Vegan proteins may reduce risk of cancer medicine 3202 order 150 mg trileptal with visa, obesity medications you cant take with grapefruit order 150 mg trileptal free shipping, and cardiovascular disease by promoting increased glucagon activity symptoms 1 week before period trileptal 150mg visa. Do soy isoflavones lower cholesterol symptoms diabetes type 2 buy trileptal with visa, inhibit atherosclerosis, and play a role in cancer prevention Dietary phytoestrogens and their effect on bone: evidence from in vitro and in vivo, human observational, and dietary intervention studies. Soybean products and reduction of breast cancer risk: a case-control study in Japan. A prospective study of vegetarianism and isoflavone intake in relation to breast cancer risk in British women. Association between soy isoflavone intake and breast cancer risk for pre and post-menopausal women: a meta-analysis of epidemiological studies. Plasma isoflavone level and subsequent risk of breast cancer among Japanese women: a nested case-controlstudy from the Japan Public Health Center-based prospective study group. Post-diagnosis soy food intake and breast cancer survival: a meta-analysis of cohort studies. Soy intake and breast cancer risk: an evaluation based on a systematic review of epidemiologic evidence among the Japanese population. Soyfood intake and breast cancer survival: a followup of the Shanghai Breast Cancer Study. Positive effects of soy isoflavone food on survival of breast cancer patients in China. Effects of soy isoflavones on estrogen and phytoestrogen metabolism in premenopausal women. Serum insulin-like growth factor-I levels among women in Hawaii and Japan with different levels of tofu intake. The effects of soy supplementation on gene expression in breast cancer: a randomized placebo-controlled study. Serum 25-hydroxyvitamin D and risk of post-menopausal breast cancer-results of a large case-control study. Plasma vitamin D levels, menopause, and risk of breast cancer: dose-response meta-analysis of prospective studies. Vitamin D intake, vitamin D receptor polymorphisms, and breast cancer risk among women living in the southwestern U. Vitamin D status at breast cancer diagnosis: correlation with tumor characteristics, disease outcome, and genetic determinants of vitamin D insufficiency. Meta-analysis of vitamin D sufficiency for improving survival of patients with breast cancer. Circulating 25-hydroxyvitamin D and postmenopausal breast cancer survival: Influence of tumor characteristics and lifestyle factors Serum 25-hydroxyvitamin D levels and survival in colorectal and breast cancer patients: systematic review and meta-analysis of prospective cohort studies. Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes. Correlation between the onset of tumors and alterations in blood melatonin levels] [Article in Italian] Prof Inferm. Effect of melatonin on tumor growth and angiogenesis in xenograft model of breast cancer. Melatonin decreases cell proliferation and transformation in a melatonin receptor dependent manner. Decreased toxicity and increased efficacy of cancer chemotherapy using the pineal hormone melatonin in metastatic solid tumor patients with poor clinical status. Melatonin suppresses aromatase expression and activity in breast cancer associated fibroblasts. Melatonin, an endogenous-specific inhibitor of estrogen receptor alpha via calmodulin. Czeczuga-Semeniuk E, Wolczynski S, Anchim T, Dzieciol J, Dabrowska M, Pietruczuk M. Combined effects of melatonin and all-trans retinoic acid and somatostatin on breast cancer cell proliferation and death: molecular basis for the anticancer effect of these molecules. Dietary Reference Intakes for Calcium, Phosphorous, Magnesium, Vitamin D, and Fluoride. Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board. Weight gain is associated with increased risk of hot flashes in breast cancer survivors on aromatase inhibitors. With that diagnosis, your life has changed and the days ahead will bring more changes and challenges. The doctors, nurses and other experienced health professionals at the University of Michigan Breast Care Center created this handbook to help explain the different surgical treatment options available to you as well as explain how to prepare for surgery and what to expect after surgery. Your medical team is available to help answer questions about this material and to help you decide which treatment options are right for you and give you the best chances of controlling your cancer. Remember that medical knowledge concerning breast cancer treatment options is always advancing, so we will update you on the newest treatment options available. Because of advances in breast cancer detection and management, most patients