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Taught Document patient encounters appropriately in Epic hypertension education materials cheap 5 mg bystolic visa, and including all pertinent information Evaluated Select relevant therapeutic interventions hypertension diabetes purchase discount bystolic, allergies heart attack xoxo bystolic 2.5mg discount, adverse drug reactions arteria hypogastrica buy discount bystolic on line, and medication errors for documentation in the appropriate electronic system. Taught Prioritize daily tasks such that patient care is first and and not neglected or issues at hand are passed along to Evaluated the preceptor or someone else. Resolve any outstanding medication problems by the end of the work day and when not possible, have an explanation as to why the issue cannot be resolved. Communicate pertinent information with covering clinical pharmacist for patients admitted from clinic. Present at appropriate rate and volume and without distracting speaker habits Provide concise, informative, and thorough case conference presentation, when assigned Goal R4. Evaluated Facilitate, when appropriate, by allowing learner independence when ready and using indirect monitoring of performance. The Family Medicine Service is made up of a 1st, 2nd and 3rd year Family Medicine residents, one attending and a clinical pharmacist. The team pharmacist is fully integrated into the Family Medicine team, rounds on a daily basis, and focuses on management of drug therapy in patients with multiple medical problems. The pharmacist is responsible for ensuring safe and effective medication use for all patients admitted to the team. Routine responsibilities include: pharmacokinetic drug monitoring, anticoagulation, drug information, order verification, discharge planning/care coordination, and education to healthcare professionals as well as patients and caregivers, if requested Disease States Common disease states in which the resident will be expected to gain proficiency through direct patient care experience for common diseases including, but not limited to: · Obstetric conditions o Chronic disease management, infections during pregnancy, labor, and postpartum, hypertensive disorders of pregnancy, gestational diabetes, other pregnancy induced conditions. Daily scheduled meeting times: Residents to prioritize questions and problems to discuss during scheduled meeting times and between rounds. Evaluated Obtain admitting medication histories and perform medication reconciliation as requested. Taught Be prepared to discuss problems identified with and preceptor after patient rounds. Evaluated Identify any issues with medication therapy (ie, lack of indication, condition for which no medication is prescribed, suboptimal regimen, therapeutic duplication, adverse events, interactions, social/ financial barriers). Taught Be prepared to discuss recommendations for and addressing problems with preceptor after morning Evaluated rounds with team. Taught Discuss recommendations with family medicine or and obstetric team after getting approval from preceptor, if Evaluated required by preceptor. If cannot be resolved, ensure that any outstanding issues are communicated to evening pharmacist prior to leaving for the day via direct communication and One Note. The hem/onc pediatric medicine teaching and rounding team also covers pediatric gastroenterology patients. The pharmacy resident will be integrated into the pediatric hem/onc medicine interdisciplinary team, round on a daily basis, and focus on management of drug therapy in pediatric hem/onc patients with multiple medical problems. Knowledge of primary treatments, supportive care, and management of complications will be emphasized. Routine responsibilities include: pharmacokinetic drug monitoring, anticoagulation, drug information, order verification which may include chemotherapy, medication reconciliation, transitions of care education, discharge planning/care coordination, and education to healthcare professionals as well as patients and caregivers, if requested. Pharmacotherapy recommendations focus on, but are not limited to the management of: pain, antibiotic, supportive care, and drug interactions. The resident will gradually assume responsibility for all of the patients within the assigned rounding service. Expectation of Learners: Preceptor Interaction Daily: · · Before 8:30 Pre-rounds (preceptor available for questions during this time) 8:30 ­ 10:30 Pediatric hem/onc medicine teaching rounds Intermittent: · 2:00 ­ 3:30 Topic Discussions and/or patient case discussion Communication: A. This may or may not be achieved during this rotation, especially if pediatrics is a new experience, but it is the goal. Evaluations are signed/ co-signed only after discussed in a summative evaluation meeting between the preceptor and resident. Taught Discuss recommendations with appropriate medical and team after getting approval from preceptor, if required Evaluated by preceptor. Evaluated Document as necessary in the patient chart for: vancomycin and aminoglycoside pharmacokinetic monitoring, sedation and analgesia weans, medication reconciliation, discharge counseling, other complicated medication issues as needed. Resolve existing and potential medication-related problems and obtain satisfactory resolutions to these issues. Perform medication reconciliation upon admission, transfer, and discharge as necessary.

