RESUMO
Advocate Aurora Health, located in the north-central United States, is the result of a merger between two large health care organizations in April 2018. The health care system comprises 26 hospitals, offers more than 500 sites of care, and employs 75,000 team members. This article discusses the effects that coronavirus disease 2019 had on the perioperative services departments while directors and site leaders were still managing the complexities of the merger. Included are strategies used to address the challenges created by the pandemic, special considerations based on level-of-care capacity, the effect that the hold on elective surgeries had on staffing assignments, the reactivation process when elective surgery resumed, and the importance of keeping the perioperative team members informed and safe. It also illustrates how facing the challenges caused by the pandemic helped to solidify the merger of the two health care organizations.
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COVID-19 , Atenção à Saúde/organização & administração , Instituições Associadas de Saúde , Humanos , Pandemias , Estados UnidosRESUMO
Importance: Chikungunya virus (CHIKV) is a mosquito-borne Alphavirus prevalent worldwide. There are currently no licensed vaccines or therapies. Objective: To evaluate the safety and tolerability of an investigational CHIKV virus-like particle (VLP) vaccine in endemic regions. Design, Setting, and Participants: This was a randomized, placebo-controlled, double-blind, phase 2 clinical trial to assess the vaccine VRC-CHKVLP059-00-VP (CHIKV VLP). The trial was conducted at 6 outpatient clinical research sites located in Haiti, Dominican Republic, Martinique, Guadeloupe, and Puerto Rico. A total of 400 healthy adults aged 18 through 60 years were enrolled after meeting eligibility criteria. The first study enrollment occurred on November 18, 2015; the final study visit, March 6, 2018. Interventions: Participants were randomized 1:1 to receive 2 intramuscular injections 28 days apart (20 µg, n = 201) or placebo (n = 199) and were followed up for 72 weeks. Main Outcomes and Measures: The primary outcome was the safety (laboratory parameters, adverse events, and CHIKV infection) and tolerability (local and systemic reactogenicity) of the vaccine, and the secondary outcome was immune response by neutralization assay 4 weeks after second vaccination. Results: Of the 400 randomized participants (mean age, 35 years; 199 [50%] women), 393 (98%) completed the primary safety analysis. All injections were well tolerated. Of the 16 serious adverse events unrelated to the study drugs, 4 (25%) occurred among 4 patients in the vaccine group and 12 (75%) occurred among 11 patients in the placebo group. Of the 16 mild to moderate unsolicited adverse events that were potentially related to the drug, 12 (75%) occurred among 8 patients in the vaccine group and 4 (25%) occurred among 3 patients in the placebo group. All potentially related adverse events resolved without clinical sequelae. At baseline, there was no significant difference between the effective concentration (EC50)-which is the dilution of sera that inhibits 50% infection in viral neutralization assay-geometric mean titers (GMTs) of neutralizing antibodies of the vaccine group (46; 95% CI, 34-63) and the placebo group (43; 95% CI, 32-57). Eight weeks following the first administration, the EC50 GMT in the vaccine group was 2005 (95% CI, 1680-2392) vs 43 (95% CI, 32-58; P < .001) in the placebo group. Durability of the immune response was demonstrated through 72 weeks after vaccination. Conclusions and Relevance: Among healthy adults in a chikungunya endemic population, a virus-like particle vaccine compared with placebo demonstrated safety and tolerability. Phase 3 trials are needed to assess clinical efficacy. Trial Registration: ClinicalTrials.gov Identifier: NCT02562482.
