Lasix 40mg tablet price in canada

COVID-19 has Extra resources evolved rapidly into a pandemic with global lasix 40mg tablet price in canada impacts. However, as the pandemic has developed, it has become increasingly evident that lasix 40mg tablet price in canada the risks of COVID-19, both in terms of infection rates and particularly of severe complications, are not equal across all members of society. While general risk factors for hospital admission with COVID-19 infection include age, male sex and specific comorbidities (eg, cardiovascular disease, hypertension and diabetes), there is increasing evidence that people identifying with Black, Asian and Minority Ethnic (BAME) groupsi have disproportionately higher risks of being adversely affected by COVID-19 in the UK and the USA. The ethnic disparities include overall numbers of cases, as well as the relative numbers of critical care admissions and deaths.1In the area of mental health, for people from BAME groups, even before the current pandemic there were already significant mental health inequalities.2 These inequalities have been increased by the pandemic in several ways lasix 40mg tablet price in canada.

The constraints of quarantine have made access to traditional face-to-face support from mental health services more difficult in general. This difficulty will increase pre-existing inequalities where there are challenges to engaging people in care and in providing lasix 40mg tablet price in canada early access to services. The restrictions may also reduce the flexibility of care offers, given the need for social isolation, limiting non-essential travel and closure of routine clinics. The service impacts are compounded by constraints on the use of non-traditional or alternative routes to care and support.In addition, there is growing evidence of specific mental health consequences from significant COVID-19 infection, with increased rates of not only post-traumatic stress disorder, anxiety and depression, but also specific neuropsychiatric symptoms.3 Given the higher lasix 40mg tablet price in canada risks of mental illnesses and complex care needs among ethnic minorities and also in deprived inner city areas, COVID-19 seems to deliver a double blow.

Physical and mental health vulnerabilities are inextricably linked, especially as a significant proportion of healthcare workers (including in mental health services) in the UK are from BAME groups.Focusing on mental health, there is very little COVID-19-specific guidance on the needs of patients in the BAME group. The risk to staff in general healthcare (including mental healthcare) is a particular concern, and in response, the Royal College of Psychiatrists and NHS England have produced a report on the impact of COVID-19 on BAME staff in mental healthcare settings, with guidance on assessment and management of risk using an associated risk assessment tool for staff.4 5However, there is little formal guidance for the busy clinician in lasix 40mg tablet price in canada balancing different risks for individual mental health patients and treating appropriately. Thus, for example, an inpatient clinician may want to know whether a patient who is older, has additional comorbidities and is from an ethnic background, should be started on one antipsychotic medication or another, or whether treatments such as vitamin D prophylaxis or treatment and venous thromboembolism prevention should be started earlier in the context of the COVID-19 pandemic. While syntheses of the existing guidelines are available about COVID-19 and mental health,6 7 there is nothing specific about the healthcare needs of patients from ethnic minorities during the pandemic.To fill this gap, we propose three core actions that may help:Ensure good information and psychoeducation packages are made available to those with English as a second language, and ensure health beliefs and knowledge lasix 40mg tablet price in canada are based on the best evidence available.

Address culturally grounded explanatory models and illness perceptions lasix 40mg tablet price in canada to allay fears and worry, and ensure timely access to testing and care if needed.Maintain levels of service, flexibility in care packages, and personal relationships with patients and carers from ethnic minority backgrounds in order to continue existing care and to identify changes needed to respond to worsening of mental health.Consider modifications to existing interventions such as psychological therapies and pharmacotherapy. Have a high index of suspicion to take into account emerging physical health problems and the greater risk of serious consequences of COVID-19 in ethnic minority people with pre-existing chronic conditions and vulnerability factors.These actions are based on clinical common sense, but guidance in this area should be provided on the basis of good evidence. There has already been a call for urgent research in the area of COVID-19 and mental health8 lasix 40mg tablet price in canada and also a clear need for specific research focusing on the post-COVID-19 mental health needs of people from the BAME group. Research also needs to recognise the diverse range of different people, with different needs and vulnerabilities, who are grouped under the multidimensional term BAME, including people from different generations, first-time migrants, people from Africa, India, the Caribbean and, more recently, migrants from Eastern Europe.

Application of lasix 40mg tablet price in canada a race equality impact assessment to all research questions and methodology has recently been proposed as a first step in this process.2 At this early stage, the guidance for assessing risks of COVID-19 for health professionals is also useful for patients, until more refined decision support and prediction tools are developed. A recent Public Health England report on ethnic minorities and COVID-199 recommends better recording of ethnicity data in health and social care, and goes further to suggest this should also apply to death certificates. Furthermore, the report recommends more participatory and experience-based research to understand causes and consequences of pre-existing multimorbidity and COVID-19 infection, integrated care systems that work well for susceptible and marginalised groups, culturally competent health promotion, prevention and occupational risk assessments, and recovery strategies to mitigate the risks of widening inequalities as we come out of restrictions.Primary data collection will need to cover not only hospital admissions but also lasix 40mg tablet price in canada data from primary care, linking information on mental health, COVID-19 and ethnicity. We already have research and specific guidance emerging on other risk factors, such as age and gender.

