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By: William A. Weiss, MD, PhD

  • Professor, Neurology UCSF Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA

Community Planning • Medical needs of re-located renal failure patients are substantial; planning on community level should Prepare incorporate their medication and dietary needs during evacuation and sheltering activities safe cialis daily 5 mg sudden erectile dysfunction causes. Insufcient Resources Available For All Patients Requiring Dialysis • Change dialysis from ‘scheduled’ to cialis daily 5mg generic erectile dysfunction premature ejaculation ‘as needed’ based on clinical and laboratory fndings (particularly hyper Conserve kalemia and impairment of respiration) – parameters may change based on demand for resources buy cialis daily 5 mg without prescription erectile dysfunction medication muse. Increased Demand on Resources • Shorten duration of dialysis for patients that are more likely to generic 5mg cialis daily mastercard erectile dysfunction type of doctor tolerate it safely. Conserve • Patients to utilize their home “kits” of medication (Kayexalate) and follow dietary plans to help increase time between treatments, if necessary. Transportation Interruptions • Dialysis patients may require alternate transportation to assure ongoing access to dialysis treatment. Mary’s Hospital in Rochester • Children’s Hospitals & Clinics • Sanford Health-Worthington • Mercy Hospital • St. Cloud Hospital • North Memorial • Altru-Grand Forks • United Hospital • Sanford Health-Fargo • University of Minnesota Medical Center-M Health • Essentia Health-Fargo • For contact information, reference the Minnesota Department of Health Burn Surge Plan. Burn casualties should initially be transported to the highest level of burn/trauma care that is available in the area. The ability of non-burn center hospitals to stabilize success fully and initially treat victims is critical to successful response. All hospitals should plan for incidents considering their relative size and role in the community. In such an event, a burn transfer coordination point will be designated and contact information circulated to hospitals. Suggested supplies per patient for frst 72 hours (amounts needed will vary) include: Adapt Quantity Item 5 8 cm x18 cm (3 x 7 inch) sheets petroleum-impregnated gauze. In contingency/crisis situation, emphasis moves away from silver im Increase pregnated dressings (expensive to stockpile) to bacitracin/petrolatum-impregnated dressings. If transfer is possi Supply ble within the frst 24 hours, simple dry sterile sheets or dressings are appropriate see Burn Triage Card for further information. See Minnesota Department of Health Burn Surge webpage for re Adapt sources and educational videos. See Stafng Strategies for Scarce Resource Situations sheet for further considerations. Conserve • Consider just-in-time training on dressing changes, wound care and monitoring – especially at non-burn centers. Special Considerations Prepare Consider availability of resources for: • Airway/inhalational injury – extra airway management supplies, bag-valve assemblies, etc. If large number of casualties and very severe burns, triage may have to be implemented based on knowledge of percent Re-Allocate burn, age and underlying health issues, combined trauma or other conditions (such as severe inhalational injury). Defning the ratio of outcomes to resources for triage of burn patients in mass casualties. Patients may have to be held for up to 72 hours at a Burn Surge Facility awating transfer to a Burn Center. Transport • Initial dressings should be dry, sterile dressing if transfer planned. If transfer will be delayed, adaptic dressings may be applied in consultation with burn center. Prepare • Obtain consultation with burn experts for ongoing care and triage/transportation prioritization if immediate trans portation/referral is not possible. Intubation recommended: Patient Arrives/Initial Assessment stridor, voice change, respiratory distress, circumferential neck burns, carbonaceous sputum, hypoxia, or prolonged transport time and major burn patient. Avoid boluses when possible increase fuid rates by 10% per hour for low urine output or lower blood pressures. Disability Assess neurologic status (including sensation and motor); cervical spine protection if trauma/high-voltage (>1000 V) injury. Yes body temperature water while consulting Poison Control* about specifc treatments. Give 50% over frst 8 hours and rest over • Any patient with burns and concomitant trauma. Pain Control – Administer analgesia; extraordinary doses may be required to control pain adequately. No Urine Output – All electrocutions, intubated patients, and major burns should have indwelling urinary catheter. Rule of Nines Numbers expressed in percentages High Priority For Transfer To Burn Center Secondary Assessment – Critical Burn Features No Secondary Priority For Transfer • May have to manage in place awaiting transfer (24-48 hours). Hennepin County Medical Center Burn Unit • Infection control – providers should gown, glove, and mask. American Burn Association Burn Centers in Minnesota • Consider early use of enteral/tube feedings if oral intake inadequate. The following centers can provide real-time consultation in support of pediatric critical care when transfer is difcult or not possible or when highly specialized services. Mary’s Medical Center (Duluth) Level lll University of Minnesota Masonic Children’s Hospital Level lV Children’s of Minnesota, St. Paul • Pediatric patients will have to be stabilized (and in some cases treated, for 24 to 48 hours) at initial receiving hospital in major incident – all facilities must be prepared for pediatric cases. Adapt • Distribute non-critical and older pediatric patients from overwhelmed pediatric centers to other accepting facilities. Inpatient Supply Planning: • Institutions should prepare based on role in community.

