65-yo patient received a standard-dose flu shot already this season. Should she get the high-dose shot too? Or get a second regular flu shot?

A 65-yo female patient received a standard-dose flu shot already this season. Should he get the high-dose shot too? Or try to get a second regular flu shot?

The simple answer is no. The patients should consider herself immunized. Studies show that getting a delayed second dose doesn't necessarily increase antibody response, and there's some concern that it might actually have a negative effect on the immunity. If you've already had the regular seasonal dose, wait until next year for another dose.

Image of the H1N1 Influenza Virus, CDC.

From CDC's Immunize.org website:

Sometimes patients age 65 years and older who have received the standard-dose influenza vaccine hear about the high-dose product (Fluzone High-Dose, sanofi) and want to receive that, too. Is this okay to administer?

No. ACIP does not recommend that anyone receive more than one dose of influenza vaccine in a season except for certain children age 6 months through 8 years for whom two doses are recommended.

Would giving an older patient 2 doses of standard-dose influenza vaccine be the same as administering the high-dose product?

No, and this is not recommended.


New High-Dose Flu Shot for Older Americans: Answers to Flu Season Questions - AARP http://buff.ly/1ttjluQ

Ask the Experts about Influenza Vaccines - CDC experts answer Q&As; http://buff.ly/1ttjn6e

Fluzone High-Dose Seasonal Influenza Vaccine | Seasonal Influenza (Flu) | CDC http://buff.ly/1ttjnTu

How to get your research published: The BMJ's tips (video)

In this video, the BMJ's research team discuss what they look for in a paper submitted for publication.

They discuss some of the pitfalls authors fall into when writing up their research, and how to present some of the information that all journals will require.

More BMJ-specific info here: http://www.bmj.com/about-bmj/resources-authors

Healthcare social media #HCSM - top articles

Here are my suggestions for some of the top articles related to healthcare social media (#HCSM) in the past 2-4 weeks:

15 Lessons from 15 Years of Blogging: Link to everything you create elsewhere on the web. And if possible, save a copy of it on your own blog. Things disappear so quickly, and even important work can slip your mind months or years later when you want to recall it. If it's in one, definitive place, you'll be glad for it.

Always write with the idea that what you're sharing will live for months and years and decades. Having a long-term perspective in mind is an incredibly effective tool for figuring out whether a topic is meaningful or not, and for encouraging a kinder, more thoughtful perspective.

Your blog can change your life in a month. If you want to understand an idea, or become a meaningful voice on a topic, or change your own thinking about a concept, write a little bit about it every day for a month.


Too many crying babies: a systematic review of pain management practices during immunizations on YouTube http://buff.ly/1j4PHaz

Unprofessional behavior is prevalent among surgical residents who use Facebook (study) http://buff.ly/1j4POCV

Support network: People discussing their weight loss are happier with Twitter (more support, less negativity) than Facebook and in-person relationships http://buff.ly/1j4PUKK

A Facebook teaching forum was set up in a London Hospital for undergraduate medical students: 92% approved http://buff.ly/1j4QacM

Why Wikipedia matters for healthcare: it dominates search results for medical information - BMJ http://buff.ly/1vOMP1Y

YouTube as a source of patient information for lumbar discectomy. http://buff.ly/1qLVd4m

The Anatomy of a Scientific Rumor http://buff.ly/TP1v4K

Email Alerts Services You Should Use http://buff.ly/TP2yBC

Are You Tweeting Your Marriage Away? Time spent on social media can create friction in relationships (study) http://buff.ly/1ooRKmc

Twitter: an opportunity for public health campaigns : The Lancet http://buff.ly/U7drPJ

Do you "like" my photo? Facebook use may increase eating disorder risk http://buff.ly/WqD284

Cleveland Clinic has a blog for patients - Health Hub http://buff.ly/1yHsRtt and a blog for physicians - Consult QD http://buff.ly/1yHsr6g

The articles were selected from Twitter @DrVes and RSS subscriptions. Please feel free to send suggestions for articles to clinicalcases at gmail.com and you will receive an acknowledgement in the next edition of this publication.

Prozac "Revolution in a Capsule" - Retro Report by The New York Times

When Prozac was introduced in 1988, the pill to treat depression launched a cultural revolution that continues to echo. Read the story here: http://nyti.ms/XMXik9

What Causes Bad Breath (Halitosis)?

Halitosis is a generic term used to describe unpleasant odor emanating from the mouth air and breath, independent of the source where the odor substances originate. It affects between 50 and 65% of the population, but despite its frequency, this problem is often unaccepted and declared as taboo.

90% of patients suffering from halitosis have oral causes. A small, but important percentage, of oral malodor cases have an extra-oral etiology, very often falling into the category of "blood-borne halitosis".

Several systemic diseases have been found to provoke malodor or to be a cofactor; bad breath may be an early sign of a serious local or systemic condition.

A psychogenic halitosis also exists including the variant "pseudo-halitosis", when the oral malodor does not exist, but the patient believes he or she is suffering severely from it, and the halitophobia, when, instead, there is an exaggerated fear of having halitosis.

It is important to determine quickly whether the odor comes from an oral cause or not: if so, it requires referral to a dentist; if not (extra-oral origin alone or combined), its management requires the treatment of the underlying causes. Extra-oral disorders can be the cause in up to 15% of cases.

From The WSJ: What really causes bad breath, what can you do to prevent it and can you tell if you have it? WSJ's Heidi Mitchell joins Lunch Break with Tanya Rivero with the answers.


Oral malodour (halitosis) - BMJ 2006 http://1.usa.gov/1sXOO8m
Halitosis: could it be more than mere bad breath? [Intern Emerg Med. 2011] - PubMed - NCBI http://1.usa.gov/1sXOR3U
Image source: Head and neck. Wikipedia, public domain.
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