August 2005 The South Central Pennsylvania Health Care Quality Unit
DON'T BUG ME!
In This Issue
Health Secretary Dr. Calvin B. Johnson announced the first human case of
West Nile Virus (WNV) in Pennsylvania for this year was reported on July 20,
Bulletin Board. . . . . 6
2005. Dr. Johnson stated that the chance for contracting WNV is small, and the
chance of becoming seriously ill is even smaller.
Most people infected with the WNV either have no symptoms or a mild
illness of fever, headache, body aches, mild skin rash or swollen lymph glands.
More serious infection can be marked by high fever, stiff neck, body tremors,
disorientation, paralysis and occasionally, death.
There is no specific treatment for a mild infection, though comfort can be
Health Risk Profiles –
provided by treating the symptoms until fully recovered. In severe cases where
What Are We Learning
encephalitis (swelling of the brain) may develop, hospitalization is necessary to
About Screenings? . . . 4
provide supportive treatment, such as IV's, airway management and prevention
Latex Sensitivity . . . . 6
of secondary infections.
Most cases occur in hot weather, during late summer or early fall, though in
warmer climates the virus can be transmitted year round. The first case in the
Awareness Month. . . 2
U.S. was detected in 1999. Pennsylvania experienced its first case in 2000 and
has had eight deaths since that time.
Certain species of mosquitoes carry the WNV, which is then transmitted to
people. It is not transmitted person to person. Take a few simple steps to ward
off these potentially dangerous pests around your home.
SC-HCQU Regional Trainings Up-Date. . . 2
• Dispose of tin cans, tires, old flower pots, or any other water-holding
containers on your property.
• Drill holes in the bottom of recycling containers.
• Clean roof gutters of leaves that plug up the drains and invite millions of
• Turn over plastic wading pools when not in use.
• Don't allow pool covers to collect water.
• Chlorinate swimming pools not in use.
• Turn over wheelbarrows and don't let water stagnate (birdbaths, water
gardens, boats, toys).
Don't invite trouble to visit you. Ward off these annoying bugs and reduce
South Central PA HCQU
the risk of being bitten.
1126 Cocoa Avenue
• Stay indoors when mosquitoes are most active (dawn, dusk, and early
Hershey, PA 17033
• Bug-tight windows and screens.
• Evaluate outdoor lighting (incandescent lighting attracts; fluorescent
lighting neither attracts nor repels).
• Minimize skin exposure if possible – wear long sleeves or long pants.
• Repel mosquitoes with electric fans.
Star Long, Director
• Apply insect repellent on skin and clothing as directed by specific
Don't let summertime fun be spoiled by illness. Take preventive steps and
Melissa Erdman, Editor
give a clear message to these pesky, little insects to Bug Off!
For more information about West
Star Long, RN
The information presented here is to increase your awareness of medical conditions and situations. It is not intended to replace
medical advice. If you believe you or someone you support has a condition, please seek the advice of a physician.
Page 1 of 6
National Health Awareness Month
Health and Safety Month
National Immunization Awareness Month
Psoriasis Awareness Month
Spinal Muscular Atrophy Awareness Month
SC-HCQU Regional Trainings
Picture it: south centra
l PA, summer, 2005. A lone HCQU office
attempts to assist the
providers in its 9 county service area in
providing free trainings for their staff and consumers. Like the
providers, the HCQU must stay within its budget and work as
efficiently as possible. But the needs are so many! What's a HCQU
to do? SC-HCQU regional trainings to the rescue!
SC-HCQU regional traini
ngs are our solution to making free trainings
available to as many
people as possible at one time. SC-HCQU
regional trainings, as th
e phrase suggests, are open to all interested
parties within our 9 coun
ty region. Where and when a regional training
is conducted is based on several factors, including but not limited to
the training referrals sent to our office, the availability of the speaker,
the speaker's fee (if from outside the SC-HCQU), and the availability
of training site space. When a regional training is scheduled, please be aware it may be the only
time during a given fiscal year that the
topic can be offered or
sponsored by the SC-HCQU; this is particularly true when the presenter is a
guest speaker. Therefore, whenever possible, please take full advantage of the SC-HCQU regional trainings!
