Get With The Guidelines® is a program that helps ensure consistent application of the most recent American Heart Association/American Stroke Association scientific guidelines for patient treatment. The program includes in-hospital modules for heart failure, stroke and resuscitation as well as a program for outpatient practices.

February is American Heart Month

The American Heart Association’s Get With The Guidelines-Outpatient has become The Guideline Advantage™ in collaboration with American Cancer Society and American Diabetes Association.

Mission: Lifeline® is a national, community-based initiative created by the American Heart Association to improve systems of care for patients with ST-elevation myocardial infarction (STEMI). The program focuses on streamlining and coordinating processes to help speed the delivery of appropriate treatment.

Target: Heart Failure is an initiative that provides healthcare professionals with content-rich resources and materials designed to help them advance heart failure awareness, prevention, treatment and recovery.

Target: Stroke is a campaign created to help hospital teams achieve the goal of door-to-needle (DTN) times of 60 minutes or less for ischemic stroke patients that receive thrombolytic therapy by providing evidence-based strategies, clinical decision support, measurement tools and other resources.

More resources for healthcare professionals are available on the American Heart Association’s website.

Source: The American Heart Association

Osteoporosis and heart failure are common, chronic and costly conditions that share common etiologic factors like older age, post-menopausal status and diabetes. Previous studies have suggested that heart failure may predispose a patient to fractures not only because it increases incidence of falling, but because both heart failure itself and its medical treatments can lead to loss of bone mass.

“Our study demonstrates for the first time that heart failure and thinning of bones go hand in hand,” said Sumit Majumdar, MD, of the University of Alberta in Edmonton, Canada, and lead author of the study. “Understanding the mechanism between heart failure and osteoporosis might lead to new treatments for both conditions.”

In this study, researchers conducted a population cohort study consisting of 45,509 adults undergoing bone mineral density testing for the first time and followed them for up to ten years. Of the 45,509 adults included in the study, 1,841 had recent-onset heart failure. After adjusting for traditional osteoporosis risk factors, researchers found that heart failure was associated with a 30% increase in major fractures.

“Part of screening for osteoporosis should involve looking at chest X-rays of patients with heart failure,” said Majumdar. “Heart failure patients get a lot of X-rays and they often incidentally show many fractures of the spine that would automatically provide an indication of severe osteoporosis and need for treatment.”

Other researchers working on the study include: Justin Ezekowitz of the University of Alberta; Lisa Lix of the University of Saskatchewan in Saskatoon, Canada; and William Leslie of the University of Manitoba in Winnipeg, Canada.

The article, “Heart Failure is a Clinically and Densitometrically Independent Risk Factor for Osteoporotic Fractures,” appears in the April 2012 issue of JCEM.

Source: Endocrine Society

Developing good habits at an early age and scheduling regular dental visits helps children get a good start on a lifetime of healthy teeth and gums.

The ADA has free online resources that can help you with oral health presentations, ideas for the classroom and coloring and activity sheets that can be used as handouts. We also have booklets, videos and other materials available for purchase through our ADA Catalog.

NCDHM resources are available on the ADA website.

Source: American Dental Association

NEWS-Line for Nurses – Vol. 13, No. 1F

Joanna J. Burgess, BSN, RN, CWOCN, is a RN specializing in wound, ostomy and continence nursing at an acute care center. She also has a specialty in the treatment of lymphedema, and has educated nurses on a state and national level utilizing the technique of Combined Decongestive Therapy. Joanna graduated with a BSN from West Virginia Wesleyan College in 1985, and holds certifications as a massage therapist (1993), a lymphedema therapist through the North American Dr. Vodder School of Lymphatic Therapy (1995), and a WOCN through the Emory School of Nursing (2007). After surviving a rare cancer as a child, Joanna knew she wanted a career helping others in a “nurturing and caring way.” Joanna was named the 2011 Great Comebacks® South Region Award Recipient by Great Comebacks®, a program designed to raise awareness of quality of life issues for people living with intestinal diseases that can lead to ostomy surgery.