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Febre de Chikungunya/prevenção & controle , Vírus Chikungunya/imunologia , Vacinas de Partículas Semelhantes a Vírus/efeitos adversos , Vacinas Virais/efeitos adversos , Adolescente , Adulto , Anticorpos Neutralizantes/sangue , Febre de Chikungunya/imunologia , Método Duplo-Cego , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Testes de Neutralização , Vacinas de Partículas Semelhantes a Vírus/administração & dosagem , Vacinas de Partículas Semelhantes a Vírus/imunologia , Vacinas Virais/administração & dosagem , Vacinas Virais/imunologia , Adulto JovemRESUMO
BACKGROUND: Seasonal influenza results in significant morbidity and mortality worldwide, but the currently licensed inactivated vaccines generally have low vaccine efficacies and could be improved. In this phase 1 clinical trial, we compared seasonal influenza vaccine regimens with different priming strategies, prime-boost intervals, and administration routes to determine the impact of these variables on the resulting antibody response. METHODS: Between August 17, 2012 and January 25, 2013, four sites enrolled healthy adults 18-70 years of age. Subjects were randomized to receive one of the following vaccination regimens: trivalent hemagglutinin (HA) DNA prime followed by trivalent inactivated influenza vaccine (IIV3) boost with a 3.5 month interval (DNA-IIV3), IIV3 prime followed by IIV3 boost with a 10 month interval (IIV3-IIV3), or concurrent DNA and IIV3 prime followed by IIV3 boost with a 10 month interval (DNA/IIV3-IIV3). Each regimen was additionally stratified by an IIV3 administration route of either intramuscular (IM) or intradermal (ID). DNA vaccines were administered by a needle-free jet injector (Biojector). Study objectives included evaluating the safety and tolerability of each regimen and measuring the antibody response by hemagglutination inhibition (HAI). RESULTS: Three hundred and sixteen subjects enrolled. Local reactogenicity was mild to moderate in severity, with higher frequencies recorded following DNA vaccine administered by Biojector compared to IIV3 by either route (p <0.02 for pain, swelling, and redness) and following IIV3 by ID route compared to IM route (p <0.001 for swelling and redness). Systemic reactogenicity was similar between regimens. Though no overall differences were observed between regimens, the highest titers post boost were observed in the DNA-IIV3 group by ID route and in the IIV3-IIV3 group by IM route. CONCLUSIONS: All vaccination regimens were found to be safe and tolerable. While there were no overall differences between regimens, the DNA-IIV3 group by ID route, and the IIV3-IIV3 group by IM route, showed higher responses compared to the other same-route regimens.
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Hemaglutininas/administração & dosagem , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Vacinas de DNA/administração & dosagem , Administração Intranasal , Adulto , Idoso , Feminino , Voluntários Saudáveis , Hemaglutininas/efeitos adversos , Hemaglutininas/imunologia , Humanos , Imunização Secundária , Vacinas contra Influenza/efeitos adversos , Vacinas contra Influenza/imunologia , Injeções Intradérmicas , Masculino , Pessoa de Meia-Idade , Vacinas de DNA/efeitos adversos , Vacinas de DNA/imunologia , Vacinas de Produtos Inativados/administração & dosagem , Vacinas de Produtos Inativados/efeitos adversos , Vacinas de Produtos Inativados/imunologia , Adulto JovemRESUMO
BACKGROUND: Children are susceptible to severe influenza infections and facilitate community transmission. One potential strategy to improve vaccine immunogenicity in children against seasonal influenza involves a trivalent hemagglutinin DNA prime-trivalent inactivated influenza vaccine (IIV3) boost regimen. METHODS: Sites enrolled adolescents, followed by younger children, to receive DNA prime (1 mg or 4 mg) intramuscularly by needle-free jet injector (Biojector), followed by split virus 2012/13 seasonal IIV3 boost by needle and syringe approximately 18 weeks later. A comparator group received IIV3 prime and boost at similar intervals. Primary study objectives included evaluation of the safety and tolerability of the vaccine regimens, with secondary objectives of measuring antibody responses at four weeks post boost by hemagglutination inhibition (HAI) and neutralization assays. RESULTS: Seventy-five children ≥6 to ≤17 years old enrolled. Local reactogenicity was higher after DNA prime compared to IIV3 prime (p<0.001 for pain/tenderness, redness, or swelling), but symptoms were mild to moderate in severity. Systemic reactogenicity was similar between vaccines. Overall, antibody responses were similar among groups, although HAI antibodies revealed a trend towards higher responses following 4 mg DNA-IIV3 compared to IIV3-IIV3. The fold increase of HAI antibodies to A/California/07/2009 [A(H1N1)pdm09] was significantly greater following 4 mg DNA-IIV3 (10.12 fold, 5.60-18.27 95%CI) compared to IIV3-IIV3 (3.86 fold, 2.32-6.44 95%CI). Similar neutralizing titers were observed between regimens, with a trend towards increased response frequencies in 4 mg DNA-IIV3. However, significant differences in fold increase, reported as geometric mean fold ratios, were detected against the H1N1 viruses within the neutralization panel: A/New Caledonia/20/1999 (1.41 fold, 1.10-1.81 95%CI) and A/South Carolina/1/1918 (1.55 fold, 1.27-1.89 95%CI). CONCLUSIONS: In this first pediatric DNA vaccine study conducted in the U.S., the DNA prime-IIV3 boost regimen was safe and well tolerated. In children, the 4 mg DNA-IIV3 regimen resulted in antibody responses comparable to the IIV3-IIV3 regimen.