will be treated successfully! As you have just received a cancer diagnosis and are reading through this handbook, you’re likely feeling overwhelmed. If so, you’re not alone – most patients and family members feel that way as they are introduced to the new concepts, tools, techniques and resources involved in cancer treatment. The information in this handbook will be reviewed and discussed throughout your treatment. You will find blank pages at the back of the handbook to use for questions, appointments or other notes. Through the portal you may securely access health information anywhere, at any time. With the portal you can message your care team, request appointments and prescription refills, pay your bill and more. Each patient receives the benefit of input from several experts in breast cancer care. Most patients with invasive breast cancer who are candidates for surgery will be scheduled for an initial full-day Monday clinic visit. We encourage you to bring one support person, be it a spouse, significant other, relative or close friend. In the morning, you will undergo a complete clinical evaluation (history and physical examination) as well as breast imaging consultation (which often involves repeat/updated mammography and/or breast ultrasound). In the afternoon, you’ll return to the clinic rooms where you will meet with one or more breast specialists to finalize your management plan. We know this is a busy day, but it does cut down on multiple visits to consult with different specialists who are involved with your treatment plan. In addition, it ensures that all members of the treatment team are working in a coordinated way. If you require evaluation for cancer genetic profiling, you will need to schedule a separate consultation appointment with the breast oncology medical genetics specialists. Your treatment team will discuss whether this genetic profiling information is recommended for your care. Many breast cancer patients receive multimodality care (surgery, medical treatment/chemotherapy, radiation) and often the results of one component of care will influence the plan for the subsequent type of care. Follow-up evaluations usually involve shorter visits, depending upon the complexity of your individual case. While discussing many aspects of multidisciplinary breast cancer treatment, this guide focuses on the surgical component of your care. Your breast surgery may be performed at University Hospital, East Ann Arbor Ambulatory Surgical Unit or at some other surgical facility within the University of Michigan Health System. Where your surgery is performed will depend upon the resources that are necessary for your particular operation and surgical suite availability. Some procedures require the combined services of a surgical breast oncologist, breast radiologist and/or the plastic/reconstruction surgeon. Some operations involve the use of pathology assessments during the surgery itself.
Endobronchial valves for intensive care medications list form purchase 300mg trileptal with mastercard, emergency and hospital admissions in patients emphysema without interlobar collateral ventilation treatment yeast in urine generic trileptal 150mg with amex. It is often caused by exposure to symptoms lyme disease discount 600 mg trileptal with visa toxic chemicals or long-term exposure to 4 medications walgreens buy trileptal australia tobacco smoke. Emphysema is characterized by loss of elasticity (increased compliance) of the lung tissue, from destruction of structures supporting the alveoli, and destruction of capillaries feeding the alveoli, due to the action of alpha 1 antitrypsin deficiency. Thus the small airways collapse during exhalation, as alveolar collapsibility has increased. This impedes airflow and traps air in the lungs, as with other obstructive lung diseases. Symptoms include shortness of breath on exertion and later at rest, hyperventilation, and an expanded chest. Mild emphysema sufferers often maintain perfect blood oxygen levels by hyperventilating, and so are sometimes called "pink puffers". Signs of emphysema include pursed-lipped breathing, central cyanosis and finger clubbing. The chest has increased percussion notes, particularly just above the liver, and a difficult to palpate apex beat, both due to hyperinflation. In advanced disease, there are signs of fluid overload such as pitting peripheral edema. It is unlike the fine crackles of pulmonary fibrosis or coarse crackles of mucus or oedematous fluid. Diagnosis Diagnosis is by spirometry (lung function testing), including diffusion testing. Pathophysiology In normal breathing, air is drawn in through the bronchial passages and down into the increasingly fine network of tubing in the lungs called the