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Http://hud.ac/ke9 Closing date. 27 September where can i buy lasix over the counter usa 2021Interview date. W/c 25 October 2021Working for Equal Opportunities.Innovative University. Inspiring EmployerResearch Fellow Salary scale where can i buy lasix over the counter usa.

£34,304 - £40,927Research Assistant Salary Scales where can i buy lasix over the counter usa. £28,756 - £33,309The hypertension medications Genomics UK (COG-UK) consortium (https://www.cogconsortium.uk/) delivers whole-genome sequencing (WGS) of the hypertension lasix to local NHS centres and the UK government. QUB is one of twelve academic partners providing sequencing and analysis capacity to where can i buy lasix over the counter usa the consortium. The QUB team led by Dr David Simpson from the Wellcome-Wolfson Institute for Experimental Medicine has worked closely with a team in the Belfast Health and Social Care Trust led by Dr Derek Fairley (Regional lasix Laboratory) to generate over 8000 sequences from N.

Ireland to date.The team invites applications for a Postdoctoral Researcher (consideration may also be given to an experienced Research Assistant) to undertake research within the QUB COG-UK team, where can i buy lasix over the counter usa analysing sequence variants, supervised by Drs Simpson and Timofey Skvortsov (School of Pharmacy). The aim is to detect intra-host variation in the hypertension WGS data from samples in Northern Ireland and use this to better understand transmission chains and evolution of potential treatment evasion in this population. The existing WGS dataset generated at QUB where can i buy lasix over the counter usa will be screened for the presence of candidate intra-host single nucleotide variants (iSNVs). RT-PCR will be repeated for these samples and sequencing performed using a different platform to validate that the iSNVs are present in the sample and not artefacts.

This will establish the appropriate parameters for reliable detection of where can i buy lasix over the counter usa iSNVs and enable determination of their prevalence. The presence of co-s and evolution of variants will then be assessed.Please note that while the intention is to where can i buy lasix over the counter usa appoint a suitable candidate on a full-time basis, we may consider accommodating part-time hours.Informal enquires may be directed to Stephen Bridgett - s.bridgett@qub.ac.uk Fixed term contract posts are available for the stated period in the first instance but in particular circumstances may be renewed or made permanent subject to availability of funding.Closing date. Monday 13 September 2021Anticipated interview date. Tuesday 28 September 2021Please click Apply where can i buy lasix over the counter usa or visit www.qub.ac.uk/jobs for further information about the role including the essential and desirable criteria, the School of Medicine, Dentistry and Biomedical Sciences and our attractive reward package.Queen’s University Belfast is recognised as one of the most diverse organisations in Northern Ireland.

We are committed to equality of opportunity, fair participation and welcomes applications from all. However, our Fair Employment Equality Monitoring data tells us that individuals where can i buy lasix over the counter usa from Black, Asian and Minority Ethnic (BAME) communities, people with a disability and those who identify as LGBT+ and members of the Protestant Community are also currently under-represented in this category of work. As such, we particularly welcome applications for this role from individuals who identify with these backgrounds and / or communities.For further information on our commitment to Equality, Diversity and Inclusion, including our work in relation to Gender Equality (Athena SWAN), LGBTQ+ inclusion (Stonewall Workplace Equality Index), Disability and Race (Race Equality Charter) please visit. Www.qub.ac.uk/diversity and/or www.qub.ac.uk/qgi For further information and details on the where can i buy lasix over the counter usa University’s Staff Networks please visit.

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Serum levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) activity are associated with how to order lasix online the presence of CAVS http://epicsportsandentertainment.com/price-of-zithromax-at-walmart/. However, it has been unclear whether this association is due to a cause–effect relationship. In this issue of Heart, Perrot and colleagues1 used genetic association studies from eight cohorts to show that CAVS was not associated with any of four single nucleotide polymorphisms that are associated with Lp-PLA2 activity or mass. These findings suggest that although Lp-PLA2 activity is a biomarker for CAVS unfortunately, it is unlikely to be a therapeutic target (figure 1).Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are how to order lasix online not associated with CAVS in this large genetic association study. CAVS, calcific aortic valve stenosis.

Lp-PLA2, lipoprotein-associated phospholipase A2." data-icon-position data-hide-link-title="0">Figure 1 Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are not associated with CAVS in this large genetic association study. CAVS, calcific aortic valve how to order lasix online stenosis. Lp-PLA2, lipoprotein-associated phospholipase A2.In an editorial, Zheng and Dweck2 discuss this article, summarise current ongoing trials of medical therapy for CAVS (table 1) and comment. €˜Strong evidence points towards elevated Lp(a) levels and its associated oxidised phospholipids (OxPL) as causal risk factors for CAVS, suggesting that targeting this lipid-driven, inflammatory pathway has a real chance to translate into therapy capable of mitigating disease. The current study suggests that this association is not mediated by Lp-PLA2 and underlines the importance of scrutinising whether biological factors within pathophysiological pathways are merely biomarkers or actually represent a feasible and causal target.’View this table:Table 1 Ongoing randomised clinical trials of medical therapies in aortic stenosisRheumatic heart disease (RHD) remains the primary cause of valve disease worldwide and contributes significantly how to order lasix online to maternal and fetal morbidity and mortality.

In a study by Baghel and colleagues3 of 681 pregnant women with RHD, adverse cardiovascular evens occurred in about 15% of pregnancies. Multivariable predictors of adverse outcomes during pregnancy were prior adverse cardiovascular events, lack of appropriate medical therapy, severity of mitral stenosis, valve replacement and pulmonary hypertension. Based on this analysis, the authors propose a risk score from pregnant women with RHD (table 2).View this table:Table 2 New prognostic score (DEVI’s score) to predict composite adverse cardiac outcome in pregnant women with rheumatic valvular heart diseaseCommenting on this paper, Elkayam and Shmueli4 point out that in how to order lasix online about one-fourth of women, the diagnosis of RHD was not known prior to pregnancy and that a late diagnosis often was associated with adverse outcomes. Their editorial provides a concise summary of optimal management of pregnant women with RHD. They conclude ‘With proper evaluation and risk stratification prior to pregnancy, a close multidisciplinary follow-up during pregnancy, and close monitoring during labour and delivery as well as the early postpartum period most complications can be prevented.’The importance of psychosocial factors in cardiovascular disease (CVD) prevalence and outcomes is increasingly recognised.

Using data how to order lasix online from the English Longitudinal Study of Ageing, Bu and colleagues5 found that loneliness was associated with CVD, independent of possible confounders and other risk factors, with a 30% higher risk of a new CVD diagnosis in the most lonely people compared with the least lonely people. As O’Keefe and colleagues6 point out, this data is especially important now in the context of social distancing and stay-at-home recommendations and they offer several approaches to mitigating loneliness during the hypertension medications lasix.The Education in Heart article7 in this issue focuses on the clinical use and prognostic implications of echocardiographic speckle tracking measurements of global longitudinal strain to detect and quantify early systolic dysfunction of the left ventricle (figure 2).Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis. (A) Apical four-chamber view of a 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy. The thickness of the septum was 28 mm and the left ventricular ejection fraction was how to order lasix online 55%. (B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%).

(C) Apical four-chamber view of a 75-year-old patient diagnosed with light chain amyloidosis. There is concentric hypertrophy of how to order lasix online the left ventricle and the ejection fraction is 56%. Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D). ANT, anterior. ANT SEPT, anteroseptal how to order lasix online.

GS, global strain. INF, inferior. LAT, lateral how to order lasix online. POST, posterior. SEPT, septal." data-icon-position data-hide-link-title="0">Figure 2 Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis.

(A) Apical four-chamber view how to order lasix online of a 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy. The thickness of the septum was 28 mm and the left ventricular ejection fraction was 55%. (B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%). (C) Apical how to order lasix online four-chamber view of a 75-year-old patient diagnosed with light chain amyloidosis. There is concentric hypertrophy of the left ventricle and the ejection fraction is 56%.

Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D). ANT, anterior how to order lasix online. ANT SEPT, anteroseptal. GS, global strain. INF, inferior how to order lasix online.

LAT, lateral. POST, posterior. SEPT, septal.Our Cardiology-in-Focus article by Hudson and Pettit8 provides a clear-eyed but brief discussion and outstanding graphic of the challenges in reconciling the varying definitions of the ‘normal’ values for how to order lasix online left ventricular ejection fraction, as stated in different guidelines (figure 3).Categories of left ventricular ejection fraction. EF, ejection fraction. HF, heart failure.

LVEF, left ventricular ejection fraction." data-icon-position data-hide-link-title="0">Figure 3 Categories of how to order lasix online left ventricular ejection fraction. EF, ejection fraction. HF, heart failure.

However, it has been unclear whether this where can i buy lasix over the counter usa association is due to a cause–effect relationship. In this issue of Heart, Perrot and colleagues1 used genetic association studies from eight cohorts to show that CAVS was not associated with any of four single nucleotide polymorphisms that are associated with Lp-PLA2 activity or mass. These findings suggest that although Lp-PLA2 activity is a biomarker for CAVS unfortunately, it is unlikely to be a therapeutic target (figure 1).Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are not associated with CAVS in this large genetic association study.

CAVS, calcific where can i buy lasix over the counter usa aortic valve stenosis. Lp-PLA2, lipoprotein-associated phospholipase A2." data-icon-position data-hide-link-title="0">Figure 1 Higher Lp-PLA2 activity is significantly associated with the presence of CAVS in patients with heart disease, but variants influencing Lp-PLA2 mass or activity are not associated with CAVS in this large genetic association study. CAVS, calcific aortic valve stenosis.

Lp-PLA2, lipoprotein-associated phospholipase A2.In an editorial, Zheng and Dweck2 discuss this article, summarise current ongoing trials of medical therapy for CAVS where can i buy lasix over the counter usa (table 1) and comment. €˜Strong evidence points towards elevated Lp(a) levels and its associated oxidised phospholipids (OxPL) as causal risk factors for CAVS, suggesting that targeting this lipid-driven, inflammatory pathway has a real chance to translate into therapy capable of mitigating disease. The current study suggests that this association is not mediated by Lp-PLA2 and underlines the importance of scrutinising whether biological factors within pathophysiological pathways are merely biomarkers or actually represent a feasible and causal target.’View this table:Table 1 Ongoing randomised clinical trials of medical therapies in aortic stenosisRheumatic heart disease (RHD) remains the primary cause of valve disease worldwide and contributes significantly to maternal and fetal morbidity and mortality.

In a study where can i buy lasix over the counter usa by Baghel and colleagues3 of 681 pregnant women with RHD, adverse cardiovascular evens occurred in about 15% of pregnancies. Multivariable predictors of adverse outcomes during pregnancy were prior adverse cardiovascular events, lack of appropriate medical therapy, severity of mitral stenosis, valve replacement and pulmonary hypertension. Based on this analysis, the authors propose a risk score from pregnant women with RHD (table 2).View this table:Table 2 New prognostic score (DEVI’s score) to predict composite adverse cardiac outcome in pregnant women with rheumatic valvular heart diseaseCommenting on this paper, Elkayam and Shmueli4 point out that in about one-fourth of women, the diagnosis of RHD was not known prior to pregnancy and that a late diagnosis often was associated with adverse outcomes.

Their editorial where can i buy lasix over the counter usa provides a concise summary of optimal management of pregnant women with RHD. They conclude ‘With proper evaluation and risk stratification prior to pregnancy, a close multidisciplinary follow-up during pregnancy, and close monitoring during labour and delivery as well as the early postpartum period most complications can be prevented.’The importance of psychosocial factors in cardiovascular disease (CVD) prevalence and outcomes is increasingly recognised. Using data from the English Longitudinal Study of Ageing, Bu and colleagues5 found that loneliness was associated with CVD, independent of possible confounders and other risk factors, with a 30% higher risk of a new CVD diagnosis in the most lonely people compared with the least lonely people.