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Development of a clinical prediction rule to buy cheap cialis daily 5 mg erectile dysfunction under 30 identify patients with knee pain and clinical evidence 94 buy 5mg cialis daily with amex erectile dysfunction medications injection. Relative efectiveness of an extension of knee osteoarthritis who demonstrate a favorable short-term re program and a combined program of manipulation and fexion and ex sponse to safe cialis daily 5 mg how to get erectile dysfunction pills hip mobilization effective cialis daily 5 mg erectile dysfunction daily pill. Trunk muscle endurance tests: reli bed versus advice to stay active for acute low-back pain and sci ability, and gender diferences in athletes. Lumbar muscle usage in use of an extension-mobilization category in acute low back syndrome: chronic low back pain. Outcome measures patients with low back pain who demonstrate short-term improvement for studying patients with low back pain. Epub nation of the reliability of a classifcation algorithm for subgrouping ahead of print. Pragmatic application of a clinical predic treated with slump stretching: a case series. Comparison of classifcation-based avoidance-based physical therapy intervention for patients with physical therapy with therapy based on clinical practice guidelines for patients with acute low back pain: a randomized clinical trial. Investigation of elevated fear-avoidance ments of the centralization phenomenon and status change during beliefs for patients with low back pain: a secondary analysis involving movement testing in patients with low back pain. Fear-avoidance beliefs as measured subgroups of patients with acute low back pain. Interrater reliabil by the fear-avoidance beliefs questionnaire: change in fear-avoidance ity and short-term treatment outcomes. Identifying psychosocial variables in patients with acute work-related low back pain: the importance of fear-avoidance 127. Efects of exercise on hip range of motion, trunk muscle performance, and gait economy. Reliability and validity of Functional Capacity Evaluation methods: a systematic 114. Is there a subgroup of review with reference to Blankenship system, Ergos work simulator, patients with low back pain likely to beneft from mechanical trac Ergo-Kit and Isernhagen work system. Accuracy of the clinical examination to predict radiographic instability of the lumbar spine. Lumbar spine segmental mobility assessment: an examination of validity for determining intervention 132. Factors related to the inability of individuals with low back pain to improve with a spinal 133. Responsiveness of a patient specifc outcome measure compared with the Oswestry Disability 134. Screening for symptoms of a clinical prediction rule for determining which patients with low back depression by physical therapists managing low back pain. Interrater reliability of clinical Mulligan traction straight leg raise: a pilot study to investigate efects examination measures for identifcation of lumbar segmental instability. Efects of the Mulligan trac disease in older adults: prevalence and clinical correlates. A systematic review of the relation between physical ca a predictor of reduced functional capacity in the health, aging and body pacity and future low back and neck/shoulder pain. Long-term efects of specifc stabiliz dent evaluation of a clinical prediction rule for spinal manipulative ing exercises for frst-episode low back pain. The inter-tester reliability of physical multifdus muscle wasting ipsilateral to symptoms in patients with therapists classifying low back pain problems based on the movement acute/subacute low back pain. Screening for malignancy in low laboratory and clinical tests of transversus abdominis function. A systematic review identifes status and pain in patients with chronic low back pain by postal ques fve “red fags” to screen for vertebral fracture in patients with low back tionnaires: a reliability study. Predicting the onset of widespread cise program reduces disability and improves functional performance body pain among children. Segmental lumbar mobility in intervention to treat recurrent nonspecifc low back pain in adolescents. A school-based survey of recurrent non-specifc low-back pain prevalence and consequences in 192. Interexaminer reliability of low back pain assessment using the Mc recurrent musculoskeletal pain: developing a screening instrument. Evaluation of the predictive validity of the the treatment of workers with chronic low back pain: a randomized, Orebro Musculoskeletal Pain Screening Questionnaire. Cytokines for psychologists: implications of bidi tion as a screening test for identifying occupational low back pain. J rectional immune-to-brain communication for understanding behavior, Orthop Sports Phys Ther. Endurance times for low back stabi sensitization in patients with musculoskeletal pain: application of pain lization exercises: clinical targets for testing and training from a normal neurophysiology in manual therapy practice. Interpreting change scores for Practice analysis survey: revalidation of advanced clinical practice in or pain and functional status in low back pain: towards international thopaedic physical therapy. Isometric back exten tive to information and advice in low back pain patients presenting sion endurance tests: a review of the literature. J Manipulative Physiol with centralization or peripheralization: a randomized controlled trial. Evidence for a direct relationship between cognitive and physical change during an education intervention in people with chron 236. Pfngsten M, Kroner-Herwig B, Leibing E, Kronshage U, Hildebrandt ic low back pain. A randomized controlled trial of intensive neurophysiology education in chronic low back pain. Oxford Centre for Evidence-based “Physical Stress Theory” to guide physical therapist practice, educa Medicine Levels of Evidence (March 2009).

