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Zika spread continues: Talk to patients about prevention

Posted By Administration, Monday, September 26, 2016

Arizona Health Alert Network

Society PA,

Zika spread continues: Talk to patients about prevention

Clinicians need to discuss Zika prevention with all patients. Arizona is at high risk for spread of Zika and cases have been reported in Sonora, Mexico.

Preventive Counseling one-pager has the following key points:

  • Pregnant women should not travel to areas with local Zika transmission, including Mexico.
  • Pregnant women should not have unprotected sex with individuals that have traveled to areas with Zika transmission.
  • All travelers from areas with Zika should avoid mosquito bites for 3 weeks after returning.
  • All Arizonans should reduce mosquito breeding sites, including dumping standing water around the house.

If there is a concern for Zika, coordinate with your local health department.  Zika testing algorithms are online for determining eligibility for testing at the Arizona State Public Health Laboratory.  Zika testing is also available at commercial laboratories.

ADHS Zika Clinician Website
CDC Zika Prevention Website
CDC Zika-affected Areas Website

IDAZ mobile app


Thank you,
Arizona Health Alert Network

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Surgeon General's Opioid Letter

Posted By Administration, Tuesday, September 6, 2016

Vivek H. Murthy, M.D., M.B.A.

August 2016

Dear Colleague,

I am asking for your help to solve an urgent health crisis facing America: the opioid epidemic. Everywhere I travel, I see communities devastated by opioid overdoses. I meet families too ashamed to seek treatment for addiction. And I will never forget my own patient whose opioid use disorder began with a course of morphine after a routine procedure.

It is important to recognize that we arrived at this place on a path paved with good intentions. Nearly two decades ago, we were encouraged to be more aggressive about treating pain, often without enough training and support to do so safely. This coincided with heavy marketing of opioids to doctors. Many of us were even taught – incorrectly – that opioids are not addictive when prescribed for legitimate pain.

The results have been devastating. Since 1999, opioid overdose deaths have quadrupled and opioid prescriptions have increased markedly – almost enough for every adult in America to have a bottle of pills. Yet the amount of pain reported by Americans has not changed. Now, nearly 2 million people in America have a prescription opioid use disorder, contributing to increased heroin use and the spread of HIV and hepatitis C.

I know solving this problem will not be easy. We often struggle to balance reducing our patients’ pain with increasing their risk of opioid addiction. But, as clinicians, we have the unique power to help end this epidemic. As cynical as times may seem, the public still looks to our profession for hope during difficult moments. This is one of those times.

That is why I am asking you to pledge your commitment to turn the tide on the opioid crisis. Please take the pledge. Together, we will build a national movement of clinicians to do three things:

First, we will educate ourselves to treat pain safely and effectively. A good place to start is this pocket guide with the CDC Opioid Prescribing Guideline. Second, we will screen our patients for opioid use disorder and provide or connect them with evidence-based treatment. Third, we can shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing.

Years from now, I want us to look back and know that, in the face of a crisis that threatened our nation, it was our profession that stepped up and led the way. I know we can succeed because health care is more than an occupation to us. It is a calling rooted in empathy, science, and service to humanity. These values unite us. They remain our greatest strength. 

Thank you for your leadership.

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NCCPA Responds to PA Concerns with Change to CME Requirements

Posted By Administration, Thursday, August 11, 2016
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FDA: Fluoroquinolone Antibacterial Drugs for Systemic Use: Drug Safety Communication

Posted By Administration, Monday, August 8, 2016

Fluoroquinolone Antibacterial Drugs for Systemic Use: Drug Safety Communication - Warnings Updated Due to Disabling Side Effects

This post is from the FDA website:

Including the following currently available fluoroquinolones

Avelox (moxifloxacin)
Cipro (ciprofloxacin)
Cipro extended-release (ciprofloxacin extended-release)
Factive (gemifloxacin)
Levaquin (levofloxacin)
Ofloxacin (generic brand)

[Posted 07/26/2016]

AUDIENCE: Family Practice, Infectious Disease, Neurology, Pharmacy, Patient

ISSUE: FDA approved changes to the labels of fluoroquinolone antibacterial drugs for systemic use (i.e., taken by mouth or by injection). These medicines are associated with disabling and potentially permanent side effects of the tendons, muscles, joints, nerves, and central nervous system that can occur together in the same patient. As a result, FDA revised the Boxed Warning, FDA’s strongest warning, to address these serious safety issues. In addition, FDA updated other parts of the drug label including the Warnings and Precautions and Medication Guide sections.