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Vírus da Influenza A Subtipo H1N1/efeitos dos fármacos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Vacinas de DNA/administração & dosagem , Adolescente , Anticorpos Antivirais/administração & dosagem , Anticorpos Antivirais/imunologia , Criança , Feminino , Testes de Inibição da Hemaglutinação , Humanos , Imunogenicidade da Vacina/efeitos dos fármacos , Imunogenicidade da Vacina/imunologia , Vírus da Influenza A Subtipo H1N1/imunologia , Vírus da Influenza A Subtipo H1N1/patogenicidade , Influenza Humana/imunologia , Influenza Humana/virologia , Masculino , Estações do Ano , Vacinas de Produtos Inativados/administração & dosagemRESUMO
Arterial blood gas (ABG) analysis is a crucial skill for perioperative nurses, in particular the RN circulator. This article provides the physiological basis for assessing ABGs perioperatively and presents a systematic approach to blood gas analysis using the Romanski method. Blood gas sample data allow the reader to practice ABG interpretation. In addition, four case studies are presented that give the reader the opportunity to analyze ABGs within the context of surgical patient scenarios. The ability to accurately assess ABGs allows the perioperative nurse to assist surgical team members in restoring a patient's acid-base balance.
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Gasometria/métodos , Artérias , Educação Continuada , Humanos , Concentração de Íons de HidrogênioRESUMO
Annual influenza vaccination reduces the risks of influenza when the vaccines are well matched to circulating strains, but development of an approach that induces broader and more durable immune responses would be beneficial. We conducted two companion Phase 1 studies, VRC 307 and VRC 309, over sequential seasons (2008-2009 and 2009-2010) in which only the influenza B strain component of the vaccines differed. Objectives were safety and immunogenicity of prime-boost vaccination schedules. A schedule of DNA vaccine encoding for seasonal influenza hemagglutinins (HA) prime followed by seasonal trivalent influenza inactivated vaccine (IIV3) boost (HA DNA-IIV3) was compared to placebo (PBS)-IIV3 or IIV3-IIV3. Cumulatively, 111 adults were randomized to HA DNA-IIV3 (n=66), PBS-IIV3 (n=25) or IIV3-IIV3 (n=20). Safety was assessed by clinical observations, laboratory parameters and 7-day solicited reactogenicity. The seasonal HA DNA prime-IIV3 boost regimen was evaluated as safe and well tolerated. There were no serious adverse events. The local and systemic reactogenicity for HA DNA, IIV and placebo were reported predominantly as none or mild within the first 5days post-vaccination. There was no significant difference in immunogenicity detected between the treatment groups as evaluated by hemagglutination inhibition (HAI) assay. The studies demonstrated the safety and immunogenicity of seasonal HA DNA-IIV3 regimen, but the 3-4week prime-boost interval was suboptimal for improving influenza-specific immune responses. This is consistent with observations in avian H5 DNA vaccine prime-boost studies in which a long interval, but not a short interval, was associated with improved immunogenicity. TRIAL REGISTRATION: NCT00858611 for VRC 307 and NCT00995982 for VRC 309.
