Dosage

Drug	Brand	Dosage	Administration	Use
Dicyclomine HCL Oral Sol	Bentyl	10 MG/5 ML	5 ml by mouth four times a day	Abdominal cramping/Antispasmodic
Plavix	Clopidogrel	75 mg	1 tab per day	Antiplatelet

HCP who were asymptomatic throughout their infection and are not moderately to severely immunocompromised could return to work after the following criteria have been met:

 HCP who were asymptomatic throughout their infection and are not moderately to severely immunocompromised could return to work after the following criteria have been met:

• At least 7 days have passed since the date of their first positive viral test if a negative viral test* is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7).

*Either a NAAT (molecular) or antigen test may be used.  If using an antigen test, HCP should have a negative test obtained on day 5 and again 48 hours later

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

The Nursing Home Discharges to be Examined by OIG

This week's episode discusses the HHS Office of Inspector General (OIG)'s 2021 plan to examine the extent to which nursing homes meet the Centers for Medicare & Medicaid Services (CMS) requirements for facility-initiated discharges. 

https://open.spotify.com/episode/5kpX8IoPeekV5PfkLGyHTr

Bill would eliminate staffing agency conversion fees that requires a facility to buy out a worker's contract for thousands of dollars

 As labor shortages continue, nursing homes sometimes want to hire proven contract-agency staffers as their own full-time employees.

But some agencies who hire out temp nurses won’t let them go without a price, specifically a “conversion” fee that requires a facility to buy out a worker’s contract for thousands of dollars. 

Lawmakers in Colorado are poised to prohibit agency collection of such damages. This week the House passed a bill prohibiting those fees. It covers agency staff in nursing homes, assisted living facilities and all other healthcare facilities in the state.

Doug Farmer, president and CEO of the Colorado Health Care Association and Center for Assisted Living, told the State of Reform website that up to one-third of Colorado nursing home labor was supplied through agency in 2022. 

Providers there have increased hourly wages by an average of more than 20% since 2020, and temp workers are often enticed by improving incentives and long-term opportunities in skilled nursing settings. But Farmer said the contract restrictions put in place by agencies create an additional barrier in bringing those workers on board at a reasonable cost. One of the bill’s sponsors called it a “ransom fee.”

“There’s a separation fee that must be paid contractually and it is often $5-7,000 in average cost to buy someone out of one of those contracts,” he told State of Reform. “But the challenge is really less about the one-time costs than it is about the fact that it’s not a guarantee.”

Workers might still leave the nursing home for a competitor, or another job, and the facilities — largely funded by taxpayer dollars — are still out the buyout fee.

Under the Colorado legislation, of which a Senate version was introduced Wednesday, any agency that violates the rule would be subject to a monetary penalty up to $5,000.

If passed, the law would be the second in Colorado to rein in aggressive agency tactics. Last year, lawmakers limited the use of non-compete clauses in agency contracts. Illinois, Iowa and Kentucky also passed updates restricting the use of non-competes for nurses or healthcare employment agency workers, according to the Fair Competition Law blog.

Earlier this year, the Federal Trade Commission also proposed barring employers across the country from requiring workers to sign noncompetes. That rule is widely viewed as applying to independent contractors as well as company employees.

https://www.mcknights.com/news/bill-would-eliminate-predatory-staffing-agency-fees/?utm_source=newsletter&utm_medium=email&utm_campaign=NWLTR_MLT_WEEKLYROUNDUP_021723

Staph Hemolyticus

 