As O’Keefe and colleagues6 point out, this data is especially important now in the context of social distancing and stay-at-home recommendations and they offer several where can i buy lasix over the counter usa approaches to mitigating loneliness during the hypertension medications lasix.The Education in Heart article7 in this issue focuses on the clinical use and prognostic implications of echocardiographic speckle tracking measurements of global longitudinal strain to detect and quantify early systolic dysfunction of the left ventricle (figure 2).Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis. (A) Apical four-chamber view of a 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy. The thickness of the septum was 28 mm and the left ventricular ejection fraction was 55%.

(B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal where can i buy lasix over the counter usa areas and the global longitudinal strain is impaired (−13.6%). (C) Apical four-chamber view of a 75-year-old patient diagnosed with light chain amyloidosis. There is concentric hypertrophy of the left ventricle and the ejection fraction is 56%.

Based on speckle tracking echocardiography analysis, the left ventricular where can i buy lasix over the counter usa global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D). ANT, anterior. ANT SEPT, anteroseptal.

GS, global where can i buy lasix over the counter usa strain. INF, inferior. LAT, lateral.

POST, posterior where can i buy lasix over the counter usa. SEPT, septal." data-icon-position data-hide-link-title="0">Figure 2 Left ventricular global longitudinal strain to differentiate between mutation-positive sarcomeric hypertrophic cardiomyopathy and cardiac amyloidosis. (A) Apical four-chamber view of a 66-year-old patient known with mutation-positive hypertrophic cardiomyopathy.

The thickness of the septum was 28 mm and where can i buy lasix over the counter usa the left ventricular ejection fraction was 55%. (B) The polar map shows markedly impaired longitudinal strain in the septal mid and basal areas and the global longitudinal strain is impaired (−13.6%). (C) Apical four-chamber view of a 75-year-old patient diagnosed with light chain amyloidosis.

There is concentric where can i buy lasix over the counter usa hypertrophy of the left ventricle and the ejection fraction is 56%. Based on speckle tracking echocardiography analysis, the left ventricular global longitudinal strain is impaired (−12.2%), with typical sparing of the longitudinal strain values in the apical segments (D). ANT, anterior.

ANT SEPT, where can i buy lasix over the counter usa anteroseptal. GS, global strain. INF, inferior.

LAT, lateral where can i buy lasix over the counter usa. POST, posterior. SEPT, septal.Our Cardiology-in-Focus article by Hudson and Pettit8 provides a clear-eyed but brief discussion and outstanding graphic of the challenges in reconciling the varying definitions of the ‘normal’ values for left ventricular ejection fraction, as stated in different guidelines (figure 3).Categories of left ventricular ejection fraction.

EF, ejection where can i buy lasix over the counter usa fraction. HF, heart failure. LVEF, left ventricular ejection fraction." data-icon-position data-hide-link-title="0">Figure 3 Categories of left ventricular ejection fraction.

EF, ejection where can i buy lasix over the counter usa fraction. HF, heart failure. LVEF, left ventricular ejection fraction..

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GUNNISON, Colo lasix medication cost Buy zithromax 500mg. €” The night after Thanksgiving, a small ambulance service that covers a huge swath of southwestern Colorado got a call that a patient needed an emergency transfer from the hospital in Gunnison to a larger one with an intensive care unit 65 miles away in Montrose. The patient — a 78-year-old man — was experiencing atrial fibrillation, an irregular heartbeat that usually isn’t lasix medication cost life-threatening. But for patients like this one with chronic health conditions, a history of cardiac issues and high blood pressure, the condition can cause a stroke or heart failure.

Workers from Gunnison Valley Health Paramedics rolled the patient, who was on a gurney, out of the hospital and into the frigid night air. AnnieGrace Haddorff, the emergency medical technician on call, helped load the patient into the ambulance and lasix medication cost jumped into the driver’s seat. Paramedic Alec Newby got into the back and hooked the patient up to a blood pressure cuff. A pulse oximeter, which measures heart rate and blood oxygen saturation.

And an electrocardiogram, which records the heart’s lasix medication cost electrical activity. €œYour heart is obviously pissed off,” Newby told the man as the ECG confirmed the atrial fibrillation. The ambulance pulled onto U.S. Highway 50 for the one-hour-and-15-minute drive past clusters of homes among rolling hills of sagebrush, the expansive Blue Mesa Reservoir lasix medication cost and the gaping Black Canyon of the Gunnison, with its craggy spires.

The patient was stable enough for the long drive, which covered only a sliver of GVH Paramedics’ 4,400-square-mile service area. It is more than twice the size of Delaware and is the largest response zone for an ambulance service in all of Colorado. A typical fire or emergency lasix medication cost medical service response area ranges from 100 to 400 square miles. Each time a patient must be transported to another medical facility, Gunnison Valley Health Paramedics is left with few vehicles to respond to emergencies in a coverage area more than twice the size of Delaware.(Helen Santoro for KHN) In recent years, interfacility transports or transfers, also known as IFTs, like this one have become increasingly common for GVH Paramedics, forcing the team to drive far outside its already vast zone.

Before the lasix, the number of transfers rose because the population of Gunnison County was steadily increasing, more tourists were being drawn to places like the popular Crested Butte ski resort, and GVH Paramedics had expanded its services to larger metropolitan hospitals outside Gunnison County. But now the team is being called to move patients more frequently, and greater distances, because the hospital beds in the lasix medication cost relatively close cities of Montrose and Grand Junction are filled with hypertension medications patients. The team is regularly required to drive patients to Denver, which is around three hours and 40 minutes from Gunnison. Officials from the ambulance service worry that they might find themselves unable to respond to an emergency because their resources, which include six ambulances but only enough staff to operate three of those vehicles, are tied up on a long-haul transfer.

What were once 2½- or three-hour trips to Montrose are now far longer excursions, “and that takes resources from this community,” said lasix medication cost CJ Malcolm, chief of emergency services. €œWe were doing that pre-hypertension medications, but now the state is so impacted, it’s like a daily part of our lives.” Before the lasix, all the ambulances would be simultaneously out on 911 calls or IFTs less than 10 times a year. Now, Malcolm said, it is happening with greater frequency. In those cases, GVH Paramedics leans on the emergency response team in Crested Butte, about 28 miles from Gunnison, or the response to the patient is lasix medication cost delayed.

In 2018, GVH Paramedics made 166 IFTs, requiring nearly 40,000 miles of travel and a total of 987 hours of ambulance operation, according to data collected by the team. Last year concluded with 260 IFTs, over 70,000 lasix medication cost miles of travel and a total of 1,486 hours of ambulance operation. That’s a 50% increase in time on the road. €œAnytime we have one or two ambulances out on an IFT, this leaves a massive tract of land with only one ambulance to respond,” Malcolm said.

€œThis is a moderately terrifying position to be put into when we lasix medication cost can easily have two or three 911 calls in a row.” In August, for example, Gunnison Valley Health hospital transferred more than 60 patients, 37 of whom were transported by GVH Paramedics. That means that at least once a day that month, a GVH Paramedics crew was taking a patient out of town, Malcolm said. And if crew members aren’t scheduled to be back in Gunnison by 1 a.m., they must spend the night in a hotel to avoid driving along treacherous mountain roads while overly tired. GVH Paramedics’ service area covers almost all of Gunnison County, a large portion of Saguache County and sections of Montrose and Hinsdale counties lasix medication cost.

It contains mountain ranges, canyons and wide expanses of high desert. With around 6,600 full-time residents and a university, Gunnison is the largest town the team serves. The surrounding towns — including Tin Cup, Pitkin and Ohio City — are villages with a couple of lasix medication cost hundred people or former mining towns where the artifacts from the boom times outnumber the residents. The Nov.

26 drive to Montrose took the Gunnison Valley Health Paramedics team an hour and 15 minutes. (Helen Santoro for KHN) GVH Paramedics’ 21 full-time staff members and lasix medication cost 10 to 20 individuals who work as needed have certifications in wildland firefighting and backcountry medicine skills, including swift-water, ice and avalanche rescue. To deal with the increased demands from IFTs, they have added an extra staff member to each shift, and off-duty staffers are being called in to assist. As the lasix drags on, the number of IFTs will probably continue to increase.

By mid-November, the number of lasix medication cost people in the hospital with hypertension medications in Colorado was staggeringly high, approaching the December 2020 peak of 1,847. Hospitalizations remained above 1,500 through the end of the month. As a result, 93% of the state’s acute care hospital beds and 94% of ICU beds were being used as of Nov. 30, according to data from the Colorado Department of Public lasix medication cost Health and Environment.

€œI don’t think we see the capacity concerns easing anytime soon,” said Cara Welch, senior director of communications at the Colorado Hospital Association. Adding to the strain are people seeking care they delayed because of the lasix and other respiratory lasixes, such as respiratory syncytial lasix, circulating in the state, Welch said. Kelly Thompson, chief of operations of CareFlight of the Rockies, an air ambulance service lasix medication cost that operates in Colorado and other parts of the West, agreed with this assessment. €œWe’ve already been transporting large numbers of kids with RSV that are sick, and you have hypertension medications on top of all of this,” Thompson said.

€œIt’s a lasix medication cost big concern. This is the time when we have a lot of sick people.” In early November, to manage escalating concerns about hospital capacity, Colorado hospitals and health systems activated tier 3 of the state's patient transfer system — the highest level. That means hypertension medications and non-hypertension medications patients can be moved without their consent from a hospital that doesn’t have enough capacity to one with more space. Hospitals can also send sicker patients to medical centers with lasix medication cost more specialized care.

As the GVH Paramedics crew members approached Montrose with their patient over the recent holiday weekend, Newby called the hospital to let the staff know they were arriving. They pulled up to the emergency room entrance, and Newby and Haddorff rolled the patient into a hospital room. The Montrose lasix medication cost hospital staff took over, moving the patient from the gurney to a hospital bed as Newby updated them on the patient’s medical records. Soon they were back in the ambulance, headed for home.

€œIFTs can be stressful,” said Haddorff as she maneuvered the twisty mountain road bathed in moonlight. Related Topics Contact Us Submit a Story TipIt’s Saturday, and Sarah Mahoney is one of several Planned Parenthood volunteers knocking on doors in Windham, Maine, lasix medication cost a politically moderate town not far from Portland. No one answers at the first couple of houses. But as Mahoney heads up the street, she sees a woman out for a walk.

€œHey!. We’re out canvassing,” she says. €œWould you mind having a conversation with us?. € Mahoney wants to talk about abortion — not a typical topic for a conversation, especially with a stranger.

But the woman, Kerry Kelchner, agrees to talk. If this were typical door-to-door canvassing, Mahoney might ask Kelchner about a political candidate, remind her to vote and then be on her way. But Mahoney is deep canvassing — a technique that employs longer conversations to move opinions on hot-button issues. Planned Parenthood in Maine has deployed the strategy for several years amid what it says are increasing threats to reproductive rights.

This year alone, states have enacted more than 100 restrictions on abortion, including one in Texas that bans most abortions after six weeks. This month, the U.S. Supreme Court heard arguments in a case about a Mississippi law that could lead to the overturning of Roe v. Wade, the landmark 1973 ruling that established a constitutional right to abortion.

And though state law in Maine protects abortion rights even if Roe v. Wade is overturned, abortion opponents have gained traction in the state in recent years. So volunteers like Mahoney start conversations. And they can get quite personal.

Mahoney first assesses Kelchner’s baseline attitude on abortion access on a scale of 0 to 10. A 10 means the interviewee believes anyone should be able to get an abortion for any reason. Kelchner says she’s a 7. Next, Mahoney asks Kelchner a series of questions to better understand her values.

€œCan you tell me a little bit about what shaped your views on abortion?. € she asks. €œHave you known anybody who’s had an abortion, a friend or a family member?. € “My mother,” says Kelchner.

