mercycare.org/pediatriccardiologyclinic

Mark Zittergruen, MD

MERCY’S NEW PEDIATRIC CARDIOLOGY CLINIC

Welcomes Mark Zittergruen, MD

PEDIATRICCARDIOLOGY CLINIC

Serving the heart-care needs of infants, children and adolescents

ACCEPTING TRANSFERRING & NEW PATIENTS (319) 398-6650

mercycare.org/pediatriccardiologyclinic

Mark Zittergruen, MD

MERCY’S NEW PEDIATRIC CARDIOLOGY CLINIC

Welcomes Mark Zittergruen, MD

PEDIATRICCARDIOLOGY CLINIC

Serving the heart-care needs of infants, children and adolescents

ACCEPTING TRANSFERRING & NEW PATIENTS (319) 398-6650

Cedar Rapids Medical Education Foundation Counting Medical Education Courses

January 2016

Page 1 of 1 1/8/2016

DATE TOPIC PRESENTOR(S)

Wed. 1/6 1315 – CRMEF – End-of-Life /Chronic Pain Speaker: Dr. James Bell

Tues. 1/26 1200 – CRMEF – Visiting Professor Program Topic: Geriatric Sleep Problems

Speaker: Mark Dyken, MD University of Iowa

ACCREDITATION * The Cedar Rapids Medical Education Foundation is accredited by the Iowa Medical Society (IMS) to provide continuing medical education for physicians. + The Cedar Rapids Medical Education Foundation designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit ™. Physicians should only claim credit commensurate with their participation in the activity.

CONFLICT OF INTEREST As a sponsor accredited by the Iowa Medical Society, the Cedar Rapids Medical Education Program must assure balance, independence, objectivity and scientific rigor in all its individually sponsored or jointly sponsored educational activities. All faculty participating in a sponsored activity are expected to disclose to the activity audience any significant financial interest or other relationship (1) with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial services discussed in an educational presentation and (2) with any commercial supporters of the activity (significant financial interest or other relationship can include such things as grants, or research support, employee, consultant, major stock holder, member of speakers bureau, etc.) The intent of this disclosure is not to prevent a speaker with a significant financial or other relationship from making a presentation, but rather to provide listeners with information on which they can make their own judgments. It remains for the audience to determine whether the speaker’s interests or relationship may influence the presentation with regard to exposition or conclusion. Disclosure forms for each presenter are on file in the CME office. Participants interested in viewing copies may write the CME Office, including a self-addressed, stamped envelope. Please write to: Continuing Medical Education Office, Cedar Rapids Medical Education Foundation, 1260 2nd Avenue, SE, Cedar Rapids, IA 52403. DURING PRESENTATIONS THERE ARE OCCASIONALLY DISCUSSIONS OF UNAPPROVED USE OF FDA APPROVED DRUGS, DEVICES OR TREATMENTS. THIS MUST BE DISCLOSED TO THE AUDIENCE DURING THE LECTURE.

Orthomyxoviruses cause

Influenza A, B and C.

Paramyxoviruses cause

Croup, bronchitis, bronchio-

litis, RSV, measles and

mumps.

What are important differ-

ences between paramyxo-

viruses and orthomyxovi-

ruses?

Orthomyxoviruses

have segmented RNA

which allows for

“antigenic shift”, this is

the genetic change that

enables a flu strain to

jump from one animal

species to another. This

only happens with In-

fluenza A.

Another change that can

occur with Orthomy-

coviruses is called

“antigenic drift”.

Each year, the flu vac-

cine contains protec-

tion against 3-4 flu

strains. Influenza

virus genes are prone

to mutations and can

change shape. Anti-

bodies that normally

would match up to

provide protection, no

longer can. This al-

lows the newly mutat-

ed virus to infect the

body. Because of

antigenic drift, new

versions of the influ-

enza vaccine are need-

ed each year.

Paramyxoviruses, on

the other hand, have

non-segmented ge-

nomes and only one

serotype, this can al-

low for long term im-

munity. For example,

once the vaccination

series is completed or

the person has had the

mumps, their bodies

will have established

long term immunity

and yearly vaccines

are not needed. Boost-

er vaccinations may be

periodically advised

by the Health Depart-

ment and CDC, when

outbreaks occur. We

have seen this recom-

mendation this fall due

to the increase in

mumps cases at local

universities.

Remember, the new, the

old and immunocompro-

mised are at highest risk for

acquiring serious complica-

tions from influenza. The

very best way to protect

yourself and others is to

vaccinate.

Differences between orthomyxo and paramyxoviruses.

Epidemic vs Pandemic

Epidemic and pandemic are

similar terms that refer to

the spread of infectious

diseases amongst a popula-

tion.