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NEWS-Line for Occupational Therapists & COTAs – Vol. 11, No. 1F

Melissa A. Abrams, MS, OTR/L, is an OT specializing in pediatrics at Theraplay, Inc. She graduated from Misericordia University in Dallas, Pennsylvania, with a BS in health science and MS in occupational therapy with a pediatric track. She is also certified in Interactive Metronome and Therapeutic Listening®. Melissa has been an occupational therapist for more than three years at Theraplay, and describes her work environment as both “fun” and “rewarding.”

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NEWS-Line for Physical Therapists & PTAs – Vol. 17, No. 1F

Michele Kehrer, PT, DPT, ATC, Owner and CEO of LifeStyle Physical Therapy is a physical therapist specializing in PT for patients with vestibular and orthopedic disorders at her own facility in Chicago, Illinois. She graduated from Western Illinois for her undergraduate degree and the University of Illinois at Chicago for her doctorate. Dr. Kehrer also has certifications in cervicogenic dizziness and vestibular rehabilitation. Michele’s clinic, LifeStyle Physical Therapy and Balance Center, has been in business for more than five years, and she describes her job as “exciting!”

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NEWS-Line for Physician Assistants – Vol. 21, No.1

Misericordia University has named Scott L. Massey, PhD, PA-C, as founding department chairperson, program director and professor of the new Physician Assistant program. The five-year Master of Science program, which is offered through the College of Arts and Sciences, begins classes in late August 2012.

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NEWS-Line for Nurse Practitioners – Vol. 18, No. 1

Marcelle Pick, MSN, OB/GYN NP, is an NP and author of The Core Balance Diet and the recent best-selling book, Are You Tired and Wired? She has a BSN and a BA in psychology from the University of New Hampshire and an MS in nursing from Boston College-Harvard Medical School. Marcelle is a certified nurse practitioner in OB/GYN and pediatrics, hosts the weekly radio show, Core Balance for Women’s Health on Hay House Radio, and writes a bi-monthly newsletter featured on the web site for Women to Women, www.womentowomen.com. Marcelle is also a regular contributor for The Huffington Post.

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NEWS-Line for Pharmacists – Vol. 21, No. 1

Melody L. Hartzler, PharmD, AE-C, is a pharmacist specializing in outpatient/ambulatory care in a family practice residency clinic and an assistant professor of pharmacy practice. She graduated from Ohio Northern University in 2009 with a Doctor of Pharmacy, earned a teaching certificate from the Ohio State University College of Pharmacy, and completed an ASHP Accredited Pharmacy Practice Residency with an emphasis in Ambulatory Care at Chalmers P. Wylie VA Ambulatory Care Center. Melody is a registered pharmacist in the state of Ohio and has certifications in Basic Life Support, APhA Pharmacy-Based Immunization Delivery and APhA Delivering Medication Therapy Management Services in the Community. Melody began teaching at CU in August 2010 and describes her job as “fun!”

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NEWS-Line for Respiratory Care Professionals – Vol. 11, No. 1/2

Keith Siegel, RRT, CPFT, AE-C, Director of Respiratory Care and Neurodiagnostics at Pen Bay Medical Center is a registered respiratory therapist in charge of managing the Respiratory Care and Neurology departments and Center for Sleep Medicine at a community hospital on the coast of Maine. He has an associate’s degree in applied science in respiratory therapy from Southern Maine Community College, and is currently enrolled in a bachelor of science in business administration program at Southern New Hampshire University (graduating in 2012). In addition to being an RRT, Keith is a Certified Pulmonary Function Technologist (CPFT) and Certified Asthma Educator (AE-C). He is also involved with the Maine Society for Respiratory Care and the American Association for Respiratory Care, and believes that “individuals can make a difference” in the lives of others through advocacy.

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NEWS-Line for Speech-Language Pathologist & Audiologists – Vol. 11, No. 1/2

Irela R. Stout, MA, CCC-SLP, is an SLP specializing in dysphagia in Doctors Hospital at Renaissance in Edinburg, Texas. She has a master’s degree in communication disorders from the University of Texas at Pan American and a Certificate of Clinical Competence from the American Speech and Hearing Association. Irela works full-time in a physician-owned acute care hospital and does contract work in a nursing home. According to Irela, she chose to focus on dysphagia in an acute care setting because “it’s one of the few areas in my field where I feel that I can make an immediate difference and contribution to the patient’s care.”