She explains her parents were young when she was born, and they weren’t ready for another baby. Then Mahoney, who’s 60, shares that she also had an abortion. €œI was in my early 20s,” she says. €œI was a little conflicted about it, and I wanted to have a family.

I knew I wanted to have a family, but I was in no way ready to do that.” Mahoney points out that she and Kelchner have similar views on what an unplanned pregnancy can mean. Then she asks her opening question again, to see whether Kelchner’s feelings about abortion access have shifted on the 0-to-10 scale. €œStill around 7,” Kelchner says. Mahoney probes further.

€œWhat would be the circumstances where you would say, ‘No — they shouldn’t have the right to have an abortion?. €™â€ Kelchner pauses. €œThat’s a good question.” Before volunteers head out to strike up conversations with voters, Katie McClelland (in black cap) of Planned Parenthood in Maine gives a pep talk. (Patty Wight/Maine Public Radio) Planned Parenthood volunteer Sarah Mahoney checks a list of addresses to see which door to knock on next.

(Patty Wight/Maine Public Radio) They talk more. Ultimately, Kelchner can’t think of any circumstance in which she believes someone should be denied an abortion. €œThere should be no judgment,” she says. €œSo that would be a 10?.

€ Mahoney asks. €œYep,” says Kelchner. In the five years she’s been deep canvassing for Planned Parenthood, Mahoney said, she hasn’t had a single unpleasant conversation. €œWhat we’ve found doing this is that it is an effective way to change minds about abortion,” said Amy Cookson, director of external communications for Planned Parenthood of Northern New England.

Cookson said Planned Parenthood started deep canvassing in Maine in 2015, after Paul LePage, an anti-abortion Republican, won a second term as governor. Gay rights advocates in California had used deep canvassing on the same-sex marriage issue, and she wondered. €œCan it work around abortion stigma?. € Joshua Kalla, a political scientist at Yale University, has conducted research that found the technique can change people’s deeply held beliefs.

The crucial elements are that canvassers listen without judgment and share their own stories. €œSo whether the person had an abortion and is talking about their abortion story,” said Kalla, “or whether the person is an ally and is talking about a friend or family member who had an abortion and is sharing that story, the effects seem to be quite similar.” Kalla has also studied Planned Parenthood’s efforts in Maine and said the group has added something else that’s effective. Moral reframing. Canvassers listen for the moral values a voter emphasizes and then incorporate those values into the story they share.

But deep canvassing is not exclusively a progressive tactic, Kalla said. Conservative groups can use it, too, and he thinks that would improve political discourse. €œYou know, it would be good for American society if the way we had political conversation was more grounded, and listening to the other side, and being nonjudgmental, and being curious.” After spending a couple of hours canvassing, volunteers with Planned Parenthood debrief about their experiences. (Patty Wight/Maine Public Radio) Back in Windham, Mahoney continues to walk through the neighborhood.

She meets a man outside his apartment building who gives only his first name, Chris. He says he’s a 4 on the abortion access scale. He opposes abortion except in cases of sexual assault. Chris tells Mahoney he had a daughter when he was 15.

€œDo you talk about, I’m curious, birth control and abortion?. € Mahoney asks. €œI do with her a lot,” Chris says. She’s a teenager, he says, and he’s not sure what he’d do if she got pregnant accidentally.

€œIt’s her own life,” he says. €œI don’t know if I would even try to change her mind. Because it’s her decision.” As the conversation goes on, Chris seems as though he supports access to abortion. But at the end, he doesn’t budge on his rating.

Mahoney said that’s OK. Some people won’t change their minds right away. €œThe worst way to think about this is that it’s some kind of Jedi mind trick,” she said, “and I’m going to let them talk about themselves and then — pow!. — I’m going to change their mind.” What Mahoney wants most from these conversations is for people to think more deeply about the nuances around abortion and identify common ground.

€œI just feel like we all need to be taking steps to hear one another and move towards each other, instead of just diving into this divisive, contrary, hostile, red and blue world.” Because of the success Planned Parenthood in Maine has had with deep canvassing, it has trained volunteers in other states, including Texas and Kansas. Next year, Kansas voters will cast ballots on a referendum question that seeks to revoke abortion access as a fundamental right. This story is part of a partnership that includes Maine Public Radio, NPR and KHN. Related Topics Contact Us Submit a Story TipTed Billinger Jr.

Liked to joke that he would work until he died. That turned out to be prophetic. When Billinger died of a heart attack in 2019 at age 71, he was still running Teddy B’s, the pharmacy his father had started more than 65 years earlier in Cheyenne Wells, Colorado. With no other pharmacist to work at the store, prescriptions already counted out and sealed in bottles were suddenly locked away in a pharmacy that no one could enter.

And Cheyenne Wells’ fewer than 800 residents were abruptly left without a drugstore. Pharmacies were once routinely bequeathed from one generation to the next, but, in interviews with more than a dozen pharmacists, many said the pressure of running an independent drugstore have them pushing their offspring toward other careers. And when they search for a buyer, they often find that attracting new pharmacists, especially to rural settings, is difficult. With a large group of pharmacists nearing retirement age, more communities may lose their only drugstore.

€œIt’s going to be harder to attract people and to pay them,” said David Kreling, a professor emeritus at the University of Wisconsin-Madison School of Pharmacy. €œIf there’s not a generational thing where someone can sit down with their son or daughter and say that they could take the store over, there’s a good chance that pharmacy will evaporate.” Tom Davis, Billinger’s friend and co-owner of Kiowa Drug in Eads, Colorado, stepped in to sort out the mess in Cheyenne Wells. With permission from the State Board of Pharmacy, the county sheriff let Davis into Teddy B’s in the eastern Colorado town to take an inventory of the remaining drugs. Customers who had dropped off their prescriptions before Billinger died were able to pick up their medications.

Davis then bought the pharmacy from Billinger’s estate. He runs it as a convenience store and six days a week delivers prescriptions to it from Eads, 44 miles away. €œBy the time you paid a pharmacist, the location there was borderline unprofitable,” Davis said. Davis and his brother co-own seven pharmacies and have started to plan for retirement by hiring five young pharmacists and allowing them to buy ownership stakes in those pharmacies over time.(Rachel Woolf for KHN) He has received numerous requests to open pharmacies in other eastern Colorado towns, but making that work financially would be difficult.

Reimbursements from insurance plans have dwindled, and customer bases have eroded as health insurers push patients toward mail-order deliveries. €œI fill prescriptions every day where my reimbursement is less than the cost of the drug,” Davis said. €œIn other settings, you might tell a patient, ‘We don’t have that in stock,’ or ‘Why don’t you go down the street to the chain?. €™ But down here, we just take care of our patients, and we just eat it.” He can survive, he said, because, after 48 years, he no longer has any business debt.

€œI look at my bottom line,” Davis said. €œWith the amount of profit that I had at the end of the year, that would not have been enough if I was having to pay a mortgage.” A woman enters Teddy B’s in Cheyenne Wells, Colorado. (Rachel Woolf for KHN) Dia Giron, manager at Teddy B’s convenience store transfers prescriptions to a locked case after Kiowa Drug delivers them. (Rachel Woolf for KHN) Studies have found the number of pharmacists nationally to be sufficient, even more than enough, to meet current needs, although supply and demand don’t always line up.

Finding pharmacists is more difficult in rural areas. €œOnce they get a taste of the big city,” Kreling said, “it’s hard to get them back to the farm.” Workforce data also shows worrisome trends. Concerns about a shortage of pharmacists led the federal government to pour money into pharmacy schools in the 1970s, creating a temporary bump in the number of graduates. The people in that bulge in the pharmacist pipeline have hit retirement age.

€œMany of them owned independent pharmacies, and they were working in rural communities,” said University of Minnesota pharmacy professor Jon Schommer, who studies workforce issues. Now, as the demand for pharmacists to provide testing and vaccinations during the hypertension medications lasix increases, drugstore chains are offering incentives — such as large salaries, signing bonuses and help paying off school loans — that are often more enticing than anything a rural pharmacy could muster. Pharmacy technician Jess Sierra prepares prescriptions at Kiowa Drug in Eads, Colorado. How pharmacy graduates envision their careers has also shifted.

Many no longer want to own a pharmacy and are content to work at pharmacy chains or other health care organizations, according to several pharmacy school professors. As of 2018, only about half of pharmacists worked in traditional retail drugstores. That makes rural recruitment more difficult. Denise Robins had worked at R&R Family Pharmacy in Springfield, Colorado, for 18 years when the owner retired.

She and three family members bought the drugstore in a last-ditch effort to keep it open. €œNone of us are pharmacists, so that made it a little tougher,” Robins said. €œWe just knew it was really going to make it hard for people here if they had to travel an hour to get to a pharmacy.” But finding a pharmacist to work in the southeastern Colorado town of fewer than 1,400 people was a challenge. The first pharmacist Robins found commuted 48 miles one way from Lamar.

But after a year and a half, the trip became too much. She then hired someone who wanted to work for only a year, to make enough money to travel. Then Robins interviewed two University of Colorado pharmacy school graduates. She hired one, but that didn’t work out.

So she called back the second candidate, who still had not found a permanent job. He had two young kids, and he and his wife were working opposite schedules. He took the job two years ago and has remained there since. I fill prescriptions every day where my reimbursement is less than the cost of the drug.Tom Davis In Berryville, Virginia, pharmacist Patricia White opened Battletown Pharmacy in 2011 because she wanted to carry on the family business.

Her father had owned a local pharmacy and had recently died. But when turning a profit with Battletown proved a struggle, White decided to retire. She lined up two potential buyers, but neither went through with the sale. She then hoped to transfer the pharmacy to a recent graduate but didn’t want to saddle him with a failing business.

€œI told him he couldn’t make any money, and he said, ‘Thanks for being honest,’” White recalled. Closing seemed like the only palatable option. Battletown shut down at the end of August. €œI did not want to sell out to a chain,” she said.

€œThat’s always been my mentality.” When a chain buys a pharmacy, it doesn’t always decide to run it. Instead, it might close the pharmacy and transfer the pharmacy’s prescription files to one of its outlets. Retiring pharmacists who spent decades serving a community generally don’t want to see that happen, said David Zgarrick, a Northeastern University pharmacy professor. €œThey’d like to sell their pharmacy to another pharmacist who would continue to run it very much in the same manner,” he said.

Some plan ahead, hiring another pharmacist and offering that person an equity stake in the business. Over time, the new pharmacist can buy out the owner. Many independent pharmacist-owners plan to live off the profits from selling their pharmacy, its inventory and its prescription records. €œTheir pharmacy is their retirement savings,” Zgarrick said.

But, Zgarrick said, the added pressure from the lasix may be pushing more pharmacists into retirement. And a long-running bull stock market may mean some pharmacists have enough in their retirement portfolios to call it quits without a sale. Davis talks with a pharmacy technician Jess Sierra at Kiowa Drug. (Rachel Woolf for KHN) In Eads, Davis, 70, still loves being a pharmacist.

He and his brother co-own seven pharmacies and have started to plan for retirement by hiring five young pharmacists and allowing them to buy ownership stakes in those pharmacies over time. He had wondered how long he could keep the Kiowa pharmacy running, though. With fewer than 700 residents, Eads may be the smallest town in Colorado with a pharmacy. Combining Davis’ customer base with Cheyenne Wells’ may have saved pharmacy access for both communities.

€œSo maybe where we could have lost two pharmacies in the area, we’ve been able to exist. We’re stronger now than we had ever been,” Davis said. €œThat wasn’t the original plan. We cared about those people and just wanted to take care of them.” Markian Hawryluk.

MarkianH@kff.org, @MarkianHawryluk Related Topics Contact Us Submit a Story TipWhen Arielle Harrison’s 9-year-old needed to see a pediatric specialist at Yale New Haven Health System in June, a telehealth visit seemed like a great option. Since her son wasn’t yet eligible to be vaccinated against hypertension medications, they could connect with the doctor via video and avoid venturing into a germy medical facility. Days before the appointment, she got a notice from the hospital informing her that she would receive two bills for the visit. One would be for the doctor’s services.