An application for extended outpatient mental health services must state that the person has received: (1) court-ordered inpatient mental health services under this subtitle or under Subchapter D or E generic 5 mg cialis daily otc erectile dysfunction injection therapy cost, Chapter 46B discount 5 mg cialis daily mastercard erectile dysfunction causes stress, Code of Criminal Procedure buy cheap cialis daily 5mg online impotence at 33, for a total of at least 60 days during the preceding 12 months; or (2) court-ordered outpatient mental health services under this subtitle or under Subchapter D or E generic cialis daily 5 mg fast delivery erectile dysfunction treatment homeopathy, Chapter 46B, Code of Criminal Procedure, during the preceding 60 days. If the proposed patient desires, the attorney shall advocate for the least restrictive treatment alternatives to court-ordered inpatient mental health services. An attorney may not withdraw from a case unless the withdrawal is authorized by court order. However, the hearing shall be held not later than the 30th day after the date on which the original application is filed. If extremely hazardous weather conditions exist or a disaster occurs that threatens the safety of the proposed patient or other essential parties to the hearing, the judge or magistrate may, by written order made each day, postpone the hearing for 24 hours. The notice shall not include the application, medical records, names or addresses of other potential witnesses, or any other information whatsoever. Any clerk, judge, magistrate, court coordinator, or other officer of the court shall provide such information and shall be entitled to 75 judicial immunity in any civil suit seeking damages as a result of providing such notice. Should such evidence be offered at trial and the adverse party claim surprise, the hearing may be continued under the provisions of Section 574. Any officer, employee, or agent of the department shall refer any inquiring person to the court authorized to provide the notice if such information is in the possession of the department. The notice shall be provided in the form that is most understandable to the person making such inquiry. The county judge shall transfer the case after receiving the request and the receiving court shall hear the case as if it had been originally filed in that court. That court shall thereafter have exclusive, continuing jurisdiction of the case, including the receipt of the general treatment program required by Section 574. The services of an associate judge who serves more than two courts may be terminated by a majority vote of all the judges of the courts the associate judge serves. The services of an associate judge who serves two courts may be terminated by either of the judges of the courts the associate judge serves. A referring court may issue attachment against and may fine or imprison a witness whose failure to appear before an associate judge after being summoned or whose refusal to answer questions has been certified to the court. At least one of the physicians must be a psychiatrist if a psychiatrist is available in the county. If extremely hazardous weather conditions exist or a disaster occurs, the presiding judge or magistrate may by written order made each day extend the period during which the two Certificates of Medical Examination for Mental Illness may be filed, and the person may be detained until 4 p. Not later than the third day before the date of a hearing that may result in the judge ordering the patient to receive court-ordered outpatient mental health services, the judge shall identify the person the judge intends to designate to be responsible for those services under Section 574. The proposed patient is entitled to remain at liberty pending the hearing on the application unless the person is detained under an appropriate provision of this subtitle. The Texas Judicial Council shall make the reported information available to the department annually. A magistrate’s duty under this section is in addition to the magistrate’s duties prescribed by other law. If the period ends on a Saturday, Sunday, or legal holiday, the hearing must be held on the next day that is not a Saturday, Sunday, or legal holiday. The judge or magistrate may postpone the hearing each day for an additional 24 hours if the judge or magistrate declares that an extreme emergency exists because of extremely hazardous weather conditions or the occurrence of a disaster that threatens the safety of the proposed patient or another essential party to the hearing. Notwithstanding any other law or requirement, an associate judge appointed to conduct a hearing under this section may practice law in the court the master serves. The proposed patient was given the opportunity to challenge the allegations that the proposed patient presents a substantial risk of serious harm to self or others. On request of the local mental health authority, the judge may order that the proposed patient be detained in an inpatient mental health facility operated by the department. The person must be isolated