RESUMO
BACKGROUND: The efficacy of current influenza vaccines is limited in vulnerable populations. DNA vaccines can be produced rapidly, and may offer a potential strategy to improve vaccine immunogenicity, indicated by studies with H5 influenza DNA vaccine prime followed by inactivated vaccine boost. METHODS: Four sites enrolled healthy adults, randomized to receive 2011/12 seasonal influenza DNA vaccine prime (n=65) or phosphate buffered saline (PBS) (n=66) administered intramuscularly with Biojector. All subjects received the 2012/13 seasonal inactivated influenza vaccine, trivalent (IIV3) 36 weeks after the priming injection. Vaccine safety and tolerability was the primary objective and measurement of antibody response by hemagglutination inhibition (HAI) was the secondary objective. RESULTS: The DNA vaccine prime-IIV3 boost regimen was safe and well tolerated. Significant differences in HAI responses between the DNA vaccine prime and the PBS prime groups were not detected in this study. CONCLUSION: While DNA priming significantly improved the response to a conventional monovalent H5 vaccine in a previous study, it was not effective in adults using seasonal influenza strains, possibly due to pre-existing immunity to the prime, unmatched prime and boost antigens, or the lengthy 36 week boost interval. Careful optimization of the DNA prime-IIV3 boost regimen as related to antigen matching, interval between vaccinations, and pre-existing immune responses to influenza is likely to be needed in further evaluations of this vaccine strategy. In particular, testing this concept in younger age groups with less prior exposure to seasonal influenza strains may be informative. TRIAL REGISTRATION: ClinicalTrials.gov NCT01498718.
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Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Vacinas de DNA/administração & dosagem , Vacinas de Produtos Inativados/administração & dosagem , Adulto , Idoso , Método Duplo-Cego , Feminino , Humanos , Virus da Influenza A Subtipo H5N1/genética , Virus da Influenza A Subtipo H5N1/imunologia , Vacinas contra Influenza/efeitos adversos , Vacinas contra Influenza/imunologia , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Vacinas de DNA/efeitos adversos , Vacinas de DNA/imunologia , Vacinas de Produtos Inativados/imunologia , Adulto JovemRESUMO
Perioperative staff nurses at Aurora Health Care, Milwaukee, Wisconsin, questioned variations in the use of mechanical venous thromboembolism prophylaxis and sought to improve the consistency of prophylaxis care and ensure use of evidence-based practices. A work group consisting of perioperative clinical nurse specialists, a nurse clinician, and a staff nurse performed a systematic literature review to determine best practices for the implementation of mechanical venous thromboembolism prevention in the perioperative period. Key practices identified included optimal application times for initiating mechanical prophylaxis before the surgical procedure and the use of unilateral mechanical prophylaxis for some orthopedic procedures. We found no published consensus regarding a cumulative benefit from combining sequential compression devices and graduated compression stockings and no clinical evidence to support the use of alternative configurations for specialty procedural tables to prevent venous thromboembolism. We disseminated the best practices that we identified within our hospital and to the greater nursing community through posters and presentations.
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Enfermagem Baseada em Evidências , Tromboembolia Venosa/prevenção & controle , Humanos , Tromboembolia Venosa/fisiopatologiaRESUMO
BACKGROUND: Induction of HIV-1-specific T-cell responses relevant to diverse subtypes is a major goal of HIV vaccine development. Prime-boost regimens using heterologous gene-based vaccine vectors have induced potent, polyfunctional T cell responses in preclinical studies. METHODS: The first opportunity to evaluate the immunogenicity of DNA priming followed by recombinant adenovirus serotype 5 (rAd5) boosting was as open-label rollover trials in subjects who had been enrolled in prior studies of HIV-1 specific DNA vaccines. All subjects underwent apheresis before and after rAd5 boosting to characterize in depth the T cell and antibody response induced by the heterologous DNA/rAd5 prime-boost combination. RESULTS: rAd5 boosting was well-tolerated with no serious adverse events. Compared to DNA or rAd5 vaccine alone, sequential DNA/rAd5 administration induced 7-fold higher magnitude Env-biased HIV-1-specific CD8(+) T-cell responses and 100-fold greater antibody titers measured by ELISA. There was no significant neutralizing antibody activity against primary isolates. Vaccine-elicited CD4(+) and CD8(+) T-cells expressed multiple functions and were predominantly long-term (CD127(+)) central or effector memory T cells and that persisted in blood for >6 months. Epitopes mapped in Gag and Env demonstrated partial cross-clade recognition. CONCLUSION: Heterologous prime-boost using vector-based gene delivery of vaccine antigens is a potent immunization strategy for inducing both antibody and T-cell responses. TRIAL REGISTRATION: ClinicalTrials.gov NCT00102089, NCT00108654.
