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VACC - VACC Vascular Access - Dump Information

Vendor : Medical
Exam Code : VACC
Exam Name : VACC Vascular Access
Questions and Answers : 80 Q & A
Updated On : January 22, 2019
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VACC Questions and Answers

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VACC VACC Vascular Access

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VACC exam Dumps Source : VACC Vascular Access

Test Code : VACC
Test Name : VACC Vascular Access
Vendor Name : Medical
Q&A : 80 Real Questions

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Medical Medical VACC Vascular Access

Fresenius medical Care Opens First community-based Vascular access carrier in Singapore | killexams.com Real Questions and Pass4sure dumps

SINGAPORE--(Marketwired - Jun eight, 2016) - Fresenius medical Care, the area's leading provider of dialysis items and capabilities opens its first community-primarily based Vascular entry service for patients with chronic kidney disorder in Singapore. Gan Kim Yong, Member of Parliament, Choa Chu Kang GRC participated at the fresh opening ceremony at Fresenius clinical Care Teck Whye Dialysis health facility.

round 70 p.c of the Singaporean population is susceptible to setting up chronic kidney ailment as a result of increasing diabetes and hypertension.1 at present nearly 6,000 people get hold of life-saving dialysis remedy.2 

To be certain productive medicine patients want an access to their bloodstream. This 'vascular entry' is often talked about as the patient's 'lifeline.' Dr. Grace Lee, scientific Director at Teck Whye Dialysis sanatorium explained during the outlet ceremony that the vascular access allows the patient's blood to flow into to and from the dialysis computer to be cleansed while waste products and further fluid are faraway from the physique. "the new Vascular entry carrier from Fresenius clinical Care offers a one-stop day surgery facility that provides surgical advent of the vascular entry for patients on hemodialysis. The pricing of the surgical procedure has been made corresponding to the restructured hospitals and sufferers can make claims from the national clinical savings scheme Medisave."

"We want to offer chronic kidney ailment patients the probability of a timely and cost effective intervention for the introduction of their vascular entry. here's a vital step towards 'Care Coordination,' where we can deliver a holistic medicine and care method past dialysis," mentioned Anthony Tann, Managing Director of Fresenius medical Care Singapore. to this point nine sufferers bought their vascular access created in the health center.

anyway vascular access carrier and hemodialysis treatment Fresenius medical Care's Teck Whye clinic is offering extra new capabilities akin to peritoneal dialysis guide provider, in addition to screening for diabetic problems in high-possibility patients.

In his speech, Gan Kim Yong stressed on the importance of all and sundry's function in the 'conflict on Diabetes.' every day four new instances of continual kidney failure are diagnosed in Singapore. Many are brought about by means of diabetes. "what is much more being concerned is that one in three diabetics is unaware that they have got diabetes. hence prevention and screening of diabetes, superior sickness manage and administration as well as public education and stakeholder collaboration to superior take care of diabetics is the key for Singaporeans," Mr. Gan concluded on the opening of the brand new Vascular access service. "I look forward to Fresenius scientific Care's contribution to the group here and to improved serve our patients."

moving forward, Fresenius scientific Care will proceed to seek collaborations with the public and personal sector to extend its capabilities to deliver integrated high normal holistic care to native renal patients.

ImageMr. Gan Kim Yong, Member of Parliament, Choa Chu Kang GRC (left) and Mr. Anthony Tann, Managing Director, Fresenius scientific Care Singapore (appropriate) on the opening of the Vascular access carrier at Fresenius scientific Care Teck Whye Dialysis health facility.http://release.media-outreach.com/i/download/4871

company Logohttp://release.media-outreach.com/i/down load/1869

References:

1 Vivekanand Jha, et al. (2013). persistent kidney sickness: world dimension and views. The Lancet, Vol. 382, problem 9888, web page four

2 Singapore Renal Registry Annual Registry file 1999 - 2014 (period in-between)

ABOUT FRESENIUS scientific CARE: Fresenius clinical Care is the world's greatest company of products and capabilities for people with renal illnesses of which more than 2.8 million patients global continuously bear dialysis medication. through its community of 3,432 dialysis clinics, Fresenius scientific Care provides dialysis treatments for 294,043 patients around the globe. Fresenius scientific Care is also the main issuer of dialysis items reminiscent of dialysis machines or dialyzers. together with the core enterprise, the company focuses on increasing the range of connected clinical functions within the field of care coordination.

For more information talk over with the business's web page at www.freseniusmedicalcare.com

graphic accessible: http://www2.marketwire.com/mw/frame_mw?attachid=3019174


benefit scientific Acquires Vascular Insights For PVD remedies | killexams.com Real Questions and Pass4sure dumps

No influence found, are trying new keyword!benefit medical techniques has bought Vascular Insights ... comparable to our micropuncture and vascular entry products, and enhance our ability to customise the whole technique for our customers.

Cardinal fitness and prepare dinner medical Announce exclusive contract for Customizable Vascular access Kitting solution | killexams.com Real Questions and Pass4sure dumps

DUBLIN, Ohio--(business WIRE)--Cardinal fitness and cook medical these days introduced a two-yr, exclusive settlement for the North American distribution of cook dinner clinical relevant venous catheter (CVC) sets with Cardinal fitness Presource® customizable procedural kits ─ featuring clinicians with advanced technology the flexibleness of customization for their vascular entry wants.

below the agreement, Cardinal health and cook dinner clinical customers at the moment are in a position to customise add-ons of their CVC procedural kits. The kits can include both uncoated or prepare dinner Spectrum® CVC sets, which characteristic the trade’s optimum circulation costs and a complete product line together with energy-injectable catheters. The partnership permits acute care suppliers to maximise value and minimize waste by using offering a cost-advantageous means to lower the number of elements they should supplement typical CVC procedural kits.