Now we also need lasix 40mg tablet price in canada to focus on an equally important aspect of vulnerability. As clinicians, we need to balance the relative risks for each of our patients, so that we can act promptly and proactively in response to their individual needs.10 For this, we need evidence-based guidance to ensure we are balancing every risk appropriately and without bias.Footnotei While we have used the term ‘people identifying with BAME groups’, we recognise that this is a multidimensional group and includes vast differences in culture, identity, heritage and histories contained within this abbreviated term..

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Start Preamble Notice of amendment lasix 40mg price. The Secretary issues this amendment pursuant to section 319F-3 of the Public Health Service Act to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures. This amendment to the lasix 40mg price Declaration published on March 17, 2020 (85 FR 15198) is effective as of August 24, 2020. Start Further Info Robert P.

Kadlec, MD, lasix 40mg price MTM&H, MS, Assistant Secretary for Preparedness and Response, Office of the Secretary, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201. Telephone. 202-205-2882. End Further Info End Preamble Start Supplemental Information The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of Health and Human Services (the Secretary) to issue a Declaration to provide liability immunity to certain individuals and entities (Covered Persons) against any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures (Covered Countermeasures), except for claims involving “willful misconduct” as defined in the PREP Act.

Under the PREP Act, a Declaration may be amended as circumstances warrant. The PREP Act was enacted on December 30, 2005, as Public Law 109-148, Division C, § 2. It amended the Public Health Service (PHS) Act, adding section 319F-3, which addresses liability immunity, and section 319F-4, which creates a compensation program. These sections are codified at 42 U.S.C.

247d-6d and 42 U.S.C. 247d-6e, respectively. Section 319F-3 of the PHS Act has been amended by the Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013 and the Coronavirus Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, Start Printed Page 521372020, to expand Covered Countermeasures under the PREP Act. On January 31, 2020, the Secretary declared a public health emergency pursuant to section 319 of the PHS Act, 42 U.S.C.

247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the COVID-19 outbreak. Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration on April 26, 2020, and July 25, 2020. On March 10, 2020, the Secretary issued a Declaration under the PREP Act for medical countermeasures against COVID-19 (85 FR 15198, Mar. 17, 2020) (the Declaration).

On April 10, the Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES Act (85 FR 21012, Apr. 15, 2020). On June 4, the Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm COVID-19 might otherwise cause. The Secretary now amends section V of the Declaration to identify as qualified persons covered under the PREP Act, and thus authorizes, certain State-licensed pharmacists to order and administer, and pharmacy interns (who are licensed or registered by their State board of pharmacy and acting under the supervision of a State-licensed pharmacist) to administer, any vaccine that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule (ACIP-recommended vaccines).[] The Secretary also amends section VIII of the Declaration to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures includes not only COVID-19 caused by SARS-CoV-2 or a virus mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by COVID-19, SARS-CoV-2, or a virus mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases.

Description of This Amendment by Section Section V. Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under subsection (b) has been issued with respect to such countermeasure. €œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed. Or (B) “a person within a category of persons so identified in a declaration by the Secretary” under subsection (b) of the PREP Act.

42 U.S.C. 247d-6d(i)(8).[] By this amendment to the Declaration, the Secretary identifies an additional category of persons who are qualified persons under section 247d-6d(i)(8)(B).[] On May 8, 2020, CDC reported, “The identified declines in routine pediatric vaccine ordering and doses administered might indicate that U.S. Children and their communities face increased risks for outbreaks of vaccine-preventable diseases,” and suggested that a decrease in rates of routine childhood vaccinations were due to changes in healthcare access, social distancing, and other COVID-19 mitigation strategies.[] The report also stated that “[p]arental concerns about potentially exposing their children to COVID-19 during well child visits might contribute to the declines observed.” [] On July 10, 2020, CDC reported its findings of a May survey it conducted to assess the capacity of pediatric health care practices to provide immunization services to children during the COVID-19 pandemic. The survey, which was limited to practices participating in the Vaccines for Children program, found that, as of mid-May, 15 percent of Northeast pediatric practices were closed, 12.5 percent of Midwest practices were closed, 6.2 percent of practices in the South were closed, and 10 percent of practices in the West were closed.