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Oral bisphosphonates are currently taken by some 3 million women in the United States for the prevention or treatment of osteoporosis. In addition, intravenous bisphosphonates are given to thousands of cancer patients each year to control the spread of bone cancer and prevent excess calcium (hypercalcemia) from accumulating in the blood. Bisphosphonates work by binding to calcium in the bone and inhibiting osteoclasts, bone cells that break down the bone’s mineral structure.

“These drugs have been widely used for years and are generally considered safe and effective,” said study leader Athanasios I. Zavras, DMD, MS, DMSc, associate professor of Dentistry and Epidemiology and Director of the Division of Oral Epidemiology & Biostatistics at the Columbia University College of Dental Medicine. “But the popular literature and blogs are filled with stories of patients on prolonged bisphosphonate therapy who were trying to control osteoporosis or hypercalcemia only to develop osteonecrosis of the jaw.”

Osteonecrosis of the jaw, or ONJ, often leads to painful and hard-to-treat bone lesions, which can eventually lead to loss of the entire jaw. Among people taking bisphosphonates, ONJ tends to occur in those with dental disease or those who undergo invasive dental procedures.

There are no reliable figures on the incidence of ONJ in patients taking oral bisphosphonates. Estimates range from 1 in 1,000 to 1 in 100,000 patients for each year of exposure to the medication, according to the American College of Rheumatology. ONJ is more common among cancer patients taking the intravenous form of the drug, affecting about 5 to 10 percent of these individuals, noted Dr. Zavras.

Studies have suggested that genetic factors play a major role in predisposing patients to ONJ.  Delving deeper into this question, Dr. Zavras and his colleagues performed genome-wide analyses of 30 patients who were taking bisphosphonates and had developed ONJ and compared them with several bisphosphonate users who were disease free.

The researchers found that patients who had a small variation in the RBMS3 gene were 5.8 times more likely to develop ONJ than those without the variation. The study also identified small variations in two other genes, IGFBP7 and ABCC4, that may contribute to ONJ risk.

“Our ultimate goal is to develop a pharmacogenetic test that personalizes risk assessment for ONJ, a test that you could give to people before they start to use bisphosphonates,” said Dr. Zavras. “Those who are positive for this genetic variation would select some other treatment, while those who are negative could take these medications with little fear of developing ONJ.”

“At the moment, many women discontinue or avoid treatment for serious osteoporosis because they are afraid of losing their jaw bones,” added Dr. Zavras. “There even are reports of dentists who have refused to perform certain invasive procedures in patients taking bisphosphonates. So there is a great need for a pharmacogenetic screening test to determine which patients are really at risk for ONJ.”

The current study looked only at Caucasians. Further studies are needed to determine whether the RBMS3 gene variation is seen in other racial groups, according to the researchers.

“Genomewide Pharmacogenetics of Bisphosphonate-Induced Osteonecrosis of the Jaw: The Role of RBMS3,” was published in The Oncologist, and is freely available online.

Source: The Oncologist

We’re passionate about school-based healthcare because we know SBHCs are the best way to keep students healthy and in the classroom. That’s why we do this work every day – so that kids have access to the care they need to thrive.

Source:NASBHC

Established in 2004, the APhA-ASP Outstanding Dean Award recognizes the Dean of a school or college of pharmacy who has made significant contributions to the APhA-ASP Chapter and promoted the welfare of student pharmacists through various community service, leadership and professional activities. Matthews will be presented with the award during the APhA Annual Meeting and Exposition in News Orleans, in March. APhA’s awards series is pharmacy’s most comprehensive recognition program.

Hewitt W. Matthews, Dean, Mercer University College of Pharmacy and Health Sciences

Nominating Matthews, a student stated, “Dean Matthews recognizes that student organizations are key in promoting professionalism and enhancing the education of student pharmacists. He has written these views and values into the university mission statement and has furthered this mission by adding faculty support to student organizations. Dean Matthews practices an open-door policy with his students and also hosts a bi-annual meeting for the entire student body where he addresses concerns regarding the curriculum, organizational involvement and the educational experience at Mercer COPHS. Dean Matthews is a visionary leader and actively works with faculty, students and administration to improve the school.”