The second would be for a hospital facility fee, even though she and her son would be at home in Cheshire, Connecticut, and never set foot in any hospital-affiliated building. Harrison, 40, who works in nonprofit communications, posted on Twitter about the unwelcome fee, including an image of Marge Simpson of TV’s The Simpsons with a disgusted look on her face, captioned “GROANS.” She called the billing office the next morning and was told the facility fee is based on where the doctor is located. Since the doctor would be on hospital property, the hospital would charge a facility fee of between $50 and $350, depending on her insurance coverage. €œIt’s just one of many examples of how this is a very difficult system to use,” Harrison said, referring to the intricacies of U.S.

Health care. Hospital facility fees have long come under criticism from patients and consumer advocates. Hospitals say the fees, which can add hundreds of dollars or even more than $1,000 to a patient’s bill, are necessary to cover the high cost of keeping a hospital open and ready to provide care 24/7. But it’s not only hospital visits that result in facility fees.

Over the past several years, hospitals have been on a buying binge, snapping up physician practices that often then begin charging the fees, too. Patients seeing the same doctor for the same care as at earlier visits are now on the hook for the extra fee — because of a change in ownership. Charging a facility fee for a video visit where the patient logs in from their living room is even more of a head-scratcher. €œThe charges seem crazy,” said Ted Doolittle, who heads up Connecticut’s Office of the Healthcare Advocate, which provides help to consumers with health coverage issues.

€œIt rankles, and it should.” Facility fees for video appointments remain rare, health finance experts say, even as the use of telehealth has soared during the hypertension medications lasix. Medicare has allowed hospitals to assess a small fee for certain beneficiaries who get telehealth care at home during the ongoing national public health emergency, and people in private health plans may also be charged for them. Harrison, however, was lucky. Doolittle reached out to her after seeing her tweet to offer his office’s assistance.

In Connecticut, hospitals are prohibited from charging facility fees for telehealth visits. Connecticut imposed what may be the only state ban on telehealth facility fees as part of a broader law passed in May that was intended to help residents access telehealth during the lasix. The prohibition on facility fees sunsets at the end of June 2023. Pat McCabe, senior vice president of finance at Yale New Haven Health System, said he can’t explain why Harrison received a notice that she’d be charged a facility fee for a telehealth visit.

He speculated that her son’s appointment might have been coded incorrectly. Under the new law, he said, the health system hasn’t charged any telehealth patients a facility fee. But such fees are justified, McCabe said. €œIt offsets the cost of the software we use to facilitate the telehealth visits, and we do still have to keep the lights on,” he said, noting that the providers doing telehealth visits are on hospital sites that incur heat and power and maintenance charges.

The American Hospital Association didn’t respond to requests for comment about the rationale for facility fees for telehealth care. As the lasix began overwhelming the health system last year, hospitals essentially closed their doors to most non-hypertension medications patients. Telehealth visits, which made up about 1% of medical visits before the lasix, jumped to roughly 50% at its height last year, said Kyle Zebley, vice president of public policy at the nonprofit American Telemedicine Association, which promotes this type of care. Those appointments have dropped off and now make up roughly 15% of medical visits across all types of coverage.

Before the lasix, the Centers for Medicare &. Medicaid Services severely limited telehealth coverage for Medicare fee-for-service beneficiaries. But with seniors more vulnerable during the lasix, the agency loosened telehealth rules temporarily. As long as the public health emergency continues, the agency is allowing Medicare beneficiaries in urban areas to receive such care, which was previously covered only in rural areas.

And patients can get telehealth care at home rather than having to go to a medical facility for the video appointment, as was previously required. The agency also beefed up covered telehealth services and expanded the types of providers who are allowed to offer them. Medicare lets hospital outpatient departments bill about $27 for telehealth visits for certain beneficiaries receiving care at home. Patients are generally responsible for 20% of that amount, or about $5, although providers can waive patient cost sharing for telehealth, said Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF.

At the beginning of the lasix, patients with commercial health plans were often not charged a copay for telehealth visits, said Rick Gundling, a senior vice president at the Healthcare Financial Management Association, a membership group for health care finance professionals. But lately, “those fees have been coming back,” he said. Facility fees for telehealth visits in commercial plans averaged $55 for the year that ended June 30, before insurance discounts, according to data from Fair Health, a national independent nonprofit that maintains a large database of insurance claims. In 2020, just 1.1% of commercial telehealth claims included a facility fee, according to Fair Health.

That’s lower than for 2019, when the figure was 2.5%. Experts predict telehealth will remain popular, but it’s unclear how those visits and any accompanying facility fees will be handled in the future. McCabe said he expects the Yale New Haven Health System to reinstitute the facility fees when state law permits it. €œThere are real costs in the health system to provide those services,” he said.

Michelle Andrews. andrews.khn@gmail.com, @mandrews110 Related Topics Contact Us Submit a Story Tip.

GUNNISON, Colo where can i buy lasix over the counter usa http://bricksource.se/buy-zithromax-500mg/. €” The night after Thanksgiving, a small ambulance service that covers a huge swath of southwestern Colorado got a call that a patient needed an emergency transfer from the hospital in Gunnison to a larger one with an intensive care unit 65 miles away in Montrose. The patient — a 78-year-old man — was experiencing atrial fibrillation, an irregular heartbeat that usually where can i buy lasix over the counter usa isn’t life-threatening. But for patients like this one with chronic health conditions, a history of cardiac issues and high blood pressure, the condition can cause a stroke or heart failure. Workers from Gunnison Valley Health Paramedics rolled the patient, who was on a gurney, out of the hospital and into the frigid night air.

AnnieGrace Haddorff, the emergency medical technician on call, helped where can i buy lasix over the counter usa load the patient into the ambulance and jumped into the driver’s seat. Paramedic Alec Newby got into the back and hooked the patient up to a blood pressure cuff. A pulse oximeter, which measures heart rate and blood oxygen saturation. And an electrocardiogram, which records the where can i buy lasix over the counter usa heart’s electrical activity. €œYour heart is obviously pissed off,” Newby told the man as the ECG confirmed the atrial fibrillation.

The ambulance pulled onto U.S. Highway 50 for the one-hour-and-15-minute drive past clusters of homes among rolling hills of sagebrush, the expansive Blue Mesa Reservoir and the gaping where can i buy lasix over the counter usa Black Canyon of the Gunnison, with its craggy spires. The patient was stable enough for the long drive, which covered only a sliver of GVH Paramedics’ 4,400-square-mile service area. It is more than twice the size of Delaware and is the largest response zone for an ambulance service in all of Colorado. A typical fire or emergency medical service response area ranges from 100 to where can i buy lasix over the counter usa 400 square miles.

Each time a patient must be transported to another medical facility, Gunnison Valley Health Paramedics is left with few vehicles to respond to emergencies in a coverage area more than twice the size of Delaware.(Helen Santoro for KHN) In recent years, interfacility transports or transfers, also known as IFTs, like this one have become increasingly common for GVH Paramedics, forcing the team to drive far outside its already vast zone. Before the lasix, the number of transfers rose because the population of Gunnison County was steadily increasing, more tourists were being drawn to places like the popular Crested Butte ski resort, and GVH Paramedics had expanded its services to larger metropolitan hospitals outside Gunnison County. But now the team is being called to where can i buy lasix over the counter usa move patients more frequently, and greater distances, because the hospital beds in the relatively close cities of Montrose and Grand Junction are filled with hypertension medications patients. The team is regularly required to drive patients to Denver, which is around three hours and 40 minutes from Gunnison. Officials from the ambulance service worry that they might find themselves unable to respond to an emergency because their resources, which include six ambulances but only enough staff to operate three of those vehicles, are tied up on a long-haul transfer.

What were once 2½- or three-hour trips to where can i buy lasix over the counter usa Montrose are now far longer excursions, “and that takes resources from this community,” said CJ Malcolm, chief of emergency services. €œWe were doing that pre-hypertension medications, but now the state is so impacted, it’s like a daily part of our lives.” Before the lasix, all the ambulances would be simultaneously out on 911 calls or IFTs less than 10 times a year. Now, Malcolm said, it is happening with greater frequency. In those cases, GVH Paramedics leans on the emergency response team in Crested Butte, about 28 miles from Gunnison, or the response to the patient where can i buy lasix over the counter usa is delayed. In 2018, GVH Paramedics made 166 IFTs, requiring nearly 40,000 miles of travel and a total of 987 hours of ambulance operation, according to data collected by the team.

Last year concluded with 260 IFTs, over 70,000 miles of travel where can i buy lasix over the counter usa and a total of 1,486 hours of ambulance operation. That’s a 50% increase in time on the road. €œAnytime we have one or two ambulances out on an IFT, this leaves a massive tract of land with only one ambulance to respond,” Malcolm said. €œThis is a moderately terrifying position to be put into when we can where can i buy lasix over the counter usa easily have two or three 911 calls in a row.” In August, for example, Gunnison Valley Health hospital transferred more than 60 patients, 37 of whom were transported by GVH Paramedics. That means that at least once a day that month, a GVH Paramedics crew was taking a patient out of town, Malcolm said.

And if crew members aren’t scheduled to be back in Gunnison by 1 a.m., they must spend the night in a hotel to avoid driving along treacherous mountain roads while overly tired. GVH Paramedics’ service area covers almost all of Gunnison County, a large portion of Saguache County and sections of Montrose where can i buy lasix over the counter usa and Hinsdale counties. It contains mountain ranges, canyons and wide expanses of high desert. With around 6,600 full-time residents and a university, Gunnison is the largest town the team serves. The surrounding towns — including Tin Cup, Pitkin and Ohio City where can i buy lasix over the counter usa — are villages with a couple of hundred people or former mining towns where the artifacts from the boom times outnumber the residents.

The Nov. 26 drive to Montrose took the Gunnison Valley Health Paramedics team an hour and 15 minutes. (Helen Santoro for KHN) GVH Paramedics’ 21 full-time staff members and 10 to 20 individuals who work as needed have certifications in wildland firefighting where can i buy lasix over the counter usa and backcountry medicine skills, including swift-water, ice and avalanche rescue. To deal with the increased demands from IFTs, they have added an extra staff member to each shift, and off-duty staffers are being called in to assist. As the lasix drags on, the number of IFTs will probably continue to increase.

By mid-November, the number of people in the hospital with where can i buy lasix over the counter usa hypertension medications in Colorado was staggeringly high, approaching the December 2020 peak of 1,847. Hospitalizations remained above 1,500 through the end of the month. As a result, 93% of the state’s acute care hospital beds and 94% of ICU beds were being used as of Nov. 30, according to where can i buy lasix over the counter usa data from the Colorado Department of Public Health and Environment. €œI don’t think we see the capacity concerns easing anytime soon,” said Cara Welch, senior director of communications at the Colorado Hospital Association.

Adding to the strain are people seeking care they delayed because of the lasix and other respiratory lasixes, such as respiratory syncytial lasix, circulating in the state, Welch said. Kelly Thompson, chief of operations of CareFlight of the Rockies, an air ambulance service that operates in Colorado and other parts of the West, agreed with this assessment where can i buy lasix over the counter usa. €œWe’ve already been transporting large numbers of kids with RSV that are sick, and you have hypertension medications on top of all of this,” Thompson said. €œIt’s a big concern where can i buy lasix over the counter usa. This is the time when we have a lot of sick people.” In early November, to manage escalating concerns about hospital capacity, Colorado hospitals and health systems activated tier 3 of the state's patient transfer system — the highest level.