“We’re thrilled to companion with Cardinal health, an business leader in custom kitting, to expand entry to cook clinical’s CVC sets for vascular entry authorities,” spoke of Dan Sirota, vp and company unit leader of cook scientific’s crucial Care and Interventional Radiology divisions. “improving affected person care and decreasing fitness care costs are of utmost magnitude to hospitals. We continue to be dedicated to offering options that streamline techniques for clinicians and empower them to provide most advantageous patient care.”

cook dinner scientific’s Spectrum catheters are impregnated with the antibiotics minocycline and rifampin and meet the newly launched 1A advice from the CDC for decreasing catheter-linked bloodstream infections (CRBSIs) if maximal sterile barrier precautions haven’t helped a facility reach its [infection prevention] intention.1 An estimated seventy eight,000 sufferers are infected with doubtlessly deadly CRBSIs in the U.S. yearly, with a standard charge estimated at $16,550 per an infection.2 Spectrum catheters have been shown to be 5 times less prone to produce infection than procedure on my own.3

“Cardinal health specializes in developing partnerships that convey imaginitive solutions that assist make it easier for our shoppers to deliver high first-class care,” referred to Lisa Ashby, president of class management at Cardinal fitness. “Our relationship with cook clinical is an excellent instance of the types of partnerships our consumers value – people that promote premiere practice standardization with advanced best products.”

About Cardinal health

Headquartered in Dublin, Ohio, Cardinal fitness, Inc. (NYSE: CAH) is a $103 billion fitness care services business that improves the cost-effectiveness of fitness care. as the enterprise behind fitness care, Cardinal fitness helps pharmacies, hospitals, ambulatory surgery facilities and medical professional workplaces focal point on patient care whereas cutting back prices, improving effectivity and improving pleasant. Cardinal fitness is a vital link within the health care provide chain, offering prescription drugs and medical products to more than 60,000 areas day after day. The business is additionally a number one company of clinical and surgical products, together with gloves, surgical attire and fluid administration products. moreover, the enterprise helps the turning out to be diagnostic business with the aid of offering clinical items to clinical laboratories and working the nation's greatest community of radiopharmacies that dispense items to support within the early analysis and medication of sickness. Ranked #19 on the Fortune 500, Cardinal health employs more than 30,000 individuals worldwide. more suggestions in regards to the company could be found at cardinalhealth.com and @CardinalHealth on Twitter.

About prepare dinner medical

a worldwide pioneer in medical breakthroughs, prepare dinner clinical is dedicated to developing effective options that improvement tens of millions of patients global. these days, we combine clinical devices, medication, biologic grafts and mobilephone healing procedures throughout greater than 16,000 products serving more than 40 medical specialties. situated in 1963 through a visionary who put affected person wants and ethical company practices first, cook is a family-owned business that has created greater than 10,000 jobs worldwide. For extra suggestions, visit www.cookmedical.com. comply with cook dinner clinical on Twitter and LinkedIn.

1 O’Grady NP, Alexander M, Burns LA, et al. guidelines for the prevention of intravascular catheter-connected infections. Am J Infect control. 2011;39(4 suppl 1):S1-S34.

2 facilities for sickness handle and Prevention. a must-have signals: principal line-associated blood stream infections–u.s., 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep. 2011:60(eight): 243-2488

three Hanna H, Benjamin R, Chatzinikolaou I, et al. “lengthy-time period silicone central venous catheters impregnated with minocycline and rifampin decrease charges of catheter-connected bloodstream infection in melanoma sufferers: a prospective randomized scientific trial;” J Clin Oncol. 2004; 22(15):3163-3171.

Presource is a registered trademark of Allegiance organisation

photographs/Multimedia Gallery purchasable: http://www.businesswire.com/cgi-bin/mmg.cgi?eid=50148458&lang=en


VACC VACC Vascular Access

Study Guide Prepared by Killexams.com Medical Dumps Experts


Killexams.com VACC Dumps and Real Questions

100% Real Questions - Exam Pass Guarantee with High Marks - Just Memorize the Answers



VACC exam Dumps Source : VACC Vascular Access

Test Code : VACC
Test Name : VACC Vascular Access
Vendor Name : Medical
Q&A : 80 Real Questions

these VACC questions and answers provide proper expertise of subjects.
this is top notch, I handed my VACC exam final week, and one exam earlier this month! As many humans factor out here, these brain dumps are a exquisite way to study, either for the examination, or just for your expertise! On my checks, I had masses of questions, good element I knew all of the solutions!!


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Subsequently, at the dinner table, my father requested me without delay if i was going to fail my upcoming VACC check and that i responded with a very enterprise No way. He modified into impressed with my self assurance however i wasso scared of disappointing him. Thank God for this killexams.Com because it helped me in maintaining my phrase and clearing my VACC test with first-rate consequences. Im thankful.


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I even have become a VACC certified final week. This profession direction may be very thrilling, so in case you are nonethelessconsidering it, ensure you get questions solutions to put together the VACC examination. This is a big time saver as you get precisely what you need to recognise for the VACC exam. This is why I selected it, and that i never appeared lower back.


Its good to read books for VACC exam, but ensure your success with these Q&A.
As I long gone via the road, I made heads turn and each single character that walked beyond me turned into searching at me. The reason of my unexpected popularity became that I had gotten the fine marks in my Cisco test and all and sundry changed into greatly surprised at it. I was astonished too however I knew how such an achievement come to be viable for me without killexams.Com QAs and that come to be all because of the preparatory education that I took on this Killexams.Com. They were first-class sufficient to make me carry out so true.


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Its a completely beneficial platform for running professionals like us to practice the query financial institution everywhere. I am very tons thankful to you human beings for creating this kind of incredible practice questions which turned into very useful to me inside the ultimate days of examinations. I actually have secured 88% marks in VACC Exam and the revision practice tests helped me loads. My inspiration is that please expand an android app in order that people like us can exercise the exams even as journeying additionally.


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There isnt plenty VACC examination materials obtainable, so I went in advance and bought those VACC questions and solutions. Honestly, it gained my coronary heart with the way the information is prepared. And yeah, thats proper: maximum questions I saw on the exam were exactly what changed into furnished through killexams.Com. Im relieved to have handed VACC examination.


