Saturday, November 18 - Christiana Hilton, Newark

Registration is open for the 234th MSD Annual Meeting to be held on Saturday, November 18th. This year's meeting will be held at the Christiana Hilton in Newark. All MSD members are encouraged to attend. Thank you to our Council members for their service to MSD and their constituents. Your fork is the most powerful tool to heal your body. Learn about the influence of nutrition on patients' wellbeing and how food can help manage chronic diseases and improve overall health during the planned education sessions. Register for the presentation (and cooking demo!) and discover the power of nutrition. It is vital for physicians to be able to educate their patients about nutrition to achieve optimal health.

Things to know:

• Registration deadline is Friday, November 10th!
• The Inaugural Gala is on hold for this year. View the Annual Meeting agenda.
• There will be two education sessions on the topic of "Food as Medicine." The Medical Society of Delaware designates this live activity for a maximum of 2 AMA PRA Category 1 Credit™. 
• Those members who graduated medical school fifty years ago (1973) will be recognized in a ceremony following the first education session.
• Delaware Medical Political Action Committee (DELPAC) members can enjoy gourmet coffee and conversation with Delaware lawmakers. Join DELPAC if you are not already a member.
• Resolutions are a vehicle to submit your issues to the Council. Resolutions must be submitted via email to Mary LaJudice no later than Friday, October 27th. The MSD Resolution Writing Guideline should be utilized to ensure proper creation and format of the resolution. Dr. Varipapa has also created video instructions on writing a resolution. Check it out here.
• For anyone who wishes to stay overnight at the Christiana Hilton, when making reservations, use code MEDSD to obtain the discounted room rate of $149/night. Reservation cut off is Friday, October 27th.

Enjoy Gourmet Coffee, Conversation with Legislators at the Annual Meeting

Why not grab a gourmet cup of coffee with some of Delaware's e-"steemed" legislators at the Delaware Medical Political Action Committee (DELPAC) Coffee and Conversation event at the MSD Annual Meeting on November 18th! Prepare to be treated to top tier, specifically tailored gourmet coffees, teas, espressos, lattes, and cappuccinos prepared by DELPAC's amazing barista, all while mixing and mingling with MSD's highly acclaimed political lobbying agency, the Byrd Group, and key Delaware legislators. This exclusive benefit is ONLY For DELPAC members and will be open from 7:30-11:00 a.m. Want to join the fun? Join DELPAC now!

Interim CDC Recommendations Prioritizes Infants Most at Risk from RSV

The Centers for Disease Control and Prevention (CDC) issued a Health Alert Network (HAN) Health Advisory to provide options for clinicians to protect infants from respiratory syncytial virus (RSV) in the context of a limited supply of nirsevimab, a long-acting monoclonal antibody immunization product recommended for preventing RSV-associated lower respiratory tract disease in infants.

CDC ACIP Follows Suit to OK Recommendations

The US Food and Drug Administration (FDA) has approved a meningococcal vaccine against the five most common serogroups causing disease in children and young adults. The new formulation, called Penbraya, is manufactured by Pfizer and combines the components from two existing meningococcal vaccines, Trumenba the group B vaccine and Nimenrix groups A, C, W-135, and Y conjugate vaccine. The U.S. Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) voted on Wednesday this week to recommend Penbraya (meningococcal group A, B, C, W and Y vaccine) for the prevention of the five most common meningococcal serogroups that cause the majority of invasive meningococcal disease in adolescents and young adults. Specifically, the ACIP voted that: Pfizer’s MenABCWY vaccine may be used when both MenACWY and MenB are indicated at the same visit. These provisional recommendations will be reviewed and finalized by the director of the CDC and the Department of Health and Human Services.

For Adults Determined to be at High Risk for Mpox Infection

The Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices (ACIP) has voted in favor of routine use of Jynneos® (smallpox and monkeypox vaccine, live, nonreplicating) for the prevention of mpox disease in adults 18 years of age and older determined to be at high risk for mpox infection. Previously, the ACIP had recommended the vaccine for use only during an outbreak. Originally approved in 2019, Jynneos was developed in collaboration with the US government to ensure a supply of a smallpox vaccine for the entire population. During the mpox outbreak in 2022, the US Department of Health and Human Services (HHS) expanded access to Jynneos to mitigate the spread of the infection, while the Food and Drug Administration (FDA) granted emergency use authorization for intradermal injection in individuals 18 years of age and older and subcutaneous injection in those younger than 18 years of age who were determined to be at high risk. This newest recommendation will be reviewed by the Director of the CDC and HHS. Following approval, Bavarian Nordic intends to launch Jynneos in the US in the first half of 2024. 

