HIV / AIDS Treatment Guidelines

As a med student in an urban area (and most likely anywhere) you are likely to treat at least one patient with HIV/AIDS. You may even have the opportunity to rotate through a clinic that exclusively treats HIV patients. In all cases you should be familiar with where to look to get a handle on the disease, the epidemic, and the drug regimens used to manage HIV.

For a highly informative overview on the state of the HIV/AIDS epidemic visit the CDCs dedicated site here: www.cdc.gov/hiv

For the latest in treatment guidelines, including pediatrics and adolescents, visit the NIH's AIDS info site here

Lumbar Puncture (LP) Results - Drawing Conclusions from the CSF

Dx	RBCs*	WBCs*	Glucose (mg/dL)	Protein (mg/dL)	Opening Pressure (cm H20)
Normal	<10	<5	~2/3 of serum	15 - 45	10 - 20
Bacterial Meningitis	+/-	↑	↓	↑	↑
Viral Meningitis	+/-	↑	+/-	↑ or +/-	↑ or +/-
Aseptic Meningitis	+/-	↑	+/-	↑ or +/-	+/-
SAH	↑	↑	+/-	↑	↑ or +/-
Guillain-Barre	+/-	+/-	↑ or +/-	↑↑	+/-
MS	+/-	↑ or +/-	+/-	+/-	+/-
Pseudotumor Cerebri	+/-	+/-	+/-	+/-	↑↑↑

*per cubic mm

Neonatal fever - Initial Assessment

• Definition = temperature > 38.0°C or 100.4°F
• All febrile infants up to age 56 days undergo a sepsis workup:
  
• CBC, blood culture
• Urinalysis, urine culture
• Lumbar puncture with cell count, Gram stain, glucose, protein, culture, +/- HSV PCR
• Chest X-ray if respiratory distress
• Age 0-4 wks
• ADMISSION and IV antibiotics, regardless of physical exam, for 48h
• If LP negative: ampicillin, gentamicin, +/- acyclovir
• If LP positive: ampicillin, cefotaxime, +/- acyclovir
• Age 4-8 wks
• If well-appearing with normal exam and unremarkable labs, discharge home with antibiotics and CLOSE PMD FOLLOW-UP
• If ill-appearing, concern based on exam findings, or positive labs*, admit and treat with vancomycin and cefotaxime
  
*Positive labs are defined as:
CBC has WBC > 15,000 or <> 0.2
LP shows CSF pleiocytosis
Urinalysis > 10 WBCs
Positive CXR findings

Resources Beyond PubMed for Research

During my year at Wharton I have had the opportunity to work on various health care projects across multiple sectors, and have needed to look beyond PubMed for data. I have found a few gold mines:

• HCUPnet: Provides access to health statistics and information on hospital inpatient and emergency department utilization. The data includes costs and charges and allows you to search by diagnosis, procedure or ICD-9 code. It is the on-line query system based on data from the Healthcare Cost and Utilization Project (HCUP)

• CMS: Centers for Medicare and Medicaid Services Research, Statistics and Data provides a wealth of information on the Medicare and Medicaid populations as well as reimbursement and health care spending data.

• Health Affairs, The Policy Journal of the Health Sphere: Health Affairs offers excellent reviews with a focus on services, reimbursement, and access to care.

• The Kaiser Family Foundation: Policy and managed care. Excellent source for public health topics.
  

• Investext: from Thomson Research. This resource requires a login, but your school may have access. If so, this is the best source for company information and analyst reports. Public, private, and international companies are covered.
  

AIDS Defining Infections Seen in HIV+ Patients

Taking A Year Out During Medical School - The 5 Year Plan

As the class I entered med school with becomes rising 4th years, an informal poll (and carefully tracked statistics by the administration) reveal that only about half of us will graduate as members of the class of 2009. So what about the other half? Drop outs? Not so much. It has become more and more common to complete med school on the 5 year plan.

Traditionally, an extra year was often taken to do research and improve one's chance of securing a top residency in a competitive field. This is still the most popular reason to delay graduation, but there are other reasons to take a little more time. My fellow classmates are earning 2nd degrees, consulting, traveling etc. Below I have created a mini-guide to get you started if you are just looking for options, or if you have a project in mind but are not quite sure what's out there.