Matthews is Dean and Vice President for the Health Sciences and Professor of Pharmaceutical Sciences, Mercer University College of Pharmacy and Health Sciences. He earned a BS in Chemistry from Clark College, BSPharm from Mercer University and MS in Pharmaceutical Biochemistry and PhD in Biochemistry from the University of Wisconsin.

A past student of Matthews commented, “Dean Matthews is an exceptionally compelling, engaging and sincere individual. In and out of the classroom, he challenged us to strive for excellence; he encouraged student pharmacists and made an effort to get to know us as individuals. The culture he creates and the support he generously gives fosters success. Thousands of student pharmacists have benefitted from his leadership, wisdom, encouragement, wit, advocacy and support over the two decades of his deanship.”

Matthews is a member of numerous professional organizations including AMCP, AACP, AAPS, APhA and ASHP. He has been honored with several awards for his achievements including Outstanding Leadership Award from the Magnolia State Pharmaceutical Association, Dean Facilitator, Academic Leadership Fellows Program from AACP, the Cahuncey I. Cooper Award from the NPhA and the ACA Dean’s Recognition Award for Outstanding Service to Community Pharmacy Practice.

Source: Mercer University College of Pharmacy and Health Sciences

New research from the University of North Carolina at Chapel Hill School of Medicine has opened a door to the answer. Researchers led by William E. Goldman, PhD, professor and chair of microbiology and immunology at the University of North Carolina at Chapel Hilland a leading authority on Y. pestis, show that the plague bacteria transform the lungs from a nasty place for microbes into a playground for them to flourish.

The research appears online in the Proceedings of the National Academy of Sciences during the week of Monday January 30, 2012.

Virulent Y. pestis bacteria (red) quickly establish a permissive environment for the growth of non-virulent microbes (green) that would normally be eliminated by lung’s immune mechanisms.

Goldman notes that most other microbes that infect the lungs trigger an antimicrobial response within a few hours after infection. This early inflammatory response is generally sufficient to eliminate microorganisms with no more than mild respiratory symptoms. Not so with Y. pestis; for about 36 hours, the lungs are “quiet,” not inflamed, and symptoms are completely absent.

But in the first 36 hours of infection, plague bacteria are having a field day, growing and reproducing rapidly – 2-fold, 100-fold, 100,000-fold – and all of that without outward disease symptoms or measurable changes in lung tissue.

“And then, rather abruptly, symptoms start to appear,” Goldman says. “They progress rapidly to the point where you realize this is not just a cold, this is not just the flu. But by then the disease has progressed too far for effective medical intervention, and death is likely within the next day or two.”

And once people have pneumonic plague, the bacteria can spread via respiratory droplets to others who have close contact with them. The US Centers for Disease Control and Prevention notes that during the delay between being exposed to Y. pestis and becoming seriously sick, people could travel over a large area, possibly infecting others, which could make the infection more difficult to control.

“Here’s the question we wanted to answer: Is the organism avoiding detection or is it actually suppressing the immune responses of the lung?” Goldman said. “The paper is really about the experiments designed to distinguish between these possibilities. And the answer we found suggests the latter.”

In their “co-infection” experiments, the UNC study team mixed together a fully virulent Y. pestis strain and a mutant strain known not to be infectious in that it lacked the components essential for it to be a pathogen. The mix was then given to a single laboratory animal.

“The expectation would be that the virulent strain would do an excellent job of infecting the host. And the non-virulent strain would get killed by the host,” Goldman said. “But in our experiments, the non-virulent strain would actually grow very well, almost as well as the virulent strain, and we would see this with any non-virulent strain of Y.pestis.”

And then the study team tried other microbes, different lung pathogens and an assortment of random microbes – “including the sort of organisms you inhale all the time and that are disposed of easily by the lungs’ standard defense mechanisms. But as long as the virulent bacteria were present, the non-virulent organisms would grow,” Goldman said.

“There is no other microbe that does that, no other inhaled organism that in a matter of minutes or hours transforms the lung into such a permissive environment for microbial proliferation,” he added.

Goldman points out that not much evolutionary distance exists between Yersinia pestis and its closest ancestor, Yersinia pseudotuberculosis, which causes a much milder disease.

