Questions and answers

Questions to Practice

New review questions Added March 13,2007

A link to more travel medicine questions An independant website that has some Tropical and Travel Medicine MCQs.

MCQs in Travel and Tropical Medicine: A Primer of Travel Medicine (Paperback)

More Tropical Medicine Case Histories

We have recently held our first meeting in Basic Travel Medicine in Calgary.

I am archiving questions that came up in discussion that were raised in either the general discussion or raised with me privately.

The Best Test Book for Travel Medice

There are many goood books but

International Guide for Travelers Health by Stuart Rose and Jay Keystone 

Is best in price, readability and suitable for studying in Travel Medicine.

we encourage of course other text books also as  every  book we have reviewed has always some new valid perspective on travel medicine.

Live vaccine

When can they be given?

The live vaccines available in Canada include Yellow fever, Vivotif, MMR., Varicella (and soon Zostavax). They should be administered either the same day or after 28 days. If given at a lesser interval say 2 weeks the subsequent vaccines are felt not to “count” and are recommended to be repeated.

One delegate asked about how to administer a vaccine when a patient does not want to pay for a full visit.

At our clinic we will have the patient fill out a form stating that they are only receiving the treatment they are asking for an agreed upon price and that they understand that other services will not be supplied because they do not wish it. We feel this is one way to deal with patients requesting partial travel medicine or trying to get a consult without paying for it.

Alternatively one other approach is simply refuse to see patients that will not agree to your posted clinic prices.

An example of the waiver we use is :

I,___________________ have attended the Travel medicine Clinic and discussed with Dr___________________. that I am being supplied the following service ______________________, at the cost of_________ at my own request. I have asked for this and requested not to have any other services today.

_____________________________________________(other services refused,optional)

Signed________________________ date

Witness_______________________date

Is one dose of Twinrix protective? No

How can I order Yellow fever vaccine?

Sanofi Pasteur sells it in Canada

The Public Health Agency of Canada licences clinics in Canada. They have criteria for education, qualifications of facilities interested and this can be accessed from their website:

http://www.phac-aspc.gc.ca/tmp-pmv/travel/clinic_e.html

One delegate asked about opportunities for volunteering.

The wilderness Medical Society holds different meeting an postings and is a good resource for information

Travel Clinic Nurse moving to Toronto

During our discussions many people expressed an interest in starting a travel clinic. We encourage attendees to post their contact information here.

One of our own Travel Medicine nurses is leaving our Winnipeg office to Toronto and will be looking for employment and could be a valuable addition to a clinic trying to set up a travel clinic . We highly recommend her and if anyone is interested please contact me ( gary_podolsky@yahoo.com )

Malarone in Children

During our discussion several delegates questioned the dose of Malarone Pediatrics I had written.

1-20kg weight for Children should have read 10-20 kg for which 1 pediatric Malarone is appropriate.

There is no prescribed prescription dose for children under 10kg and to prescribe so would be off label.

Malaria is very serious in young children so that even young infants must have appropriate malaria chemoprophylaxis.

There is more experience with chloroquine and mefloquine in young infants.

Practioners must do what they feel is appropriate so that if young infants are travelling to mefloquine resistant areas they may need either Malarone or be counselled not to go.

Charting

During the break several people asked about forms

I have placed examples of our clinic templates. These are not perfect and we are constantly revising them.

Yellow fever Template- a screening tool to document contraidications for people requesting yellow fever vaccines

A Hepatitis A ClinicTemplate

A Travel Medicine Clinic Template