We at the SC-HCQU are always eager to learn what training topics are important to those in our region.
Please feel free to contact me with your ideas for possible regional training topics. Hope to see YOU at
our regional trainings!
Cherie Adkins, RN, SC-HCQU Training Coordinator
Page 2 of 6
Trainings are free, but registration is required.
• Autism and Cerebral Palsy – August 11, 9:30am-12:00 noon @ Typical Life Corp., North East
Plaza, North George Street, Manchester – Registration Deadline: August 4
• Grief and Coping With Death and Dying – August 22, 10:30am-12:30pm @ Typical Life Corp.,
North East Plaza, North George Street, Manchester – Registration Deadline: August 15
• Communicating With Healthcare Professionals – August 23, 2:00pm-4:00pm @ Bell
Socialization Services, 160 South George Street, York – Registration Deadline: August 16
• Communicating With Those Who Are Non-Verbal – September 8, 10:00am-12:00noon @
Typical Life Corp., North East Plaza, North George Street, Manchester – Registration Deadline:
• De-Stress The Discharge & Communicating With Healthcare Professionals – September 8,
9:00am-12:00 noon @ Hershey Public Library, 701 Cocoa Avenue, Hershey – Registration
Deadline: September 1
• Grief and Coping with Death and Dying – September 13, 10:30am-12:30pm @ Lancaster
County Public Safety Training Center, 101 Champ Blvd., Manheim – Registration Deadline:
• Substitute Health Care Decision Making with Linda and Bob Derr – September 15, 9:00am-
3:30pm @ Franklin County Administration Annex Building, 218 N. Second Street, Chambersburg –
Registration Deadline: September 1
• Preventing Med Errors & Reporting and Documentation – September 20, 2:00pm-4:00pm @
Bell Socialization Services, 160 South George Street, York – Registration Deadline: September 13
• Observation Skills – October 6, 10:00am-12:00 noon @ Typical Life Corp., North East Plaza,
North George Street, Manchester – Registration Deadline: September 29
• Substitute Health Care Decision Making with Linda and Bob Derr – October 6, 10:00am-12:00
noon @ Lancaster County Public Safety Training Center, 101 Champ Blvd., Manheim – Registration Deadline: September 22
• Changing Needs With Aging – October 18, 2:00pm-4:00pm @ Bell Socialization Services, 160
South George Street, York – Registration Deadline: October 11
• Getting The Most Out of a Psychiatrist with Jim Siberski – October 24, 9:30am-3:00pm @
Lancaster County Public Safety Training Center, 101 Champ Blvd. Manheim – Registration
Deadline: October 10
• Substitute Health Care Decision Making with Linda and Bob Derr – October 27, 9:00am-3:30pm
@ Lancaster County Public Safety Training Center, 101 Champ Blvd., Manheim – Registration Deadline: October 13
Unfortunately, we are unable to accommodate registrations after the deadline.
For more inform
ation call Cherie Adkins at 717-909-3858 and
leave a me
ssage re: registration, questions, etc.
Listen to prompts on this phone line regarding trainings that are full,
as well as
cancellations due to weather.
Page 3 of 6
Health Risk Profiles –
What Are We Learning About Screenings?
Wanda Nikolaus, RN
As Agency staff and HCQU nurses have completed numerous HRP's
(Health Risk Profiles) over the past several years many recommendations
have revolved around possible needed screenings. Certain conditions go
undetected, either because risk factors are not identified or because routine screenings are not
performed. Here are some common ones to consider for your consumers and, if indicated, discuss
with the PCP:
Dysphagia – This is difficulty swallowing. Many people have this condition but it remains
undiagnosed. This problem can occur as people age but also may exist with some of our younger people. Some symptoms include coughing while eating or after a meal, holding food in the mouth, excessive saliva, and eating rapidly. Food may be lost from the mouth or nose during a meal.
Observe the individual closely for potential problems. Undetected dysphagia can result in choking
and aspiration pneumonia. If you suspect someone may have this condition talk to the doctor about
a chair-side evaluation by a speech pathologist or possibly a videofluoroscopy. When someone is
diagnosed with this condition it is important that all staff follow the eating program that is ordered.