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Vacinas contra a AIDS/imunologia , Adenoviridae/imunologia , Anticorpos Antivirais/imunologia , HIV-1/imunologia , Linfócitos T/imunologia , Vacinas de DNA/imunologia , Vacinas contra a AIDS/administração & dosagem , Adenoviridae/genética , Adolescente , Adulto , Linfócitos T CD8-Positivos/imunologia , Linfócitos T CD8-Positivos/metabolismo , Ensaio de Imunoadsorção Enzimática , Feminino , Citometria de Fluxo , Vetores Genéticos/administração & dosagem , Vetores Genéticos/genética , Vetores Genéticos/imunologia , Infecções por HIV/imunologia , Infecções por HIV/prevenção & controle , HIV-1/genética , Humanos , Imunização Secundária , Imunofenotipagem , Interferon gama/metabolismo , Masculino , Linfócitos T/metabolismo , Vacinas de DNA/administração & dosagem , Adulto JovemRESUMO
BACKGROUND: The severe acute respiratory syndrome (SARS) virus is a member of the Coronaviridae (CoV) family that first appeared in the Guangdong Province of China in 2002 and was recognized as an emerging infectious disease in March 2003. Over 8000 cases and 900 deaths occurred during the epidemic. We report the safety and immunogenicity of a SARS DNA vaccine in a Phase I human study. METHODS: A single-plasmid DNA vaccine encoding the Spike (S) glycoprotein was evaluated in 10 healthy adults. Nine subjects completed the 3 dose vaccination schedule and were evaluated for vaccine safety and immune responses. Immune response was assessed by intracellular cytokine staining (ICS), ELISpot, ELISA, and neutralization assays. RESULTS: The vaccine was well tolerated. SARS-CoV-specific antibody was detected by ELISA in 8 of 10 subjects and neutralizing antibody was detected in all subjects who received 3 doses of vaccine. SARS-CoV-specific CD4+ T-cell responses were detected in all vaccinees, and CD8+ T-cell responses in approximately 20% of individuals. CONCLUSIONS: The VRC SARS DNA vaccine was well tolerated and produced cellular immune responses and neutralizing antibody in healthy adults.
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Anticorpos Antivirais/sangue , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD8-Positivos/imunologia , Síndrome Respiratória Aguda Grave/prevenção & controle , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/imunologia , Vacinas de DNA , Vacinas Virais , Adolescente , Adulto , Feminino , Humanos , Masculino , Glicoproteínas de Membrana/genética , Glicoproteínas de Membrana/imunologia , Pessoa de Meia-Idade , Testes de Neutralização , Coronavírus Relacionado à Síndrome Respiratória Aguda Grave/genética , Síndrome Respiratória Aguda Grave/imunologia , Glicoproteína da Espícula de Coronavírus , Resultado do Tratamento , Vacinas de DNA/administração & dosagem , Vacinas de DNA/genética , Vacinas de DNA/imunologia , Proteínas do Envelope Viral/genética , Proteínas do Envelope Viral/imunologia , Vacinas Virais/administração & dosagem , Vacinas Virais/genética , Vacinas Virais/imunologia , Adulto JovemRESUMO
The joint commission recognizes effective communication among caregivers as an important factor for ensuring patient safety, especially at times when the patient's care is handed off from one caregiver or service to another. This case study reviews the course of treatment for one patient throughout the perioperative continuum, including the postoperative unit where a pre-arrest situation developed. A workshop using Bloom's Taxonomy of Educational Objectives enabled staff members to more clearly understand the patient's situation. It also allowed the participants to gain an increased understanding of significant data and has been strategic in preventing patient complications.