• The bacteria can be found on normal human skin flora and can be isolated from axillae, mucus membrane, perineum, and inguinal areas of humans.
• Among coagulase-negative staphylococci (CoNS), Staphylococcus haemolyticus is the second most frequently isolated from human blood cultures 
• Hemolyticus has the highest level of antimicrobial resistance. 
• S. haemolyticus causes severe infections in several body systems including meningitis, endocarditis, prosthetic joint infections and bacteremia and is prevalent in the hospital environment and on the hands of healthcare workers. S. haemolyticus is also known to cause septicemia, peritonitis, otitis media and diabetic foot ulcer (DFU) infections.
• Diabetes mellitus (DM) is a metabolic disease that is associated with increased susceptibility to bacterial infections. Patients usually suffer from infected foot ulcers, which increases the complexity of their treatment. About 15% of patients with DM develop foot ulcers that may progress to osteomyelitis and amputation [5]. These bacterial infections are usually caused by the coagulase-positive Staphylococcus aureus (S. aureus) and also the emerging CoNS, including Staphylococcus epidermidis (S. epidermidis) and S. haemolyticus .
• A characteristic feature of S. haemolyticus is its ability to form biofilms, which play an essential role in the establishment of infections. The produced exopolysaccharides can inhibit the growth of other bacteria and also decrease their ability to form biofilms. This specieshas gained an increased clinical significance due to its genome plasticity, which allowed a great adaptation and development of resistance to different antibiotics, including methicillin and its ability to survive in the hospital environment. The remarkable ability of S. haemolyticus to acquire antibiotic resistance, especially to oxacillin, limits the available therapeutic options for catheter-related infections caused by methicillin resistant S. haemolyticus isolates and may predispose to sepsis and increase patient’s morbidity and mortality . S. haemolyticus and S. aureus have >99.9% identities in the sequences of beta-lactamase and qacA genes, pointing to the possibility of interspaces exchange of the genetic elements responsible for resistance to antibiotics

Staph Species

 Common Staph Species.

1. Staph aureus - (nares)
2. Staph. epidermidis - (nares, skin)
3. Staph hemolyticus - 

Take Action Against All Staph

 

Appropriate Use of Antipsychotic Approach

 

New QSO - Anti-Psychotics, Five Star - Date January 18, 2023

 DEPARTMENT OF HEALTH & HUMAN SERVICES

Centers for Medicare & Medicaid Services

7500 Security Boulevard, Mail Stop C2-21-16

Baltimore, Maryland 21244-1850

Center for Clinical Standards and Quality/Quality, Safety & Oversight Group

Ref: QSO-23-05-NH QSO-23-05-NH (PDF) - CMS

DATE: January 18, 2023

TO:  State Survey Agency Directors

FROM:  Director, Quality, Safety & Oversight Group (QSOG)

SUBJECT: Updates to the Nursing Home Care Compare Website and Five Star Quality Rating System: Adjusting Quality Measure Ratings Based on Erroneous Schizophrenia Coding, and Posting Citations Under Dispute

Memorandum Summary

•Adjusting Quality Measure Ratings: CMS will be conducting audits of schizophrenia coding in the Minimum Data Set data and, based upon the results, adjust the Nursing Home Care Compare quality measure star ratings for facilities whose audits reveal inaccurate coding.

•Posting Citations Under Dispute: To be more transparent, CMS will now display citations under informal dispute on the Nursing Home Care Compare website.

Background:

Adjusting Quality Measure Ratings Based on Erroneous Schizophrenia Coding

In 2008, CMS added the Five-Star Quality Rating System to the CMS Nursing Home Compare website. The rating system comprises three rating domains: health inspections, staffing, and quality measures (QMs). One of the QMs reported on Nursing Home Care Compare and included in the star rating calculation is the percentage of long-stay residents who are receiving antipsychotic drugs. This measure excludes residents with diagnoses of schizophrenia, Huntington’s disease, or Tourette syndrome. CMS is concerned that some nursing homes have erroneously coded residents as having schizophrenia, which can mask the facilities’ true rate of antipsychotic medication use. Therefore, CMS will conduct offsite audits of schizophrenia coding and, based upon the results, adjust the quality measure star ratings for facilities whose audit reveals inaccurate coding.

Posting Citations Under Informal Dispute Resolution and Independent Informal Dispute Resolution (IDR/IIDR)

The Informal Dispute Resolution (IDR) process gives nursing homes an informal opportunity to dispute citations. Additionally, when CMS imposes a civil money penalty, providers have the opportunity to request an Independent IDR (IIDR). Currently, citations under IDR/IIDR are not posted publicly on the Nursing Home Care Compare and the Quality Certification and Oversight Reports (QCOR) website until the dispute is complete. This process usually takes approximately 60 days, however, there are some cases that take longer. For example, based on surveys that occurred within the past two years, there are over 300 citations under informal dispute that are 6 months or older and are still not posted on Nursing Home Care Compare.