Keep in mind that the condition can progress (or improve) so if someone has had the diagnosis for a long time they may need to be re-evaluated.
Osteoporosis – A lot of consumers are at risk for osteoporosis at an early age. Those who
are confined to wheelchairs, have Down Syndrome (Trisomy 21), lack of weight-bearing exercise, and lack poor calcium intake frequently have low bone density. The PCP may order a PIXIE heel scan initially, and then a DEXA scan, if results of PIXIE are positive. Results of these may show
osteopenia (low bone density) or osteoporosis (porous bones). Generally testing for women is done
after menopause, but many of our clients may be at risk at a much earlier age. Keep in mind that
men get osteoporosis as well as women.
Glaucoma – Many of the individuals we serve do not see an eye doctor (ophthalmologist or
optometrist) for their annual eye examinations. The PCP will do a vision screening at the annual physical and a physical check of the eyes. Although the PCP may be able to diagnose cataracts in some cases, the eyes aren't dilated. Eye pressure isn't measured and therefore a risk for glaucoma could go undetected. Consider discussing the need for a complete eye exam with the PCP, especially for older residents.
Colon Cancer – Frequently physicians will order a colonoscopy after age 50 for those in the
general population, but often this test isn't done for our consumers until after a problem occurs. A
family history of colon cancer or polyps may indicate the need for earlier screening. Many
consumers don't have good medical family histories and therefore the PCP is not alerted to
potential risk factors. After age 50 stool samples for occult (hidden) blood are included in annual
physicals. These may be difficult to collect and often the PCP will collect a sample as part of a rectal examination but sometimes no other screening is done.
Cardiac Risks – The age for testing for risks of heart disease varies according to the
individual's age and apparent risk factors. Blood pressure screening is routine and lipid profiles are generally ordered as part of routine blood work. Those with Down Syndrome are at higher risk for cardiac problems and a baseline EKG may be indicated.
Remember – unless you see an immediate problem the best time to discuss needed
screenings is at the annual physical. Testing is expensive in terms of time and money but can
provide the physician with necessary information and accurate diagnoses so that necessary
treatment can be initiated.
Page 4 of 6
Can I Take This with Food?
Printed with permission from Shawn Slenker, PharmD,
York Hospital, WellSpan Health
This is one of the most common questions asked of pharmacists. As a rule of thumb, you should take your
pill(s) with water to properly dissolve tablets. Some medications can be taken with food and drink, others cannot.
Food can alter the drug's action, known as food-drug interactions. Some food-drug interactions can be harmful.
The list below is not meant to be complete. If you have questions regarding your own medicine, please see your
doctor or pharmacist.
Take On an Empty Stomach
Like food and nutrients, medications taken by mouth must be absorbed through the lining of the stomach or
the small intestine. Food may interfere with drug absorption. To be sure your stomach is empty, take these drugs
at least 1 hour before or at least 2 hours after your meals or snacks:
o Anti-infective drugs – ampicillin, azithromycin (Zithromax), cephalexin, isoniazid, ketoconazole,
o Thyroid medication – liothyronine (Cytomel), levothyroxine (Synthroid, Levoxyl) o Others – captopril, moexipril (Univasc), methotrexate, sucralfate, nadolol o Osteoporosis medications, Actonel, Didronel, and Fosamax have very specific instructions to insure
they will work. Take these with water only, first thing in the morning before eating or drinking anything. After taking these, one should not lie down, eat, or drink for at least 30 minutes to avoid irritation of the esophagus or "food pipe".
