1. know INR target for stroke/afib

a. (INR) target of 2.0 to 3.0 for preventing ischemic stroke in atrial fibrillation.

2. who can get hep B vaccine

a. The current recommendations for childhood immunizations include

administering the three-dose HBV series to newborns or at age 11 to 12

years to children not previously vaccinated. The series can be started at any

age, although it is recommended that preterm infants be at least 1 month of

age before starting HPV series

b. Vaccination with HBV is recommended for all ages, particularly patients at

high risk of contracting hepatitis B. Those at high risk include IV drug users,

infants born to mothers who are HbsAg-positive, hemodialysis patients,

sexually active people with multiple partners, incarcerated people,

international travelers, household contacts of hepatitis B carriers, and

sexual contacts of hepatitis B carriers. Patients who are getting tattoos or

who share razors, toothbrushes, or body-piercing jewelry are also at risk of

contracting hepatitis B. Health-care workers, daycare staff, and other people

who may have exposure to body fluids also have a greater risk of contracting

hepatitis B. Patients with diabetes are at increased risk of contracting HBV

and it is recommended they receive the HBV series

2. who can get tuberculin screening

a. Targeted screening for TB is usually based on the patient's presenting with

an identified risk factor. In some areas of the country, routine TB testing is

part of all health maintenance visits because of an increased incidence of TB

in the area.

b. Patients identified as being at risk are those with compromised immune

systems (e.g., HIV-positive or undergoing immunosuppressive therapy or

prolonged adrenocorticosteroid therapy), close contacts of patients with

newly diagnosed infectious TB, injection drug users known to be HIV

seronegative, foreign-born persons from high-prevalence countries,

medically underserved low-income populations, and residents and staff of

long-term-care facilities or prisons. All health-care providers should be

screened routinely.

2. ultimate goal of therapy for HIV

(1) reduce HIV-associated morbidity and prolong the duration and quality of survival

(2) restore and preserve immunological function

(3) achieve maximal and durable suppression of plasma HIV viral load, (4) and prevent HIV

transmission

o maximal suppression goal HIV RNA less than 50 copies/mL goal

• Improve quality of life

• Obtain maximal and durable suppression of HIV

• Prevent vertical HIV transmission

• Prolong survival

• Reduce HIV-related morbidity

• Reduce transmissibility of HIV

• Restore and preserve immunological function

5. t score and what to do

o T scores of less than 2.5 are the major focus of any prefracture treatment.

Those patients with BMD T scores between −1.0 and −2.5 with other 

factors that increase fracture risk to more than 20% in 10 years are also

considered for drug interventions.

o The T-score on your bone density report shows how much your bone mass

differs from the bone mass of an average healthy 30 year old adult. A bone

density test is like any other medical test or measurement. The results for

the entire population will be distributed around an average score (the

mean). A T-score is a standard deviation — a mathematical term that

calculates how much a result varies from the average or mean. The score

that you receive from your bone density (BMD or DXA) test is measured as

a standard deviation from the mean. The manufacturers of the DXA

machines have programmed them to use a formula to compute these

values.

o Most commonly, your BMD test results are compared to the ideal or peak

bone mineral density of a healthy 30-year-old adult, and you are given a Tscore. A score of 0 means your BMD is equal to the norm for a healthy

young adult. Differences between your BMD and that of the healthy young

adult norm are measured in units called standard deviations (SDs). The

more standard deviations below 0, indicated as negative numbers, the

lower your BMD and the higher your risk of fracture.

o As shown in the table below, a T-score between +1 and −1 is considered

normal or healthy. A T-score between −1 and −2.5 indicates that you have

low bone mass, although not low enough to be diagnosed with

osteoporosis. A T-score of −2.5 or lower indicates that you have

osteoporosis. The greater the negative number, the more severe the

osteoporosis