alveoli, which are many millions of tiny sacs surrounded by capillaries. When toxins such as smoke are breathed into the lungs, the particles are trapped and cause a localized inflammatory response. As the process proceeds, thoracic cage expansion (barrel chest) and diaphragm contraction (flattening) occur to enhance inspiratory reexpansion/ ventilation of the residual partially collapsed healthy parenchyma. Moreover, expiration increasingly depends on the thoracic cage and abdominal muscle action, particularly in the end expiratory phase, instead that on the physiological elastic lung recoil, thus triggering the bronchial obstruction. Mainly decreased is the ability to exude carbon dioxide due to ventilation deficit and, in the more serious cases, oxygen uptake is also impaired. The activity of another molecule called alpha 1-antitrypsin normally neutralizes the destructive action of one of these damaging molecules. After a prolonged period, hyperventilation becomes inadequate to maintain high enough oxygen levels in the blood. This leads to pulmonary hypertension, which places increased strain on the right side of the heart, the one that pumps deoxygenated blood to the lungs, and it often fails. Eventually, as the heart continues to fail, it becomes larger and blood backs up in the liver. Studies for the better part of the past century have focused mainly upon the putative role of leukocyte elastase (also neutrophil elastase), a serine protease found in neutrophils, as a primary contributor to the connective tissue damage seen in the disease. However, more recent studies have brought into light the possibility that one of the many other numerous proteases, especially matrix metalloproteases might be equally or more relevant than neutrophil elastase in the development of non hereditary emphysema. The better part of the past few decades of research into the pathogenesis of emphysema involved animal experiments where various proteases were instilled into the trachea of various species of animals. These animals developed connective tissue damage, which was taken as support for the protease-antiprotease theory. More recent experiments have focused on more technologically advanced approaches, such as ones involving genetic manipulation. Perhaps the most interesting development with respect to our understanding of the disease involves the production of protease "knock-out" animals, which are genetically deficient in one or more proteases, and the assessment of whether they would be less susceptible to the development of the disease. The most important measure to slow progression is for the patient to stop smoking and avoid all exposure to cigarette smoke and lung irritants. Emphysema is also treated by supporting the breathing with anticholinergics, bronchodilators, steroid medication (inhaled or oral), and supplemental oxygen as required. Supplemental oxygen used as prescribed (usually more than 20 hours per day) is the only non-surgical treatment which has been shown to prolong life in emphysema patients. There are lightweight portable oxygen systems which allow patients increased mobility. The only known "cure" for emphysema is lung transplant, but few patients are strong enough physically to survive the surgery. Transplants also require the patient to take an anti-rejection drug regime which suppresses the immune system, and so can lead to microbial infection of the patient. Panacinary emphysema is related to the destruction of alveoli, because of an inflammation or deficiency of alfa-1-antitrypsin. Centroacinary emphysema is due to destruction of terminal bronchioli muchosis, due to chronic bronchitis. A study published by the European Respiratory Journal suggests that tretinoin (an anti-acne drug commercially available as Accutane) derived from vitamin A can reverse the effects of emphysema in mice by returning elasticity (and regenerating lung tissue through gene mediation) to the alveoli. While vitamin A consumption is not known to be an effective treatment or prevention for the disease, this research could in the future lead to a cure. A follow-up study done in 2006 found inconclusive results ("no definitive clinical benefits") using Vitamin A (retinoic acid) in treatment of emphysema in humans and stated that further research is needed to reach conclusions on this treatment. Alpha-1 Date Time Date medication needed Prescriber’s frst name Four simple steps to submit your referral. Current weight lb kg Date recorded Insurance company Phone Has the patient ever received augmentation therapy Administer intramuscularly as needed for severe anaphylactic reaction times one dose; may repeat one time. Diphenhydramine25mg by mouth for mild allergic reactions and50mg for moderate-severe. Flushing orders: Normal saline3mL intravenous (peripheral line) or10mL intravenous (central line) before and after infusion, or as needed for line patency Heparin10units per mL3mL intravenous (peripheral line) as fnal fush Heparin100units per mL5mL intravenous (central line) as fnal fush Supplies:(please strike through if not required) Dispense needles, syringes, ancillary supplies and home medical equipment necessary to administer medication. If shipped to physician’s offce, physician accepts on behalf of patient for administration in offce. 