Archive for September, 2014

Attention Members Receiving their Degree of Fellow: Attend the Convocation Ceremony at the Annual Meeting

Did you complete your Fellows Application…but you haven’t taken the oath?


Would you like to become a Fellow?

Come and Join Us in November!

~ Degree of Fellow Convocation Ceremony at the GAFP Annual Meeting ~

The Georgia Academy of Family Physicians (GAFP) will hold a Convocation Ceremony at its Annual Meeting, Sunday, November 16, for members eligible to receive their Degree of Fellow.   The deadline to apply for the Degree of Fellow for this year is September 30.  All approved applicants, whether approved this year or in the past but have not yet convocated, will be eligible to take their oath and receive their degree of Fellow at our meeting.

In addition, to register for the GAFP Annual Meeting and Scientific Assembly, go to the Annual Assembly event page and sign up online.  If you have any questions, call the GAFP office at 800-392-3841.

Application Requirements

Any Active, Life or Inactive member, with dues and re-elections in good standing, may, upon application to the American Academy of Family Physicians, be elected to receive the Degree of Fellow upon fulfilling the following requirements:

  1. Member must have held Active membership for six years, or held a combination of Resident and Active membership for a total of six years.
  1. Accrue a grand total of 100 points as defined by this application. Cite experiences and activities in the following areas: Life-Long Learning, Practice Quality and Improvement, Volunteer Teaching, Public Service, Publishing and Research, and Service to the Specialty.
  1. Submit a one-time fee of $195.

To submit online go to this link on the AAFP website: If you need assistance, please contact the AAFP Fellowship Coordinator, Heather Ynda by phone (1-800-274-2237, ext. 6821) or email (

CDC Releases Information on Severe Respiratory Illness Associated with Enterovirus D68

September 12, 2014 / 63(36);798-799
Claire M. Midgley, PhD1,2, Mary Anne Jackson, MD3, Rangaraj Selvarangan, PhD4, George Turabelidze, MD5, Emily Obringer, MD6, Daniel Johnson, MD6, B. Louise Giles, MD6, Ajanta Patel, MD6, Fredrick Echols, MD7, M. Steven Oberste, PhD2, W. Allan Nix2, John T. Watson, MD2, Susan I. Gerber, MD2 (Author affiliations at end of text)


On September 8, 2014, this report was posted as an MMWR Early Release on the MMWR website (


On August 19, 2014, CDC was notified by Children’s Mercy Hospital in Kansas City, Missouri, of an increase (relative to the same period in previous years) in patients examined and hospitalized with severe respiratory illness, including some admitted to the pediatric intensive care unit. An increase also was noted in detections of rhinovirus/enterovirus by a multiplex polymerase chain reaction assay in nasopharyngeal specimens obtained during August 5–19. On August 23, CDC was notified by the University of Chicago Medicine Comer Children’s Hospital in Illinois of an increase in patients similar to those seen in Kansas City. To further characterize these two geographically distinct observations, nasopharyngeal specimens from most of the patients with recent onset of severe symptoms from both facilities were sequenced by the CDC Picornavirus Laboratory. Enterovirus D68* (EV-D68) was identified in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. Since these initial reports, admissions for severe respiratory illness have continued at both facilities at rates higher than expected for this time of year. Investigations into suspected clusters in other jurisdictions are ongoing.

Of the 19 patients from Kansas City in whom EV-D68 was confirmed, 10 (53%) were male, and ages ranged from 6 weeks to 16 years (median = 4 years). Thirteen patients (68%) had a previous history of asthma or wheezing, and six patients (32%) had no underlying respiratory illness. All patients had difficulty breathing and hypoxemia, and four (21%) also had wheezing. Notably, only five patients (26%) were febrile. All patients were admitted to the pediatric intensive care unit, and four required bilevel positive airway pressure ventilation. Chest radiographs showed perihilar infiltrates, often with atelectasis. Neither chest radiographs nor blood cultures were consistent with bacterial coinfection.

Of the 11 patients from Chicago in whom EV-D68 was confirmed, nine patients were female, and ages ranged from 20 months to 15 years (median = 5 years). Eight patients (73%) had a previous history of asthma or wheezing. Notably, only two patients (18%) were febrile. Ten patients were admitted to the pediatric intensive care unit for respiratory distress; two required mechanical ventilation (one of whom also received extracorporeal membrane oxygenation), and two required bilevel positive airway pressure ventilation.

Enteroviruses are associated with various clinical symptoms, including mild respiratory illness, febrile rash illness, and neurologic illness, such as aseptic meningitis and encephalitis. EV-D68, however, primarily causes respiratory illness (1), although the full spectrum of disease remains unclear. EV-D68 is identified using molecular techniques at a limited number of laboratories in the United States. Enterovirus infections, including EV-D68, are not reportable, but laboratory detections of enterovirus and parechovirus types are reported voluntarily to the National Enterovirus Surveillance System, which is managed by CDC. Participating laboratories are encouraged to report monthly summaries of virus type, specimen type, and collection date.

Since the original isolation of EV-D68 in California in 1962 (2), EV-D68 has been reported rarely in the United States; the National Enterovirus Surveillance System received 79 EV-D68 reports during 2009–2013. Small clusters of EV-D68 associated with respiratory illness were reported in the United States during 2009–2010 (3).

