Ccirh middle east evidence-based checklist

eventive Care Checklist
Date of Arrival in Canada Language(s) spoken Country of Origin Settlement/Refugee Claimant Worker Refugee Claimant Hearing Date Vital Signs
Patient Health Concerns
Address reason for visit
Patient-centered approach
Clinic appointments and health system Allergies, Current meds Previous Illness Immunization status Remain aler
routinely screen for history of trauma
Past occupation(s): If linked to integrated program:
Document date of refugee claimants-hearing Nutrition screening & counseling Screen for Unmet
(programs to promote breastfeeding) Exercise programs to prevent obesity (active living) Home visitation for high risk mothers (infant <3)
Physical Exam
Focused examination to address patient's presenting complaint Important signs in immigrants
Plan and book follow-up visit Do not perform a Mantoux test
CBC with differential (children/females)
Serology for
Children (Age Dependent):
: Links to an interactive synopsis of available evidence and recommendations for the condition.
: Links to the relevant section of the guidelines published in the Canadian Medical Association Journal. : Links to the recommendations on the map.
Evidence Link: Bold-CCIRHs Recommendations Systematic Review Linked Evidence: US and Canadian Task Force Preventive Care.
Disclaimer: Given the constantly evolving nature of evidence and changing recommendations, the preventative checklist is meant as a guide only.
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2nd Visit (2-7 days)
Vital Signs
Patient Health Concerns
Address reason for visit
Patient-centered approach
Physical Exam
Important signs in immigrants Nutritional status, fevers, scars/skin lesions, clubbing, wheezes, heart murmurs, lymphadenopathy, organomegaly, limb weakness NSAIDs for and Refer for
Fasting Glucose (>35)
LDL/Cholesterol (men>35, women >45) Screen for obesity Remain alert for isolation for pregnant women 3rd Visit (1-3 months)
Later visits (3-6 months)
Vital Signs
Patient Health Concerns
Address reason for visit
Verify links to local resources (ie libraries, local events) Remain alert for adjustment stress, signs of Remain alert for possible onset Education
Diet counseling (
Positive Parenting (tooth brushing)
Assess for Smoking and Alcohol misuse Adequate Vitamin D Ensure appropriate clothing for weather Important signs in immigrants frProblems and Plan
Refer if positive for
Cervical cytology
Mammography (50-75) Consider testing for chlamydia; GC, Fecal Occult Blood (>50) syphilis (VDRL) Osteoporosis screening (women >65) (non-immune)
(for 9-25 year old females)
Disclaimer: Given the constantly evolving nature of evidence and changing recommendations,
the CCIRH preventative checklist is meant as a guide only.
Fair Use Authorization: Design & Production:

Tuberculosis Screening: Tuberculin skin test (TST)
INH Treatment of Latent Tuberculosis Infection
Indications for TST: persons at high risk for disease
(active disease ruled out)
• Contact with contagious TB, immigrants from TB endemic country within Isoniazid 300mg OD (children 5mg/kg); consider pyridoxine 25-50mg OD 5 years of arrival to prevent neuropathy in malnourished states • Increased risk of reactivation due to impaired immunity: • Provide 9 months of INH for all adults HIV-AIDS, Diabetes, Renal Failure, Corticosteroids or other • Consider up to 12 months in children immunosuppressant drugs Canadian criteria for a positive TST
*Risk of INH hepatotoxicity (AST> 5 times normal)
High risk people: 5mm
HIV, Contact with active TB, signs of inactive TB on CXR, organ transplant steroids >15mg/day High risk conditions: 10 mm
Silicosis, DM, Chronic Renal Failure, Leukemia, lymphoma, Malnutrition, Monitoring (i.e. AST at 3 weeks and Q 3months) is required for those over child<5 years of age 50 years of age and those with pre-existing liver disease, alcoholism or High Prevalence Population: 10 mm
concomitant use of hepatotoxic drugs.
Foreign Born (high prevalence countries- see Greenaway et al. TB in CMAJ 2011) arrived <5 years, health care worker, aboriginal, prisons, homeless, Immunizations: Needed for primary prevention- particularly for travel to country Visiting Friends and Relatives (VFR) Travel- preparation for future travel home
of origin. If status unknown, serology: Hepatitis B, Varicella and offer a primary (see travel health website: series: MMR, TdPP.
Consider: Fever, Meningococcal, Typhoid vaccines, prophylaxis for malaria.
Consider: Also consider Hepatitis A for all immigrants and refugees and
Counseling for Mosquito avoidance, DEET repellent, and bed nets Pneumococcal and H influenza for sickle cell disease Sex Transmitted Disease and motor vehicle accident prevention: seat belts, -92 % of congenital Rubella syndrome in Canada in foreign born (FB) alcohol moderation -Large proportion of FB involved in Rubella and Varicella outbreaks Antibiotics for severe diarrhea (i.e. Azithromycin 1000mg once) -Most neonatal Tetanus in the FB Generous supply of regular medication in case trips are extended -WHO Extended Program of Immunization (EPI) program began in 1974- so Summary of health information many FB adults not covered this program does not routinely provide Rubella Laboratory Investigations:
Special Laboratory Investigations to Consider
*Basic Tenets of Screening: suitable test and facilities to diagnose available,
*Malaria: Rapid Diagnostic Test (RDT), thick & thin smears when fever
accepted treatment available, recognized latent or asymptomatic disease stage, within 3 months of travel to Malaria zone. diagnosis and treatment should be cost effective. Note: Many cases of Malaria occur in immigrants from developing countries, *Consider periodic screening for infectious disease and chronic illness tailored
both on migration or after traveling home to history of travel and lifestyle *Vitamin D: 25-Hydroxycholecalciferol: bone and muscle aches in women
who use body veils.
Working with an interpreter
Global Health Risks
Pre-interview: Discuss with the interpreter the goal of the interview,
Tuberculosis, Malaria, HIV-AIDS, Hepatitis A, B,C, Typhoid, Measles, emphasize confidentiality, and seating arrangements Intestinal Parasites, Rheumatic Heart Disease, undiagnosed chronic Interview: Speak to patient not to the interpreter- ensures patient faces
conditions; Trauma and Violence: Rape, Torture physician when interpreter speaks, explain the interpreter's role, and frequently Malnutrition and Micronutrient deficiency: iron, folate, iodine (some regions), repeat back to patient what you hear. Thalasemias (Africa, Middle East) Sickle cell (Africa, Caribbean); microcytic End of the interview: Repeat important concepts, review treatment plan
anemia, replace iron and then do Hgb electrophoresis carefully, have patient repeat back general diagnosis and plan Treatment of common asymptomatic intestinal worms and parasites
* Doses are same for children unless noted by asterisk. ** not available in Canada Intestinal worm or parasite
Paramomycin 500 mg po tid×7d* Metronidazole 750 tid x 10d (positive serology or stool antigen) Iodoquinol 650 mg po tid×20d* Metronidazole 250 mg po tid×5d* Albendazole 400 mg po×1 dose6 Mebendazole 100mg bidx3d Albendazole 400 mg po×1 dose (repeat in 2wks) Mebendazole 100mg once then repeat in 2wks Thiabendazole 50 mg/kgdivided bid×2d (max dose 3 g/d) ** Praziquatel 40mg/kg po divided bid x 1d Albendazole 400 mg po×1 dose Mebendazole 100mg tid x3d Resources: /
2. Children and Youth to Canada: A Health Care Guide, Canadian Pediatric Society 4. Travel and Tropical Medicine, Public Health Agency of Canada 5. Life expectancy calculator, PHIRN, 2012 6. Health Canada' s Special Access Programme: Drugs and health products [database] Ottawa (ON): Health Canada; 2008 A 7. Additional resources and information for clinicians, Bridge Refugee Clinic, V Disclaimer: Given the constantly evolving nature of evidence and changing recommendations,
the CCIRH preventative checklist is meant as a guide only.
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JOURNAL OF CURRENT RESEARCH IN SCIENCE JCRS 4 (1), 2016: 57-62 CODEN (USA): JCRSDJ Available at Effect of Ondansetron in Prevention of Spinal Anesthesia-Induced Hypotension in Pregnant Women Candidate for Elective Cesarean Section Hashem Jarineshin, Fereydon Fekrat, Saeed Kashani* Anesthesiology, Critical Care and Pain Management Research Center, Hormozgan University of Medical Sciences. Bandar Abbas, Iran. Corresponding Author email

Secondary open-angle glaucomas

Thomas F. Freddo, O.D., Ph.D., F.A.A.O. Professor of Optometry University of Waterloo  Ocular injury; recent or old Secondary to Iritis  Phacolytic Ghost cell Melanomalytic Steroid-induced Pigmentary glaucoma Exfoliative glaucoma Note especially deep ciliary body band and posterior dislocation of iris root. Follows non-penetrating blunt trauma – Important to remember that not all patients can document a traumatic event. Gonio all young patients with unilateral cataract.Following blunt trauma recession develops often, especially if associated hyphemaR/O ruptured globe – no gonio for first 2-3 weeks. Gonio both eyes to compare. Use goniolens not prism.Only 5-20% of those with recession will develop glaucoma, but it can occur at any time after the injury.More common if recession greater than 180 degrees.Prostaglandin analogs have a theoretical benefit because the trabecular meshwork is thought to be dysfunctional. Otherwise, initial med therapy similar to other OAGs