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If you have received this information in error, please notify the sender immediately and arrange for the return or destruction of these documents. All rights in the product names, trade names or logos of all third-party products that appear in this form, whether or not appearing with the trademark symbol, belong exclusively to their respective owners. Referral Form (not required for electronic prescriptions) Completed Alpha-1 referral form (available at accredo. If you have any questions, please call your Accredo Provider Support Advocate, or call 866. The liver may be damaged by diseases that continue for a long period One out of every 10 Americans is of time. As the liver is injured repeatedly, its healing response produces afected by liver disease. If you have cirrhosis, your doctor may use a scoring system to assess its severity and stage of progression. Assigns a score of A, B, and C A score = B and C scores = One such tool is the Child-Turcotte-Pugh Score, which is named compensated decompensated cirrhosis with after the physicians who developed it, and assigns points for:6 cirrhosis progressive worsening • Levels of bilirubin and albumin in the blood • How efciently the body is able to clot blood • Build-up of fuid in the abdomen (stomach) • Impairment of mental function (such as confusion, cloudy or foggy brain, and disorientation) Page 1 of 2 Cirrhosis: Learn more at LiverFoundation.
Hyperinsulinaemia and increased risk of breast cancer: findings from the British Women’s Heart and Health Study medicine to treat uti discount trileptal 600mg otc. Biological mechanisms in breast cancer invasiveness: relevance to symptoms 6 days after iui purchase trileptal 600 mg amex preventive interventions symptoms ulcer purchase trileptal 300 mg online. Insulin symptoms torn meniscus cheap trileptal line, macronutrient intake, and physical activity: are potential indicators of insulin resistance associated with mortality from breast cancer Fasting insulin and outcome in early-stage breast cancer: results of a prospective cohort study. Consumption of sweet foods and mammographic breast density: a cross-sectional study. Consumption of sweet foods and breast cancer risk: a case-control study of women on Long Island, New York. Fasting blood glucose and long-term prognosis of non metastatic breast cancer: a cohort study. High fasting blood glucose and obesity significantly and independently increase risk of breast cancer death in hormone receptor-positive disease. Dietary glycemic index, glycemic load, and the risk of breast cancer in an Italian prospective cohort study. Carbohydrate intake, glycemic index, glycemic load, and risk of postmenopausal breast cancer in a prospective study of French women. Glycemic index, glycemic load, and chronic disease risk-a meta-analysis of observational studies. Glycemic load, glycemic index and breast cancer risk in a prospective cohort of Swedish women. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women’s Intervention Nutrition Study. Diet and sex hormones in girls: findings from a randomized controlled clinical trial. Meat and fat intake as risk factors for pancreatic cancer: the multiethnic cohort study. Dietary patterns and breast cancer risk among women in northern Tanzania: a case-control study. High and low-fat dairy intake, recurrence, and mortality after breast cancer diagnosis. Biomarkers of dietary fatty acid intake and the risk of breast cancer: a meta-analysis. Dietary fat and breast cancer risk revisited: a meta-analysis of the published literature. Opposing effects of dietary n-3 and n-6 fatty acids on mammary carcinogenesis: the Singapore Chinese Health Study. A prospective study of association of monounsaturated fat and other types of fat with risk of breast cancer. Adipose fatty acids and cancers of the breast, prostate and colon: an ecological study. Intake of conjugated linoleic acid, fat, and other fatty acids in relation to postmenopausal breast cancer: the Netherlands Cohort Study on Diet and Cancer. Adipose tissue trans fatty acids and breast cancer in the European Community Multicenter Study on Antioxidants, Myocardial