“Our work shows that of these two species, only Y. pestis has the ability to transform the lung into an environment that permits an extended period of unrestricted microbial proliferation with no symptoms. Looking at the genetic differences between these two species may reveal the mechanism responsible for this phenomenon exclusive to Y. pestis, and that may lead to new therapeutic strategies for pneumonic plague.”

UNC study coauthors were graduate student Paul A. Price, and Jianping Jin, PhD, of the UNC Center for Bioinformatics.

Source: University of North Carolina at Chapel Hill School of Medicine

The DSM, from the American Psychiatric Association, is the standard reference for the diagnosis of mental disorders and has an important influence on insurance coverage and access to educational support and therapeutic services, as well as research.

The new, more restrictive criteria would combine three subgroups on the autism spectrum into one category and require a child to display more pronounced symptoms to qualify for a diagnosis. The effect may be that it is harder for some more mildly affected children to qualify for insurance to cover therapeutic and educational support services.

Jennifer A Pinto-Martin, PhD, MPH Viola MacInnes/Independence Professor of Nursing, Chair, Department of Biobehavioral Health Sciences

Rather than debate about whether changes in diagnostic criteria are warranted or wise, the focus should be on the effects such a change would have, says Dr. Pinto-Martin, who directs the Center for Autism and Developmental Disabilities Research and Epidemiology (CADDRE) at Penn Nursing. CADDRE is one of six centers funded by the Centers for Disease Control (CDC) to study the prevalence and causes of autism spectrum disorders.

“The proposed changes raise important issues for both the parents of children on the autism spectrum and researchers focused on understanding the trends and risk factors for autism,” says Dr. Pinto-Martin. She is the lead researcher in the first large-scale study to find a link between low birthweight and children diagnosed with autism. Dr. Pinto-Martin’s work, supported by a $3 million grant from the National Institute of Mental Health, showed that premature infants are five times more likely to have autism than children born at a normal weight. The study appeared in the journal Pediatrics in October.

For families, the change provides an opportunity to seek educational support and therapeutic services that are tailored to the specific needs of their child rather than the one-size-fits-all approach so common today, says Dr. Pinto-Martin. By separating children into more homogeneous groups with respect to their needs and challenges, therapies can be designed to target the specific needs of each group.

“The challenges faced by children who function at the higher end of the spectrum would not diminish with a change in diagnostic criteria,” says Dr. Pinto-Martin. “Seeking ways to better address therapy and educational support needs of all children with autism must be a commitment and a goal in the face of changing eligibility.”

For autism researchers, she says, the proposed changes are both good and bad. The search for the cause of autism has been hampered by the heterogeneity of those who fall under the umbrella of the autism spectrum. Many researchers believe that the various sub-types of autism may have differing causes, just as there are different causes for the numerous types of cancer.

Refining the diagnostic criteria could help to sort those with the disorder into a more homogeneous group by requiring greater clarity and consistency in symptom presentation, says Dr. Pinto-Martin. This would enhance research efforts focused on uncovering risk factors for autism by refining the group under consideration. This is the strategy researchers follow for uncovering risk factors for cancer, sorting patients by the specific type of cancer and then looking for risk factors in that group. While there are some common risk factors across cancer types, there are also risk factors that are specific to each type. Researchers expect the same will be true for the sub-types of autism such as autistic disorder, pervasive developmental delay, and Asperger disorder.

Monitoring changes in the prevalence of autism over time, another important, ongoing research initiative, could be hampered by changes in the way children are labeled, Dr. Pinto-Martin explains. Tracking prevalence is one of the major tools in epidemiologic investigations because it gives important clues about etiology. Autism researchers may be faced with a decrease in prevalence due to a change in the way the diagnosis is defined. Sorting out any actual change in risk from an artificial increase or decrease due to a change in the size of the diagnostic umbrella will be made more difficult.

Says Dr. Pinto-Martin: “We must be cognizant of the potential effect of a decrease in reported prevalence using the new DSM criteria from research and clinical perspectives, and pay careful attention to the real and ongoing needs of children and families who are coping with autism, no matter the criteria used to make the diagnosis.”

Source: University of Pennsylvania School of Nursing