Dont forget about to strive those real exam questions questions for VACC examination.
As I long long past through the street, I made heads turn and each single person that walked past me changed into lookingat me. The purpose of my sudden recognition changed into that I had gotten the fine marks in my Cisco check and all of us was bowled over at it. I used to be astonished too but I knew how such an fulfillment modified intopossible for me without killexams.Com QAs and that became all because of the preparatory instructions that I took in thisKillexams.Com. They were perfect sufficient to make me perform so suitable.


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VACC Vascular Access

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CE: Original Research Does Certification in Vascular Access Matter? An Analysis of the PICC1 Survey | killexams.com real questions and Pass4sure dumps

Accreditation or certification by an external agency is common in many professions. In the field of health care, certification denotes that a person has specific qualifications for performing a certain job or set of activities. First, it signifies the completion of a prescribed course of study and the resultant acquisition of specialized knowledge and skills. Second, it attests to some demonstration of such learning, usually through a qualifying examination. Lastly, it serves to assure the public and other stakeholders of competence in a domain. Although some controversy regarding the expense and value of certification has recently emerged,1, 2 there is substantial evidence linking certification to greater job satisfaction, knowledge, and sense of empowerment among both physicians and nurses.3, 4 Among nurses, certification has also been associated with improved attitudes, better practice, and greater financial compensation.5, 6

In the specialty of vascular access, the most common certifications are those administered by the Vascular Access Certification Corporation (which offers Vascular Access–Board Certified [VA-BC] certification) and by the Infusion Nurses Certification Corporation (which offers Certified Registered Nurse Infusion [CRNI] certification). Although these certifications vary in content and emphasis, they share certain essential features. Both require a minimum number of hours of clinical experience in planning, managing, and evaluating intravenous infusions and in inserting vascular access devices. Both also emphasize evidence-based approaches; and both certifications are often obtained by clinicians who specialize in inserting peripherally inserted central catheters (PICCs).

Although state boards of nursing require health care facilities to have written policies and procedures that ensure demonstration of competency by vascular access specialists, certification is not mandatory for practice. Some organizations encourage certification as a condition of employment, but others do not. To our knowledge, no study has examined whether certified and noncertified PICC inserters differ with respect to their practices and views about PICC use.

Study purpose. Understanding whether and how certification might affect PICC practices and outcomes is critical to informing policy and improving patient safety. Using data from a national survey of vascular access specialists, we compared the characteristics of certified PICC inserters to those of noncertified inserters. Our objective was to gather information regarding whether and how certified and noncertified PICC inserters differ with respect to their practices and views about PICC use. We hypothesized that, compared with noncertified inserters, certified inserters would report having greater experience and would be more likely to work in leadership positions. We also hypothesized that certified inserters would report greater use of evidence-based practices.

METHODS

Study setting and participants. We partnered with the Association for Vascular Access (AVA) and the Infusion Nurses Society (INS) to distribute a survey aimed at vascular access specialists who insert PICCs (the PICC1 survey). The AVA is a multidisciplinary professional organization for vascular access specialists, and the INS is a professional nursing organization for nurses who participate in various aspects of infusion therapy. Both organizations maintain membership directories accessible for practice-relevant surveys. They have a combined membership of over 8,300 specialists, although not all members insert PICCs. These agencies represent the most common sources of certification in vascular access.

Development and dissemination of the survey. First, a literature search was conducted to identify relevant evidence regarding vascular access practices. These data were used to inform the development of survey questions related to inserting, caring for, and troubleshooting PICCs, as well as questions regarding policies, practices, and various other relevant topics.

The initial survey was pretested with four nurses who had experience in inserting PICCs and expertise in the field. Based on their feedback, the instrument was revised and edited for clarity. The final survey instrument consisted of 76 questions on PICC policies and procedures at the inserters’ facilities, the use of technologies for PICC insertion, device management (including management of complications), inserters’ perceptions about PICC use, and inserters’ relationships with other health care providers. Information about respondents, such as number of years in practice, certification or noncertification status, and the primary practice setting, was also collected. The survey instrument made use of skip logic, allowing respondents to skip questions that were contingent on a prior response.

Following its approval by the AVA and the INS, the instrument was programmed into an online survey administration tool (SurveyMonkey) to facilitate electronic dissemination. We tested the online survey to ensure its functionality. It was then announced and disseminated by the AVA and the INS to their members via an e-mail that contained an electronic link. Advertisements publicizing the survey were also placed on the organizations’ websites. Over the next five weeks, each organization sent timed reminder e-mails to encourage participation. Data were collected over a three-month period from June through August 2015. No identifiable information was collected from respondents, but a $10 Amazon gift card was offered to those who completed the survey.

The study was reviewed and deemed exempt from regulation by the University of Michigan's institutional review board before data collection began.

Identification of certified PICC inserters. To distinguish certified from noncertified PICC inserters, we first restricted the sample to respondents who indicated that they insert PICCs. We then evaluated these respondents’ answers to the question “Do you currently hold a dedicated vascular access certification?” Respondents who answered yes were asked to identify which certification they held. Those who indicated holding VA-BC or CRNI (or both) certification were categorized as certified PICC inserters. Conversely, those who lacked such certification were categorized as noncertified inserters.

Data analysis. Descriptive statistics were used to tabulate results. Since respondents weren't required to answer all questions, the response rate for individual questions was calculated based on the total number of responses to that question. Responses for certified and noncertified PICC inserters were compared across work settings, practice patterns, and views regarding PICCs. (Given that this was our focus, we did not analyze the data in terms of nurses and nonnurses.) Bivariable comparisons were made using χ2 or Fisher's exact tests, as appropriate, for categorical data. Two-sided significance tests with α set at 0.05 was considered statistically significant. All statistical analyses were conducted using Stata/MP version 13 (StataCorp, College Station, TX).

RESULTS

Sample. The survey link was e-mailed to a combined 8,386 members of the AVA and the INS. Of these, 2,762 accessed the survey and 1,698 (61%) indicated that they inserted PICCs and were eligible for participation in the study. Of those eligible, 1,450 (85%) provided data regarding certification and made up the final cohort used for analysis. Of these, 1,007 (69%) reported being certified and 443 (31%) indicated they were not certified. Most respondents (96%) reported practicing within the United States, and all 50 U.S. states and the District of Columbia were represented. A small number of respondents (4%) practiced outside the United States.