If Approved, Could Be Available for the 2024-2025 Flu Season

AstraZeneca’s Supplemental Biologics License Application (sBLA) for the approval of a self- or caregiver-administered option for FluMist Quadrivalent, a needle-free nasal spray, has been accepted for review by the US Food and Drug Administration (FDA). If approved, FluMist will be the first flu vaccine available to be self-administered by eligible patients or administered by caregivers, which does not necessitate a health care professional for administration, adding an additional option to be vaccinated against influenza. FluMist was first approved by the FDA in 2003. The company said it expects the FDA to decide on the vaccine by the first quarter of 2024, adding that it expects the vaccine to be made available for self-administration in the United States during the 2024-2025 flu season, if approved.

Consumers Have More Choices and Stable Premiums

Starting on October 25th, HealthCare.gov consumers can preview their health care coverage options and see detailed information about 2024 health insurance plans and prices offered in their area ahead of the Open Enrollment period that begins November 1. For plan year 2024, 96% of HealthCare.gov consumers have access to three or more health insurance issuers, up from 93% in plan year 2023. At the same time CMS created policies aimed to mitigate choice overload and present consumers with meaningful plan choices. As a result, the average number of plans per enrollee decreased. This year, for the first time, health plans will have to include Mental Health Facilities, Substance Use Disorder Treatment Centers, and rural emergency hospitals in their provider networks. 

Paxlovid Remains Available for Ordering Through December 15th

The U.S. Department of Health and Human Services (HHS), announced that HHS and Pfizer have reached an agreement that begins Paxlovid’s transition to the commercial market in November 2023. During this transition to commercial distribution, Paxlovid will remain available for ordering from HHS through December 15, 2023. Authorized for emergency use, the supply will remain available for ordering from HHS through December 15, 2023. Individuals on Medicare, Medicaid, and those who are uninsured will continue to be able to access HHS-procured Paxlovid for free through the end of 2024 via a patient assistance program. From 2025-2028, Pfizer will continue to run a patient assistance program for individuals who are uninsured or underinsured with HHS-procured Paxlovid. In parallel, Pfizer will operate a copay assistance program for individuals with commercial insurance through 2028.

Saturday, October 28th, 10 a.m. - 2 p.m.

Delaware will hold its 25th National DEA Prescription Drug Take-Back Day on Saturday, October 28, 2023. Delawareans can discard their expired or unused medications at locations statewide between 10:00 a.m. and 2:00 p.m. Sharps disposals for needle disposal will be available at select locations (only for the public and not commercial entities), as well as overdose response education with free Narcan available at select locations. Organized nationally by the Drug Enforcement Administration (DEA), Prescription Drug Take-Back Day is operated locally by the Division of Public Health (DPH). In addition to the sites participating in National Prescription Drug Take-Back Day activities, there are permanent medicine drop-off locations available year-round. In addition to medicine drop-off locations, DPH and community partners also distribute Deterra bags (medication deactivation bags) to use at home. Besides medications, vape pens and e-cigarettes will be collected if the batteries are removed. Twenty (20) locations in Delaware are currently participating in the National Prescription Drug Take-Back event. You can find the current list of locations here: https://www.dea.gov/takebackday. For other community trainings and where to get free Narcan, visit: https://www.helpisherede.com/addiction/prevention.

Privacy and Security of Protected Health Information

The Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS), issued two resource documents to help explain to patients the privacy and security risks to their protected health information (PHI) when using telehealth services and ways to reduce these risks. The first resource is for health care professionals on “Educating Patients about Privacy and Security Risks to Protected Health Information when Using Remote Communication Technologies for Telehealth.” Although health care professionals are not required by the HIPAA Rules to provide this education, the resource supports the continued and increased use of telehealth by providing information to help health care professionals who choose to discuss telehealth privacy and security with patients. OCR also issued a resource for patients called “Telehealth Privacy and Security Tips for Patients.” This resource provides recommendations that patients can implement to protect and secure their health information.

Administrative Position, Good Pay, State Benefits

The Delaware Department of Correction (DDOC) seeks a physician to fill the role of Medical Director within the Bureau of Healthcare, Substance Abuse and Mental Health Services. This is a fully administrative role with no direct patient care involvement. Please go to 

https://www.jobapscloud.com/DE/sup/bulpreview.asp?b=&R1=091923&R2=MDEB03&R3=380200 for further details and to apply. For questions, please contact Awele Maduka-Ezeh, MD, MPH, PhD, CCHP, Medical Director & Healthcare Epidemiologist, at the Delaware Department of Correction or Michael Records, Chief of Health Services.