There are over 200,000 citations posted on the Nursing Home Care Compare website. So, the number of citations under IDR/IIDR is relatively small, however, they can include severe instances of non-compliance. For example, in the past two years, there were 80 deficiencies across 67 surveys identified as Immediate Jeopardy (IJ) that went through the IDR/IIDR process. Deficiencies are identified as IJ if the noncompliance placed the health and safety of residents at risk for serious injury, serious harm, serious impairment or death. Waiting to post these citations leaves consumers without knowledge of serious citations. Therefore, to be more transparent, CMS will now display these citations on Nursing Home Care Compare with a note that they are under dispute by the nursing home.

Discussion:

Adjusting Quality Measure Ratings Based on Erroneous Schizophrenia Coding

When nursing home residents are given erroneous schizophrenia diagnoses, they are subject to poor care and unnecessary antipsychotic medications, both of which can be very dangerous. Additionally, this inaccurate coding misleads the public by misrepresenting the nursing homes’ rate of antipsychotic usage in the posted quality measure.

In 2016, CMS launched focused schizophrenia onsite surveys to specifically address the issue of erroneous coding of schizophrenia in nursing homes. These surveys identified facilities with patterns of erroneous coding of residents with a diagnosis of schizophrenia. To increase our focus on this issue, CMS will begin conducting offsite audits to assess the accuracy of Minimum Data Set (MDS) data. Specifically, we will examine the facility’s evidence for appropriately documenting, assessing, and coding a diagnosis of schizophrenia in the MDS for residents in a facility.

Earlier this year, CMS conducted pilot audits to test the effectiveness of the MDS audit process. During these pilot audits, we found several issues related to the inaccurate MDS coding of residents with a diagnosis of schizophrenia. For example, there was an absence of comprehensive psychiatric evaluations and behavior documentation. Also, many residents had only sporadic behaviors noted in their medical records, and these behaviors were related to dementia, rather than schizophrenia. Moving forward, CMS will conduct these audits and, based upon the results, adjust the quality measure star ratings for facilities whose audits reveal inaccurate MDS coding. This action supports CMS’s goal to reduce the use of unnecessary antipsychotics and improve the accuracy of the quality measure and the five-star rating system. It is also consistent with the White House’s Fact Sheet listing efforts to improve safety and quality of care in the nation’s nursing homes. Specifically, the Fact Sheet states that, “CMS will launch a new effort to identify problematic diagnoses and refocus efforts to continue to bring down the inappropriate use of antipsychotic medications.”

Facilities selected for an audit will receive a letter explaining the purpose of the audit, the process that will be utilized, and instructions for providing supporting documentation. During the audit process, facilities will have the opportunity to ask questions and seek any clarification needed. Additionally, at the conclusion of the audit, the facility will have the opportunity to discuss the audit results with CMS.

Facilities that have coding inaccuracies identified through the schizophrenia MDS audit will have their QM ratings adjusted as follows:

• The Overall QM and long stay QM ratings will be downgraded to one star for six months (this drops the facility’s overall star rating by one star).

• The short stay QM rating will be suppressed for six months.

• The long stay antipsychotic QM will be suppressed for 12 months.

Also, we plan to offer facilities the opportunity to forego the audit by admitting they have errors and committing to correct the issue. This will reduce the burden of conducting audits for CMS and nursing homes, and allow CMS to audit more facilities. To incentivize this admission and to promote improvement, for facilities that admit miscoding after being notified by CMS that the facility will be audited, but prior to the start of the audit, CMS will consider a lesser action related to their star ratings than those listed above, such as suppression of the QM ratings (rather than downgrade).

For all facilities where patterns of coding inaccuracies were identified, either through an audit or through a facility’s admission, CMS will monitor each audited facility’s data to identify if the information indicates they have addressed the identified issues, and if any downgrades or suppressions that are applied should be lifted at the timeframes indicated above. Also, a follow-up audit may be conducted to confirm the issue is corrected.

