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Anonymous865

Anonymous865

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  1. Anonymous865

    To vaccinate or not to vaccinate, that is the question

    I want to start with saying I agree vaccines have improved and extended lives. I got my 2nd shingrix vaccine yesterday. You have to recognize that a percentage of the population does not trust the CDC, so telling people to read the pink book and trust the experts is not going to convince them People have legitimate reasons not to trust the CDC specifically and the medical community in general. A few that I can think of include: 1. The Tuskegee Syphilis Study run by the US Public Health Service and the CDC. Black men were told they would be receiving medical care and instead were used to study untreated syphilis. The study began in 1932. By 1945 it was clear that penicillin was the best treatment for syphilis. They were not offered treatment. Instead CDC and USPHS worked to prevent them from receiving treatment. In 1969 the CDC reaffirmed the need for the study and gained local medical societies’ support (AMA and NMA chapters officially support continuation of study). The study wasn't halted until 1972 when someone leaked information about the study to the press. Public outrage stopped the study. There have been many, many studies published on the effect this had on trust in the medical community. It's still affecting trust in the medical community. 2. In 1955 200,000 children received the Salk (injected) polio vaccine. 4000 (20%) of them contracted polio from the vaccine. The Salk vaccine was a killed virus. There was a problem in the manufacturing process at Cutter Laboratories, so the virus wasn't killed. Many researchers trace the beginnings of vaccine hesitancy to this incident. 3. From 1963 to 2001 the US used the Sabin (oral) polio vaccine. This was a live, but attenuated virus. One in 75,000 children receiving their 1st oral polio vaccine contracted polio from the vaccine. That was 8-10 children each year. The virus in the oral vaccine can revert to the wild type and cause polio. The injectable vaccine was less likely to cause polio, but the oral vaccine was cheaper. "When eight to 10 children a year contracted polio, and millions of others were protected, “my feeling was it was a small price to pay,” Walter A. Orenstein, who was director of the U.S. immunization program at the CDC from 1988 to 2004, recalled Friday in an interview." The father (a lobbyist) of one of the affected children lobbied the CDC to use the injectable vaccine or at least use the injectable vaccine as the first dose. Since 2001 the US has used the injectable vaccine. 4. Then there is how you still can be enrolled into a research study without your knowledge or consent. http://blogs.einstein.yu.edu/minnesota-case-demonstrates-continuing-erosion-of-informed-consent/ "A board that approves research at Minnesota's largest safety-net hospital failed to follow federal rules designed to protect patients when it fast-tracked studies on powerful sedatives, including ketamine, according to inspection reports from the Food and Drug Administration (FDA). The Institutional Review Board (IRB) at Hennepin Healthcare expedited approval for at least four studies between 2014 and 2018 that did not require patients to consent beforehand, even though they included a likelihood of using "vulnerable subjects."" http://www.startribune.com/fda-hennepin-healthcare-flouted-patient-safety-rules-in-sedation-studies/498891251/ Researchers are also using "passive consent." The patient is handed some information to read. If they don't object, they are enrolled in the study. No one makes sure they understood the material. They don't even make sure they can read. An IRB can decide the risk is minimal, so passive consent is fine.
  2. Anonymous865

    To vaccinate or not to vaccinate, that is the question

    They would have been at risk of shingles if they had been vaccinated. "About 91 percent of U.S. children are vaccinated against chickenpox, according to the most recent National Immunization Survey data, but that does not necessarily mean they cannot get shingles. The chickenpox vaccine is made with the live attenuated (weakened) varicella virus, so “not surprisingly, it can also become latent after vaccination,” explains Anne A. Gershon, a professor of pediatric infectious disease at Columbia University. “The virus has been altered so the vaccine rarely causes symptoms, but once you’ve been immunized and after the natural infection, you carry the virus in your neurons for the rest of your life They could have avoided chickenpox had they received the vaccination. Their risk of shingles would have been lower (after age 2), but they still could have shingles.
  3. Anonymous865

    Sterile water for injection

    That was an interesting question. What I have read supports your interpretation. I found this reason for not using sterile water for irrigation: "Sterile water for irrigation is NOT FDA labeled for any use as an injection in patients. Sterile water for injection, USP, must pass a particulate-matter test that sterile water for irrigation, USP, does not have to pass. " https://www.ashp.org/-/media/assets/drug-shortages/docs/drug-shortages-sterile-water-faq.ashx Also this: "Sterile water for injection. This water has been packaged and rendered sterile. This water is for the processing of sterile products intended to be used intravenously. Additionally, it is used for other applications where bulk WFI or purified water is indicated but access to a validated water system is either not practical or only a relatively small quantity is needed. Sterile WFI is typically packaged in single-dose containers that are typically less than 1 L in size. Sterile water for irrigation. This water has been packaged and rendered sterile. This water is commonly used when sterile water is required, but when the application does not have particulate matter specifications. Sterile water for irrigation is often packaged in containers that are typically greater than 1 L in size. Sterile water for inhalation. This water has been packaged and rendered sterile. This water is usually intended for use with inhalators and in preparation of inhalation solutions. It carries a less stringent specification for bacterial endotoxins than sterile WFI and, therefore, is not suitable for parenteral applications. http://www.pharmtech.com/understanding-usp-water-pharmaceutical-use The FDA defines 8 types of water and requirements are different depending on the type of water. https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/inspection-technical-guides/water-pharmacuetical-use I didn't find any requirements for sterile water for enteral feeding.
  4. Anonymous865