General characteristics of PICC inserters. Most certified and noncertified PICC inserters identified as vascular access nurses (89% in both groups). Nonnurse inserters included respiratory therapists, physicians, and advanced practice providers. Significantly higher percentages of certified than noncertified inserters reported having five or more years’ experience with inserting PICCs (78% versus 54%) and having placed 1,000 or more PICCs (58% versus 32%). A significantly higher percentage of certified than noncertified inserters worked in a facility that was affiliated with a medical school (52% versus 46%). But there was no significant difference between the groups regarding their facility's affiliation with a nursing school. Significantly higher percentages of certified than noncertified inserters reported being on a vascular access team with 10 or more members (35% versus 19%) and being the vascular access lead for their team (56% versus 44%).

A significantly higher percentage of certified than noncertified inserters reported that their facility had a written medical or nursing process for reviewing the necessity of PICCs on a daily basis (71% versus 58%). With respect to relationships with other providers, there was a significant difference between certified and noncertified inserters in their rating of support received from hospital leadership but not in their relationships with physicians and bedside nurses. See Table 1 for more on the general characteristics of certified and noncertified inserters in this study.

Variations in practice between certified and noncertified PICC inserters. Several important differences in reported practices were noted. For instance, a significantly higher percentage of certified than noncertified inserters reported receiving assistance from another vascular access specialist when inserting a PICC (52% versus 41%). A significantly higher percentage of certified than noncertified inserters reported having placed a PICC in a patient receiving dialysis (63% versus 51%). In doing so, certified inserters more frequently reported consulting with a nephrologist before placement (92% versus 88%). While a significantly lower percentage of certified inserters reported that their facility tracked the total number of PICCs placed each month (93% versus 97%), a significantly higher percentage indicated that it tracked PICC dwell times (70% versus 63%).

Important differences specific to insertion practices were also found. For instance, a lower percentage of certified than noncertified inserters reported using all five sterile barriers (cap, mask, gown, sterile gloves, and full body drapes) (78% versus 84%). Although 96% of inserters in both groups reported using ultrasound to find a suitable vein for PICC insertion, significantly more certified than noncertified inserters indicated using ultrasound to estimate a catheter-to-vein ratio before placement (86% versus 76%) and documenting this ratio in the PICC insertion note (43% versus 30%). Similarly, significantly more certified inserters reported the use of electrocardiographic guidance to place PICCs (67% versus 55%). But the percentages of certified and noncertified inserters who reported the use of chlorhexidine for skin antisepsis at the insertion site (96% in both groups) and the routine trimming of PICCs to an appropriate length following insertion (94% versus 92%) were similar.

Some care and maintenance practices also varied between the two groups. For instance, significantly fewer certified than noncertified inserters reported using a combination dressing and securement device for routine care following placement (18% versus 26%). Most certified and noncertified inserters reported using securement devices to prevent PICC migration (95% versus 93%). But there were differences in the type of securement devices used, with noncertified inserters more often using wing-based products than certified inserters (89% versus 80%). With respect to flushing protocols, a significantly higher percentage of certified than noncertified inserters reported using a “targeted” strategy (flushing only those lumens that weren't being actively used or were only used for blood draws) (33% versus 24%). Differences in recommended flushing techniques were also noted: fewer certified than noncertified inserters practiced pulsatile flushing (76% versus 81%), while more certified than noncertified inserters practiced rapid push flushes (14% versus 9%). Although frequency of flushing was similar in the two groups, there were some differences in use of flushing agents, with fewer certified than noncertified inserters using normal saline (63% versus 69%) and more certified than noncertified inserters using heparin (7% versus 2%). See Table 2 for more on variations in reported practices between certified and noncertified inserters.

Variations in approach to complications and views about PICC practice. Several differences in reported management of PICC complications were noted. Similar percentages of certified and noncertified inserters reported the use of a tissue plasminogen activator to treat catheter-related occlusions (92% versus 91%). But their approaches to managing PICC-related phlebitis varied somewhat. For instance, fewer certified than noncertified inserters said they would discuss the situation with a physician (41% versus 46%), but more certified than noncertified inserters said they would do so with a nurse (10% versus 7%). The two groups also differed regarding the management of PICC-related deep vein thrombosis, with more certified than noncertified inserters recommending ultrasound evaluation (59% versus 45%) and notification of all caregivers (59% versus 45%).

The two groups also expressed somewhat different views about PICC practice. For instance, a significantly higher percentage of certified than noncertified inserters reported being empowered to remove PICCs that were idle or not clinically indicated without physician approval (26% versus 18%). Significantly more certified inserters also felt that a higher percentage of PICCs (10% or more) were unnecessarily removed when a patient developed a fever, without compelling evidence to suggest catheter infection (75% versus 63%). Similarly, significantly more certified inserters felt that a higher percentage of PICCs (10% or more) were placed for inappropriate reasons and could have been avoided (44% versus 34%). See Table 3 for more on variations in the reported approaches and views of certified and noncertified inserters.

DISCUSSION

To our knowledge, this is the first study to examine associations between certification in vascular access and reported practices and views related to PICC insertion and use. In our analysis of 1,450 vascular access specialists who insert PICCs, the majority of respondents (69%) reported holding certification by an accredited external agency. We found that more certified than noncertified inserters reported working in larger facilities and on larger vascular access teams. In accordance with our hypotheses, we found that significantly higher percentages of certified inserters reported having more practice experience and greater use of certain evidence-based practices (such as ultrasound to determine catheter-to-vein ratio). Certain care and maintenance practices, including approaches to managing complications such as thrombosis and phlebitis, also varied significantly between the two groups. Collectively, these data suggest that certification in vascular access is associated with important differences in work settings, practice patterns, and views regarding PICCs. Whether or not these variations influence the quality of patient care and patient outcomes is a question that deserves further scrutiny.