from any person who is charged with or convicted of a crime. The hearing should be held in a physical setting that is not likely to have a harmful effect on the proposed patient. The judge shall furnish the presiding judge of the statutory probate courts or the presiding judge of the administrative region, as appropriate, an accounting of the expenses for certification. The presiding judge shall provide a certification of expenses approved to the county judge responsible for payments of costs under Section 571. For a mental health proceeding, the fee assessed under this subsection includes costs incurred for the preparation of documents related to the proceeding. The court may award as court costs fees for other costs of a mental heath proceeding against the county responsible for the payment of the costs of the hearing under Section 571. The withdrawal must be made not later than the eighth day before the date on which the hearing is scheduled. The jury may not make a finding about the type of services to be provided to the proposed patient. The certificates admitted under this subsection constitute competent medical or psychiatric testimony, and the court may make its findings solely from the certificates. In addition, the court may consider the testimony of a non-physician mental health professional as provided by section 547. The court may not enter an order for extended mental health services unless appropriate findings are made and are supported by testimony taken at the hearing. The person designated must be the facility administrator or an individual involved in providing court-ordered outpatient services.

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Patient Positioning the patient should be positioned on the operating table in a prone position order 5 mg cialis daily free shipping erectile dysfunction injection device. There are numerous frames that can be used including purchase cialis daily 5 mg otc erectile dysfunction doctor visit, but not limited to generic 5 mg cialis daily amex benadryl causes erectile dysfunction the Wilson Frame 5mg cialis daily sale impotence after 60, Chest Rolls, Relton Hall Frame, Hasting Frame, Heffington Frame and the Andrews Frame. Minimize intra-abdominal pressure to avoid venous congestion and excess intra-operative bleeding and allow adequate ventilation under anesthesia in the patient as well. The patient s hips should beextended to preserve lumbar lordosisfor fusion and instrumentation of the lumbosacral junction. Exposure the surgical approach is carried out through a standard midline incision to the spinal column over the anatomic position of the spinous process. The spinal column is then exposed inroutine fashion by the surgeon and decompression is carried out as needed. Transforming the Orthopaedic Marketplace 1 Dymaxeon Spine System Pedicle Entry Point the pedicle entry point is intersected by the vertical line that connects the lateral edges of bony crest extension of the pars inter articularis, and the horizontal line that bisects the middle of the transverse process. Anatomical variation in individual patients may cause slight differences in the entry site. The probe is passed through the pedicle canal until the anterior cortex of the vertebral body is reached. Caution should be taken not to violate the anterior wall of the vertebral body or cortical walls Ball Tip Control Probe Insertion Following the insertion of the probe, the Ball Tip Control Probe, Standard (09. It can also be used to palpate the inner surface of the pedicle canal to check for defects or perforations of the cortical walls Transforming the Orthopaedic Marketplace 2 Dymaxeon Spine System Screw Selection Select the proper screw. The driver may be ratcheted for clockwise or counter clockwise rotation or set in fixed position. Screw Insertion the pedicle screws are inserted using the Poliaxial & Monoaxial Screwdriver (with T handle 09. The pedicle screw should parallel the endplates and extend 50% to 80% into the vertebral body when fully seated. After screw insertion is complete, the poly screw driver is disengaged from the Dymaxeon Screw housing by turning the poly screw driver shaft counterclockwise. The rod should extend approximately 5 millimeters beyond the outer edges of the proximal screw bodies of the most superior and most inferior pedicle screws. Transforming the Orthopaedic Marketplace 3 Dymaxeon Spine System Rod Bending A standard feature of the Dymaxeon system is pre-lordosed rods. In select circumstances requiring customized bends based on rod templating, the rod can be shaped utilizing the Rod Bender (09. The poliaxial adjustability of the system eliminates the need for precision bending of the rod. The screw allows up to 50° of angulation which should be sufficient to adjust to the position of the rod which can also be done by the Rod Benders (09. While the rod is held in place with the Rod Holder, the set screw of the superior Fusion screw housing is provisionally tightened using the 4mm T Screwdriver (09. The remaining Dymaxeon set screws are left loose so compression and distraction can