Nursing homes should work with their psychiatric providers and medical directors to ensure the appropriate professional standards and processes are being implemented related to diagnosing individuals with schizophrenia. Information is also available in Appendix PP of the State Operations Manual (F-tags 658, 740, and 758) and the Minimum Data Set 3.0 Resident Assessment Instrument Manual (page 2 of the Errata (v2) effective July 15, 2022). Additionally, for assistance in reducing the use of antipsychotic medications, we encourage nursing homes to contact their Quality Improvement Organization (QIO) for additional resources, assistance, and tools that are available. Facilities can locate their QIO by visiting Locate Your QIO | qioprogram.org.

Posting Citations Under Informal Dispute Resolution and Independent Informal Dispute Resolution (IDR/IIDR)

As part of CMS’s commitment to transparency, consumers should have as much information about nursing homes as possible to support their healthcare decisions. Allowing consumers to see all of the citations a facility receives regardless of whether they are under IDR/IIDR is consistent with our commitment to transparency and also enhances accountability and oversight of nursing homes.

Therefore, CMS will post deficiency citations under IDR/IIDR in each section of Nursing Home Care Compare that currently displays citations, and will indicate if a citation is under dispute. If, based on the results of the IDR/IIDR process, the citations are upheld, they will remain posted and will be included in the calculation of the facility’s star rating if applicable. If the citations are overturned (i.e., removed), they will be removed from the website. If the level of scope or severity of a citation is reduced, the citation will be displayed at the reduced level. We note that on average, the majority of citations (approximately 75%) do not change after completion of the IDR/IIDR process.

While the citations will be publicly displayed, we will not include them in the calculation of a facility’s star rating until the dispute is complete (and the survey is considered final). In order to be consistent in how citations are reported across different platforms, CMS will also include citations under IDR/IIDR on the QCOR website.

CMS will update the Five Star Rating Technical Users’ Guide and Chapter 7 of the State Operations Manual to reflect these changes

Contact:

For questions or concerns relating to this memorandum, please contact BetterCare@cms.hhs.gov

For questions about the schizophrenia MDS audits, please contact DNH_BehavioralHealth@cms.hhs.gov

Effective Date:

Immediately. Please communicate to all appropriate staff.

/s/

David R. Wright

Director, Quality, Safety & Oversight Group

NHSN COVID-19 Data Submission Guide

 NHSN COVID-19 Data Submission Guide

• NHSN Submission Training https://docs.google.com/presentation/d/1Cor5roPlGMn2fmWz6mumSiEwaOYyMMt9cW8msCrfogM/edit#slide=id.g20120fb2958_0_4

• Genesis NHSN Weekly Submission sheet https://drive.google.com/drive/u/1/folders/1b5jZEZvzZCphdEPj7nyyKmqUlvdbyHQt

• Submission

• Submission: Resident Pathway

• COVID-19 Form- Resident Impact & Facility Capacity https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/57.144-res-blank-p.pdf

• Instructions for Completion of COVID-19 Form - Resident Impact & Facility Capacity https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/57.144-toi-508.pdf

• Submission: Staff Pathway

• COVID-19 Form - Staff & Personnel Impact https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/57.145-staff-blank-p.pdf

• Instruction for Completion of COVID-19 Form - Staff & Personnel Impact https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/57.145-toi-508.pdf

• Submission: Therapeutics

• COVID-19 Form - Resident Therapeutics https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/57.158-p.pdf

• Instruction for COVID-19 Form - Resident Therapeutics https://www.cdc.gov/nhsn/pdfs/covid19/ltcf/57.158-toi-508.pdf

• Submission: Resident COVID-19 Immunizations

• COVID-19 Form - Resident Vaccination https://www.cdc.gov/nhsn/forms/COVIDVax.LTC_.Resident.FORM_May2022-508.pdf

• Instruction for COVID-19 Form - Resident Vaccination https://www.cdc.gov/nhsn/forms/instr/COVIDVax.LTC_.Residents.TOI_.MAY2022-508.pdf