In nursing, a substantial body of evidence suggests that specialty certification is associated with several improved patient outcomes. For example, a 2014 study reported a direct association between certification status among surgical and anesthetic RNs and rates of central line–associated bloodstream infections—specifically, hospitals with higher percentages of specialty-certified RNs had lower rates of such infections.7 In acute care settings, another study found a significant relationship between increased rates of unit-level nursing specialty certification and fewer patient falls.8 And in an analysis of risk-adjusted surgical discharges, specialty certification in nurses with baccalaureates or higher degrees was associated with decreased mortality and failure-to-rescue rates after multivariable adjustment.9

Despite such findings, barriers to obtaining specialty certification—including lack of financial or logistical support for review courses and examinations, time constraints, and fear of failure—persist.10 With regard to vascular access certification specifically, the fees for certification, recertification, and maintenance of credentials aren't trivial, ranging from $300 to $700 at this writing.11-13

Although the knowledge base in this specialty varies in quality, specific evidence-based practices have been associated with improved outcomes when it comes to inserting PICCs. For example, it's been demonstrated that “real-time” guidance of the PICC tip during insertion and measurement of vein size can reduce complications such as malposition and thrombosis.14-16 Similarly, using alcohol-containing chlorhexidine for cutaneous antisepsis and having multiple team members trained in placing vascular catheters has been shown to reduce the risk of catheter-related infection.17-19

In general, it seems reasonable to presume that providers with certification will be more likely to use evidence-based practices than their noncertified counterparts. Our analysis of data from the PICC1 survey supports this in part. For example, certified inserters were more likely to use certain evidence-based practices that reduce complication risks, including using ultrasound to evaluate catheter-to-vein ratios, using ECGs to guide PICC placement, and receiving assistance from another team member during insertion. But certified inserters also reported some practices that either aren't clearly supported by evidence or contradict best practice. For example, fewer certified inserters reported using all five sterile barriers when placing PICCs than noncertified inserters did. And more certified inserters reported placing PICCs in patients receiving dialysis, although current guidelines indicate that this is contraindicated and associated with adverse outcomes, regardless of nephrologist approval.20, 21

Such findings highlight the importance not only of transmitting up-to-date evidence through certification programs, but also of ensuring that such knowledge influences practice. For example, in accordance with current INS guidelines, certified inserters might recommend an alternative device rather than a PICC in patients receiving dialysis.22 The focus thus shifts from a device-centric view to one that prioritizes the appropriateness of use.23, 24 Our findings that higher percentages of certified inserters were likely to perceive inappropriate PICC placement and to feel empowered to remove clinically unnecessary devices suggest that certification may help guide decisions about the suitability of PICC use. Exploring ways to further enable PICC inserters to apply evidence to practice, communicate such knowledge to physicians, and act as vanguards for patient safety is paramount.23, 25

Policy implications. Given that certified inserters more frequently reported engaging in key evidence-based practices, our findings also have important policy implications. Essential next steps might include working with health care system leaders to remove financial barriers to obtaining certification, encouraging the adoption and implementation of practices taught in certification programs, and measuring key outcomes based on certification status. Given our finding that more certified inserters are leaders on their vascular access teams, encouraging certification as an adjunct to career advancement might also improve staff satisfaction and retention, important factors in organizational planning and sustainability.

Limitations. This study has several limitations. First, we used data from a survey that targeted vascular access specialists belonging to two large professional organizations; thus, selection bias might affect our findings. Second, we defined certified inserters as those who reported current certification by one or both of two agencies; findings may differ if reporting was inaccurate or if different standards are used to define certification status. Third, although we observed differences in practice patterns and views by certification status, we cannot attribute these differences solely to this characteristic. Nor can certification status be separated from employer or site-specific requirements that might influence practice and views. Studies that examine these relationships in more detail are necessary.

CONCLUSION

Certification in vascular access appears to be associated with important differences among PICC inserters with regard to their practices and views. Encouraging broader adoption of this credential—which is currently often voluntary—may be warranted. Further research to foster a better understanding of the impact of certification on patient outcomes is essential. In particular, studies aimed at clarifying how certification influences thinking and practice in clinical settings are needed if we are to unlock the potential of this professional training.

REFERENCES 1. Hayes J, et al Association between physician time-unlimited vs time-limited internal medicine board certification and ambulatory patient care quality JAMA 2014 312 22 2358–63 3. Beaudoin G, et al Supporting and empowering nurses undergoing critical care certification Clin Nurse Spec 2016 30 4 216–26 4. Peterson LE, et al Physician satisfaction with and practice changes resulting from American Board of Family Medicine maintenance of certification performance in practice modules J Contin Educ Health Prof 2016 36 1 55–60 5. Beck SL, et al Oncology nursing certification: relation to nurses’ knowledge and attitudes about pain, patient-reported pain care quality, and pain outcomes Oncol Nurs Forum 2016 43 1 67–76 6. Burchill CN, Polomano R Certification in emergency nursing associated with vital signs attitudes and practices Int Emerg Nurs 2016 27 17–23 7. Boyle DK, et al The relationship between direct-care RN specialty certification and surgical patient outcomes AORN J 2014 100 5 511–28 8. Boyle DK, et al Longitudinal association of registered nurse national nursing specialty certification and patient falls in acute care hospitals Nurs Res 2015 64 4 291–9 9. Kendall-Gallagher D, et al Nurse specialty certification, inpatient mortality, and failure to rescue J Nurs Scholarsh 2011 43 2 188–94 10. Ciurzynski SM, Serwetnyk TM Increasing nurse certification rates using a multimodal approach J Nurs Adm 2015 45 4 226–33 14. Rossetti F, et al The intracavitary ECG method for positioning the tip of central venous access devices in pediatric patients: results of an Italian multicenter study J Vasc Access 2015 16 2 137–43 15. Sharp R, et al The catheter to vein ratio and rates of symptomatic venous thromboembolism in patients with a peripherally inserted central catheter (PICC): a prospective cohort study Int J Nurs Stud 2015 52 3 677–85 16. Walker G, et al Effectiveness of electrocardiographic guidance in CVAD tip placement Br J Nurs 2015 24 14 S4–S12 17. Mimoz O, et al Skin antisepsis with chlorhexidine-alcohol versus povidone iodine-alcohol, with and without skin scrubbing, for prevention of intravascular-catheter-related infection (CLEAN): an open-label, multicentre, randomised, controlled, two-by-two factorial trial Lancet 2015 386 10008 2069–77 18. Mimoz O, et al Chlorhexidine-alcohol versus povidone iodine-alcohol antisepsis for catheter-related infection prevention: an open-label, multicentre, randomised controlled trial [poster presentation] Intensive Care Med Exp 2015 3 Suppl 1 A409 19. Pronovost P, et al An intervention to decrease catheter-related bloodstream infections in the ICU N Engl J Med 2006 355 26 2725–32 20. McGill RL, et al Peripherally inserted central catheters and hemodialysis outcomes Clin J Am Soc Nephrol 2016 11 8 1434–40 21. McGill RL, et al Inpatient venous access practices: PICC culture and the kidney patient J Vasc Access 2015 16 3 206–10 22. Gorski L, et al Infusion therapy standards of practice J Infus Nurs 2016 39 1S S1–S156 23. Chopra V, et al The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): results from a multispecialty panel using the RAND/UCLA appropriateness method Ann Intern Med 2015 163 6 Suppl S1–S40 24. Moureau N, Chopra V Indications for peripheral, midline and central catheters: summary of the MAGIC recommendations Br J Nurs 2016 25 8 S15–S24 25. Meyer BM, Chopra V Moving the needle forward: the imperative for collaboration in vascular access J Infus Nurs 2015 38 2 100–2