FDA has determined that fluoroquinolones should be reserved for use in patients who have no other treatment options for acute bacterial sinusitis, acute exacerbation of chronic bronchitis, and uncomplicated urinary tract infections because the risk of these serious side effects generally outweighs the benefits in these patients. For some serious bacterial infections the benefits of fluoroquinolones outweigh the risks, and it is appropriate for them to remain available as a therapeutic option.

FDA is continuing to assess safety issues with fluoroquinolones as part of FDA’s usual ongoing review of drugs and will update the public if additional actions are needed. See the FDA Drug Safety Communication for additional information, including a Data Summary and Additional Information for Health Care Professionals and Patients.

BACKGROUND: The labels of fluoroquinolone medicines already have a Boxed Warning for tendinitis, tendon rupture, and worsening of myasthenia gravis. The labels also include warnings about the risks of peripheral neuropathy and central nervous system effects. Other serious risks associated with fluoroquinolones are described in the labels, such as cardiac, dermatologic, and hypersensitivity reactions. After FDA’s 2013 review that led to the additional warning that peripheral neuropathy may be irreversible, FDA evaluated post-marketing reports of apparently healthy patients who experienced disabling and potentially permanent side effects involving two or more body systems after being treated with a systemic fluoroquinolone

RECOMMENDATION: Patients must contact your health care professional immediately if you experience any serious side effects while taking your fluoroquinolone medicine. Some signs and symptoms of serious side effects include unusual joint or tendon pain, muscle weakness, a “pins and needles” tingling or pricking sensation, numbness in the arms or legs, confusion, and hallucinations. Talk with your health care professional if you have any questions or concerns (see List of Serious Side Effects from Fluoroquinolones in the FDA Drug Safety Communication).

Health care professionals should not prescribe systemic fluoroquinolones to patients who have other treatment options for acute bacterial sinusitis (ABS), acute bacterial exacerbation of chronic bronchitis (ABECB), and uncomplicated urinary tract infections (UTI) because the risks outweigh the benefits in these patients. Stop fluoroquinolone treatment immediately if a patient reports serious side effects, and switch to a non-fluoroquinolone antibacterial drug to complete the patient’s treatment course.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA's MedWatch Safety Information and Adverse Event Reporting Program:

  • Complete and submit the report Online:
  • Download form or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178

[07/26/2016 - Drug Safety Communication - FDA] en Español

Previous MedWatch Alert:

[05/12/2016 - Fluoroquinolone Antibacterial Drugs: Drug Safety Communication - FDA Advises Restricting Use for Certain Uncomplicated Infections]

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Local Zika Transmission in Miami: Recommendations for Clinicians

Posted By Administration, Thursday, August 4, 2016

Arizona Health Alert Network

Society PA,

To date, Arizona has had 13 travel-associated cases of Zika.

The Florida Department of Health identified local Zika transmission in Wynwood, a neighborhood of Miami. Travel and testing recommendations for Zika have been expanded to now include this area going back to June 15th, 2016.

Counseling recommendations:

• Counsel all pregnant women to avoid nonessential travel to areas with local Zika transmission, which now includes part of Miami. Pregnant women and their partners traveling to this area should prevent mosquito bites.

• Assess all pregnant women in the United States for Zika virus exposure during each prenatal visit.

• Advise all men and women with travel to Zika-affected areas who have a pregnant sex partner to use condoms or other barriers to prevent infection every time they have sex or to not have sex during the pregnancy.

Updated Zika testing recommendations are available; coordinate testing at the Arizona State Public Health Laboratory with the local health department.


Thank you,
Arizona Health Alert Network



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Zika Testing Updates for Providers

Posted By Administration, Wednesday, June 22, 2016

Message from the Arizona Health Alert Network

Society PA,

To date, Arizona has had 6 travel-associated and no locally acquired cases of Zika. The Arizona State Public Health Laboratory (ASPHL) has the ability to perform PCR and IgM Zika testing, and PCR testing is now available commercially at select labs.

PCR will only be positive up to 7 days after symptom onset. As a result, IgM testing is recommended for individuals who traveled to a Zika-affected area within the past 2-12 weeks AND are asymptomatic pregnant women OR individuals with two or more symptoms consistent with Zika. IgM testing can also be performed on symptomatic individuals who have a history of unprotected sexual contact with a male partner who traveled to or lived in an area with Zika transmission. 

Since signs and symptoms of Zika can be similar to those of dengue and chikungunya, it is important to test for all three diseases. ASPHL has a trioplex PCR capable of testing for all three simultaneously in serum and CSF. Specimens that can be tested for Zika virus are serum (2 vials), urine (5 mL), CSF (1 mL), and amniotic fluid (1 mL). Urine should be collected on individuals within 2 weeks of symptom onset.


Testing for Zika at ASPHL must be approved by Arizona Department of Health Services (ADHS) prior to specimen submission. Healthcare providers should contact their local health department to report suspect cases and coordinate testing at ASPHL.