An EPIDEMIC is a classi-

fication of a disease that

appears as new cases in a

given human population

during a given period, at a

rate that exceeds what is

expected. It may be local-

ized to a small region , but

the number of people af-

fected my be very large.

An epidemic that is NOT

localized to a city or small

region, but spans a larger

geographical area, or ex-

ceeds a far higher number

of people in that region, is

called a PANDEMIC.

Simply put, when an epi-

demic gets out of hand, it’s

called a pandemic. This

may spread across a large

region or even world-wide.

Scarves, gloves and mittens…….OH MY!!!!

Ok, let’s all admit it. Who hasn’t used a scarf, glove or mitten to wipe a runny

nose or cover a hacky cough? Remember, good laundering can alleviate those

pesky germs that linger on such items. Also, although it’s recommended to

replace your toothbrush every 3-4 months, washing on a regular schedule and

more often when sick is super easy. Just pop it in the dishwasher or simply

hand wash with soap and water. Don’t forget, NO ONE likes a dirty mouth! Re

sp

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tor

y V

iru

se

s

ME

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ME

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Bugs n Drugs

December 2015

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Medication Management Committee

Mercy Medical Center

Cedar Rapids, Iowa

Volume 21 December 2015

Formulary Additions

Tucks (Witch Hazel)

Approved indications include: after-stool

wipe to remove most causes of local

irritation; temporary management of

vulvitis, pruritus ani and vulva, help relieve

the discomfort of simple hemorrhoids,

anorectal surgical wounds, and

episiotomies.

Orbactiv (Oritavancin)

Approved for adult patients with acute

bacterial skin and skin structure infections

only suspected to be caused by MRSA.

Patients should have local and systemic

signs of infection that necessitate IV

therapy over oral therapy but are stable

enough to go home after the infusion.

Medication Alert Suppressions

Aluminum Hydroxide Warning

Therapeutic Interchanges

Medication Ordered Interchanged To

Verelan PM and

Verelan

VERApamil SR

Citrucel Powder Citrucel Tablets

Cepastat Lozenges Chloraseptic Spray

Policies/Protocols

-Disposal of Controlled Substance

-Pediatric and Neonatal Dosing Policy

-Labeling Standards Policy

-Herbals Policy

-Medication Reconciliation Policy

-Discharge Prescription Policy

-Prescriber Signature and DEA Authorization

Policy

-Anticoagulation Management Policy

-Aminoglycoside Monitoring Protocol

-Metformin Initiation Guidelines

-IV to PO Protocol

-High Alert Medications

-Safe Management of Medications and Security

-Automatic Renal Dosing Protocol

Membership

Fadi Yacoub, Chair Vincent Reid, MD

Susan Schima, MD Chris Walsh, MD

Asma Al-Zougbi, MD Usha Renganathan, MD

Martin Cearras, MD Mary Brobst

Lauren Cumings Sarah Schloss, ARNP

Stephanie Hoenig, ARNP Jamie Sinclair

Becky Prier Ariel Loring

Lisa Ridge Jen Goings

Linda Klein Megan Standish

Kathy Swift Andrea Bennett

Katy Rolfes

I N S I D E T H I S I S S U E

Formulary Additions

Therapeutic Interchange

Medication Alert Suppressions

Policy Approvals

PPI for FT Administration

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PPI for FT Administration:

Situation:

We would like to assess our current formulary proton pump inhibitor (PPI) for administration via feeding tube (FT).

Background:

We currently utilize Protonix powder for administration of a PPI via a FT. The problem is that the powder can only be mixed with apple juice and this is not always readily available on the patient care floors.

Assessment:

There are other PPIs that can be mixed into a suspension to be administered via a FT.

Recommendations:

Switch to Omprazole 2 mg/mL suspension compounded by pharmacy as our PPI of choice

for FT administration. This would result in nursing satisfaction improvement and annual cost

savings of approximately $530.

Mercy Specialty Clinics – Updates on New Services Provided

General Surgery Clinici. The surgeons  are willing to place peritoneal dialysis catheters on a case by 

case basis; Bulent Cetindag, MD will primarily perform these proceduresii. Screening Colonoscopies – Nora Royer, MD adding this service to her practice

Surgical Oncologyi. Vince Reid, MD addressing skin cancers including: melanoma, basal cell 

cancer, squamous cell carcinomaCardiology Clinic

i. Dave Glassman, MD is adding subcutaneous ICD as an option for patients with an ICD indication who do not also require pacing

Pulmonology Clinici. Eduardo Celis, MD named interventional pulmonology medical director and 

within this role is reviewing quality and costs of all cases performed at MercyPediatric Clinic

i. Sara Neff, ARNP offering pediatric diabetic care and education for our inpatient and outpatient pediatric patients

BUG’S-N-DRUG’S

DECEMBER 2015

MUMPS Prevention

What steps can I take to prevent be-

coming infected with mumps?