For more than 240 additional continuing nursing education activities on advanced practice nursing topics, go to www.nursingcenter.com/ce.


School-located vaccination programs could reduce flu cases and deaths among children | killexams.com real questions and Pass4sure dumps

Offering flu vaccines at elementary schools could expand vaccination rates and reduce costs, according to a new study reported in the scientific journal Vaccine by researchers from UC Davis Health System; the Monroe County, N.Y., Department of Public Health; University of Rochester Medical Center; and U.S. Centers for Disease Control and Prevention (CDC).

New research shows that school-located clinics could expand access to seasonal flu vaccines for children, who are among those most at risk for the flu and its complications. New research shows that school-located clinics could expand access to seasonal flu vaccines for children, who are among those most at risk for the flu and its complications.

The best protection against flu for children at least 6 months of age is the seasonal vaccine, yet vaccination rates among children are low, according to the CDC. Only about 40 percent of children received a 2012-2013 flu vaccine, which is typically provided in a primary-care setting.

“Primary-care practices may not have the capacity to vaccinate all U.S. children against seasonal influenza,” said Byung-Kwang Yoo, an associate professor of public health sciences at UC Davis and lead author of the study. “If the CDC’s recommendations were followed, primary-care offices would have to accommodate 42 million additional patient visits during the five-month window for each flu season.”

The vaccine can be lifesaving, especially for children, who are among those most at risk for the flu and its complications. The CDC reports that 90 percent of children who died from flu during 2012-2013 were not vaccinated. This is why public health experts have made it a priority to identify cost-effective ways to broaden access to flu vaccines for children.

“The flu is a disease with high probability of reaching epidemic levels even though we have an effective vaccine,” said Yoo, who was with the University of Rochester when the study was conducted. “Our goal is to find ways to ensure that the best prevention is as accessible as possible.”

The Monroe County study team conducted a prospective, randomized trial during late 2009 that involved 18 urban and 14 suburban elementary schools with more than 13,000 students in the Rochester, N.Y., area. Two onsite flu vaccination clinics were held four weeks apart at 21 of these schools, with a total student population of 9,027. The remaining 11 schools, with a total of 4,534 students, served as the control-group site where vaccination clinics were not held.

The researchers then compared the overall flu vaccination rates of children enrolled in all schools included in the study. The results showed a 13.2 percentage point increase in vaccination rates among children with access to school-located vaccination clinics.

Because the health department–academic center collaborators had hypothesized that direct-vaccination costs would be lower in onsite school clinics than in traditional pediatric practices, they were at first surprised when their cost analysis revealed the opposite. The per-dose direct cost, $54.26, of onsite school vaccination clinics was — in the first year of the program — higher than the mean, $38.23, or median, $21.44, of the direct cost of flu vaccinations in pediatricians’ offices.

“This is likely because the start-up onsite program required substantial administration time and costs related to obtaining informed consent from parents,” said Yoo.

However, when the analysis considered costs related to taking children to pediatricians’ offices for flu vaccines, the per-dose cost decreased to $19.26, falling below both the mean and median costs of obtaining flu vaccinations in medical practices.

The figure dropped even more substantially — to just $3.90 per dose — when data from the second day of the school-located clinics was excluded from the analysis.

“Participation in the second clinics was much lower, while administration costs remained the same,” said Yoo. “But some children were still vaccinated on the second day, so the team’s next goal is to refine operations.”

The Monroe County team is currently evaluating data from the subsequent 2010-2011 flu season. During that year, vaccination clinics were held only once per school, which may reduce project costs. Currently led by Peter Szilagyi of the University of Rochester, the team is also developing an online consent process to further improve efficiency. If those efforts show savings over traditional flu-vaccine delivery sites, the researchers will propose the school-located vaccination program as a national model for broadening flu prevention.

Byung-Kwang Yoo © UC RegentsByung-Kwang Yoo

Additional authors on the economic evaluation were senior author Maureen Kolasa of the CDC and coauthors Sharon Humiston of Children’s Mercy Hospitals and Clinics in Kansas City, Mo.; Peter Szilagyi and Stanley Schaffer of the University of Rochester School of Medicine and Dentistry; and Christine Long of the University of Rochester Center for Community Health.

The paper, titled “Cost effectiveness analysis of elementary school-located vaccination against influenza — Results from a randomized controlled trial,” is published in the April 17 issue of Vaccine. Copies of the study are available to credentialed journalists by contacting Elsevier’s newsroom at newsroom@elsevier.com or +31 20 4853564.