Allege Use of Addictive Features Aimed at Kids on Social Media Platforms

Attorney General Kathy Jennings announced on Tuesday that Delaware has joined a bipartisan coalition of attorneys general suing Meta in federal and state courts, alleging that the company knowingly designed and deployed harmful features that purposefully addict children and teens on Instagram and its other social media platforms. At the same time, Meta falsely assured the public that these features are safe and suitable for young users.

The attorneys general assert that Meta’s business practices violate state consumer protection laws and the federal Children’s Online Privacy Protection Act (COPPA). These practices have harmed and continue to harm the physical and mental health of children and teens and have fueled what the U.S. Surgeon General has deemed a “youth mental health crisis” which has ended lives, devastated families, and damaged the potential of a generation of young people.  

Causing Contamination of Delaware's Natural Resources

Attorney General Kathy Jennings announced that the Department of Justice has filed a lawsuit to hold numerous companies accountable for contaminating Delaware’s natural resources with per- and poly-fluoroalkyl substances (PFAS) traceable to the use and disposal of aqueous film-forming foam (“AFFF”), a specialized firefighting foam product widely used at airports and military bases. The lawsuit results from a detailed investigation conducted over a two-year period, including environmental sampling and forensic analysis as well as review of corporate records. 

Helping Local Communities Who Speak Spanish

The Delaware Breast Cancer Coalition is proud to share their latest video explaining how their Women’s Health Screening Program works and can help our local communities who speak Spanish! Watch the video (In Spanish).

Power Management Printed Circuit Board Assemblies Not Meeting Ventilator Standards

Philips Respironics, Inc. is recalling their V60 Ventilators and V60 Plus Ventilators. The ventilators contain Power Management Printed Circuit Board Assemblies (PM PCBA) that were distributed by a third-party warehouse. The PM PCBAs do not meet ventilators standards. Please be aware, this recall is a voluntary correction, not a product removal. The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death.

For Potential Exposure to Toxic Compounds

Fresenius Medical Care is recalling some of its 2008 Series Hemodialysis Machines because patients may be exposed to non-dioxin-like (NDL) polychlorinated biphenyl acids (PCBAs) that leach from some peroxide cured silicone tubing used as part of the hydraulics in the machine and dialysate lines. Data provided by the manufacturer indicates that the amount of NDL PCBAs decreases over the first month during routine clinical use of the hemodialysis machine. Fresenius Medical Care is updating affected machines manufactured between August 21, 2008, and June 6, 2022, that contain chlorinated peroxide cured silicone tubing and may not have been used or may have been in use for less than 36 days (or 486 total hours). The FDA has identified this as a Class I recall, the most serious type of recall. Use of these devices may cause serious injuries or death.

Sodium Bicarbonate Injection, Midazolam, ELCYS for Particulate Matter

Exela Pharma Sciences, LLC, (Exela) is voluntarily recalling the products listed in the table below to the consumer level. Particulate matter identified as silicone was observed during routine inspection of retain samples.

Risk Statement: Administration of an injectable product that contains particulate matter may result in local irritation or swelling in response to the foreign material. If the particulate matter reaches the blood vessels it can travel to various organs and block blood vessels in the heart, lungs or brain which can cause stroke and even lead to death. Exela has not received any reports of adverse events related to this recall. Product was distributed nationwide to wholesalers, distributors, and health systems between January 18, 2022 and February 15, 2023.

Potentially Defective McGRATH MAC Video Laryngoscopes

Medtronic issued a notification to inform the public of stolen defective McGRATH™ MAC video laryngoscopes that have been offered for sale illegally by unauthorized third parties through various social media platforms. These affected products did not pass Medtronic’s rigorous quality tests established for the product, were not released for sale, distribution, or importation and were designated for destruction. These affected products are defective and should not be used. Medtronic is working closely with regulatory authorities and law enforcement organizations to help ensure that unauthorized advertisements are being removed as identified, and actions to recover the stolen defective products are underway. NOTE: McGRATH™ MAC video laryngoscopes purchased directly from Medtronic or via its authorized distributors are not affected by this safety notice.