Using research to change practice: Enteral feedings for pediatric oncology patients arteria x veia bystolic 5 mg with amex. Medical and psychological experiences of family caregivers with children fed enterally at home enrique iglesias heart attack discount bystolic 5mg with visa. Nutritional management and the multisystem organ failure/systemic inflammatory response syndrome in critically ill preterm neonates blood pressure medication overdose order bystolic with amex. Impact of intraoperative duodenal feeling on the oxygen bilance of the splanchnic region in severely burned patients pulse pressure 50 order cheap bystolic on line. Bedside method for placing small bowel feeding tubes in critically ill patients: A prospective study. Comparison of weighted versus unweighted enteral feeding tubes for efficacy of transpyloric intubation. Gastric vs smallbowel feeding in critically ill children receiving mechanical ventilation. Bedside transpyloric tube placement in the pediatric intensive care unit: A modified insufflation air technique. Efficacy of metoclopramide as an adjunct to duodenal placement of smallbore feeding tubes: A randomized, placebo-controlled, double-blind study. Efficacy of erythromycin for postpyloric placement of feeding tubes in critically ill children: A randomized, double-blind, placebo controlled study. A randomized controlled trial comparing three different techniques of nasojejunal feeding tube placement in critically ill children. Fluoroscopically guided nasoenteric feeding tube placement: Results of a 1-year study. Transnasal endoscopy for enteral feeding tube placement in critically ill patients. The "buried bumper syndrome": A complication of percutaneous endoscopic gastrostomy. Retrograde percutaneous gastrostomy and gastrojejunostomy in 505 children: A 4 1/2 year experience. Efficacy and safety of radiologically placed gastrostomy tubes in paediatric haematology/oncology patients. A simplified technique for laparoscopic jejunostomy and gastrostomy tube placement. The limitations of gastro-jejunal (G-J) feeding tubes in children: A 9-year pediatric hospital database analysis. Detection of inadvertent respiratory placement of small-bore feeding tubes: A report of 10 cases. Visual characteristics of aspirates from feeding tubes as a method of predicting tube location. Development of a reliable and valid bedside test for bilirubin and its utility for improving prediction of feeding tube location. Confirmation of enteral feeding tube placement using duodenal slowwave frequency analysis. However, liquid drug preparations tend to have a high osmolality (1,000 and 11,000 mOsm/kg) and may cause feeding intolerance when infused into the jejunum. The osmotic properties of these liquids are usually attributable to the presence of sorbitol, propylene glycol, or polyethylene glycol. Although included among the inactive ingredients on drug labels, the amount is not usually quantified. Osmotic diarrhea and delayed gastric emptying can occur if the cumulative dose is more than 20 g (range, 7. Successful enteral nutrition therapy has limited the use of parenteral nutrition therapy, resulting in important benefits in terms of safety, manageability, and cost. Further improvements in technology enabling light, simple, feeding pumps and modifications to tube design will continue to assist in the administration of enteral nutrition to children. The history of enteral nutrition therapy: From raw eggs and nasal tubes to purified amino acids and early post-operative jejunal delivery. Early postoperative enteral nutrition improves gut oxygenation and reduces costs compared with total parenteral nutrition.