Infarction, and Breast Cancer. Dietary polyunsaturated fatty acids and cancers of the breast and colorectum: emerging evidence for their role as risk modifiers. Olive oil consumption and risk of breast cancer in the Canary Islands: a population-based case-control study. Consumption of olive oil and specific food groups in relation to breast cancer risk in Greece. Dietary intakes of fat and fatty acids and risk of breast cancer: a prospective study in Japan. N-3 and N-6 fatty acids in breast adipose tissue and relative risk of breast cancer in a case-control study in Tours, France. Olive oil intake is inversely related to cancer prevalence: a systematic review and a meta-analysis of 13, 800 patients and 23, 340 controls in 19 observational studies. Olive oil intake and breast cancer risk in the Mediterranean countries of the European Prospective Investigation into Cancer and Nutrition study. Long-chain n-3-to-n-6 polyunsaturated fatty acid ratios in breast adipose tissue from women with and without breast cancer. Kuriki K, Hirose K, Wakai K, Matsuo K, Ito H, Suzuki T, Hiraki A, Saito T, Iwata H, Tatematsu M, Tajima K. Breast cancer risk and erythrocyte compositions of n-3 highly unsaturated fatty acids in Japanese. Erythrocyte fatty acids and breast cancer risk: a case-control study in Shanghai, China. Dietary long-chain n-3 fatty acids for the prevention of cancer: a review of potential mechanisms. N-3 poly-unsaturated fatty acids shift estrogen signaling to inhibit human breast cancer cell growth. Dietary polyunsaturated fatty acids and breast cancer risk in Chinese women: a prospective cohort study. Fatty fish and fish omega-3 fatty acid intakes decrease the breast cancer risk: a case-control study. W-3 and W-6 Polyunsaturated fatty acid intakes and the risk of breast cancer in Mexican women: impact of obesity status. Adipose tissue fatty acid composition in Greek patients with breast cancer versus those with benign breast tumors. Intake of fish and marine n-3 polyunsaturated fatty acids and risk of breast cancer: meta-analysis of data from 21 independent prospective cohort studies. Effects of fatty acids and eicosanoid synthesis inhibitors on the growth of two human prostate cancer cell lines. Diet and risk of breast cancer: major findings from an Italian case-control study. Achieving optimal essential fatty acid status in vegetarians: current knowledge and practical implications. Can adults adequately convert alpha-linolenic acid (18:3n-3) to eicosapentaenoic acid (20:5n-3) and docosahexaenoic acid (22:6n-3) Fatigue, inflammation, and W-3 and W-6 fatty acid intake among breast cancer survivors. High-dose eicosapentaenoic acid and docosahexaenoic acid supplementation reduces bone resorption in postmenopausal breast cancer survivors on aromatase inhibitors: a pilot study. Omega-3 fatty acids are protective against paclitaxel induced peripheral neuropathy: a randomized double-blind placebo controlled trial. Overexpression of cyclooxygenase-2 is associated with breast carcinoma and its poor prognostic factors. Do both heterocyclic amines and omega-6 polyunsaturated fatty acids contribute to the incidence of breast cancer in postmenopausal women of the Malmo diet and cancer cohort Diet and biomarkers of oxidative damage in women previously treated for breast cancer. The importance of the omega-6/omega-3 fatty acid ratio in cardiovascular disease and other chronic diseases. Dietary fat and physical activity in relation to breast cancer among Polish women. Well-done meat intake and meat-derived mutagen exposures in relation to breast cancer risk: the Nashville Breast Health Study. Human exposure to heterocyclic amine food mutagens/ carcinogens: relevance to breast cancer. The cooked meat-derived mammary carcinogen 2-amino-1-methyl 6-phenylimidazo[4, 5-b]pyridine promotes invasive behaviour of breast cancer cells. Meat intake, heterocyclic amines, and risk of breast cancer: a case-control study in Uruguay. Breast cancer, heterocyclic aromatic amines from meat and N-acetyltransferase 2 genotype. Heterocyclic amines: Mutagens/ carcinogens produced during cooking of meat and fish.