That means hypertension medications and non-hypertension medications patients can be moved without their consent from a hospital that doesn’t have enough capacity to one with more space. Hospitals can also send sicker patients to medical centers with more where can i buy lasix over the counter usa specialized care. As the GVH Paramedics crew members approached Montrose with their patient over the recent holiday weekend, Newby called the hospital to let the staff know they were arriving. They pulled up to the emergency room entrance, and Newby and Haddorff rolled the patient into a hospital room. The Montrose hospital staff took over, moving the patient from the gurney to a where can i buy lasix over the counter usa hospital bed as Newby updated them on the patient’s medical records.

Soon they were back in the ambulance, headed for home. €œIFTs can be stressful,” said Haddorff as she maneuvered the twisty mountain road bathed in moonlight. Related Topics Contact Us Submit a Story TipIt’s where can i buy lasix over the counter usa Saturday, and Sarah Mahoney is one of several Planned Parenthood volunteers knocking on doors in Windham, Maine, a politically moderate town not far from Portland. No one answers at the first couple of houses. But as Mahoney heads up the street, she sees a woman out for a walk.

€œHey!. We’re out canvassing,” she says. €œWould you mind having a conversation with us?. € Mahoney wants to talk about abortion — not a typical topic for a conversation, especially with a stranger. But the woman, Kerry Kelchner, agrees to talk.

If this were typical door-to-door canvassing, Mahoney might ask Kelchner about a political candidate, remind her to vote and then be on her way. But Mahoney is deep canvassing — a technique that employs longer conversations to move opinions on hot-button issues. Planned Parenthood in Maine has deployed the strategy for several years amid what it says are increasing threats to reproductive rights. This year alone, states have enacted more than 100 restrictions on abortion, including one in Texas that bans most abortions after six weeks. This month, the U.S.

Supreme Court heard arguments in a case about a Mississippi law that could lead to the overturning of Roe v. Wade, the landmark 1973 ruling that established a constitutional right to abortion. And though state law in Maine protects abortion rights even if Roe v. Wade is overturned, abortion opponents have gained traction in the state in recent years. So volunteers like Mahoney start conversations.

And they can get quite personal. Mahoney first assesses Kelchner’s baseline attitude on abortion access on a scale of 0 to 10. A 10 means the interviewee believes anyone should be able to get an abortion for any reason. Kelchner says she’s a 7. Next, Mahoney asks Kelchner a series of questions to better understand her values.

€œCan you tell me a little bit about what shaped your views on abortion?. € she asks. €œHave you known anybody who’s had an abortion, a friend or a family member?. € “My mother,” says Kelchner. She explains her parents were young when she was born, and they weren’t ready for another baby.

Then Mahoney, who’s 60, shares that she also had an abortion. €œI was in my early 20s,” she says. €œI was a little conflicted about it, and I wanted to have a family. I knew I wanted to have a family, but I was in no way ready to do that.” Mahoney points out that she and Kelchner have similar views on what an unplanned pregnancy can mean. Then she asks her opening question again, to see whether Kelchner’s feelings about abortion access have shifted on the 0-to-10 scale.

€œStill around 7,” Kelchner says. Mahoney probes further. €œWhat would be the circumstances where you would say, ‘No — they shouldn’t have the right to have an abortion?. €™â€ Kelchner pauses. €œThat’s a good question.” Before volunteers head out to strike up conversations with voters, Katie McClelland (in black cap) of Planned Parenthood in Maine gives a pep talk.

(Patty Wight/Maine Public Radio) Planned Parenthood volunteer Sarah Mahoney checks a list of addresses to see which door to knock on next. (Patty Wight/Maine Public Radio) They talk more. Ultimately, Kelchner can’t think of any circumstance in which she believes someone should be denied an abortion. €œThere should be no judgment,” she says. €œSo that would be a 10?.

€ Mahoney asks. €œYep,” says Kelchner. In the five years she’s been deep canvassing for Planned Parenthood, Mahoney said, she hasn’t had a single unpleasant conversation. €œWhat we’ve found doing this is that it is an effective way to change minds about abortion,” said Amy Cookson, director of external communications for Planned Parenthood of Northern New England. Cookson said Planned Parenthood started deep canvassing in Maine in 2015, after Paul LePage, an anti-abortion Republican, won a second term as governor.

Gay rights advocates in California had used deep canvassing on the same-sex marriage issue, and she wondered. €œCan it work around abortion stigma?. € Joshua Kalla, a political scientist at Yale University, has conducted research that found the technique can change people’s deeply held beliefs. The crucial elements are that canvassers listen without judgment and share their own stories. €œSo whether the person had an abortion and is talking about their abortion story,” said Kalla, “or whether the person is an ally and is talking about a friend or family member who had an abortion and is sharing that story, the effects seem to be quite similar.” Kalla has also studied Planned Parenthood’s efforts in Maine and said the group has added something else that’s effective.

Moral reframing. Canvassers listen for the moral values a voter emphasizes and then incorporate those values into the story they share. But deep canvassing is not exclusively a progressive tactic, Kalla said. Conservative groups can use it, too, and he thinks that would improve political discourse. €œYou know, it would be good for American society if the way we had political conversation was more grounded, and listening to the other side, and being nonjudgmental, and being curious.” After spending a couple of hours canvassing, volunteers with Planned Parenthood debrief about their experiences.

(Patty Wight/Maine Public Radio) Back in Windham, Mahoney continues to walk through the neighborhood. She meets a man outside his apartment building who gives only his first name, Chris. He says he’s a 4 on the abortion access scale. He opposes abortion except in cases of sexual assault. Chris tells Mahoney he had a daughter when he was 15.

€œDo you talk about, I’m curious, birth control and abortion?. € Mahoney asks. €œI do with her a lot,” Chris says. She’s a teenager, he says, and he’s not sure what he’d do if she got pregnant accidentally. €œIt’s her own life,” he says.

€œI don’t know if I would even try to change her mind. Because it’s her decision.” As the conversation goes on, Chris seems as though he supports access to abortion. But at the end, he doesn’t budge on his rating. Mahoney said that’s OK. Some people won’t change their minds right away.

€œThe worst way to think about this is that it’s some kind of Jedi mind trick,” she said, “and I’m going to let them talk about themselves and then — pow!. — I’m going to change their mind.” What Mahoney wants most from these conversations is for people to think more deeply about the nuances around abortion and identify common ground. €œI just feel like we all need to be taking steps to hear one another and move towards each other, instead of just diving into this divisive, contrary, hostile, red and blue world.” Because of the success Planned Parenthood in Maine has had with deep canvassing, it has trained volunteers in other states, including Texas and Kansas. Next year, Kansas voters will cast ballots on a referendum question that seeks to revoke abortion access as a fundamental right. This story is part of a partnership that includes Maine Public Radio, NPR and KHN.

Related Topics Contact Us Submit a Story TipTed Billinger Jr. Liked to joke that he would work until he died. That turned out to be prophetic. When Billinger died of a heart attack in 2019 at age 71, he was still running Teddy B’s, the pharmacy his father had started more than 65 years earlier in Cheyenne Wells, Colorado. With no other pharmacist to work at the store, prescriptions already counted out and sealed in bottles were suddenly locked away in a pharmacy that no one could enter.

And Cheyenne Wells’ fewer than 800 residents were abruptly left without a drugstore. Pharmacies were once routinely bequeathed from one generation to the next, but, in interviews with more than a dozen pharmacists, many said the pressure of running an independent drugstore have them pushing their offspring toward other careers. And when they search for a buyer, they often find that attracting new pharmacists, especially to rural settings, is difficult. With a large group of pharmacists nearing retirement age, more communities may lose their only drugstore. €œIt’s going to be harder to attract people and to pay them,” said David Kreling, a professor emeritus at the University of Wisconsin-Madison School of Pharmacy.

€œIf there’s not a generational thing where someone can sit down with their son or daughter and say that they could take the store over, there’s a good chance that pharmacy will evaporate.” Tom Davis, Billinger’s friend and co-owner of Kiowa Drug in Eads, Colorado, stepped in to sort out the mess in Cheyenne Wells. With permission from the State Board of Pharmacy, the county sheriff let Davis into Teddy B’s in the eastern Colorado town to take an inventory of the remaining drugs. Customers who had dropped off their prescriptions before Billinger died were able to pick up their medications. Davis then bought the pharmacy from Billinger’s estate. He runs it as a convenience store and six days a week delivers prescriptions to it from Eads, 44 miles away.

€œBy the time you paid a pharmacist, the location there was borderline unprofitable,” Davis said. Davis and his brother co-own seven pharmacies and have started to plan for retirement by hiring five young pharmacists and allowing them to buy ownership stakes in those pharmacies over time.(Rachel Woolf for KHN) He has received numerous requests to open pharmacies in other eastern Colorado towns, but making that work financially would be difficult. Reimbursements from insurance plans have dwindled, and customer bases have eroded as health insurers push patients toward mail-order deliveries. €œI fill prescriptions every day where my reimbursement is less than the cost of the drug,” Davis said. €œIn other settings, you might tell a patient, ‘We don’t have that in stock,’ or ‘Why don’t you go down the street to the chain?.

€™ But down here, we just take care of our patients, and we just eat it.” He can survive, he said, because, after 48 years, he no longer has any business debt. €œI look at my bottom line,” Davis said. €œWith the amount of profit that I had at the end of the year, that would not have been enough if I was having to pay a mortgage.” A woman enters Teddy B’s in Cheyenne Wells, Colorado. (Rachel Woolf for KHN) Dia Giron, manager at Teddy B’s convenience store transfers prescriptions to a locked case after Kiowa Drug delivers them. (Rachel Woolf for KHN) Studies have found the number of pharmacists nationally to be sufficient, even more than enough, to meet current needs, although supply and demand don’t always line up.

Finding pharmacists is more difficult in rural areas. €œOnce they get a taste of the big city,” Kreling said, “it’s hard to get them back to the farm.” Workforce data also shows worrisome trends. Concerns about a shortage of pharmacists led the federal government to pour money into pharmacy schools in the 1970s, creating a temporary bump in the number of graduates. The people in that bulge in the pharmacist pipeline have hit retirement age. €œMany of them owned independent pharmacies, and they were working in rural communities,” said University of Minnesota pharmacy professor Jon Schommer, who studies workforce issues.

Now, as the demand for pharmacists to provide testing and vaccinations during the hypertension medications lasix increases, drugstore chains are offering incentives — such as large salaries, signing bonuses and help paying off school loans — that are often more enticing than anything a rural pharmacy could muster. Pharmacy technician Jess Sierra prepares prescriptions at Kiowa Drug in Eads, Colorado. How pharmacy graduates envision their careers has also shifted. Many no longer want to own a pharmacy and are content to work at pharmacy chains or other health care organizations, according to several pharmacy school professors. As of 2018, only about half of pharmacists worked in traditional retail drugstores.

That makes rural recruitment more difficult. Denise Robins had worked at R&R Family Pharmacy in Springfield, Colorado, for 18 years when the owner retired. She and three family members bought the drugstore in a last-ditch effort to keep it open. €œNone of us are pharmacists, so that made it a little tougher,” Robins said. €œWe just knew it was really going to make it hard for people here if they had to travel an hour to get to a pharmacy.” But finding a pharmacist to work in the southeastern Colorado town of fewer than 1,400 people was a challenge.

The first pharmacist Robins found commuted 48 miles one way from Lamar. But after a year and a half, the trip became too much. She then hired someone who wanted to work for only a year, to make enough money to travel. Then Robins interviewed two University of Colorado pharmacy school graduates. She hired one, but that didn’t work out.

So she called back the second candidate, who still had not found a permanent job. He had two young kids, and he and his wife were working opposite schedules. He took the job two years ago and has remained there since. I fill prescriptions every day where my reimbursement is less than the cost of the drug.Tom Davis In Berryville, Virginia, pharmacist Patricia White opened Battletown Pharmacy in 2011 because she wanted to carry on the family business. Her father had owned a local pharmacy and had recently died.