Interim Zika Testing Algorithms for Providers

ADHS Zika Website 

Local Health Department Contacts 

•ADHS staff can be reached at 602-364-3676 or


Thank you,
Arizona Health Alert Network


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JOPA 2016 Writing Awards - Submit Your Article

Posted By Administration, Tuesday, June 21, 2016




JBJS Journal of Orthopaedics for Physician Assistants (JOPA)

2016 Writing Awards

JOPA, a peer-reviewed publication that covers all orthopaedic subspecialties for PAs and NPs, is proud to announce that it is now published by The Journal of Bone and Joint Surgery (JBJS), one of the most highly respected journals in the field of orthopaedics.


To welcome JOPA into its family of journals, JBJS is offering $1000 awards for each of-

  • Two best review articles by authors who are PA students at time of article submission.
  • Three best review articles by certified, practicing Physician Assistants or Nurse Practitioners


Academic reviews of literature on broad orthopaedic topics AND concise overviews of single clinical conditions, diagnostic/therapeutic/surgical procedures, or any other topic related to orthopaedics.

Submit your article, via the JOPA Editorial Manager submission site for consideration for publication in JOPA. Corresponding authors will be asked whether they wish their articles to also be considered for the awards.

Make sure to adhere to the requirements for Review Articles as outlined in the JOPA Instructions for Authors.
Questions regarding the contest and submission process can be sent to

Remember to register for free access to JBJS Journal of Orthopaedics for Physician Assistants (JOPA) and receive complimentary access to JBJS Reviews for 2016. Go to

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Post-Graduate PA Mental Health Residency Program

Posted By Administration, Monday, June 20, 2016

We are beginning a new psychiatric residency program for PAs here at the Michael E. DeBakey VA Medical Center in Houston, Texas along with our academic partner, Baylor College of Medicine.

Our program is one year in duration and pays a stipend, with no cost for the training except for their CAQ in Psychiatry, which they will be eligible for at the end of the training. They will train alongside physician psychiatric residents in the outstanding Baylor College of Medicine Psychiatry Residency Program, attending many of the same didactic lectures and the same clinical rotations, though on a more compressed schedule due to the residency being one year in length versus the physicians’ residency being 4 years.

We will train excellent mental health providers and seek to hire them on completion of the residency at an advanced pay standing within the VA, with the strong possibility of student loan repayment as additional incentive.

I hope you will share the attached brochure and application with your members, who may be interested in a psychiatry career. I am happy to speak with anyone who has questions, and can be reached at 713-791-1414 x26937 or my cell phone at 281-770-5461.


Kind Regards,

J. Michael Smith, DHSc, MPAS, PA-C, CAQ – Psychiatry
Post-Graduate PA Mental Health Residency Training Director
Physician Assistant, ACCESS Clinic, GMHC
Michael E. DeBakey VA Medical Center, Houston, Texas

Download File (PDF)

 Attached Files:

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Jennifer Francyk Resigns from ASAPA Board

Posted By Administration, Wednesday, June 15, 2016

We want to inform the membership that Jennifer Francyk has resigned as President.  We thank her for her years of leadership on the board and wish her luck in the future.

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10 Cases of Measles in AZ

Posted By Administration, Tuesday, May 31, 2016

 Message from the Arizona Health Alert Network

Society PA,

The Arizona Department of Health Services, Maricopa County Department of Public Health, and Pinal County Public Health Services District have confirmed TEN cases of measles in Arizona. Additional cases in the community are highly likely.

Providers should:

  • Take precautions to ensure your patients are not exposed by:
    • Posting the attached signage outside of your facility with surgical masks available
    • Having patients with febrile rash illness report to a back door or provide the last appointment of the day to prevent exposing other patients
    • Having suspect cases wear surgical masks in common areas when airborne isolation is not available
  • Immediately mask and place patients presenting with a febrile rash illness in airborne isolation if available, obtain vaccine and travel history.
  • Consider measles as a diagnosis for patients with a febrile rash illness and immediately report this to your local health department.
  • Coordinate with your local health department for specimen collection, transport, and testing for suspect measles cases.
  • Make sure your staff is fully immunized.
    • Healthcare workers should receive two doses of MMR, regardless of year of birth, unless they have documentation of previous immunity.

To report cases or for additional information, please contact your local health department:

A measles surveillance toolkit for healthcare facilities is available at

For more information on this situation, please visit the ADHS public information website at

For more information on measles, please visit the ADHS measles webpage at


ER Discharge Instructions  |  Inpatient Discharge Instructions  |  Measles Signage  |  Measles Signage 2

Thank you,
Arizona Health Alert Network

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