• Submission: HCP (HeathCare Personnel) COVID-19 Immunizations

• COVID-19 Form - HealthCare Personnel Vaccination https://www.cdc.gov/nhsn/forms/COVIDVax.HCP_.FORM_May2022-508.pdf

• COVID-19 Form - HealthCare Perosnnel Vaccination https://www.cdc.gov/nhsn/forms/instr/COVIDVax.Staff_.Revised.TOI_.MAY2022-508.pdf

• NHSN SAMS Help Desk
  Monday-Friday, 8:00 AM to 6:00 PM EST
  Excluding U.S. Federal Holidays
  877-681-2901 (Select Option #5)
  samshelp@cdc.gov

Rhabdomyolysis

• Rhabdomyolysis is a potentially life-threatening syndrome resulting from the breakdown of skeletal muscle fibers with leakage of muscle contents into the circulation. 
• The most common causes are crush injury, overexertion, alcohol abuse, and certain medicines and toxic substances. 
• Several inherited genetic disorders, such as McArdle's disease and Duchenne's muscular dystrophy, are predisposing factors for the syndrome.

https://www.aafp.org/pubs/afp/issues/2002/0301/p907.html

CDC - Return to Work Criteria for HCP with SARS-CoV-2 Infection

 Return to Work Criteria for HCP with SARS-CoV-2 Infection

The following are criteria to determine when HCP with SARS-CoV-2 infection could return to work and are influenced by severity of symptoms and presence of immunocompromising conditions. After returning to work, HCP should self-monitor for symptoms and seek re-evaluation from occupational health if symptoms recur or worsen.  If symptoms recur (e.g., rebound) these HCP should be restricted from work and follow recommended practices to prevent transmission to others (e.g., use of well-fitting source control) until they again meet the healthcare criteria below to return to work unless an alternative diagnosis is identified.

HCP with mild to moderate illness who are not  moderately to severely immunocompromised could return to work after the following criteria have been met:

• At least 7 days have passed since symptoms first appeared if a negative viral test* is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7), and
• At least 24 hours have passed since last fever without the use of fever-reducing medications, and
• Symptoms (e.g., cough, shortness of breath) have improved.

*Either a NAAT (molecular) or antigen test may be used.  If using an antigen test, HCP should have a negative test obtained on day 5 and again 48 hours later

HCP who were asymptomatic throughout their infection and are not moderately to severely immunocompromised could return to work after the following criteria have been met:

• At least 7 days have passed since the date of their first positive viral test if a negative viral test* is obtained within 48 hours prior to returning to work (or 10 days if testing is not performed or if a positive test at day 5-7).

*Either a NAAT (molecular) or antigen test may be used.  If using an antigen test, HCP should have a negative test obtained on day 5 and again 48 hours later

HCP with severe to critical illness who are not moderately to severely immunocompromised could return to work after the following criteria have been met:

• At least 10 days and up to 20 days have passed since symptoms first appeared, and
• At least 24 hours have passed since last fever without the use of fever-reducing medications, and
• Symptoms (e.g., cough, shortness of breath) have improved.
• The test-based strategy as described below for moderately to severely immunocompromised HCP can be used to inform the duration of work restriction.

The exact criteria that determine which HCP will shed replication-competent virus for longer periods are not known. Disease severity factors and the presence of immunocompromising conditions should be considered when determining the appropriate duration for specific HCP. For a summary of the literature,  refer to Ending Isolation and Precautions for People with COVID-19: Interim Guidance (cdc.gov)

HCP who are moderately to severely immunocompromised may produce replication-competent virus beyond 20 days after symptom onset or, for those who were asymptomatic throughout their infection, the date of their first positive viral test.

• Use of a test-based strategy (as described below) and consultation with an infectious disease specialist or other expert and an occupational health specialist is recommended to determine when these HCP may return to work.