But when turning a profit with Battletown proved a struggle, White decided to retire. She lined up two potential buyers, but neither went through with the sale. She then hoped to transfer the pharmacy to a recent graduate but didn’t want to saddle him with a failing business. €œI told him he couldn’t make any money, and he said, ‘Thanks for being honest,’” White recalled. Closing seemed like the only palatable option.

Battletown shut down at the end of August. €œI did not want to sell out to a chain,” she said. €œThat’s always been my mentality.” When a chain buys a pharmacy, it doesn’t always decide to run it. Instead, it might close the pharmacy and transfer the pharmacy’s prescription files to one of its outlets. Retiring pharmacists who spent decades serving a community generally don’t want to see that happen, said David Zgarrick, a Northeastern University pharmacy professor.

€œThey’d like to sell their pharmacy to another pharmacist who would continue to run it very much in the same manner,” he said. Some plan ahead, hiring another pharmacist and offering that person an equity stake in the business. Over time, the new pharmacist can buy out the owner. Many independent pharmacist-owners plan to live off the profits from selling their pharmacy, its inventory and its prescription records. €œTheir pharmacy is their retirement savings,” Zgarrick said.

But, Zgarrick said, the added pressure from the lasix may be pushing more pharmacists into retirement. And a long-running bull stock market may mean some pharmacists have enough in their retirement portfolios to call it quits without a sale. Davis talks with a pharmacy technician Jess Sierra at Kiowa Drug. (Rachel Woolf for KHN) In Eads, Davis, 70, still loves being a pharmacist. He and his brother co-own seven pharmacies and have started to plan for retirement by hiring five young pharmacists and allowing them to buy ownership stakes in those pharmacies over time.

He had wondered how long he could keep the Kiowa pharmacy running, though. With fewer than 700 residents, Eads may be the smallest town in Colorado with a pharmacy. Combining Davis’ customer base with Cheyenne Wells’ may have saved pharmacy access for both communities. €œSo maybe where we could have lost two pharmacies in the area, we’ve been able to exist. We’re stronger now than we had ever been,” Davis said.

€œThat wasn’t the original plan. We cared about those people and just wanted to take care of them.” Markian Hawryluk. MarkianH@kff.org, @MarkianHawryluk Related Topics Contact Us Submit a Story TipWhen Arielle Harrison’s 9-year-old needed to see a pediatric specialist at Yale New Haven Health System in June, a telehealth visit seemed like a great option. Since her son wasn’t yet eligible to be vaccinated against hypertension medications, they could connect with the doctor via video and avoid venturing into a germy medical facility. Days before the appointment, she got a notice from the hospital informing her that she would receive two bills for the visit.

One would be for the doctor’s services. The second would be for a hospital facility fee, even though she and her son would be at home in Cheshire, Connecticut, and never set foot in any hospital-affiliated building. Harrison, 40, who works in nonprofit communications, posted on Twitter about the unwelcome fee, including an image of Marge Simpson of TV’s The Simpsons with a disgusted look on her face, captioned “GROANS.” She called the billing office the next morning and was told the facility fee is based on where the doctor is located. Since the doctor would be on hospital property, the hospital would charge a facility fee of between $50 and $350, depending on her insurance coverage. €œIt’s just one of many examples of how this is a very difficult system to use,” Harrison said, referring to the intricacies of U.S.

Health care. Hospital facility fees have long come under criticism from patients and consumer advocates. Hospitals say the fees, which can add hundreds of dollars or even more than $1,000 to a patient’s bill, are necessary to cover the high cost of keeping a hospital open and ready to provide care 24/7. But it’s not only hospital visits that result in facility fees. Over the past several years, hospitals have been on a buying binge, snapping up physician practices that often then begin charging the fees, too.

Patients seeing the same doctor for the same care as at earlier visits are now on the hook for the extra fee — because of a change in ownership. Charging a facility fee for a video visit where the patient logs in from their living room is even more of a head-scratcher. €œThe charges seem crazy,” said Ted Doolittle, who heads up Connecticut’s Office of the Healthcare Advocate, which provides help to consumers with health coverage issues. €œIt rankles, and it should.” Facility fees for video appointments remain rare, health finance experts say, even as the use of telehealth has soared during the hypertension medications lasix. Medicare has allowed hospitals to assess a small fee for certain beneficiaries who get telehealth care at home during the ongoing national public health emergency, and people in private health plans may also be charged for them.

Harrison, however, was lucky. Doolittle reached out to her after seeing her tweet to offer his office’s assistance. In Connecticut, hospitals are prohibited from charging facility fees for telehealth visits. Connecticut imposed what may be the only state ban on telehealth facility fees as part of a broader law passed in May that was intended to help residents access telehealth during the lasix. The prohibition on facility fees sunsets at the end of June 2023.

Pat McCabe, senior vice president of finance at Yale New Haven Health System, said he can’t explain why Harrison received a notice that she’d be charged a facility fee for a telehealth visit. He speculated that her son’s appointment might have been coded incorrectly. Under the new law, he said, the health system hasn’t charged any telehealth patients a facility fee. But such fees are justified, McCabe said. €œIt offsets the cost of the software we use to facilitate the telehealth visits, and we do still have to keep the lights on,” he said, noting that the providers doing telehealth visits are on hospital sites that incur heat and power and maintenance charges.

The American Hospital Association didn’t respond to requests for comment about the rationale for facility fees for telehealth care. As the lasix began overwhelming the health system last year, hospitals essentially closed their doors to most non-hypertension medications patients. Telehealth visits, which made up about 1% of medical visits before the lasix, jumped to roughly 50% at its height last year, said Kyle Zebley, vice president of public policy at the nonprofit American Telemedicine Association, which promotes this type of care. Those appointments have dropped off and now make up roughly 15% of medical visits across all types of coverage. Before the lasix, the Centers for Medicare &.

Medicaid Services severely limited telehealth coverage for Medicare fee-for-service beneficiaries. But with seniors more vulnerable during the lasix, the agency loosened telehealth rules temporarily. As long as the public health emergency continues, the agency is allowing Medicare beneficiaries in urban areas to receive such care, which was previously covered only in rural areas. And patients can get telehealth care at home rather than having to go to a medical facility for the video appointment, as was previously required. The agency also beefed up covered telehealth services and expanded the types of providers who are allowed to offer them.

Medicare lets hospital outpatient departments bill about $27 for telehealth visits for certain beneficiaries receiving care at home. Patients are generally responsible for 20% of that amount, or about $5, although providers can waive patient cost sharing for telehealth, said Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF. At the beginning of the lasix, patients with commercial health plans were often not charged a copay for telehealth visits, said Rick Gundling, a senior vice president at the Healthcare Financial Management Association, a membership group for health care finance professionals. But lately, “those fees have been coming back,” he said. Facility fees for telehealth visits in commercial plans averaged $55 for the year that ended June 30, before insurance discounts, according to data from Fair Health, a national independent nonprofit that maintains a large database of insurance claims.

In 2020, just 1.1% of commercial telehealth claims included a facility fee, according to Fair Health. That’s lower than for 2019, when the figure was 2.5%. Experts predict telehealth will remain popular, but it’s unclear how those visits and any accompanying facility fees will be handled in the future. McCabe said he expects the Yale New Haven Health System to reinstitute the facility fees when state law permits it. €œThere are real costs in the health system to provide those services,” he said.

Michelle Andrews. andrews.khn@gmail.com, @mandrews110 Related Topics Contact Us Submit a Story Tip.

Lasix diuretic type

NCHS Data lasix diuretic type Brief No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep lasix diuretic type is associated with an increased risk for chronic conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition.

Menopause is lasix diuretic type “the permanent cessation of menstruation that occurs after the loss of ovarian activity” (3). This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women are premenopausal, 3.7% lasix diuretic type are perimenopausal, and 22.1% are postmenopausal.

Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) lasix diuretic type (Figure 1). Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period.

Figure 1 lasix diuretic type. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image lasix diuretic type icon1Significant quadratic trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if lasix diuretic type they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data lasix diuretic type table for Figure 1pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal lasix diuretic type status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week.

Figure 2 lasix diuretic type. Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal lasix diuretic type status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if lasix diuretic type they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data lasix diuretic type table for Figure 2pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by lasix diuretic type menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week.

Figure 3 lasix diuretic type. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal lasix diuretic type status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their lasix diuretic type last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 3pdf lasix diuretic type icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the lasix diuretic type past week increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week.

Figure 4 lasix diuretic type. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 4pdf icon.SOURCE.

NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5).

Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion. DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?.

€. 2) “Do you still have periods or menstrual cycles?. €. 3) “When did you have your last period or menstrual cycle?.

€. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less.

Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?.

€ Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis. NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS.

For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States. The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS.

Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics. The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report.

ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No.

141. Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF.

Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon. 2016.Santoro N. Perimenopause.

From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al. Recommended amount of sleep for a healthy adult.

A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software].

2012. Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286.

Hyattsville, MD. National Center for Health Statistics. 2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J.

Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J. Blumberg, Ph.D., Associate Director for Science.

NCHS Data where can i buy lasix over the counter usa buy lasix 40mg Brief No. 286, September 2017PDF Versionpdf icon (374 KB)Anjel Vahratian, Ph.D.Key findingsData from the National Health Interview Survey, 2015Among those aged 40–59, perimenopausal women (56.0%) were more likely than postmenopausal (40.5%) and premenopausal (32.5%) women to sleep less than 7 hours, on average, in a 24-hour period.Postmenopausal women aged 40–59 were more likely than premenopausal women aged 40–59 to have trouble falling asleep (27.1% compared with 16.8%, respectively), and staying asleep (35.9% compared with 23.7%), four times or more in the past week.Postmenopausal women aged 40–59 (55.1%) were more likely than premenopausal women aged 40–59 (47.0%) to not wake up feeling well rested 4 days or more in the past week.Sleep duration and quality are important contributors to health and wellness. Insufficient sleep is associated with where can i buy lasix over the counter usa an increased risk for chronic conditions such as cardiovascular disease (1) and diabetes (2). Women may be particularly vulnerable to sleep problems during times of reproductive hormonal change, such as after the menopausal transition. Menopause is “the permanent cessation of menstruation that occurs after the where can i buy lasix over the counter usa loss of ovarian activity” (3).

This data brief describes sleep duration and sleep quality among nonpregnant women aged 40–59 by menopausal status. The age range selected for this analysis reflects the focus on midlife sleep health. In this analysis, 74.2% of women where can i buy lasix over the counter usa are premenopausal, 3.7% are perimenopausal, and 22.1% are postmenopausal. Keywords. Insufficient sleep, menopause, National Health Interview Survey Perimenopausal where can i buy lasix over the counter usa women were more likely than premenopausal and postmenopausal women to sleep less than 7 hours, on average, in a 24-hour period.More than one in three nonpregnant women aged 40–59 slept less than 7 hours, on average, in a 24-hour period (35.1%) (Figure 1).

Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period (56.0%), compared with 32.5% of premenopausal and 40.5% of postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to sleep less than 7 hours, on average, in a 24-hour period. Figure 1 where can i buy lasix over the counter usa. Percentage of nonpregnant women aged 40–59 who slept less than 7 hours, on average, in a 24-hour period, by menopausal status. United States, 2015image icon1Significant where can i buy lasix over the counter usa quadratic trend by menopausal status (p <.

0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a where can i buy lasix over the counter usa menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure 1pdf where can i buy lasix over the counter usa icon.SOURCE.

NCHS, National Health Interview Survey, 2015. The percentage of women aged where can i buy lasix over the counter usa 40–59 who had trouble falling asleep four times or more in the past week varied by menopausal status.Nearly one in five nonpregnant women aged 40–59 had trouble falling asleep four times or more in the past week (19.4%) (Figure 2). The percentage of women in this age group who had trouble falling asleep four times or more in the past week increased from 16.8% among premenopausal women to 24.7% among perimenopausal and 27.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to have trouble falling asleep four times or more in the past week. Figure 2 where can i buy lasix over the counter usa.