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Liability: Health care providers are not held liable for any civil damages medications used to treat adhd purchase generic trileptal from india, except in cases where they are found to medications overactive bladder order discount trileptal be negligent in treating or in failing to treatment zone lasik generic 300mg trileptal with amex provide treatment symptoms 0f high blood pressure trileptal 300 mg discount. This includes out-of-State health care providers for whom relevant permits to practice have been waived by the Public Health Authority. These orders are not in effect now; they would have to be signed by the Governor at the time of the emergency. A Framework and Guiding Principles When Planning for Health and Medical Care in a Mass Casualty Event A framework for planning should take into account the ways in which response to a mass casualty event is both similar to and different from responses to current surge capacity issues. The goal is to devise a framework that is applicable to both ordinary (daily routine) and extraordinary situations. Incorporating these five principles will ensure that standards of care are altered sufficiently to respond to issues arising from a mass casualty event, such as pandemic influenza. Principle 1: In planning for a mass casualty event, the aim should be to keep the healthcare system functioning and to deliver acceptable quality of care to preserve as many lives as possible. Adhering to this principle will involve: • Allocating scarce resources in order to save the most lives. Principle 3: There must be an adequate legal framework for providing health and medical care in a mass casualty event. Principle 4: the rights of individuals must be protected to the extent possible and reasonable under the circumstances. The rights of individuals must be protected to the extent possible and reasonable: • In establishing and operationalizing an adequate legal framework for the delivery of care. Principle 5: Clear communication with the public is essential before, during, and after a mass casualty event. It may be necessary to vary the modes of communication according to the type of information to be communicated, the target audience for which it is intended, and the operating condition of media outlets, which may be directly affected. Notification and Tracking of Deaths to the Appropriate Authorities Medico-legal death investigation systems are not designed to be the first responders in death reporting by private citizens and/or medical institutions. Actionable recommendation to senior leaders: 116 • Separate call dispatch systems may be required for death reporting by private citizens to ensure life safety calls are dispatched by the most expeditious system in existence. Identified human remains could be immediately transported and released to the funeral home (or appropriate holding facility) of the next-of-kin’s choice for final disposition processing and the death certificate requirements would be immediately established and acted upon by the certifying officials. Responders will need the knowledge and capability to identify influenza-related deaths verses non-influenza-related deaths to ensure proper actions are taken at the scene. Actionable recommendation to senior leaders: • Legal requirements for pronouncement may require amendment during a pandemic event to allow for additional personnel to complete the task. The result will be an increased number of trained personnel to augment the medical examiner/coroner during pandemic influenza, increased response resources, better public relations and public confidence. Many medical examiner/coroner systems rely upon police investigations and/or lay deputy coroners (trained funeral directors) to conduct an initial investigation and then to notify the medical examiner/coroner of the death for response. Attending physicians who hold the records for their patients may 118 not have the ability to respond to telephone calls from the scene responders. Physicians have access to resources to assist in the determination of the cause and manner of death. Some medical examiner/coroner and police only utilize existing contractors (Funeral Directors and/or transport companies) who will be overwhelmed during pandemic influenza. Families and or friends may transport human remains to a facility in their private vehicles. Non-traditional human remains transporters may be required to conduct movement from homes, scenes, hospitals, morgues, funeral homes, cemeteries, and crematories. Amend code, if necessary, to allow for surge capacity with non traditional vehicles if required. The accomplishment of these measures will increase capacity to transport the increased number of human remains to appropriate facilities and freeing up funeral homes to complete their human remains preparations and allow for more timely response and less waiting times for families. Advisory Committee recommendations presented in that report are intended to provide guidance for planning purposes and to form the basis for further discussion of how to equitably allocate medical countermeasures that will be in short supply early in an influenza pandemic. The committees acknowledged that further work is needed, in particular, to identify the functions that must be preserved to maintain effective services