Test-based strategy

HCP who are symptomatic could return to work after the following criteria are met:

• Resolution of fever without the use of fever-reducing medications, and
• Improvement in symptoms (e.g., cough, shortness of breath), and
• Results are negative from at least two consecutive respiratory specimens collected 48 hours apart (total of two negative specimens) tested using an antigen test or NAAT.

HCP who are not symptomatic could return to work after the following criteria are met:

• Results are negative from at least two consecutive respiratory specimens collected 48 hours apart (total of two negative specimens) tested using an antigen test or NAAT.

https://www.cdc.gov/coronavirus/2019-ncov/hcp/guidance-risk-assesment-hcp.html

Paxlovid

 

AL - Amyloidosis

 

Respironics - BiPAP Machine

 

https://www.youtube.com/watch?v=ktusQwnQu_Q

N 95 Fit Testing

 

https://www.ahrq.gov/sites/default/files/wysiwyg/nursing-home/materials/respirator-fit-testing.pdf

CMS - Nursing Home Visitation Guidelines 9-23-2022

 

Visitation

Visitors no longer need to be actively screened for COVID -19 symptoms (for example, undergo temperature checks or screening questions) for entry into long term care facilities.

However, nursing homes should clearly emphasize (for example through signage) that people with symptoms consistent with COVID-19 or have confirmed COVID- 19 should not enter the facility.

Please see the updated CMS guidance QSO 20-39-NH Revised.

https://www.cms.gov/files/document/qso-20-39-nh-revised.pdf

Osimertinib (Tagrisso)

Osimertinib is a tyrosine kinase inhibitor, which acts by blocking the activity of the epidermal growth factor receptor (EGFR). The EGFR in the lungs causes growth and uncontrolled division of cancer cells.

Osimertinib inhibits the growth of the cancer cells with T790 M mutation in the EGFR gene and acts against the metastatic EGFR T790 M mutation.

https://www.clinicaltrialsarena.com/projects/tagrisso-osimertinib-for-the-treatment-of-egfr-mutation-in-non-small-cell-lung-cancer/#:~:text=Tagrisso's%20mechanism%20of%20action,uncontrolled%20division%20of%20cancer%20cells.

Gastroparesis

Gastroparesis which means partial paralysis of the stomach is a disease in which your stomach cannot empty itself of food in a normal way. If you have this condition, damaged nerves and muscles don't function with their normal strength and coordination - slowing the movement of contents through your digestive system.

This is a common condition in people who've had diabetes for a long time, but it may also occur in other situations. Gastroparesis can be misdiagnosed and is sometimes mistaken for an ulcer, heartburn or an allergic reaction, In people without diabetes, the condition may relate to acid reflux.

Insulin Pump Therapy

 

https://www.medtronicdiabetes.com/treatments/insulin-pump-therapy

Transaminitis

 

Guide to Transaminitis

Liraglutide (Victoza)

 Anti-diabetic medication treats type 2 diabetes, obesity, and chronic weight management.

In diabetes, it is a less preferred agent compared to metformin.

Proventil HFA Inhaler

 Salbutamol, also known as albuterol, is sold under the brand name Ventolin or Proventil.

B2 adrenergic receptor agonist works by causing relaxation of the airway smooth muscle.

Calcinosis Cutis and Calciphylaxis

Calcinosis cutis (CC) is defined as the deposition of calcium salts in the skin. The condition is divided into 5 types: calciphylaxis and dystrophic, metastatic, idiopathic, and iatrogenic CC. Dystrophic CC is the most common form and usually occurs in association with autoimmune diseases. CC can be treated surgically or with the use of drugs such as diltiazem, bisphosphonates, warfarin, ceftriaxone, probenecid, minocycline, or aluminum hydroxide. Calciphylaxis is defined as calcification of the media of small- and medium-sized blood vessels in the dermis and subcutaneous tissue. Clinically, calciphylaxis causes livedo racemosa, which progresses to retiform purpura and skin necrosis. First-line treatment is with sodium thiosulfate. We present a review of the calcifying disorders of the skin, focusing on their diagnosis and treatment.

Calcinosis Cutis and Calciphylaxis - National Library of Medicine

Calciphylaxis (kal-sih-fuh-LAK-sis) is a serious, uncommon disease in which calcium accumulates in small blood vessels of the fat and skin tissues.

