Administration Recommendations Research Articles

Magnetic Resonance Imaging Screening after Silicone Implant Breast Surgery: Patient Survey of Adherence to U.S. Food and Drug Administration Recommendations.

The U.S. Food and Drug Administration recommends women with silicone breast implants undergo magnetic resonance imaging surveillance to detect asymptomatic rupture. Screening is costly and often not covered by insurance. The authors assessed awareness of and adherence to these recommendations among patients with silicone breast implants. The authors searched electronic medical records for patients aged 18 years or older with silicone breast implants placed between 2011 and 2016. Consenting patients were surveyed by telephone using a standardized script to assess awareness of U.S. Food and Drug Administration recommendations, whether they had undergone magnetic resonance imaging screening, and barriers to testing. Patients who declined to participate or could not be contacted were excluded. Demographics and operative data were collected. Odds ratios were calculated with one-sample 95 percent confidence intervals, and Fisher exact tests of independence were conducted under assumptions of normality. Multivariable logistic regression analysis was performed to test for confounding. Of 370 patients meeting inclusion criteria, 109 consented to participate. Adherence to U.S. Food and Drug Administration recommendations was 5.9 percent (95 percent CI, 0.15 to 28.7 percent). There was no difference in adherence between patients undergoing cosmetic versus reconstructive surgery ( p = 1.00; OR, 0.80; 95 percent CI, 1.17 to 2.93), having health insurance ( p = 0.58), or residing in a county with median annual household income greater than that of the state of residence ( p = 0.33). A small proportion of respondents had undergone magnetic resonance imaging in accordance with U.S. Food and Drug Administration recommendations. Low adherence highlights a potential limitation of current federal surveillance recommendations. Additional research is needed to better characterize adherence to magnetic resonance imaging surveillance recommendations, identify barriers to implementation, and determine whether this recommendation remains valid.

Development and content validation of patient-reported outcomes tools for ulcerative colitis and Crohn’s disease in adults with moderate-to-severe disease

BackgroundUlcerative colitis (UC) and Crohn’s disease (CD) are associated with a range of symptoms that adversely affect health-related quality of life. This research aimed to develop and validate two patient-reported outcome (PRO) tools to assess signs and symptoms in patients with moderate-to-severe UC or CD.MethodsPRO-UC and PRO-CD Diaries were developed in accordance with US Food and Drug Administration (FDA) recommendations. Data were collected from concept elicitation interviews (in which patients described their symptoms and experience of the disease) and further refined through cognitive interviews (in which patients assessed the relevance and clarity of questions in the tools).ResultsInterviews were conducted with 12 patients for each indication. Five symptoms (urgent bowel movements, abdominal pain, frequent bowel movements, bloody stools, diarrhea/watery stools) were reported by 83–100% of participants with UC and were included in the final 6-item PRO-UC Diary: stool frequency, rectal bleeding (2 items), diarrhea, rectal urgency, and abdominal pain. For CD, seven symptoms (abdominal pain, diarrhea/loose stools, urgent bowel movements, fatigue/tiredness/weakness, frequent bowel movements, bloody stools, nausea) were reported by 50–100% of participants. These, together with vomiting and incontinence (reported by 42% and 33% of participants, respectively), were included in the final 10-item PRO-CD Diary, covering abdominal pain (2 items), stool frequency, liquid/very soft stool frequency, rectal bleeding, rectal urgency, nausea, vomiting, bowel incontinence, and general well-being. Symptoms were consistently cited across both indications to have an impact on quality of life, with frequent complaints being the need to always be near a toilet and inability to leave home, as well as general pain, discomfort, and nausea. For both tools, questions were accurately interpreted, with at least 67% of participants in both indications stating that items were easy to answer/relevant to their condition and symptoms were easy to recall over the last 24 h.ConclusionsBoth the PRO-UC and PRO-CD Diaries were developed and validated in accordance with FDA recommendations, providing two new tools for use in clinical trials to assess response to treatment in patients with UC or CD. Psychometric analyses are warranted to fully evaluate their properties and value for use in clinical trials.