Some foods increase the absorption of a medication. Grapefruit juice is one example. Grapefruit juice may cause blood levels of some drugs to become too high. In fact, low blood pressure or change in heart rhythm may occur during use of certain heart medications. Grapefruit juice interaction with some cholesterol medicine increases risk of muscle damage or kidney failure. Do not use grapefruit juice within 24 hours of any of the following:
o Heart medicine – felodipine, nisoldipine, nicardipine, verapamil, amiodarone, losartan o Cholesterol meds – simvastatin (Zocor), lovastatin (Mevacor), atorvastatin (Lipitor). o Others with increased side effects – diazepam (Valium), alprazolam (XanaX), carbamazepine,
sertraline (Zoloft), trazodone, quetiapine (Seroquel), Sildenafil (Viagra), cyclosporine
Calcium, Magnesium, and Iron
Milk products (such as: milk, cheese, yogurt, evaporated milk, and ice cream), may interfere with drug absorption. The calcium attaches to the drug and it will not work. Antacids, calcium, magnesium and iron supplements do the same thing. Avoid these when taking:
o Anti-infective meds – tetracycline, doxycycline, Levaquin, Cipro, Tequin, fluconazole (Diflucan),
itraconazole (Sporanox), ketoconazole (Nizoral), terbinafine (Lamisil)
Salt Substitutes Containing Potassium
Some medications force the body to accumulate potassium. All of us need potassium, but too much can cause heart rhythm problems. Some salt substitutes contain potassium. They contribute to this food-drug interaction when used regularly. Avoid salt substitutes with potassium if you take any of these:
o Heart meds – captopril, lisinopril (Prinivil, Zestril), enalapril (Vasotec), ramipril (Altace), quinapril
(Accupril), benazepril (Lotensin)
o Diuretics – amiloride, triamterene (Dyazide, Maxzide), spironolactone, Inspra
What You Can Do
Always tell your doctors what other medications you are taking, including nonprescription, herbal remedies, and vitamin supplements. Let your doctor know if you follow a special or restricted diet— especially one that is unusually high or low in a particular kind of food—or if you plan to begin such a diet. Check with your pharmacists if you are unsure. Food-drug interactions are almost always manageable. It is important to call your physician if you suspect a possible reaction to a new medication. If you are taking medication on a regular schedule with no problems, continue that routine.
Page 5 of 6
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The HCQU View
A perfect summer day is when
the sun is shining, the breeze is
blowing, the birds are singing, and
the lawn mower is broken.
-- James Dent
Enjoy your summer!
Kathleen Jaczynski, RN
Latex is a form of natural rubber and is found in many of the things we use daily. Since the advent of
Standard Precautions (formerly known as universal precautions) latex gloves are used whenever care
giving staff may come in contact with body secretions. Latex is also in many other products that we use –
blood pressure cuffs, syringes, adhesive tape, catheters, IV tubing, G-tubes and every day things like
balloons or elastic waistbands.
The most commonly used item in the medical field is latex gloves. During manufacturing the latex
glove is formed from liquid rubber which is a natural protein. In the production process cornstarch powder is
applied to the gloves and absorbs some of the water soluble protein. When the gloves are used, the dry
powder carries the protein into the air and also sticks to the hands when gloves are removed.
Latex sensitive individuals may have minor to severe reactions to the protein powder, from burning
and itching to life-threatening shock. Here are some of the symptoms you should report if observed after
contact with latex: itchy eyes, sneezing, shortness of breath, facial edema, bronchial spasms, dermatitis,
itchy burning skin (mouth/lips after a dental procedure) and hives.
Once a person is latex sensitive there is no way to know how severe a reaction may occur the next
time….so be alert! If you or a consumer has any indication that latex is causing these reactions, tell your
PCP, dentist and other healthcare providers. Using latex free equipment and scheduling doctor/dentist
appointments early in the day is important. For latex-sensitive individuals, remember to mark "latex
sensitivity" in the allergy section of their medical records.
Page 6 of 6
Government of Fiji Request for Tender Supply of Water Level and Rainfall Station Equipment for the Fiji Meteorological Service Dated: December 19, 2013 Change History Date Changed Description of the change December 19th 2013 Original draft – FMS QA STO(Hydrology) PS, Ministry of Transport FPO Advertisement
THAI J GASTROENTEROL 2007 Vol. 8 No. 1 Ua-sukphanpranee B, Anantapanpong S Jan. - Apr. 2007 Comparative Study Between Norfloxacin and Ciprofloxacin inProphylaxis of Spontaneous Bacterial Peritonitis inCirrhotic Patients This study was conduct prospective randomized study to compare efficacy of ciprofloxacin, 750 mg weekly,