be accomplished. Transforming the Orthopaedic Marketplace 4 Dymaxeon Spine System Compression & Distraction Compression or Distraction may then be performed at the surgeon’s discretion. The compressor fits onto the rod on the outside of the provisionally-tightened Dymaxeon screw and the Dymaxeon screw to be compressed. As the compressor handle is closed, the loose Dymaxeon screw is drawn toward the other provisionally tightened Dymaxeon screw accomplishing compression of the desired segment. When the desired amount of compression has been achieved, the set screw of the loose connector is tightened using the 4mm T Screwdriver while being held in place with the compressor. The spreader fits onto the rod on the inside of the provisionally tightened screw and the screw to be distracted. As the spreader handle is closed, the loose Fusion screw is pushed away from the other provisionally tightened screw accomplishing distraction of the desired segment. When the desired amount of distraction has been achieved, the set screw of the loose screw is tightened using the 4mm driver while being held in place with the spreader. Transforming the Orthopaedic Marketplace 5 Dymaxeon Spine System Tranverse Link Assembly (optional) the Transverse Link assembly consists of one transverse bar and two transverse hooks. Once the desired location of the transverse link has been determined, the appropriate transverse bar size is selected. The bar is assembled with one transverse hook and the hook-bar assembly is placed over the rod with the Adjustable Transverse Connector Driver (09. The second transverse hook is then assembled on the transverse bar and placed into position on the opposite rod Adjustable Transverse Connector Driver (09. The compressor may be used to adjust and position the transverse link on the rods. And the 3mm driver is used to tighten each transverse hook set screw onto the rods. Wound Closure Wound closure is performed in the customary manner Transforming the Orthopaedic Marketplace 6 Dymaxeon Spine System Implantables Ref. The surgeon is instructed to thoroughly explain the general surgical risks to the patient before surgical treatment is initiated. The safety and effectiveness of pedicle screw spinal systems have been established for spinal conditions with significant mechanical instability or deformity requiring fusion with Warnings instrumentation. These conditions are significant mechanical instability or deformity of the thoracic, lumbar, and sacral spine secondary to severe spondylolisthesis (grade 3 and 4) of the L5-S1 vertebra, degenerative spondylolisthesis with objective evidence of neurological impairment, fracture, dislocation, scoliosis, kyphosis, spinal tumor, and failed previous fusion (pseudarthrosis or nonunion.

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Type A includes 15 subtypes of which only 2 (H1and H3) are associated with widespread epidemics; type B is infrequently associated with regional or widespread epidemics; type C with sporadic cases and minor localized outbreaks order cialis daily 5 mg overnight delivery erectile dysfunction treatment in vadodara. The antigenic properties of the 2 relatively stable internal structural proteins generic 5mg cialis daily visa effexor xr impotence, the nucleoprotein and the matrix protein generic cialis daily 5mg with mastercard erectile dysfunction aids, determine virus type buy cialis daily 5 mg free shipping impotence ginseng. Frequent muta tion of the genes encoding surface glycoproteins of inuenza A and inuenza B viruses results in emergence of variants that are described by geographic site of isolation, year of isolation and culture number. Exam ples are A/New Caledonia/20/99(H1N1), A/Moscow/10/99(H3N2)-like virus, B/Hong Kong/330/2001. The relatively minor antigenic changes (antigenic drift) of A and B viruses responsible for frequent epidemics and regional outbreaks occur constantly and require annual reformulation of inuenza vaccine. Occurrence—As pandemics (rare), epidemics (almost annual), localized outbreaks and sporadic cases. Clinical attack rates during epi demics range from 10% to 20% in the general community to more than 50% in closed populations. During the initial phase of epidemics in industrialized countries, infection and illness appear predominantly in school-age children, with a sharp rise in school ab sences, physician visits, and pediatric hospital admissions. During a subsequent phase, infection and illness occur in adults, with industrial absenteeism, adult hospital admissions, and an increase in mortality from inuenza related pneumonia. Epidemics generally last 3–6 weeks, although the virus is present in the community for a variable number of weeks before and after the epidemic. The highest attack rates during type A epidemics occur among children aged 5–9, although the rate is also high in preschool children and adults. Epidemics of inuenza occur almost every year, caused primarily by type A viruses, occasionally inuenza B viruses or both. In temperate zones, epidemics tend to occur in winter; in the tropics, they often occur in the rainy