Impact of pre-emptive rapid testing for glucose-6-phosphate dehydrogenase deficiency prior to rasburicase administration at a tertiary care centre: A retrospective study.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency, the most common enzymopathy in humans, can cause acute haemolysis resulting from exposure to certain medications, chemicals, infections and fava beans. Rasburicase, used to manage elevated uric acid levels in the oncologic emergency of tumour lysis syndrome, is one such drug. The US Food and Drug Administration (FDA) recommends testing of G6PD status prior to rasburicase administration for patients at higher risk for G6PD deficiency. We performed a retrospective chart review of all oncology patients for whom a semi-quantitative biochemical test for detecting G6PD deficiency was performed prior to rasburicase administration over a 2.5-year period, in a large academic metropolitan hospital. We identified 16 out of 260 tested individuals as G6PD-deficient (6.1%), including six females. On average, test results were electronically available to health care providers within 4hours of sample collection, with most results available within 2-3hours. Four G6PD-deficient patients developed elevated uric acid levels. Two of the G6PD-deficient patients were treated with rasburicase, and subsequently developed haemolysis, which was appropriately managed. In summary, by providing information about G6PD status with a rapid turnaround time, we have taken a significant step towards personalized medicine in our institution. In spite of the test implementation, two out of four G6PD-deficient patients, who were no longer candidates for rasburicase use, still received the drug, highlighting the need for improved provider education.

Pulmonary Procedures During the COVID-19 Pandemic: A Work Group Report of the AAAAI Asthma Diagnosis and Treatment (ADT) Interest Section

The COVID-19 pandemic has placed increased demands on the ability to safely perform pulmonary procedures in keeping with Centers for Disease Control and Prevention (CDC), American Thoracic Society (ATS), and the Occupational Safety and Health Administration (OSHA) recommendations. Accordingly, the American Academy of Allergy, Asthma & Immunology (AAAAI) Asthma Diagnosis and Treatment convened this work group to offer guidance. The work group is composed of specialist practitioners from academic and both large and small practices. Individuals with special expertise were assigned sections on spirometry, fractional exhaled nitric oxide, nebulized treatments, and methacholine challenge. The work group met periodically to achieve consensus. This resulting document has recommendations for the allergy/asthma/immunology health care setting based on available evidence including reference documents from the CDC, ATS, and OSHA.

Modern developments in germline pharmacogenomics for oncology prescribing.

The integration of genomic data into personalized treatment planning has revolutionized oncology care. Despite this, patients with cancer remain vulnerable to high rates of adverse drug events and medication inefficacy, affecting prognosis and quality of life. Pharmacogenomics is a field seeking to identify germline genetic variants that contribute to an individual's unique drug response. Although there is widespread integration of genomic information in oncology, somatic platforms, rather than germline biomarkers, have dominated the attention of cancer providers. Patients with cancer potentially stand to benefit from improved integration of both somatic and germline genomic information, especially because the latter may complement treatment planning by informing toxicity risk for drugs with treatment-limiting tolerabilities and narrow therapeutic indices. Although certain germline pharmacogenes, such as TPMT, UGT1A1, and DPYD, have been recognized for decades, recent attention has illuminated modern potential dosing implications for a whole new set of anticancer agents, including targeted therapies and antibody-drug conjugates, as well as the discovery of additional genetic variants and newly relevant pharmacogenes. Some of this information has risen to the level of directing clinical action, with US Food and Drug Administration label guidance and recommendations by international societies and governing bodies. This review is focused on key new pharmacogenomic evidence and oncology-specific dosing recommendations. Personalized oncology care through integrated pharmacogenomics represents a unique multidisciplinary collaboration between oncologists, laboratory science, bioinformatics, pharmacists, clinical pharmacologists, and genetic counselors, among others. The authors posit that expanded consideration of germline genetic information can further transform the safe and effective practice of oncology in 2022 and beyond.

Chickensplash! Exploring the health concerns of washing raw chicken.

The Food and Drug Administration recommends against washing raw chicken due to the risk of transferring dangerous food-borne pathogens through splashed drops of water. Many cooks continue to wash raw chicken despite this warning, however, and there is a lack of scientific research assessing the extent of microbial transmission in splashed droplets. Here, we use large agar plates to confirm that bacteria can be transferred from the surface of raw chicken through splashing. We also identify and create a phylogenetic tree of the bacteria present on the chicken and the bacteria transferred during splashing. While no food-borne pathogens were identified, we note that organisms in the same genera as pathogens were transferred from the chicken surface through these droplets. Additionally, we show that faucet height, flow type, and surface stiffness play a role in splash height and distance. Using high-speed imaging to explore splashing causes, we find that increasing faucet height leads to a flow instability that can increase splashing. Furthermore, splashing from soft materials such as chicken can create a divot in the surface, leading to splashing under flow conditions that would not splash on a curved, hard surface. Thus, we conclude that washing raw chicken does risk pathogen transfer and cross-contamination through droplet ejection, and that changing washing conditions can increase or decrease the risk of splashing.