The research was supported by the CDC (grant U01IP000195) and National Institute of Allergy and Infectious Disease (grant 1K25AI073915).

For more information about flu, visit the CDC’s website at http://www.cdc.gov/flu/keyfacts.htm or the UC Davis Health System website at https://www.ucdmc.ucdavis.edu/medicalcenter/healthtips/2010-2011/02/20110217_spring-flu.html

Vaccine is the pre-eminent journal for those interested in vaccines and vaccination. It is the official journal of The Edward Jenner Society, The International Society for Vaccines and The Japanese Society for Vaccinology. For information, visit www.elsevier.com/locate/vaccine

UC Davis Health System is improving lives and transforming health care by providing excellent patient care, conducting groundbreaking research, fostering innovative, interprofessional education and creating dynamic, productive partnerships with the community. The academic health system includes one of the country's best medical schools, a 619-bed acute-care teaching hospital, a 1,000-member physician's practice group and the new Betty Irene Moore School of Nursing. It is home to a National Cancer Institute-designated comprehensive cancer center, an international neurodevelopmental institute, a stem cell institute and a comprehensive children's hospital. Other nationally prominent centers focus on advancing telemedicine, improving vascular care, eliminating health disparities and translating research findings into new treatments for patients. Together, they make UC Davis a hub of innovation that is transforming health for all. For information, visit healthsystem.ucdavis.edu.


The Anti-Vaccination Movement: Spreading Misconceptions,Fueling Epidemics,Circulating Misinformation | killexams.com real questions and Pass4sure dumps

“Outdated” diseases, such as measles, have affected over 900 people in the past three years in the United States. “Informed” celebrities, such as Dr. Oz, have spread misconceptions about autism in relation to vaccination. One thing’s for certain: “dangerous,” “unchecked,” and “useless” vaccinations are the reasons for the end of polio, measles, smallpox, and pertussis epidemics. At the close of the 18th century, Edward Jenner invented the first vaccine by injecting cowpox-infected bodily fluid into a boy that was infected with the disease. Ever since then, deadly diseases had preventions as soon as ethical, acceptable, and safe vaccines hit the market. For decades and even centuries, people felt privileged to have access to this medical innovation that saved millions of lives internationally. Lately, however, preventable diseases unheard of in decades have resurfaced as a result of the anti-vaccination movement. This movement resulted from citizens of first world countries taking this privilege for granted by believing that diseases such as measles were completely eradicated. Misconceptions about inoculation blew completely out of proportion, ranging from unscientific links with autism to fraudulent anecdotes and studies. Consequently, medical doctors such as Paul Offit have dedicated their lives to eliminating the negative stigma that frequently surrounds immunization. The anti-vaccination movement, fueling misconceptions and catastrophically harming children, threatens the well-being of society. Vaccinations must be reinstated as one of the most valuable and vital modern-day developments of mankind to prevent further denouncement and devaluation incited by skeptics.

On February 28, 1998, an article was published in The Lancet titled, “Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children”Wakefield). The doctor behind the article, Andrew Wakefield, was undoubtedly the man that sparked the autistic side of the anti-vaccine movement. Wakefield was the first to ever publish a study that showed a correlation between autism and vaccination. This experiment was completely disproved and even retracted by the Lancet, but its impact in terms of the anti-vaccine movement was incredibly devastating. The doctor’s data was found fraudulent and falsified, and he was ultimately stripped of his medical license. Scientists, doctors, and medical professionals rejoiced; they thought an era of misconception regarding vaccination was ending rather than beginning.

Despite these findings and former Dr. Wakefield’s complete lack of credibility, popular anti-vaccine figures such as Jenny McCarthy found inspiration in these findings. McCarthy, mother of an autistic son, has been using her child’s diagnosis as a means to win public attention in the anti-vaccination movement. She claims that inoculating her child led to his autism. McCarthy soon became one of the biggest anti-vaccination advocates in the United States, without any feasible evidence behind her autism-vaccine link. This link is a logical fallacy, where a correlation between vaccination and autism is assumed only because both are present in a child. In fact, McCarthy’s son may have autism for another reason--McCarthy’s behaviors and addictions before pregnancy. Maternal drug abuse is directly correlated with autism in babies, which Jenny McCarthy was all too proud to advertise before and during her misconception-propelled anti-vaccination campaign started. For instance, McCarthy referred to herself as a “recovering Catholic,” after trying everything from ecstasy to prescription pills and ultimately getting hooked on Vicodin. These drugs definitely had a negative influence on McCarthy’s son as a growing fetus (Marcus). Although it cannot be stated for certain that her addictions led to his autism, that argument is much more plausible than the one accusing vaccinations. The AAP, or American Academy of Pediatrics, published in a comprehensive vaccine-autism research paper, “Studies do not show any link between autism and MMR vaccine, thimerosal, multiple vaccines given at once, fevers or seizures” (“Vaccines”). Autism Speaks, a charity revolving around improving the quality of life for children and adults diagnosed with autism, claimed, “Each family has a unique experience with an autism diagnosis, and for some it corresponds with the timing of their child’s vaccinations. The results of...research is clear: Vaccines do not cause autism” (“What Causes Autism?”). Evidently, credible sources have denounced the autism-vaccine link as non-existent; even though children are diagnosed with autism around the same time as they are initially inoculated, the two aren’t correlated.

There are undoubtedly side effects to immunization, but they don’t compare to the catastrophic consequences of contracting a deadly virus. Approximately 1 in 3 people report headaches following vaccination, and 1 in 100 even complain of a high fever as a side effect. On the other hand, diseases that vaccines prevent, such as measles, have incredibly worse and usually fatal consequences. A measles contraction starts with a rash that slowly spreads through the entire body. As the rash progresses, the infected have extremely high fevers. Their immune system weakens and they become more susceptible to other deadly infections. In the early 2000s, only about 37 people in the United States died from measles annually. Recently, due to the anti-vaccine there have been almost 650 cases in a year (“Measles”). Minimal side effects of vaccination cannot begin to compare to the devastating consequences of contracting fatal diseases.