There are no available vaccines or specific treatments for EV-D68, and clinical care is supportive. Health care providers should consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness; suspected clusters or outbreaks should be reported to local or state health departments. CDC’s Picornavirus Laboratory (e-mail: is available for assistance with diagnostic testing.

1Epidemic Intelligence Service, 2Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, CDC; 3Infectious Disease Department, 4Department of Pathology and Laboratory Medicine, Children’s Mercy Hospital, Kansas City, Missouri; 5Missouri Department of Health and Senior Services; 6University of Chicago Medicine; 7Illinois Department of Public Health. (Corresponding author: Claire M. Midgley,


  1. Oberste MS, Maher K, Schnurr D, et al. Enterovirus 68 is associated with respiratory illness and shares biological features with both the enteroviruses and the rhinoviruses. J Gen Virol 2004;85:2577–84.
  2. Schieble JH, Fox VL, Lennette EH. A probable new human picornavirus associated with respiratory disease. Am J Epidemiol 1967;85:297–310.
  3. CDC. Clusters of acute respiratory illness associated with human enterovirus 68—Asia, Europe, and United States, 2008–2010. MMWR 2011;60:1301–4.


* Enterovirus and rhinovirus species names recently were revised to remove host names and to append the type number to the species designation; hence, human enterovirus 68 (HEV-68, also previously called EV68) is now EV-D68.

New Georgia Preceptor Tax Incentive Program (GA-PTIP) Webinar Available!

The Georgia Statewide AHEC Network Program Office held a webinar on August 29th, 2014 to discuss the Georgia Preceptor Tax Incentive Program and certifying physician activity towards obtaining the deduction. The webinar focused on the rationale for the newly created tax deduction commencing July 2014, understanding the definitions as set forth in the law (SB 391), understanding the mechanics for gathering and certifying eligible rotations, and answered some Frequently Asked Questions. The recorded webcast from August 29th is now available to view online here.

Hydrocodone combinations become Schedule II drugs on Oct. 6

Pharmaceuticals containing hydrocodone will be reclassified from Schedule III to Schedule II as of Oct. 6, 2014. The Drug Enforcement Administration published the final rule making the change in the Federal Register in August. The change is intended to curb abuse of hydrocodone, but it will require some changes in the way physicians and pharmacists handle these prescriptions. After the reclassification:

  • Prescriptions for hydrocodone combinations cannot be faxed or called in to a pharmacy; instead they must be written on an official form or submitted electronically directly to the pharmacy;
  • Hydrocodone prescriptions cannot be refilled; they will require a new prescription for each order; and
  • Physicians will not be able to delegate authority to prescribe hydrocodone combinations to nurse practitioners and physician assistants outside of hospital or hospice settings.

Physicians and pharmacists are well aware of the requirements for filling Schedule II prescriptions, but the sheer volume of scripts for hydrocodone combinations is likely to make this a significant change in the daily practice of many doctors.

According to the Georgia Drugs & Narcotics Agency:

In Georgia, the State Board of Pharmacy plans to pass a rule reclassifying HCPs to Schedule II as of October 6, 2014 – the same effective date as that of the DEA.  This rule will ensure that pharmacies handle HCPs as Schedule II products, however this rule will not have the force of law in regards to criminal illegal possession or distribution. Georgia law will have to be changed via the 2015 annual drug update for the Legislature will include language to mimic the federal law for HCPs.

Georgia HCP Guidelines:

Any HCP prescription written before October 6, 2014 should be treated and filled as a Schedule III controlled substance, including refills as specified below.

Refills authorized on a HCP prescription, written and filled before October 6, 2014, may be dispensed up to five (5) times, as authorized, until April 8, 2015 or six months from the date the HCP was originally issued. No additional refills may be authorized, nor can refills be dispensed beyond the six month original issue date.  (Example: a HCP prescription issued on August 1, 2014 with 2 authorized refills may be refilled 2 times up until February 1, 2015)

**Note: this refill policy comes directly from the DEA HCP rule comments and directives**

Any HCP prescription written on or after October 6, 2014 should be treated and filled as a Schedule II controlled substance.

ALL hard copy HCP prescriptions must be issued on security paper as of October 6, 2014.

No Refills may be authorized for any HCP prescription written on or after October 6, 2014.

No call-in HCP prescriptions are allowed except as authorized in emergencies for C-II controlled substances.

After October 6, 2014 APRNs and PAs can no longer order or issue HCP prescriptions.

On October 6, 2014, all pharmacies and practitioners should inventory any HCP in their possession or stock by conducting an actual count of each HCP drug.  This inventory should be signed and dated and included with the registrant’s biennial controlled substance inventory.

Other than existing requirements for Schedule II controlled substance prescriptions, there are no new limitations or restrictions on how often a HCP can be prescribed. There is no restriction on the quantity of a HCP that can be prescribed on one prescription. Nor is there any new requirement that a patient see a practitioner prior to obtaining a new HCP prescription.

There are simply no new requirements for HCPs other than they are now classified as C-II instead of C-III controlled substances. HCPs should be maintained the same as any other C-II controlled substance.

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