The drug liking and craving questionnaire (DLCQ) to evaluate addiction risk for ketamine and esketamine

Ketamine and esketamine (SPRAVATO) are rapid acting antidepressants that have gained evidence and popularity in recent years in treating depression, and are under investigation for other psychiatric indications. Ketamine is a potential drug of abuse and the addiction potential of these medications has been repeatedly cautioned in the psychiatric literature. However, no studies have included a systematic evaluation of addiction potential in their research so risk of this harm remains theoretically and has not been quantified to place in properly in a risk/benefit perspective. There is currently no easily accessible and ready to use tool for this purpose, which poses a barrier to including measures of addiction potential in ketamine and esketamine research. Based on review of the literature and a recently suggested comprehensive Ketamine Side Effect Tool (KSET), as well as the United States Food and Drug Administration recommendations for evaluation addictive potential of a drug, we created a simple, patient rated visual analog scale specifically for assessing ketamine/esketamine drug likeability, cravings and temptation to misuse. While this scale is not validated, in the absence of other accessible tools, use of this questionnaire would provide researchers and clinicians a simple and easy to use tool to begin monitoring addictive potential in patients taking ketamine or esketamine, and better inform future research, clinical practice and publicy policy regarding these substances. • Ketamine and Esketamine are rapid acting antidepressants thought to have potential for abuse or misuse, but this has not been studied in clinical trials. • There is need for a simple tool to screen for predictors of addictive potential of ketamine and esketamine in psychiatric practice and research use in clinical ketamine/esketamine programs or associated clinical research. • Based on United States Food and Drug Administration recommendation to screen for drug likeability using a visual analog scale, a simple questionnaire was developed and is shared.

2021-2022 AMMI Canada guidance on the use of antiviral drugs for influenza in the COVID-19 pandemic setting in Canada.

We provide an update to the Association of Medical Microbiology and Infectious Disease Canada seasonal influenza foundation guideline on the use of antiviral drugs for influenza for the upcoming 2021-2022 influenza season in Canada. Peramivir and baloxavir marboxil were licensed in Canada in 2017 and 2020, respectively, but neither is currently marketed. Thus, this guidance continues to focus on further optimizing the use of oseltamivir and zanamivir. Important issues for this year include the implications of co-circulation of severe acute respiratory syndrome coronavirus 2 and influenza viruses; the role of diagnostic testing in relation to impact on patient management; and dosing and administration recommendations for neuraminidase inhibitors for various at-risk age groups.

A Multidisciplinary Educational Approach to Anticoagulation Management for a Percutaneous Endovascular Mechanical Circulatory Support Device.

Anticoagulation (AC) management of the Impella varies considerably among treatment centers. Published data regarding the management of complications including heparin-induced thrombocytopenia, bleeding and thrombosis are limited. A multidisciplinary team was assembled to 1) identify baseline knowledge of nurses and pharmacists involved in Impella anticoagulation management; 2) develop an educational tool specific to Impella anticoagulation; 3) reassess knowledge following implementation of the tool. A team consisting of pharmacists, nurses and a physician developed surveys that were subsequently distributed to 28 nurses and 17 pharmacists. Survey questions measured knowledge in 4 areas of anticoagulation management: product selection, administration, monitoring and therapeutic recommendation. A pocket card containing flow diagrams for Impella anticoagulation management was developed. Following distribution of the card and education on its application, surveys were redistributed to measure the change in knowledge. The frequency (%) of correct answers for all survey questions for both pharmacists and nurses significantly increased from 38% to 84% (p < 0.00001) and 63% to 93% (p < 0.00001), respectively. Substantial increases in the frequency of correct answers in the majority of question categories were observed for both pharmacists and nurses postintervention. Using a multidisciplinary approach, an institution-specific pocket card addressing the complexities of Impella anticoagulation was developed. Following dissemination of the card and education on its application, improved knowledge across the scope of Impella anticoagulation management was observed in both pharmacists and nurses.