Deadline Extended to November 30th

The Physicians Foundation recently launched the new Physicians Foundation’s Leadership Award Program to honor the next generation of physician leaders. Award winners will receive a $10,000 scholarship to elevate their efforts to address drivers of health (DOH) or to advance innovative solutions to make their communities or practices a healthier place for patients and physicians. New or early-career physicians are encouraged to apply by November 30th. 

January 2, 2024 Deadline

As a reminder, physicians may now apply for an Extreme and Uncontrollable Circumstances hardship exception to avoid an up to 9% penalty in the Merit-based Incentive Payment System (MIPS) due to the impact of the COVID-19 public health emergency (PHE). Applications can be submitted through Jan. 2, 2024. Read more.

Tracking Work Outside of Work

The use data available in your electronic health record (EHR) can track a variety of essential metrics, including the hours a physician is logged in on nights, weekends or during a vacation. This “pajama time”—one of the main work-life balance issues connected to EHR use—is a predictor of higher physician burnout, which is associated with care quality, patient safety and satisfaction.

LEARN MORE:

Toolkits:

• EHR Inbox Management
• Getting Rid of Stupid Stuff

Podcast: Reducing Pajama Time and Work Outside of Work (WOW)

Success Story: Personalized Electronic Health Record Coaching

AMA STEPS Forward^® offers a collection of engaging and interactive educational content designed to help put the joy back into medicine.

Curated by Medscape

Considering a part-time job after you retire? Explore these 20 top opportunities in high-demand industries, curated by Medscape, in collaboration with job experts and retired physicians.

Extra Vigilance on Roads as Days Shorten, Deer Become More Active

As clocks are about to fall back to Eastern Standard Time and the days and daylight shorten, it’s also a dangerous time of year to be on the road because of the annual white-tailed deer mating season known as the rut. During the rut, which lasts from late October through November and into December, males (bucks) go about their annual pursuit of females (does) in the First State. The Delaware Department of Natural Resources and Environmental Control, the Office of Highway Safety (OHS) within the Department of Safety and Homeland Security and Delaware State Police (DSP) are again urging extra caution at the wheel during this time – especially after the Nov. 5 change from Daylight Saving Time to EST. Dusk and dawn are times when deer also are typically most active. Driving unlit rural roads without heavy traffic or traveling busier roadways bordered by woods are the most common scenarios for deer-vehicle collisions in Delaware, where white-tailed deer are more likely to cross. The latest figures from OHS show that most deer-vehicle collisions in Delaware occur between 5 a.m. and 7 a.m., spiking again between 5 p.m. and midnight. In 2022, the state recorded 1,619 crashes involving deer on the roadway. To date in 2023, there have been more than 860 deer-related crashes. OHS data also finds deer-related crashes to be most common in October, November and December, representing 46% of all Delaware vehicle-deer collisions from 2017 to 2021.

Bayhealth

Cape Henlopen Dermatology

ChristianaCare

TidalHealth Nanticoke

Fabian P. Ngido, MD

MSD spotlights members throughout the state, highlighting medical students, residents, and practicing colleagues, whether they are new to membership or have been a member over the years.

This week's spotlight is on Fabian P. Ngido, MD, pediatrician with Nemours Children's Health at Beebe Healthcare. Read more about Dr. Ngido.

If you would like to be featured in a future Member Spotlight, please contact Michelle.Seymour@medsocdel.org, Membership Manager.

Alfonso J. Arevalo, DO - Delaware Orthopaedic Specialists, PA

Zachary Bopp - Medical Student, Sidney Kimmel Medical College (2024)

Thomas C. Mueller, MD - ChristianaCare Neurology Specialists

Akul S. Patel, MD - Delaware Orthopaedic Specialists, PA 

MSD members are afforded a seven-day review period from the date of this publication to comment regarding applicants for membership. Please contact Michelle Seymour at (302) 224-4905 or Michelle.Seymour@medsocdel.org with any comments on the current pending members(s) listed above or if you know of someone interested in joining MSD. You could be eligible for a membership referral dues discount!

The Latin phrase Rerum Cognoscere translates to learn, examine, or become aware of facts or things. In this section, we highlight measurable items of interest in health care from MSD, Delaware, the US, and the world.