Personal action, such as hand wash-

ing, covering your coughs and sneezes,

not sharing cups, utensils or food, and

staying home when sick, can help re-

duce your chances of getting and

spreading mumps.

All health care workers, and especially

those who work in acute care or with

people at high risk for mumps compli-

cations (such as OB-GYN), should re-

ceive two doses of Measles, Mumps,

Rubella (MMR) or have serologic evi-

dence of immunity.

Droplet Isolation for patients suspect-

ed of Mumps until ruled ou t.

College Students, staff and faculty

should make sure they are immune to

mumps. Immunity to mumps includes:

o 2 doses of MMR vaccine given at

least 4 weeks apart

o Laboratory confirmation of mumps

disease

o Laboratory confirmation of mumps

immunity

If mumps is occurring among your

family, friends or community, insure

everyone has received two doses of

MMR (or had mumps already).

MUMPS

Updated December 12, 2015, there have been 241 lab

confirmed cases of Mumps in Iowa for 2015, . Of the 241

cases 196 are from John son County. Mumps is a viral illness

It is spread by contact with saliva (e.g., sharing eating utensils, drinking glasses or

straws, kissing) and airborne respiratory droplets – similar to influenza.

Symptoms include: low-grade fever, headache, muscle ache, decreased appetite

and swollen glands under the jaw. As many as 15-27% of people infected with

mumps may have no symptoms at all.

Mumps is generally a mild to moderate illness, with complete recovery and no

long-term health problems in most cases. Hospitalizations are uncommon. Com-

plications, such as male testicular inflammation and deafness can occur.

What should I do if I have these symptoms?

People with these symptoms should stay home from work, school or childcare,

and contact their personal health care provider.

Contact your health provider by telephone. Those providers will make arrange-

ments to minimize chances you will spread the illness in waiting rooms (perhaps

by wearing a mask).

Isolate yourself at home until 5 days after onset of symptoms or until symptoms

go away – whichever time period is longer.

There is a vaccine to prevent Mumps disease

Virtually all Iowa school children have received two doses of the MMR vaccine.

Two doses of MMR vaccine is approximately 88% effective in protecting against

mumps disease. This means out of every 100 people who received 2 doses of

MMR vaccine 12 did not develop protective antibodies against mumps disease.

The mumps vaccine is effective in preventing disease. Without mumps vaccina-

tion there would be considerably more cases than we are currently seeing.

Those who are not yet immune to mumps should receive age appropriate MMR.

The first dose of MMR vaccine should be given on or after 12 months of age and

the second dose is usually given when the child is 4–6 years of age.

.

Eastern Iowa Sleep Center Release: Monday, December 28, 2015 Contact: Lisa Gleason, (319) 362-4433 ext. 302, Lisa.Gleason@eiSleep.com Cedar Rapids, IA – Eastern Iowa Sleep Center (EISC) plans its new additional sleep study location in Belle Plaine, IA. In a recent agreement with the City of Belle Plaine, EISC will provide sleep studies to Belle Plaine, Benton County and surrounding areas. The facility is located at 1010 8th Ave and was the former location of Belle Plaine Family Medicine. EISC looks to officially open its doors there March 7th and host an Open House event on March 10, 2016 from 4pm-7pm. “The City of Belle Plaine has been great to work with. We are excited to bring this unique service to such a welcoming community. Patients can reduce time and mileage to receive EISC top of the line service that would normally require travel into Cedar Rapids”, says Mrs. Gleason, EISC Administrative Director. EISC plans to remodel interior areas to provide state-of-the-art sleep study technology while providing a comfortable hotel like experience. A gracious private room, cable TV and WI-FI will be available for each patient. Infrared light and camera in each room allows the sleep technologist to monitor the study without interruption to the patient. Eastern Iowa Sleep Center (EISC) is a partnership between UnityPoint St. Luke’s Hospital, Mercy Medical Center and Physician’s Clinic of Iowa. EISC is accredited by the American Academy of Sleep Medicine. EISC is an Independent Diagnostic Testing Facility that provides comprehensive care for sleep-related disorders such as: Obstructive Sleep Apnea, Restless Leg Syndrome, Narcolepsy, Insomnia and more. Medical Director Andrew Peterson, M.D., Scott Geisler, M.D., Robert Struthers, M.D. and Warangkhana Wongba, M.D. are board certified in Sleep Medicine and serve at the Eastern Iowa Sleep Center in Cedar Rapids, IA.