Identification and Determination of 1,3-Thiazinane-4-carboxylic Acid in Human Urine-Chromatographic Studies.

It is well established that homocysteine (Hcy) and its thiolactone (HTL) are reactive towards aldehydes in an aqueous environment, forming substituted thiazinane carboxylic acids. This report provides evidence that Hcy/HTL and formaldehyde (FA) adduct, namely 1,3-thiazinane-4-carboxylic acid (TCA) is formed in vivo in humans. In order to provide definitive proof, a gas chromatography–mass spectrometry (GC–MS) based method was elaborated to identify and quantify TCA in human urine. The GC–MS assay involves chemical derivatization with isobutyl chloroformate (IBCF) in the presence of pyridine as a catalyst, followed by an ethyl acetate extraction of the obtained isobutyl derivative of TCA (TCA-IBCF). The validity of the method has been demonstrated based upon United States Food and Drug Administration recommendations. The assay linearity was observed within a 1–50 µmol L−1 range for TCA in urine, while the lowest concentration on the calibration curve was recognized as the limit of quantification (LOQ). Importantly, the method was successfully applied to urine samples delivered by apparently healthy volunteers (n = 15). The GC–MS assay may provide a new analytical tool for routine clinical analysis of the role of TCA in living systems in the near future.

АҲОЛИ ДАРОМАДЛАРИНИ ОШИРИШ, КАМБАҒАЛЛИКНИ ҚИСҚАРТИРИШНИНГ АНИҚ МЕХАНИЗМЛАРИ

This article describes the role of increasing the income of the population, improving the mechanism of increasing incomes in poverty reduction, increasing the entrepreneurial activity of the population and improving the business environment. Effective coordination of the activities of public administration bodies, non-governmental organizations, proposals and recommendations on the development of criteria for determining the level of poverty and assessment methods, the normative framework of minimum standards of social security and poverty reduction.

Matching-Adjusted Indirect Comparison of Crisaborole Ointment 2% vs. Topical Calcineurin Inhibitors in the Treatment of Patients with Mild-to-Moderate Atopic Dermatitis

IntroductionCrisaborole topical ointment, 2%, is a nonsteroidal, topical anti-inflammatory phosphodiesterase-4 (PDE4) inhibitor that is approved for the treatment of mild-to-moderate atopic dermatitis (AD). The objective of the current analysis was to compare the efficacy of crisaborole 2% relative to pimecrolimus 1%, tacrolimus 0.03% and tacrolimus 0.1% in patients aged ≥ 2 years with mild-to-moderate AD by comparing improvement in Investigator’s Static Global Assessment scores ( (ISGA scores of 0/1 indicating “clear or almost clear”). ISGA was selected as the primary efficacy outcome given the US Food and Drug Administration’s recommendations on the use of ISGA for assessment of global severity in AD and to align with efficacy measurements in the crisaborole registration trials. Safety endpoints could not be analyzed due to differences in outcome definitions across studies.MethodsEfficacy of crisaborole was evaluated using individual patient data (IPD) from two pivotal phase III randomized controlled trials (RCTs), and efficacy of comparators was evaluated using published RCTs included in a previous network meta-analysis. Vehicle controls were not comparable due to differences in ingredients and population imbalance and, therefore, an unanchored matching-adjusted indirect comparison (MAIC) was used, which reweighted IPD for crisaborole to estimate absolute response in comparator populations.ResultsThe odds of achieving an improvement in ISGA score was higher with crisaborole 2% versus pimecrolimus 1% (odds ratio [OR] 2.03; 95% confidence interval [CI] 1.45–2.85; effective sample size = 627, reduced from 1021; p value < 0.001) and for crisaborole 2% versus tacrolimus 0.03% (OR 1.50; 95% CI 1.09–2.05; effective sample size = 311, reduced from 1021; p = 0.012).ConclusionThe unanchored MAIC suggests that the odds of achieving an improvement in ISGA score is greater with crisaborole 2% than with pimecrolimus 1% or tacrolimus 0.03% in patients aged ≥ 2 years with mild-to-moderate AD. These results are consistent with findings from the previously published network meta-analysis, which used a different methodology for performing indirect treatment comparisons.Supplementary InformationThe online version contains supplementary material available at 10.1007/s13555-021-00646-1.