Paul Offit, in his book Deadly Choices: How the Anti-Vaccine Movement Threatens Us All, asserts that movements against vaccination are misinformed and consequently dangerous to the well-being of society. Offit, a medical doctor, intelligently refutes every possible argument made against vaccination, provides a variety of anecdotes, and supports every claim he makes with plenty of scientific evidence. He eliminates all arguments against vaccination in order to t stop parents from being misinformed when choosing whether or not to vaccinate, as well as to discourage the further spread of anti-vaccine propaganda on media platforms. Offit attempts to persuade the public to make informed decisions with their children by warning them about the tragic consequences if they don’t. Throughout his book, Offit presents scientists that have made strides towards accurately informing the public about inoculation. Samuel Berkovic, a neurologist, realized the existence of a link between Dravet’s Syndrome and epilepsy following vaccinations. This discovery undermined every media figure, such as Lea Thompson, who claimed that vaccinations caused seizures. Berkovic, however, didn’t get the recognition he deserved for this brilliant medical link in 2006. The neurologists and other informed doctors that worked with him recognized his work as something remarkable, but the people circulating anti-vaccination propaganda continued their fight despite it all. Rorke-Adams, another scientist mentioned by Offit in his research, examined over thirty children whose parents claimed had seizures after vaccinations; every single child she examined ended up having a different reason behind the epilepsy, ranging from vascular disorders to degenerative diseases. As Offit stated, “...despite her expertise, and despite the fact that she has supported her evaluations with cogent, well-researched opinions, Rorke-Adams often finds that petitioners prevail” (Offit 90).

Different types of vaccines are administered depending on the age and maturity level of the child. As a result, herd immunity plays an incredibly important role before the child can receive the shot. Herd immunity, also known as community immunity, occurs when enough people in a group are vaccinated so that the few that aren’t will also be protected. However, as the amount of people not vaccinating grows tremendously, herd immunity decreases at the same rate. Physicians Phoebe Day Danzinger and Rebekah Diamond propose an extreme solution: don’t give the anti-vaxxers a choice. The two doctors wrote, “Neither of us imagined we would devote so much of our time to working with parents who oppose what is arguably the very greatest invention of modern medicine” (Danzinger and Diamond). Furthermore, they assert why there should be no inoculation exemptions, regardless of personal preference or values. The truth is that these diseases put everyone at risk, since immunity is only a valid concept when enough people are immunized. This proposition is one possible solution to the threat of losing community immunity all over the United States.

Some propose a different solution: inform parents before their children are born to give them a better chance of making informed decisions in terms of immunization. Matthew Daley and Jason Glanz, in their Scientific American article “Straight Talk about Vaccination,” consider a variety of ways to inform parents about the importance of vaccination. This includes encouraging a prenatal class or providing a forum for parents to discuss the issue amongst themselves. The most feasible proposal, however, is figuring out a better way for doctors to schedule visits to fully provide parents with information about vaccination. Daley and Glanz also suggest scheduling separate visits for standard prenatal checkups and vaccine information sessions. This would allow doctors to take more time carefully explaining why inoculation shouldn’t be taken lightly. They also acknowledge that often times, misinformation isn’t the parents’ fault, but the media and influences they’ve been surrounded with. Therefore, it is the responsibility of medical professionals to help stop the spread of misconceptions.

1796 was one of the most important years in medical history when the first vaccine came into existence. Its existence for the past couple of centuries has shifted public opinion of it for the worse. A negative stigma now surrounds the word vaccination, as if it’s something dangerous and fatal, rather than the diseases it prevents. Plenty of doctors, including Paul Offit, Rorke-Adams, Day Danzinger, and Rebekah Diamond have heavily advocated for inoculation as a means to keep epidemics from happening. Professionals outweigh the credibility of the likes of Jenny McCarthy and Dr. Oz, who have been serious promoters of the anti-vaccine movement. Vaccination is and continues to be essential in everyday life, from protecting herd immunity to ensuring the safety of children from resurfacing fatal diseases and infections. Overall, the anti-vaccination movement is one sparked by misconceptions and misinformation that must be stopped to keep children healthy and the world epidemic-free.

Works CitedDaley, Matthew F., and Jason M. Glanz. "Straight Talk about Vaccination." Scientific American. 11 Aug. 2011. Web. 30 Mar. 2017.Danziger, Phoebe Day, and Rebekah Diamond. "We Can’t Convince Anti-Vaxxers of Science. We Need to Mandate Vaccination."Slate Magazine. 25 July 2016. Web. 29 Mar. 2017.Marcus, Stephanie. "Jenny McCarthy Ecstasy: Actress Tried To Have Sex With A Tree While On Ecstasy." The Huffington Post. TheHuffingtonPost, 09 Nov. 2012. Web. 28 Mar. 2017."Measles." KidsHealth. Ed. Scott A. Barron. The Nemours Foundation, Feb. 2015. Web. 29 Mar. 2017."Measles Cases and Outbreaks." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 06 Mar. 2017. Web. 27 Mar. 2017.Offit, Paul A. Deadly Choices: How the Anti-vaccine Movement Threatens Us All. New York: Basic , a Member of the Persecus Book Group, 2015. Print."Possible Side-effects from Vaccines." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 02 Dec. 2016. Web. 29 Mar. 2017.U.S. Department of Health and Human Services. "Vaccines" Vaccines. U.S. Department of Health and Human Services, 11 Oct. 2006. Web. 29 Mar. 2017."Vaccines Cause Seizures?: Samuel Berkovic, An Unsung Hero." Parenting Patch. 02 Dec. 2013. Web. 29 Mar. 2017.Wakefield, Andrew. "Ileal-lymphoid-nodular Hyperplasia, Non-specific Colitis, and Pervasive Developmental Disorder in Children." The Lancet. Elsevier Limited, 28 Feb. 1998. Web. 27 Mar. 2017."What Causes Autism?" Autism Speaks. 24 July 2012. Web. 29 Mar. 2017.



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