and critical infrastructures and to identify the groups that should be protected to achieve this goal. There is little surge patient contact, other support capacity among healthcare sector services essential for direct patient personnel to meet increased demand care, and vaccinators (8-9 million) *The committee focused its deliberations on the U. Also included are healthcare workers in public health with direct patient contact, including those who may administer vaccine or distribute influenza antiviral medications, and essential public health support staff for these workers. In addition, increases in bed/nurse ratios have been associated with increases in overall patient mortality. Recommendations were made to guide planning needed for effective implementation at State and local levels. The committee recognizes that recommendations will need to be reconsidered at the time of a pandemic when information on the available drug supply, epidemiology of disease, and impacts on society are known. The committee considered the primary goal of a pandemic response to decrease health impacts including severe morbidity and death. Minimizing societal and economic impacts were considered secondary and tertiary goals. If stockpiled antiviral drug supplies are very limited, the priority of this group could be reconsidered based on the epidemiology of the pandemic and any additional data on effectiveness in this population. Definitions and rationale for draft priority groups: Healthcare workers and emergency medical service providers who have direct patient contact a) Definition Persons providing direct medical services in inpatient and outpatient care settings. Good data exist documenting the impacts of early treatment on duration of illness and time off work, and on the occurrence of complications such as lower respiratory infections. It also would be acceptable to the public, who would recognize the importance of maintaining quality healthcare and would understand that persons with direct patient contact are putting themselves at increased risk. Implementation issues include the approach to identifying healthcare providers who would be eligible for treatment and where the treatment would be provided, particularly for outpatient care providers. Protect persons caring for influenza patients in healthcare settings from contact with the pandemic influenza virus. Contain infectious respiratory secretions: • Instruct persons who have “flu-like” symptoms to use respiratory hygiene/cough etiquette. Gloves • A single pair of patient care gloves should be worn for contact with blood and body fluids, including during hand contact with respiratory secretions. Gloves made of latex, vinyl, nitrile, or other synthetic materials are appropriate for this purpose; if possible, latex-free gloves should be available for healthcare workers who have latex allergy. In this circumstance, reserve gloves for situations where there is a likelihood of extensive patient or environmental contact with blood or body fluids, including during suctioning. Gowns • Wear an isolation gown, if soiling of personal clothes or uniform with a patient’s blood or body fluids, including respiratory secretions, is anticipated. Goggles or Face Shield In general, wearing goggles or a face shield for routine contact with patients with pandemic influenza is not necessary. Additional information related to the use of eye protection for infection control can be found at. Respirators should be used within the context of a respiratory protection program that includes fit-testing, medical clearance, and training. Therefore precautions consistent with all possible etiologies, including a newly emerging infectious agent, should be implemented. Linen and Laundry Standard precautions are recommended for linen and laundry that might be contaminated with respiratory secretions from patients with pandemic influenza: • Place soiled linen directly into a laundry bag in the patient’s room. Contain linen in a manner that prevents the linen bag from opening or bursting during transport and while in the soiled linen holding area. If needed, positive-pressure ventilation 91 should be performed using a resuscitation bag-valve mask. When possible, use vehicles that have separate driver and patient compartments that can provide separate ventilation to each area. During an influenza pandemic, surgical masks and respirators—along with other forms of personal protective equipment. Planning assumptions and projections suggest that shortages of respirators are likely in a sustained pandemic. Therefore, in the event of an actual or anticipated shortage, planners must ensure that sufficient numbers of respirators are prioritized for use during the high risk procedures.