Calciphylaxis causes blood clots, painful skin ulcers and may cause serious infections that can lead to death. People who have calciphylaxis usually have kidney failure and are on dialysis or have had a kidney transplant. The condition can also occur in people without kidney disease.

Gastric Emptying Study

This exam demonstrates the time it takes for solid food to empty from the stomach.

Gastric Emptying Study

Methocarbamol (Robaxin)

 Class: Muscle relaxants, Centrally Acting

Description: Oral and parenteral centrally acting muscle relaxant

Used as adjunct therapy for acute, painful musculoskeletal conditions and in the management of tetanus

Studies indicate the drug is not effective for spasticity.

Enzalutamide ( Xtandi)

 Class: Cytostatic Androgen Receptor Antagonists

Description: Androgen receptor inhibitor

                   Used for the treatment of castration-resistant prostate cancer
                    Seizures have been reported

Purewick Female External Catheter

The PureWick™ Female External Catheter allows for simple, non-invasive urine output management in female patients. Using low-pressure wall suction, the PureWick™ Female External Catheter wicks urine away from the patient and into a designated collection canister. With the PureWick™ Female External Catheter, you now have a new option for managing female urinary incontinence.

https://www.purewickathome.com/

MDS Review Process Webinar - Connecticut Department of Social Services January 10, 2023

 The State of Connecticut will be implementing an MDS Review process during the first quarter of 2023.

To assist in this endeavor, the State of Connecticut has contracted with Myers and Stauffer to conduct provider training for this review process. The training will be held via webinar format on January 10, 2023.

Please click on the link to register.

Registration

Please plan to join us during the scheduled session.

If unable to attend, the presentation will be posted to the Myers and Stauffer website following the event.

Registration is required.

Who Should Attend

This training’s targeted audience are those facility staff members involved with or impacted by the MDS process, including but not limited to:

� Administrators                           � MDS Coordinators

� Directors of Nursing                  � Consultants

Date & Time

January 10, 2023 2:00 pm - 3:00 pm

To register, Click here!

Webinar Code: 2429 624 7110

Webinar Password: CTTraining

Dial–in Number: 1-844-740-1264

Dial–in Password: 28872464

Ankle Brachial Index

 The ankle-brachial index test is a quick, simple way to check for peripheral artery disease (PAD). 

The disease occurs when narrowed arteries reduce the blood flow to the arms and legs. 

PAD can cause leg pain when walking. PAD also increases the risk of heart attack and stroke. 

Ankle Brachial Index

F - 695

 

KEY ELEMENTS OF NONCOMPLIANCE §483.25(i)

To cite deficient practice at F695, the surveyor's investigation will generally show that the facility failed to do one or more of the following:

• Provide necessary respiratory care and services, such as oxygen therapy, treatments, mechanical ventilation, tracheostomy care, and/or suctioning; or
• Provide necessary respiratory care consistent with professional standards of practice, the resident’s care plan, goals and preferences.

F - 695

F657

 F-657

Hemptosis

 

https://www.gponline.com/haemoptysis-red-flag-symptoms/respiratory-system/article/1336656?bulletin=bulletins%2Fdailynews&utm_medium=EMAIL&utm_campaign=eNews%20Bulletin&utm_source=20221216&utm_content=GP%20Daily%20(38)::www_gponline_com_article__9&email_hash=#r3z-addoor

Peau d'orange

 https://www.cancer.gov/publications/dictionaries/cancer-terms/def/peau-dorange

Dicyclomine

 

Amyloidosis

Amyloid fibrils are protein polymers comprising identical monomer units (homopolymers). 

Functional amyloids play a beneficial role in a variety of physiologic processes (eg, long-term memory formation, gradual release of stored peptide hormones). 

Amyloidosis results from the accumulation of pathogenic amyloids—most of which are aggregates of misfolded proteins—in a variety of tissues. ^[1]

^{https://emedicine.medscape.com/article/335414-overview}

https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/amyloidosis/amyloidosis