    Question About Sterility Related To Giving Injections

    per the CDC "At end of workday, any remaining vaccine in provider predrawn syringes should be discarded." https://www.cdc.gov/flu/professionals/vaccination/vax_clinic.htm#storage-administration also "Syringes other than those filled by the manufacturer should be used only for immediate administration and not for vaccine storage. " https://www.cdc.gov/vaccines/pubs/pinkbook/vac-storage.html
  5. Anonymous865

    Manager wants me to force prn pain meds

    HCAPPS has removed the questions about pain management from the survey. "On July 31, 2018, in the CY 2019 OPPS Proposed Rule, CMS proposed a plan to remove the HCAHPS Survey's Communication About Pain items (questions 12, 13 and 14 on the HCAHPS Survey). The recently released CY 2019 OPPS Final Rule requires that the pain items must be removed from all surveys beginning with patients discharged on October 1, 2019 and forward. This change affects all survey translations and all survey modes." This is from https://www.hcahpsonline.org/en/whats-new/ You can see the survey here. https://www.hcahpsonline.org/en/survey-instruments/
  6. Anonymous865

    Dosage Calc Format Problem

    Use a calculator to divide 0.5g by 104.5. You won't get 4.78. You are off by a factor of 1000. When doing math ask yourself if it makes sense that by dividing 0.5 by 104 that you would get a number BIGGER than you started with. Of course not. If you have 1/2 and divide it by 104, your answer is going to be a lot SMALLER than the 0.5g that you started with.
  7. Anonymous865

    Dosage Calc Format Problem

    Your friend didn't pay attention to their units when doing the problem. For example, they divided 230 lbs by 2.2 lbs and came up with 104.55 lbs. The patient weighed 104.5 kg not 104.5 lbs. The correct way to do the problem would be 230 lbs x 1 kg/2.2 lbs = 104.5 kg Because lbs appears in both the numerator and denominator, you can eliminate lbs in the equations. You are left with kg in the numerator. Now you know that a 104.5 kg patient was given 500 mg of the med. Another way to say that is the dose was 500mg/104.5kg. The question is asking what was the dose in grams/kilogram.
  8. I didn't know that. That is very interesting.
  9. To me what shows a tremendous disconnect is the photo she chose for her gofundme page. She is all dolled-up and sitting in her husband's lap at a party/celebration. She is trying to raise money to defend herself after killing Charlene Murphy. Sam Murphy will never again touch his wife of 50+ years. Even after more than a year Sam Murphy "is too upset to talk about his wife" with reporters. She and all her supporters seem to have forgotten Charlene, Sam, and their family. A less festive photo for her gofundme page would have been more appropriate and respectful.
  10. CORRECTED to add NOT
  11. You are right. The letter said it did not merit further action. I couldn't download the PDF document from the document cloud. I instead downloaded the Txt document from their document cloud. Apparently when it was converted to a txt document it left out the not probably because the not was underlined. Now I can't go back and fix the post.
  12. Just curious - Why do you think there is bad blood between Mr. Funk and Ms. Welch?
  13. That's the article. Here's the letter for anyone who can't access it. STATE OF TENNESSEE DEPARTMENT OF HEALTH DIVISION OF HEALTH LICENSURE AND REGULATION OFFICE OF INVESTIGATIONS Metro Center 665 Mainstream Drive, Second Floor Nashville, TN 37243 615-741-8485 or 1-800-852-2187 Antoinette.Welch@Tn.gov October 23, 2018 PERSONAL CONFIDENTIAL 7005 3110 0001 7274 7346 Radpmda Vaught a Re: Disposition of Complaint No. Dear Ms. Vaught, Thank you for the work you have done with us through this necessary process. A complaint, which was filed against you, was forwarded to the Board Consultant for disposition after investigation. After a review by the Board's Consultant and a staff attorney for the Tennessee Department of Health, a decision was made that this matter did merit further action. The purpose of this letter is to inform you of the outcome. This is not a disciplinary action, and no record of it will appear in your licensure file. As you can appreciate, this Office has the statutory duty to investigate any allegation received against a practitioner licensed and/or certified under Title 63 of the Tennessee Code Annotated. The purposes for the investigative process are to maintain the administration and enforcement of the laws regulating your practice and to ensure that the citizens of Tennessee receive good quality health care from all practitioners. Please accept our sincere appreciation for your cooperation in the resolution of this matter. Sincerely, Antoinette Welch, Esq. Director Office of Investigations Tennessee Department of Health AW: be Complaint No,
  14. Apparently in Tennessee it's really, really, really hard to lose your license. What is really scary - if the board decides not to take action, the complaint is never made public. There is no way to know how many similar or even worse nurses were reported and the board decided not to take action. I've been reading through their Disciplinary Action Reports. Cynthia Leigh Clemons APRN, RN and Courtney Newman APRN, RN were indicted in 2016 for being part of the region's largest drug distribution and money laundering ring. The ring made $21 million in profit during just 4 years. The ring is accused of distributing "billions of opiates." https://www.knoxnews.com/story/news/crime/2018/01/19/rico-indictment-opiate-pill-mill-east-tennessee/1049174001/ Both appeared before the board in 2018, because they didn't report their indictment to the board. The board fined one $50 and the other $100. They put restrictions on their licenses - They can't work in a pain clinic and they can't prescribe controlled substances. Both are still working.
  15. You just have to look at the way hospitals and medical boards protect physicians who sexually abuse patients to see that. They don't care if they are abusing children or women. https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/76948 Apparently voters don't care if physicians commit sexual misconduct either. https://www.timesfreepress.com/news/local/story/2012/nov/16/scott-desjarlais-supported-ex-wifes-abortions/92999/ The board fined him $250 for each patient he had sex with.
  16. A few nurse examples would include: Genene Jones Charles Cullen John Meehan (a.k.a. “Dirty John”)