheibmeir, PhD, ARNP
• Assistant Professor
• University of Kansas
• School of Nursing

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Topics to be Covered

• Immunizations
• Screening guidelines for children and adults
• Ways to implement health promotion in a clinical
  setting

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Immunizations

• Pediatrics
• Starts early!!!
• Always changing!!! (e.g New Prenvar aka
  pneumococcal vaccine)
• Full of Funny Acronyms (e.g. PRP-OMP

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Immunizations

• Adults
• Annually (e.g. influenza vaccine)
• Periodically (tetanus, diptheria
  booster)
• Once only (e.g. pneumococcal vaccine)

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Immunizations

• Types of Immunizations
• Live virus (e.g. MMR)
• Killed or attenuated virus (e.g. IPV)
• genetically altered virus/bacteria (e.g.
  acellular pertussis)

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Immunizations

• Advisory Committee on Immunization Practices
  (ACIP)
• American Academy of Pediatrics
• American Academy of Family Physicians
• American College of Physicians
• American College of Obstetricians and Gynecologist

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Immunizations

• How/Where to Find the Latest Recommendations
• American Academy of Family Physicians
  http//www.aafp.org
• American Academy of Pediatrics http//www.aap.org

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Immunizations

• How/Where to Find the Latest Recommendations
• Centers for Disease Control http//www.cdc.org/nip
  
• http//www.immunize.org

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Health Screening

• Why Should We Want To
• To detect early stage disease accurately
• To improve clinical outcomes through early
  detection
• Notion of selective screening e.g. high-risk
  populations

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A Few Words About Statistics

• Sensitivity the proportion of persons with
  disease who correctly test positive
• Specificity the proportion of persons without
  the disease who correctly test negative

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A Few Words About Statistics

• Positive Predictive Value The probability of
  true disease if a screening test is positive
• Negative Predictive Value The probability of no
  disease if a screening test is negative

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Formula for Commonly Used Statistics

• Disease
• D D -
• Test______________________________
• T TP (a) FP (b)
• T - FN (c ) TN (d)

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Children

• Screening
• Infants Phenylketonuria, Hypothryoidism, Sickle
  Cell, Lead, hemoglobin
• Preschool Dental, Hearing, Vision, Lead
• School Age Violence, Abuse, Illicit Drugs,
  Sexual Activity, Depression

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Adults

• Women
• Cervical Cancer Pap Smear (age 18 or earlier if
  sexually active), level of monitoring varies
  depending upon the professional group
• Breast Cancer Mammogram at age 40 and annually
  thereafter, yearly breast exams by clinician,
  encourage SBE

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Adults

• Men
• Testicular Cancer self-exam, testicular exam by
  clinician at periodic exams
• Prostate Cancer PSA recommended at age 50,
  digital rectal exam ( DRE) not recommended

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Adults

• Colon Cancer Screening options include FOBT,
  flexible sigmoidoscopy, colonoscopy (new ACS
  guidelines)
• Cholesterol Screeningat age 20, if normal every
  5 years
• Selective screening Blood glucose, HIV, HCV,
  TSH,

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Electronic Medical Records

• New options for help with monitoring health
  maintenance
• Not always easy to use
• Provider should take full responsibility even if
  EMR is in place
• Other options???

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Case Studies

• Screening
• There are 200 women who have cervical cancer and
  800 women who do not have cervical cancer. 68
  women have a positive pap smear who have cervical
  cancer, and 688 women have a negative pap smear
  who do not have cervical cancer. What is the
  sensitivity, specificity, PPV, and NPV of the pap
  smear?

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Case Studies

• Immunizations
• Bobby is a 6 month old baby in for a well-child
  check up. The mom states that hes had all of
  his shots so far. What immunizations has Bobby
  received in the prior 6 months?

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Case Studies

• Immunizations
• Mary is an 15 month old infant who is way
  behind in her immunizations according to her
  mom. You check the chart and see that she has
  received 2 HIBs, 1 IPV, and 2 DTaP. What
  immunizations do we need to give Mary today?