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November 10, 2009

EXCLUSIVITY AGREEMENT FOR EMERGENCY SERVICES AND NEONATOLOGY: Dayton Children's maintains an exclusive arrangement with a variety of physician subspecialists.  The board of trustees grants this special arrangement when it is determined that such exclusivity is needed for a variety of clinical, administrative and financial reasons.  When Dayton Children's renegotiates contracts with any of the physician groups, the board must reaffirm that there continues to be a need for such exclusivity.  Discussions concerning renewal of the emergency services and neonatology contract have begun.  The board will be asked to reaffirm that there is a need for an exclusivity arrangement for this service.  Resolutions addressing exclusivity for emergency services and neonatology will be presented to the board at an upcoming meeting for review, discussion and final determination.  If you have any feedback or thoughts regarding exclusivity for emergency services and neonatology, please contact Bob Meyers, DO, at 937-438-1115 or Renae Phillips, RN, at 937-641-3610.

INFLUENZA UPDATE: Over the last 10 days, we have seen a significant decrease in the number of children that have presented to our emergency department and urgent care center for symptoms of influenza-like illness. Cindy Burger recently summarized some of the data for the emergency department. During the month of October, the emergency department volume was 6,749 patients with an additional 1,485 seen at the on-site urgent care center. This exceeded the October 2008 numbers by 43 percent. Conversations with many of you have indicated similar surges in your practices. For the past six days, our numbers have dropped below 300. These numbers are closer to early to mid-September of 2009, before the surge occurred.

Vaccine distribution
Nationally, Louisiana is the only one of the continental states not reporting “widespread” flu.  Vaccine delivery has increased with 983,500 total doses delivered to Ohio from the distribution centers as of November 4, 2009. To date, we have administered approximately 1,000 doses of vaccine to pregnant employees, health care workers providing direct care to patients, our day care center staff and children, and approximately 75 children from the health clinic who are between 2 and 5 years of age (intranasal vaccine). The local health departments have each used a different strategy, but have also been very visible delivering vaccine. Of note, vaccine is available for health care providers, but you might have to go to one of the sites (such as UD last Thursday, or the Drew Center in late October). These sites change weekly, so it is important to check local websites often. Finally, the Public Health Department of Montgomery County is entering the third week of vaccine delivery in the schools; to date at least 57 schools have been visited and students immunized. I was in Florida last week, and while they have received 1.5 million doses of vaccine, it is much more difficult to find.

We continue to have sufficient supplies of Tamiflu suspension on hand to treat those individuals who meet the criteria outlined by the CDC. Remember that most pharmacies can convert the capsules to suspension if they desire. You can also mix the capsules with food. The CDC website describes the process for the latter in detail. Interestingly, the controversy over the use of the N-95 respirators continues. A Cleveland paper announced late last week that ODH had reversed its stand on the use of the N-95s, we are reviewing the letter from ODH. It is very important to assure your staff that engineering controls including hand washing, isolation of patients with influenza-like illness and use of surgical masks in the absence of the N-95 are all effective means of mitigating the risk of exposure to H1N1. Final comment: While this wave may be subsiding, it may not be the end of H1N1 this year, so please encourage your staff and patients to be immunized.


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