• Research

• American Australian Association - 4 fellowships available per year with a stipend of up to $20,000. More information available here: http://www.americanaustralian.org/Educational/usa-australia.php.

• American Diabetes Association - Stipend $30,000. Application deadline 1/15 annually. More information here http://www.diabetes.org/diabetes-research/research-grant-application-forms/training-awards.jsp#medical.

• The American Heart Association - $21,000.00 stipend per year. Application deadline 1/16 annually. For more information visit http://www.americanheart.org.

• Applied Epidemiology Fellowship at the CDC offers 8 positions to medical students. Application deadline 1/16 annually. For more information visit: http://www.cdcfoundation.org/thecdcexperience.

• Howard Hughes Medical Institute-National Institutes of Health (HHMI-NIH) Research Scholars Program offers two research training programs: one for research conducted at the NIH-Cloister facilities and one for research conducted at any other institution in the United States. Students may apply simultaneously to both programs. Scholars will receive annual compensation of $27,000, health insurance, and other benefits. For more information visit: http://www.hhmi.org/cloister or http://www.hhmi.org/grants/individuals/medfellows.html

• NIH Pre-Doctoral Intramural Research Training Award (IRTA) fellowship - Designed to augment the educational preparation and development of future scientists by supporting a period of research at the NIH. Stipend levels for participants will be determined by the amount of education completed by the candidate at the time the award is activated. More info is available at http://www.training.nih.gov/student/Pre-IRTA/previewinterim.asp.

• NIH The Clinical Research Training Program (CRTP) is a year-long opportunity to do mentored research at the NIH. The stipend is $29,400. Health insurance and moving costs are provided. Deadline 1/15 annually. For more information visit: http://www.training.nih.gov/crtp/index.asp

• Pharmaceutical Research and Manufacturers of America Foundation (PhRMA) Fellowship - full-time research effort within a pharmacology or clinical pharmacology unit. Available for 6 to 24 months with a maximum stipend of $18,000. Deadline 9/1 annually. For more information visit: http://www.phrmafoundation.org/awards/clinical/medstudent.php

• The Stanley J. Sarnoff Fellowship in Cardiovascular Research - Up to 20 fellowships are awarded with a stipend of $27,500 and additional research-related funds. Fore more information visit http://www.sarnofffoundation.org/program/information.cfm.

• Dual Degree Opportunities - For all dual degree programs students must apply separately to both programs.
  

• MD/MBA - Designed for students interested in integrating the study of medicine with training in managerial, financial, and technical expertise in the health care field.Over 50 medical schools now offer combined MD/MBA degrees.

• MD/MPH - Designed for students interested in studying medicine with a special focus on population health problems. The goal of the program is to provide strong interdisciplinary training to individuals interested in clinical practice, prevention, hygiene, education and policy making.

• MD/JD - Just like it sounds. Shave off a year (at most institutions) and get a jump start on becoming a medical litigator or policy maker.
  

• MD/Master of Bioethics program (MD/MBE) - designed to provide its graduates with the interdisciplinary training they will need in order to address the ethical, legal, and social challenges in health care today and in the future.

• Other - Want to travel either in the states or internationally? Check out AMSA's site or the home pages of other medical schools. Also many schools have global health offices that are a great starting point.
  

ACLS Algorithms

Every student should take an advanced cardiac life support (ACLS) class before their sub-internship / externship. Although you may find that by the time you arrive at a code there are already approximately 302934 people there, you should know your algorithms and understand the logic of the person running the code...one day it could be you. Below are links to the ACLS algorithms based on the most recent American Heart Association (AHA) guidelines.

• Adult CPR Algorithm
  
• Bradycardia Algorithm
• Pulseless Arrest Algorithm
• Tachycardia with Pulses Algorithm

NHLBI EPR3: Guidelines for the Diagnosis and Management of Asthma

Below are two pdf. files summarizing the NHLBI EPR3: Guidelines for the Diagnosis and Management of Asthma. These are the current standard of care issued in 2007.

Guidelines for children ages 0 - 4 years old
Guidelines for children ages 5 - 11 years old