Percentage of nonpregnant women aged 40–59 who had trouble falling asleep four times or more in the past week, by menopausal status. United States, where can i buy lasix over the counter usa 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal where can i buy lasix over the counter usa if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less.

Women were premenopausal if they still had a menstrual cycle. Access data where can i buy lasix over the counter usa table for Figure 2pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week varied by menopausal status.More than one in four nonpregnant women aged 40–59 had trouble staying asleep where can i buy lasix over the counter usa four times or more in the past week (26.7%) (Figure 3). The percentage of women aged 40–59 who had trouble staying asleep four times or more in the past week increased from 23.7% among premenopausal, to 30.8% among perimenopausal, and to 35.9% among postmenopausal women.

Postmenopausal women were significantly more likely than premenopausal women to have trouble staying asleep four times or more in the past week. Figure 3 where can i buy lasix over the counter usa. Percentage of nonpregnant women aged 40–59 who had trouble staying asleep four times or more in the past week, by menopausal status. United States, 2015image icon1Significant linear trend where can i buy lasix over the counter usa by menopausal status (p <. 0.05).NOTES.

Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last where can i buy lasix over the counter usa menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle. Access data table for Figure where can i buy lasix over the counter usa 3pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015.

The percentage of women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week varied by menopausal status.Nearly one in two nonpregnant women aged 40–59 did not wake up feeling well rested 4 days or more in the past week (48.9%) (Figure 4). The percentage of women in this age group who did not wake up feeling well rested 4 days or more in the past week where can i buy lasix over the counter usa increased from 47.0% among premenopausal women to 49.9% among perimenopausal and 55.1% among postmenopausal women. Postmenopausal women were significantly more likely than premenopausal women to not wake up feeling well rested 4 days or more in the past week. Figure 4 where can i buy lasix over the counter usa. Percentage of nonpregnant women aged 40–59 who did not wake up feeling well rested 4 days or more in the past week, by menopausal status.

United States, 2015image icon1Significant linear trend by menopausal status (p <. 0.05).NOTES. Women were postmenopausal if they had gone without a menstrual cycle for more than 1 year or were in surgical menopause after the removal of their ovaries. Women were perimenopausal if they no longer had a menstrual cycle and their last menstrual cycle was 1 year ago or less. Women were premenopausal if they still had a menstrual cycle.

Access data table for Figure 4pdf icon.SOURCE. NCHS, National Health Interview Survey, 2015. SummaryThis report describes sleep duration and sleep quality among U.S. Nonpregnant women aged 40–59 by menopausal status. Perimenopausal women were most likely to sleep less than 7 hours, on average, in a 24-hour period compared with premenopausal and postmenopausal women.

In contrast, postmenopausal women were most likely to have poor-quality sleep. A greater percentage of postmenopausal women had frequent trouble falling asleep, staying asleep, and not waking well rested compared with premenopausal women. The percentage of perimenopausal women with poor-quality sleep was between the percentages for the other two groups in all three categories. Sleep duration changes with advancing age (4), but sleep duration and quality are also influenced by concurrent changes in women’s reproductive hormone levels (5). Because sleep is critical for optimal health and well-being (6), the findings in this report highlight areas for further research and targeted health promotion.

DefinitionsMenopausal status. A three-level categorical variable was created from a series of questions that asked women. 1) “How old were you when your periods or menstrual cycles started?. €. 2) “Do you still have periods or menstrual cycles?.

€. 3) “When did you have your last period or menstrual cycle?. €. And 4) “Have you ever had both ovaries removed, either as part of a hysterectomy or as one or more separate surgeries?. € Women were postmenopausal if they a) had gone without a menstrual cycle for more than 1 year or b) were in surgical menopause after the removal of their ovaries.

Women were perimenopausal if they a) no longer had a menstrual cycle and b) their last menstrual cycle was 1 year ago or less. Premenopausal women still had a menstrual cycle.Not waking feeling well rested. Determined by respondents who answered 3 days or less on the questionnaire item asking, “In the past week, on how many days did you wake up feeling well rested?. €Short sleep duration. Determined by respondents who answered 6 hours or less on the questionnaire item asking, “On average, how many hours of sleep do you get in a 24-hour period?.

€Trouble falling asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble falling asleep?. €Trouble staying asleep. Determined by respondents who answered four times or more on the questionnaire item asking, “In the past week, how many times did you have trouble staying asleep?. € Data source and methodsData from the 2015 National Health Interview Survey (NHIS) were used for this analysis.

NHIS is a multipurpose health survey conducted continuously throughout the year by the National Center for Health Statistics. Interviews are conducted in person in respondents’ homes, but follow-ups to complete interviews may be conducted over the telephone. Data for this analysis came from the Sample Adult core and cancer supplement sections of the 2015 NHIS. For more information about NHIS, including the questionnaire, visit the NHIS website.All analyses used weights to produce national estimates. Estimates on sleep duration and quality in this report are nationally representative of the civilian, noninstitutionalized nonpregnant female population aged 40–59 living in households across the United States.

The sample design is described in more detail elsewhere (7). Point estimates and their estimated variances were calculated using SUDAAN software (8) to account for the complex sample design of NHIS. Linear and quadratic trend tests of the estimated proportions across menopausal status were tested in SUDAAN via PROC DESCRIPT using the POLY option. Differences between percentages were evaluated using two-sided significance tests at the 0.05 level. About the authorAnjel Vahratian is with the National Center for Health Statistics, Division of Health Interview Statistics.

The author gratefully acknowledges the assistance of Lindsey Black in the preparation of this report. ReferencesFord ES. Habitual sleep duration and predicted 10-year cardiovascular risk using the pooled cohort risk equations among US adults. J Am Heart Assoc 3(6):e001454. 2014.Ford ES, Wheaton AG, Chapman DP, Li C, Perry GS, Croft JB.

Associations between self-reported sleep duration and sleeping disorder with concentrations of fasting and 2-h glucose, insulin, and glycosylated hemoglobin among adults without diagnosed diabetes. J Diabetes 6(4):338–50. 2014.American College of Obstetrics and Gynecology. ACOG Practice Bulletin No. 141.

Management of menopausal symptoms. Obstet Gynecol 123(1):202–16. 2014.Black LI, Nugent CN, Adams PF. Tables of adult health behaviors, sleep. National Health Interview Survey, 2011–2014pdf icon.

2016.Santoro N. Perimenopause. From research to practice. J Women’s Health (Larchmt) 25(4):332–9. 2016.Watson NF, Badr MS, Belenky G, Bliwise DL, Buxton OM, Buysse D, et al.

Recommended amount of sleep for a healthy adult. A joint consensus statement of the American Academy of Sleep Medicine and Sleep Research Society. J Clin Sleep Med 11(6):591–2. 2015.Parsons VL, Moriarity C, Jonas K, et al. Design and estimation for the National Health Interview Survey, 2006–2015.

National Center for Health Statistics. Vital Health Stat 2(165). 2014.RTI International. SUDAAN (Release 11.0.0) [computer software]. 2012.

Suggested citationVahratian A. Sleep duration and quality among women aged 40–59, by menopausal status. NCHS data brief, no 286. Hyattsville, MD. National Center for Health Statistics.

2017.Copyright informationAll material appearing in this report is in the public domain and may be reproduced or copied without permission. Citation as to source, however, is appreciated.National Center for Health StatisticsCharles J. Rothwell, M.S., M.B.A., DirectorJennifer H. Madans, Ph.D., Associate Director for ScienceDivision of Health Interview StatisticsMarcie L. Cynamon, DirectorStephen J.

Blumberg, Ph.D., Associate Director for Science.

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The Neonatal Intensive Care Unit (NICU) at UC Davis Children’s Hospital is now the lasix and potassium replacement 12th NICU in the U.S. To receive a gold-level Beacon Award for Excellence from the American Association of Critical-Care Nurses (AACN). It is the only lasix and potassium replacement hospital in Northern California to receive this honor. The UC Davis NICU received a gold-level Beacon Award for Excellence.

The Beacon Award for Excellence — a significant milestone on the path to exceptional patient care and healthy work lasix and potassium replacement environments — recognizes caregivers who successfully improve patient outcomes and align practices with AACN’s six Healthy Work Environment Standards. These standards are skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition and authentic leadership. “We are so proud to receive this award,” said Sheryl Ruth, nurse manager of the UC Davis NICU. €œThis award recognizes the quality of care and commitment to constant improvement, while providing an environment that empowers nurses.”AACN President Beth Wathen applauds the commitment of the caregivers at the UC Davis NICU for working together to meet and exceed the high standards set forth by the Beacon Award for Excellence.“The Beacon Award for Excellence lasix and potassium replacement is a testament to a team’s commitment to providing safe, patient-centered and evidence-based care to patients and families.

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UC Davis Children’s Hospital’s NICU earned a gold award by meeting the following evidence-based Beacon Award for Excellence criteria:Leadership Structures and SystemsAppropriate Staffing and Staff EngagementEffective Communication, Knowledge Management, and Learning and DevelopmentEvidence-Based Practice and ProcessesOutcome MeasurementAbout the Beacon Award for Excellence. Established in 2003, the Beacon Award for Excellence offers a road map to help guide exceptional care through improved outcomes and greater overall patient satisfaction. U.S. And Canadian units where patients receive their principal nursing care after hospital admission qualify for this excellence award.

Units that receive the Beacon Award for Excellence meet criteria in six categories. Leadership structures and systems. Appropriate staffing and staff engagement. Effective communication, knowledge management, and learning and development.

Evidence-based practice and processes. And outcome measurement. To learn more, visit www.aacn.org/beacon or call 800-899-2226.About the American Association of Critical-Care Nurses. Founded in 1969 and based in Aliso Viejo, Calif., the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world.

AACN represents the interests of more than half a million acute and critical care nurses and includes more than 200 chapters in the United States. The organization’s vision is to create a health care system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. To learn more about AACN, visit www.aacn.org, connect with the organization on Facebook at www.facebook.com/aacnface or follow AACN on Twitter at www.twitter.com/aacnme.Jason E. Hawkes, an associate professor of dermatology at UC Davis Health, has been seeing more patients with psoriasis who are interested in cannabidiol (CBD) as an alternative or complementary treatment for their condition.

Are skin creams with cannabis extract and infused CBD oil safe alternative skin care treatments?. In this Q&A, he answers questions on the safety and effectiveness of using CDB for treating psoriasis or reducing its symptoms.What is psoriasis?. Psoriasis is a chronic, inflammatory condition linked to the body’s immune system. When immune cells become dysregulated in psoriasis patients, they cause red, scaly patches of skin and inflammation throughout the body.Up to 30% of patients with psoriasis also have psoriatic arthritis with symptoms such as morning stiffness, fatigue, swollen fingers and toes, pain in joints, and nail changes.

Psoriasis patients also have an increased risk for other conditions such as heart disease, stroke, kidney disease, sleep and respiratory problems, depression and anxiety, high blood pressure, diabetes and obesity.What is CBD and can it help with psoriasis?. Cannabis is a plant that contains more than 80 biologically active chemical compounds known as cannabinoids, which have a range of biological activities in the body, including anti-inflammatory, antioxidant, and psychological effects.Despite many very effective topical and systemic treatments for psoriasis, many patients still suffer from chronic itching and pain. They also face the stigma and psychosocial consequences of having a highly visible skin condition. It is, therefore, not surprising that patients affected with this disease have sought relief via a variety of alternative treatment options, including cannabis-based products like CBD.The medical community has just barely scratched the surface with regards to the potential benefits and risks of cannabis-derived products.