The CDC adopted the 2023-2024 Advisory Committee on Immunization Practices’ (ACIP) recommendations on annual influenza (flu) vaccination for everyone 6 months and older in the United States on June 27, 2023. There were small changes to the annual recommendations around flu vaccination, including an acknowledgement of the updated flu vaccine composition for the 2023-2024 flu season and a change in the recommendations for vaccination of people with egg allergies. The adoption of the ACIP recommendations makes them official CDC policy, which have been published in the Morbidity and Mortality Weekly Recommendation Report August 23, 2023. Health care professionals should begin vaccinating patients according to CDC’s recommended timing, which remains the same as last season. Read the CDC Vaccine Recommendations for the 2023-2024 flu season.

Flu Vaccination Guidance for Children

Flu can be a serious threat to children. During a COCA call on August 31, 2023, presenters discussed flu prevention and treatment recommendations from the American Academy of Pediatrics and CDC. If you’ve missed it, this recording is a great update on vaccination, coadministration of flu vaccines, coverage, and health disparities.

The FDA has outlined the following brief guidelines for the updated COVID-19 vaccines to simplify the questions regarding whom should receive the vaccine and when: 

• Individuals 5 years of age and older regardless of previous vaccination are eligible to receive a single dose of an updated mRNA COVID-19 vaccine at least 2 months since the last dose of any COVID-19 vaccine.  
• Individuals 6 months through 4 years of age who have previously been vaccinated against COVID-19 are eligible to receive one or two doses of an updated mRNA COVID-19 vaccine (timing and number of doses to administer depends on the previous COVID-19 vaccine received).  
• Unvaccinated individuals 6 months through 4 years of age are eligible to receive three doses of the updated authorized Pfizer-BioNTech COVID-19 Vaccine or two doses of the updated authorized Moderna COVID-19 Vaccine. 
• On October 3, 2023, the FDA amended the emergency use authorization (EUA) of the Novavax COVID-19 Vaccine, Adjuvanted for use in individuals 12 years of age and older to include the 2023-2024 formula. Individuals 12 years of age and older previously vaccinated with a COVID-19 vaccine (and who have not already been vaccinated with a recently updated mRNA COVID-19 vaccine) are eligible to receive one dose and unvaccinated individuals receive two doses. As part of this action, the Novavax COVID-19 Vaccine, Adjuvanted (Original monovalent) is no longer authorized for use in the United States.

Vaccination will be available free for everyone through one of three methods.

• Most Private and government insurance plans - cost fully covered by insurance (receive through pharmacies, health care professionals)
• Uninsured, underinsured - cost covered through FQHCs; public health clinics; pharmacies; health care professionals via Delaware Immunization Program; and Walgreens, CVS, and pharmacies affiliated with ETrue North pharmacy network through Bridge Access Program.
• Children participating in CDC's Vaccines for Children Program - free from where they receive routine vaccinations.

 A full listing of vaccine locations is posted on www.vaccines.gov.

The national emergency and public health emergency (PHE) declarations related to the COVID-19 pandemic ended on May 11, 2023. The Centers for Medicare & Medicaid Services (CMS) has resources available, some of which have been updated based on recent action by Congress.

• Frequently Asked Questions: CMS Waivers, Flexibilities, and the End of the COVID-19 Public Health Emergency (Updated 5/12/2023).
• Provider-specific fact sheets for information about COVID-19 Public Health Emergency (PHE) waivers and flexibilities: https://www.cms.gov/coronavirus-waivers
• Acute Hospital Care At Home
• Loss of Medicaid or CHIP coverage
• FAQs on CMS Waivers, Flexibilities, end of COVID-19 PHE (May 4, 2023)

Updates will continue to be provided as we approach the end of the PHE. You are encouraged to regularly visit the CMS Emergencies Page for the most up to date information

• Find COVID-19 Vaccines: https://www.vaccines.gov/
• No Cost COVID-19 Testing Locator can help people find current community and pharmacy partners participating in the Increasing Community Access to Testing (ICATT) program.
• FDA At-Home OTC COVID-19 Diagnostic Tests provides a list of all FDA-authorized at-home over-the-counter (OTC) COVID-19 diagnostic tests
• Federal website for information on navigating COVID: COVID.gov
• CDC Isolation and Precautions for People with COVID-19
• COVID-19 Therapeutics Locator
• CDC COVID Data Tracker
• CDC will report regional-level test positivity data from the National Respiratory and Enteric Virus Surveillance System (NREVSS)
• COVID-19 by County Community Level Check (# hospital admissions and beds used and total number of new cases)
• (Delaware) General Questions: call 211 or email DPHCall@delaware.gov or Vaccine@delaware.gov for vaccine-specific questions.
• Latest information on Delaware's response (testing, treatment, vaccination): de.gov/coronavirus (Updated 2/2023)