The Minimal Clinically Important Difference: A Review of Clinical Significance

Background: The minimal clinically important difference (MCID) is a term synonymous with orthopaedic clinical research over the past decade. The term represents the smallest change in a patient-reported outcome measure that is of genuine clinical value to patients. It has been derived in a myriad of ways in existing orthopaedic literature. Purpose: To describe the various modalities for deriving the MCID. Study Design: Narrative review; Level of evidence, 4. Methods: The definitions of common MCID determinations were first identified. These were then evaluated by their clinical and statistical merits and limitations. Results: There are 3 primary ways for determining the MCID: anchor-based analysis, distribution-based analysis, and sensitivity- and specificity-based analysis. Each has unique strengths and weaknesses with respect to its ability to evaluate the patient’s clinical status change from baseline to posttreatment. Anchor-based analyses are inherently tied to clinical status yet lack standardization. Distribution-based analyses are the opposite, with strong foundations in statistics, yet they fail to adequately address the clinical status change. Sensitivity and specificity analyses offer a compromise of the other methodologies but still rely on a somewhat arbitrarily defined global transition question. Conclusion: This current concepts review demonstrates the need for (1) better standardization in the establishment of MCIDs for orthopaedic patient-reported outcome measures and (2) better study design—namely, until a universally accepted MCID derivation exists, studies attempting to derive the MCID should utilize the anchor-based within-cohort design based on Food and Drug Administration recommendations. Ideally, large studies reporting the MCID as an outcome will also derive the value for their populations. It is important to consider that there may be reasonable replacements for current derivations of the MCID. As such, future research should consider an alternative threshold score with a more universal method of derivation.

Understanding and addressing racial stress and trauma in schools: A pathway toward resistance and healing

AbstractYouth of color are disproportionately impacted by stressful and traumatic life events, including race‐based experiences, which are linked to negative consequences. School is a salient context where youth encounter, witness, and process racial stress and trauma (RST). However, RST is often overlooked within general school‐based trauma models. Thus, we propose the School Trauma and Racial Stress (STARS) blueprint, focused on RST across three levels of the school ecology. By building upon and expanding the Substance Abuse and Mental Health Services Administration recommendations regarding trauma‐informed approaches (2014), the STARS blueprint applies a multilevel approach to acknowledging and addressing RST within schools. This integrated framework is a call to action across the school ecology, with the goal to increase recognition of RST within school‐based trauma‐informed approaches and to build racial equity and healing for students of color in K‐12 schools. Practical applications for schools are discussed.

Graduate training and provider concerns about distress and comprehension in PTSD treatment choice: A mediation analysis.

The Veterans Health Administration (VHA) recommends that patients with posttraumatic stress disorder (PTSD) receive either of the 2 frontline evidence-based psychotherapies, cognitive processing therapy (CPT) and prolonged exposure (PE). However, VHA providers have reported low use of these treatments, and voiced their concerns over exposing patients to distress in PE and their patients not understanding CPT. In the current study, we surveyed VHA providers (N = 225) in PTSD clinical teams across the United States on their graduate school training experience in structured cognitive-behavioral therapy protocols, agreement with the 2 provider concerns, and use of the 2 treatments. Results from our mediation analyses indicated that graduate school training in structured protocols led to lower discomfort of exposing patients to distress during PE, and in turn, greater PE utilization. However, there was no significant relationship between graduate school training and CPT utilization. Findings suggest an important role for graduate training in the uptake of guideline recommended treatment for PTSD at VHA. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Pediatric Poisoning Fatalities: Beyond Cough and Cold Medications.