The biochemical impact of CBD on the body needs to be carefully considered. Their effects are determined by many variables, including the delivery method to the body (topical application, inhalation, oral ingestion), dose or concentration of the cannabinoid, or the specific chemical(s) isolated from a particular plant strain.Yet, it is a very reasonable assumption that the potential beneficial psychological (e.g. Anxiety reduction) and anti-inflammatory effects of cannabinoids could help alleviate the disease burden associated with psoriatic disease.How do cannabinoids like CBD affect the body?. Like CBD, delta-9-tetrahydrocannabinol (THC) is a common cannabinoid isolated from the cannabis plant.

However, CBD and THC have distinct properties and vary dramatically in their observed effects on the human body. Both compounds can work in place of the body’s own cannabinoid system – known as the endocannabinoid system – wherein THC and CBD interact with receptors in specific tissues or the nervous system to mediate a broad range of physiological effects like reduced inflammation, itching and pain relief, increased ability to sleep, appetite stimulation, and decreased anxiety.For psoriasis patients with specific complaints such as pain, itching, or trouble sleeping, cannabis-derived products might help reduce the negative impact these symptoms have on their life. Ongoing medical research can help tease out the complex mechanisms by which cannabinoids like CBD or THC impact health and modulate biological systems such as the immune response.In general, CBD appears to retain many of the biological effects of THC, without the “high” most people associate with THC or marijuana. This key difference has led many companies or research groups to study and develop pure CBD products that may be more desirable for patients who wish to avoid or may not tolerate the stronger psychoactive effects of THC-based products.

This difference has also made CBD a popular choice among consumers who are first-time or inexperienced users of cannabis-based products.Are CBD products safe for psoriasis patients?. What are the risks of using CBD products?. The risks of CBD and other cannabis-derived products in patients with psoriasis and other inflammatory skin diseases have not been carefully studied. This is an unmet need that deserves ongoing attention and research.

Nevertheless, prior clinical studies are informative and suggest that potential risks should be considered, especially in patients with psoriatic disease.Several studies have associated systemic CBD and other cannabis-derived products with worsening heart disease, obesity and diabetes, fatty liver disease, or a higher likelihood of surgery to treat inflammatory bowel disease. Psoriasis patients need to be aware of the psoriasis-associated diseases and their potential worsening with cannabis products. Adverse events are also more likely with systemic or high-dose intake, compared to other delivery methods such as topical CBD oil, for example.Are there clinical studies on CBD use for psoriasis and other skin inflammations?. No.

There is a need for controlled clinical studies or at least prospective patient registries or databases designed to collect information and monitor the potential risks and benefits of CBD and other cannabis-derived products for the treatment of psoriatic disease.The medical community must think creatively about ways to evaluate and determine the safety and effectiveness of CBD products for specific conditions. We need to advance our understanding of CBD and other cannabinoid derivates because the cannabis product industry is here to stay.Several factors make the investigational effort very challenging. They include:Lack of regulations in the cannabis industryWidespread availability of CBD and other cannabis-derived products in the U.S.Product variations that would need to be studiedComplexity of research design to address patient disease severity, strain-specific compounds, concentration and dosing, method of delivery, and treatment durationLack of transparency of ingredient lists for specific productsWhat should patients with psoriasis do if they are considering CBD?. Doing your research is important.

Patients considering holistic or alternative forms of medical treatments for their chronic medical conditions need to have open conversations with their health care provider to navigate the cannabis landscape better. Looking for transparent ingredient lists and products with a good brand reputation is also important before trying CBD.Until we have more substantial, comprehensive information about the potential effects cannabis products have on human physiology, we recommend psoriasis patients seek resources from established medical organizations and patient advocacy groups to make informed decisions. The National Psoriasis Foundation (NPF) is currently working to put out psoriasis guidelines related to cannabis use in the setting of psoriatic disease..

The Neonatal where can i buy lasix over the counter usa Intensive Care Unit (NICU) at UC Davis Children’s Hospital is now the 12th NICU in the U.S. To receive a gold-level Beacon Award for Excellence from the American Association of Critical-Care Nurses (AACN). It is the only hospital in Northern California to where can i buy lasix over the counter usa receive this honor. The UC Davis NICU received a gold-level Beacon Award for Excellence.

The Beacon Award for Excellence — a significant milestone on the path to exceptional patient care and healthy work environments — recognizes caregivers who successfully improve where can i buy lasix over the counter usa patient outcomes and align practices with AACN’s six Healthy Work Environment Standards. These standards are skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition and authentic leadership. “We are so proud to receive this award,” said Sheryl Ruth, nurse manager of the UC Davis NICU. €œThis award recognizes the quality of care and commitment to constant improvement, while providing an environment that empowers nurses.”AACN President Beth Wathen applauds the commitment of the caregivers at the UC Davis NICU for working together to meet and exceed the high standards set forth by the Beacon Award for Excellence.“The Beacon Award for Excellence is a testament to a team’s commitment to providing safe, patient-centered and evidence-based care to patients and families where can i buy lasix over the counter usa.

Creating healthy and supportive work environments empowers nurses and other team members to make their optimal contribution,” Wathen explained. €œAchieving this award is an honor that brings such where can i buy lasix over the counter usa joy to those who have worked so hard to achieve excellence in patient care and positive patient outcomes.”The gold-level Beacon Award for Excellence signifies an effective and systematic approach to policies, procedures and processes that include engagement of staff and key stakeholders. Fact-based evaluation strategies for continuous process improvement. And performance measures that meet or where can i buy lasix over the counter usa exceed relevant benchmarks.

UC Davis Children’s Hospital’s NICU earned a gold award by meeting the following evidence-based Beacon Award for Excellence criteria:Leadership Structures and SystemsAppropriate Staffing and Staff EngagementEffective Communication, Knowledge Management, and Learning and DevelopmentEvidence-Based Practice and ProcessesOutcome MeasurementAbout the Beacon Award for Excellence. Established in 2003, the Beacon Award for Excellence offers a road map to help guide exceptional care through improved outcomes and greater overall patient satisfaction. U.S. And Canadian units where patients receive their principal nursing care after hospital admission qualify for this excellence award.

Units that receive the Beacon Award for Excellence meet criteria in six categories. Leadership structures and systems. Appropriate staffing and staff engagement. Effective communication, knowledge management, and learning and development.

Evidence-based practice and processes. And outcome measurement. To learn more, visit www.aacn.org/beacon or call 800-899-2226.About the American Association of Critical-Care Nurses. Founded in 1969 and based in Aliso Viejo, Calif., the American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world.

AACN represents the interests of more than half a million acute and critical care nurses and includes more than 200 chapters in the United States. The organization’s vision is to create a health care system driven by the needs of patients and their families in which acute and critical care nurses make their optimal contribution. To learn more about AACN, visit www.aacn.org, connect with the organization on Facebook at www.facebook.com/aacnface or follow AACN on Twitter at www.twitter.com/aacnme.Jason E. Hawkes, an associate professor of dermatology at UC Davis Health, has been seeing more patients with psoriasis who are interested in cannabidiol (CBD) as an alternative or complementary treatment for their condition.

Are skin creams with cannabis extract and infused CBD oil safe alternative skin care treatments?. In this Q&A, he answers questions on the safety and effectiveness of using CDB for treating psoriasis or reducing its symptoms.What is psoriasis?. Psoriasis is a chronic, inflammatory condition linked to the body’s immune system. When immune cells become dysregulated in psoriasis patients, they cause red, scaly patches of skin and inflammation throughout the body.Up to 30% of patients with psoriasis also have psoriatic arthritis with symptoms such as morning stiffness, fatigue, swollen fingers and toes, pain in joints, and nail changes.

Psoriasis patients also have an increased risk for other conditions such as heart disease, stroke, kidney disease, sleep and respiratory problems, depression and anxiety, high blood pressure, diabetes and obesity.What is CBD and can it help with psoriasis?. Cannabis is a plant that contains more than 80 biologically active chemical compounds known as cannabinoids, which have a range of biological activities in the body, including anti-inflammatory, antioxidant, and psychological effects.Despite many very effective topical and systemic treatments for psoriasis, many patients still suffer from chronic itching and pain. They also face the stigma and psychosocial consequences of having a highly visible skin condition. It is, therefore, not surprising that patients affected with this disease have sought relief via a variety of alternative treatment options, including cannabis-based products like CBD.The medical community has just barely scratched the surface with regards to the potential benefits and risks of cannabis-derived products.

The biochemical impact of CBD on the body needs to be carefully considered. Their effects are determined by many variables, including the delivery method to the body (topical application, inhalation, oral ingestion), dose or concentration of the cannabinoid, or the specific chemical(s) isolated from a particular plant strain.Yet, it is a very reasonable assumption that the potential beneficial psychological (e.g. Anxiety reduction) and anti-inflammatory effects of cannabinoids could help alleviate the disease burden associated with psoriatic disease.How do cannabinoids like CBD affect the body?. Like CBD, delta-9-tetrahydrocannabinol (THC) is a common cannabinoid isolated from the cannabis plant.

However, CBD and THC have distinct properties and vary dramatically in their observed effects on the human body. Both compounds can work in place of the body’s own cannabinoid system – known as the endocannabinoid system – wherein THC and CBD interact with receptors in specific tissues or the nervous system to mediate a broad range of physiological effects like reduced inflammation, itching and pain relief, increased ability to sleep, appetite stimulation, and decreased anxiety.For psoriasis patients with specific complaints such as pain, itching, or trouble sleeping, cannabis-derived products might help reduce the negative impact these symptoms have on their life. Ongoing medical research can help tease out the complex mechanisms by which cannabinoids like CBD or THC impact health and modulate biological systems such as the immune response.In general, CBD appears to retain many of the biological effects of THC, without the “high” most people associate with THC or marijuana. This key difference has led many companies or research groups to study and develop pure CBD products that may be more desirable for patients who wish to avoid or may not tolerate the stronger psychoactive effects of THC-based products.

This difference has also made CBD a popular choice among consumers who are first-time or inexperienced users of cannabis-based products.Are CBD products safe for psoriasis patients?. What are the risks of using CBD products?. The risks of CBD and other cannabis-derived products in patients with psoriasis and other inflammatory skin diseases have not been carefully studied. This is an unmet need that deserves ongoing attention and research.

Nevertheless, prior clinical studies are informative and suggest that potential risks should be considered, especially in patients with psoriatic disease.Several studies have associated systemic CBD and other cannabis-derived products with worsening heart disease, obesity and diabetes, fatty liver disease, or a higher likelihood of surgery to treat inflammatory bowel disease. Psoriasis patients need to be aware of the psoriasis-associated diseases and their potential worsening with cannabis products. Adverse events are also more likely with systemic or high-dose intake, compared to other delivery methods such as topical CBD oil, for example.Are there clinical studies on CBD use for psoriasis and other skin inflammations?. No.

There is a need for controlled clinical studies or at least prospective patient registries or databases designed to collect information and monitor the potential risks and benefits of CBD and other cannabis-derived products for the treatment of psoriatic disease.The medical community must think creatively about ways to evaluate and determine the safety and effectiveness of CBD products for specific conditions. We need to advance our understanding of CBD and other cannabinoid derivates because the cannabis product industry is here to stay.Several factors make the investigational effort very challenging. They include:Lack of regulations in the cannabis industryWidespread availability of CBD and other cannabis-derived products in the U.S.Product variations that would need to be studiedComplexity of research design to address patient disease severity, strain-specific compounds, concentration and dosing, method of delivery, and treatment durationLack of transparency of ingredient lists for specific productsWhat should patients with psoriasis do if they are considering CBD?. Doing your research is important.

Patients considering holistic or alternative forms of medical treatments for their chronic medical conditions need to have open conversations with their health care provider to navigate the cannabis landscape better. Looking for transparent ingredient lists and products with a good brand reputation is also important before trying CBD.Until we have more substantial, comprehensive information about the potential effects cannabis products have on human physiology, we recommend psoriasis patients seek resources from established medical organizations and patient advocacy groups to make informed decisions. The National Psoriasis Foundation (NPF) is currently working to put out psoriasis guidelines related to cannabis use in the setting of psoriatic disease..

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