season, but outbreaks or sporadic cases may occur in any month. Inuenza viral infections with different antigenic subtypes also occur naturally in swine, horses, mink and seals, and in many other domestic species in many parts of the world. Aquatic birds are a natural reservoir and carrier for all inuenza virus subtypes. Interspecies transmission (mainly transitory) and reassortment of inuenza A viruses have been reported among swine, humans and some wild and domestic fowl. Since 1997 inuenza avian infections of the A(H3N1) type have been identied in isolated human groups, with high fatality. Transmission gradually increased among poultry; in the rst half of 2004, poultry outbreaks of inuenza A(H3N1) were occurring in several Asian countries, with transmission to humans in Thailand and Viet Nam. The cases fatality was high in human infections; there are no records of person-to-person transmission. Reservoir—Humans are the primary reservoir for human infec tions; birds and mammalian reservoirs such as swine are likely sources of new human subtypes thought to emerge through genetic reassortment. Mode of transmission—Airborne spread predominates among crowded populations in enclosed spaces; the inuenza virus may persist for hours, particularly in the cold and in low humidity, and transmission may also occur through direct contact. Period of communicability—Probably 3–5 days from clinical onset in adults; up to 7 days in young children. Susceptibility—Size and relative impact of epidemics and pandem ics depend upon level of protective immunity in the population, strain virulence, extent of antigenic variation of new viruses and number of previous infections. Infection produces immunity to the specic antigenic variant of the infecting virus; duration and breadth of immunity depend on the degree of antigenic similarity between viruses causing immunity. Pandemics (emergence of a new subtype): Total population immuno logically naive; children and adults equally susceptible, except for those who have lived through earlier pandemics caused by the same or an antigenically similar subtype. Vaccines produce serological responses specic for the subtype viruses included and elicit booster responses to related strains with which the individual had prior experience. Age-specic attack rates during an epidemic reect persisting immunity from past experience with strains related to the epidemic subtype, so that incidence of infection is often highest in school-age children. Preventive measures: 1) Educate the public and health care personnel in basic personal hygiene, especially transmission via unprotected coughs and sneezes, and from hand to mucous membrane. Inuenza immunization should prefer ably be coupled with immunization against pneumococcal pneumonia (see Pneumonia). A single dose sufces for those with recent exposure to inuenza A and B viruses; 2 doses more than 1 month apart are essential for children under 9. Routine immunization programs should be directed primarily towards those at greatest risk of serious complications or death (see Identi cation) and those who might spread infection (health care personnel and household contacts of high-risk persons). Immunization of children on long-term aspirin treatment is also recommended to prevent development of Reye syn drome after inuenza infection. The vaccine should be given each year before inuenza is expected in the community; timing of immunization should be based on the seasonal patterns of inuenza in different parts of the world (April to September in the southern hemisphere and rainy season in the tropics). Contraindications: Allergic hypersensitivity to egg pro tein or other vaccine components is a contraindication. Subsequent vaccines produced from other virus strains have not been clearly associated with an increased risk of Guillain-Barre. The use of these drugs should be consid ered in nonimmunized persons or groups at high risk of complications, such as residents of institutions or nursing homes for the elderly, when an appropriate vaccine is not available or as a supplement to vaccine when immediate maximal protection is desired against inuenza A infection. The drug will not interfere with the response to inuenza vaccine and should be continued throughout the epidemic. Control of patient, contacts and the immediate environment: 1) Report to local health authority: Reporting outbreaks or laboratory-conrmed cases assists disease surveillance. Re port identity of the infectious agent as determined by laboratory examination if possible, Class 1 (see Reporting). In epidemics, because of increased patient load, it would be desirable to isolate patients (especially infants and young children) believed to have inuenza by placing them in the same room (cohorting) during the initial 5–7 days of illness. Dosages are 5 mg/kg/day in 2 divided doses for ages 1–9, 100 mg twice a day above 9 years (if weight less than 45 kg, 5 mg/kg/day in 2 doses) for 2–5 days. Doses should be reduced for those over 65 or with decreased hepatic or renal function.

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