In 1970 blood pressure medications that start with l generic bystolic 5 mg fast delivery, legal production of amphetamines reached over 10 billion tablets arrhythmia flowchart 5mg bystolic with mastercard, many times the amount needed for legitimate medical use high blood pressure medication and lemon juice purchase 2.5 mg bystolic amex. A survey of use among a national sample of over 7 blood pressure medication that doesn't cause dizziness buy bystolic once a day,000 college students conducted that year found that 11% reported amphetamine/methamphetamine use (Grinspoon and Hedbloom, 1975). Changing laws and changing drug trends over the next two decades appeared to effect the virtual disappearance of these drugs. However, starting in the 1980s, methamphetamine use resurfaced, steadily gathering a following once again. Beginning in Hawaii and the West, methamphetamine became increasingly popular, spiking treatment admissions from 2% of all treatment admissions in 1993 to 7% in 2003 (U. Methamphetamine use has been at epidemic stages in some areas of the country for over a decade, while in others its popularity is confined to smaller subgroups. In California, the proportion of all the treatment admissions for methamphetamine has gone from 8% to 31% from 1992 to 2003; in Arkansas, it skyrocketed from 2% to 22%; and in Iowa the rate went from 2% to 22% (U. Many data sources do not distinguish between the general category of amphetamine and methamphetamine, and simply combine them into a general category of amphetamine-like substances. Cheap, easy to manufacture and long acting, methamphetamine has become a major player in the drug culture. While the largest number of seizures are still found in the West, Midwest, and the South, other areas show marked increases. Amphetamine/methamphetamine use in the Northeast, Mid-Atlantic, and some parts of the South is less common, but is appearing in subpopulations of users with increasing frequency. The percentage of admissions to treatment for abuse of amphetamines/methamphetamine in Connecticut, Delaware, Washington, D. Powerful stimulant effects and the high potential for profit by distributors are just two of the reasons methamphetamine is as popular or more popular than cocaine in some U. Difficulty treating meth addicts and difficulty regulating the precursor chemicals used to manufacture it challenge law enforcement, treatment professionals, and already strained rural and urban resources. This monograph summarizes current information about methamphetamine: characteristics of users, treatment approaches, production and trafficking, and the impact on law enforcement. We draw on a variety of sources: scientific and professional literature, published materials from Federal and state reporting systems, analysis of several Federal datasets, and discussions with law enforcement and public health providers at all levels of government. In addition, we have reviewed Internet chat rooms, visited blog sites, and explored the many Internet sites distributing information that offer supplies, detail manufacture, and discuss use. We first trace the development of methamphetamine, describe trends in use, and examine characteristics of users. In Chapter 2, we discuss trafficking, production, and law enforcement efforts, and in Chapter 4, look at the effects of the drug on behavior and health and describe approaches to treatment. Chapter 4 summarizes our findings and discusses their implications for research and policy and presents the case of the impact of methamphetamine use on two rural counties. Methamphetamine Use: Lessons Learned 2 Chapter 1: Methamphetamine Use in the United States 1. The active ingredient in Ephedra, ephedrine, was isolated in the 1880s by German chemists, but not marketed until the 1920s, when it was formulated for use in bronchial inhalers. In 1932, Smith, Kline, and French introduced these drugs in over-the-counter inhalers for asthma and congestion (Brecher, 1972). In the 1930s, the American Medical Association approved the use of amphetamines under names like Benzedrine for treatment of a range of disorders-narcolepsy, depression, Parkinsons, attention deficit disorder, and alcoholism. In 1940, the Burroughs Wellcome company introduced methamphetamine tablets to commercial markets under the name Methedrine, and amphetamine and methamphetamine were both widely available in the early 1940s. The first Japanese methamphetamine epidemic peaked in 1954, with up to 2 million people (over 2% of the total population) using meth intravenously. A survey of pilots in Desert Storm also indicated substantial (57%) use of stimulants to remain awake in combat (Emonson and Vanderbeek, 1995). Methamphetamine Use: Lessons Learned 3 Civilian use of amphetamine and methamphetamine began to escalate in the late 1950s and early 1960s with its appearance in other forms (Dexedrine, Dexamyl, Desoxyn, Biphetamine), available by prescription and leaked to the illegal market. In addition, users began injecting the contents of benzedrine inhalers and liquid methamphetamine in ampoules. The 1960s rise in use has often been linked to new distribution networks operated by motorcycle gangs in the U.

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