* Abbreviations: CCM — : cough and cold medication NPDS — : National Poison Data System For more than 10 years, there have been Food and Drug Administration recommendations and manufacturer labeling changes in place advising against the use of cough and cold medications (CCMs) in young children.1,2 In this issue of Pediatrics , Halmo et al3 present concerning findings characterizing fatalities associated with CCMs in recent years. Identifying cases through the Pediatric Cough and Cold Safety Surveillance System and then using an expert panel for review, the authors report 40 CCM-related fatalities in children under 12 years old that occurred from 2008 to 2016. Although overall fatalities associated with CCMs were rare, they found that most fatalities were in children <2 years old and were of nontherapeutic intent, with more than one-half of nontherapeutic intent cases determined to be malicious in nature. Diphenhydramine, a commonly used antihistamine, was found to be the index-ingredient most often involved in CCM-related fatalities. This important fatality review demonstrates that despite safety efforts, young children remain at risk for death from CCMs. The strengths of the study include the use of a cough-and-cold–specific safety surveillance system that includes data from several national sources and data collection that covered several years after advisory and labeling changes. The surveillance system was limited, however, by self-report and potential misclassification of cases as well as inconsistencies in detailed case information. Autopsy reports were also reviewed, but reports were only available in 55% of cases.3 Therefore, the expert panel could not determine the contributory factors that led to the child’s death in almost one-half of fatalities. Thus, these limitations likely … Address correspondence to Michele M. Burns, MD, MPH, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115. E-mail: michele.burns{at}childrens.harvard.edu

Should Estimated Glomerular Filtration Rate Be Adjusted for Race?

Should Estimated Glomerular Filtration Rate Be Adjusted for Race?

Mycobacterium chimaera infections among cardiothoracic surgery patients associated with heater-cooler devices-Kansas and California, 2019.

In 2015, an international outbreak of Mycobacterium chimaera infections among patients undergoing cardiothoracic surgeries was associated with exposure to contaminated LivaNova 3T heater-cooler devices (HCDs). From June 2017 to October 2020, the Centers for Disease Control and Prevention was notified of 18 patients with M. chimaera infections who had undergone cardiothoracic surgeries at 2 hospitals in Kansas (14 patients) and California (4 patients); 17 had exposure to 3T HCDs. Whole-genome sequencing of the clinical and environmental isolates matched the global outbreak strain identified in 2015. Investigations were conducted at each hospital to determine the cause of ongoing infections. Investigative methods included query of microbiologic records to identify additional cases, medical chart review, observations of operating room setup, HCD use and maintenance practices, and collection of HCD and environmental samples. Onsite observations identified deviations in the positioning and maintenance of the 3T HCDs from the US Food and Drug Administration (FDA) recommendations and the manufacturer's updated cleaning and disinfection protocols. Additionally, most 3T HCDs had not undergone the recommended vacuum and sealing upgrades by the manufacturer to decrease the dispersal of M. chimaera-containing aerosols into the operating room, despite hospital requests to the manufacturer. These findings highlight the need for continued awareness of the risk of M. chimaera infections associated with 3T HCDs, even if the devices are newly manufactured. Hospitals should maintain vigilance in adhering to FDA recommendations and the manufacturer's protocols and in identifying patients with potential M. chimaera infections with exposure to these devices.

Static magnetic field measurements of smart phones and watches and applicability to triggering magnet modes in implantable pacemakers and implantable cardioverter-defibrillators

Implantable pacemakers and implantable cardioverter-defibrillators (ICDs) are designed to include a "magnet mode" feature that can be activated from magnets stronger than 10 G. This feature is designed to be used when a patient is undergoing a procedure where electromagnetic interference is possible, or anytime suspension of tachycardia detection and therapy is needed. A publication in Heart Rhythm demonstrates an iPhone 12 triggering the magnet mode of a Medtronic ICD. The purpose of this study is to determine the separation distance between consumer electronic devices that may create magnetic interference, including cell phones and smart watches, and implantable pacemakers and ICDs where magnet mode can be triggered. The static magnetic fields of the iPhone 12 models and Apple Watch were measured at several planes in 1 cm resolution using an FW Bell 5180 Gauss Meter with STD18-0404 Transverse probe (unidirectional probe). All iPhone 12 and Apple Watch 6 models tested have static magnetic fields significantly greater than 10 G in close proximity (1-11 mm), which attenuates to below 10 G between 11 and 20 mm. The findings of this study support the US Food and Drug Administration recommendation that patients keep any consumer electronic devices that may create magnetic interference, including cell phones and smart watches, at least 6 inches away from implanted medical devices, in particular pacemakers and cardiac defibrillators.

Improving adherence to hepatitis B vaccine administration recommendations in two newborn nurseries

Administration of the birth dose of hepatitis B vaccine is an important step in reducing perinatally acquired hepatitis B infection, yet the USA is below the Healthy People 2020 goal...