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Dor Abdominal/diagnóstico , Colecistectomia/métodos , Dor Pós-Operatória/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/enfermagem , Colecistectomia/efeitos adversos , Educação em Enfermagem/classificação , Educação em Enfermagem/métodos , Feminino , Humanos , Capacitação em Serviço , Pessoa de Meia-Idade , Modelos Educacionais , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/enfermagem , Equipe de Assistência ao Paciente , Enfermagem Perioperatória/educação , Enfermagem Perioperatória/métodos , Enfermagem Perioperatória/normas , PensamentoRESUMO
Modified vaccinia Ankara (MVA) was evaluated as an alternative to Dryvax in vaccinia-naïve and vaccinia-immune adult volunteers. Subjects received intramuscular MVA or placebo followed by Dryvax challenge at 3 months. Two or more doses of MVA prior to Dryvax reduced severity of lesion formation, decreased magnitude and duration of viral shedding, and augmented post-Dryvax vaccinia-specific CD8(+) T cell responses and extracellular enveloped virus protein-specific antibody responses. MVA vaccination is safe and immunogenic and improves the safety and immunogenicity of subsequent Dryvax vaccination supporting the potential for using MVA as a vaccine in the general population to improve immunity to orthopoxviruses.
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Vacina Antivariólica/efeitos adversos , Vacina Antivariólica/imunologia , Varíola/prevenção & controle , Vaccinia virus/imunologia , Adolescente , Adulto , Formação de Anticorpos/imunologia , Linfócitos T CD8-Positivos/imunologia , Método Duplo-Cego , Humanos , Pessoa de Meia-Idade , Vacina Antivariólica/administração & dosagemRESUMO
Early researchers accurately predicted that AIDS would have a globally destructive impact. However, other experts erroneously believed that they would be able to develop a vaccine against the virus in a relatively short period. More than twenty years later, scientists continue to work to achieve this goal. This paper addresses the unique obstacles faced by HIV vaccine researchers. It concludes with recommendations for how policymakers and public health officials could collaborate with researchers to overcome these obstacles and contribute to the discovery of an HIV vaccine that would save millions of lives.
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Vacinas contra a AIDS , Infecções por HIV/prevenção & controle , Pesquisa/organização & administração , Ensaios Clínicos como Assunto , Indústria Farmacêutica , Infecções por HIV/transmissão , Experimentação Humana , Humanos , Formulação de Políticas , Estados UnidosRESUMO
TWO RIVAL HEALTH CARE SYSTEMS collaborated to meet an increasing demand for surgical technologists in the Milwaukee area by developing and implementing a nine-month surgical technologist program. THIS UNIQUE APPROACH included using grant funds from the Private Industry Council of Milwaukee County to help fulfill local health care organizations' commitment to employee development and adequate staffing. TWENTY-ONE SURGICAL TECHNOLOGISTS graduated from the program and successfully began health care careers; three of the graduates are continuing their education in nursing school.
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Comportamento Cooperativo , Atenção à Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde , Relações Interinstitucionais , Auxiliares de Cirurgia/provisão & distribuição , Acreditação , Organização do Financiamento , Humanos , Auxiliares de Cirurgia/educação , Desenvolvimento de Programas , WisconsinRESUMO
Despite the declaration of smallpox eradication in 1980, the existence of variola stockpiles and the threat of bioterrorism demand that immunity to smallpox through vaccination be maintained. Although the currently available vaccine was used for the most successful medical intervention ever accomplished, it also is associated with side effects that are difficult to accept in a vaccine for a disease that has not been present for >25 years. Herein, we review alternative approaches to maintaining immunity to smallpox through vaccination with attenuated poxviruses, and we suggest modified vaccinia Ankara (MVA) as a leading candidate for an alternative smallpox vaccine.
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Varíola/prevenção & controle , Vaccinia virus/imunologia , Vacinas Virais , Humanos , Imunidade Ativa , Varíola/imunologia , Vacina Antivariólica , Vacinação , Vacinas Atenuadas , Vacinas Virais/imunologiaRESUMO
PATIENTS WITH BODY PIERCINGS present a challenge for today's perioperative nurses. The need to prepare these patients for surgery while promoting safety, preserving body image, and respecting cultural values has gone beyond the routine practice of jewelry removal. BODY ART (ie, tattooing, piercing) has been practiced by men, women, and children from ancient times to the present. It was used then, as it is now, for many purposes, including personal expression, rite of passage, and fashion trends. THE EXPANDING POPULARITY of body piercing increases the likelihood that patients will arrive for surgery with body jewelry in place. This article provides perioperative nurses with the proper tools to deliver culturally sensitive care to patients with body piercings.