Most practices had reduced office hours for in-person visits. When asked whether their practices would likely be able to accommodate new patients for immunization services through August, 418 practices (21.3 percent) either responded that this was not likely or the practice was permanently closed or not resuming immunization services for all patients, and 380 (19.6 percent) responded that they were unsure. Urban practices and those in the Northeast were less likely to be able to accommodate new patients compared with rural practices and those in the South, Midwest, or West.[] In response to these troubling developments, CDC and the American Academy of Pediatrics have stressed, “Well-child visits and vaccinations are essential services and help make sure children are protected.” [] The Secretary re-emphasizes that important recommendation to parents and legal guardians here. If your child is due for a well-child visit, contact your pediatrician's or other primary-care provider's office and ask about ways that the office safely offers well-child visits and vaccinations.

Many medical offices are taking extra steps to make sure that well-child visits can occur safely during the COVID-19 pandemic, including. Scheduling sick visits and well-child visits during different times of the Start Printed Page 52138day or days of the week, or at different locations. Asking patients to remain outside until it is time for their appointments to reduce the number of people in waiting rooms. Adhering to recommended social (physical) distancing and other infection-control practices, such as the use of masks.

The decrease in childhood-vaccination rates is a public health threat and a collateral harm caused by COVID-19. Together, the United States must turn to available medical professionals to limit the harm and public health threats that may result from decreased immunization rates. We must quickly do so to avoid preventable infections in children, additional strains on our healthcare system, and any further increase in avoidable adverse health consequences—particularly if such complications coincide with additional resurgence of COVID-19. Together with pediatricians and other healthcare professionals, pharmacists are positioned to expand access to childhood vaccinations.

Many States already allow pharmacists to administer vaccines to children of any age.[] Other States permit pharmacists to administer vaccines to children depending on the age—for example, 2, 3, 5, 6, 7, 9, 10, 11, or 12 years of age and older.[] Few States restrict pharmacist-administered vaccinations to only adults.[] Many States also allow properly trained individuals under the supervision of a trained pharmacist to administer those vaccines.[] Pharmacists are well positioned to increase access to vaccinations, particularly in certain areas or for certain populations that have too few pediatricians and other primary-care providers, or that are otherwise medically underserved.[] As of 2018, nearly 90 percent of Americans lived within five miles of a community pharmacy.[] Pharmacies often offer extended hours and added convenience. What is more, pharmacists are trusted healthcare professionals with established relationships with their patients. Pharmacists also have strong relationships with local medical providers and hospitals to refer patients as appropriate. For example, pharmacists already play a significant role in annual influenza vaccination.

In the early 2018-19 season, they administered the influenza vaccine to nearly a third of all adults who received the vaccine.[] Given the potential danger of serious influenza and continuing COVID-19 outbreaks this autumn and the impact that such concurrent outbreaks may have on our population, our healthcare system, and our whole-of-nation response to the COVID-19 pandemic, we must quickly expand access to influenza vaccinations. Allowing more qualified pharmacists to administer the influenza vaccine to children will make vaccinations more accessible. Therefore, the Secretary amends the Declaration to identify State-licensed pharmacists (and pharmacy interns acting under their supervision if the pharmacy intern is licensed or registered by his or her State board of pharmacy) as qualified persons under section 247d-6d(i)(8)(B) when the pharmacist orders and either the pharmacist or the supervised pharmacy intern administers vaccines to individuals ages three through 18 pursuant to the following requirements. The vaccine must be FDA-authorized or FDA-approved.

The vaccination must be ordered and administered according to ACIP's standard immunization schedule.[] The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training Start Printed Page 52139program must include hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines.[] The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines.[] The licensed pharmacist and licensed or registered pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation.[] The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.[] The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers vaccines, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (vaccine registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a vaccine must review the vaccine registry or other vaccination records prior to administering a vaccine.[] The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregivers accompanying the children of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate.[] These requirements are consistent with those in many States that permit licensed pharmacists to order and administer vaccines to children and permit licensed or registered pharmacy interns acting under their supervision to administer vaccines to children.[] Administering vaccinations to children age three and older is less complicated and requires less training and resources than administering vaccinations to younger children. That is because ACIP generally recommends administering intramuscular injections in the deltoid muscle for individuals age three and older.[] For individuals less than three years of age, ACIP generally recommends administering intramuscular injections in the anterolateral aspect of the thigh muscle.[] Administering injections in the thigh muscle often presents additional complexities and requires additional training and resources including additional personnel to safely position the child while another healthcare professional injects the vaccine.[] Moreover, as of 2018, 40% of three-year-olds were enrolled in preprimary programs (i.e.

Preschool or kindergarten programs).[] Preprimary programs are beginning in the coming weeks or months, so the Secretary has concluded that it is particularly important for individuals ages three through 18 to receive ACIP-recommended vaccines according to ACIP's standard immunization schedule. All States require children to be vaccinated against certain communicable diseases as a condition of school attendance. These laws often apply to both public and private schools with identical immunization and exemption provisions.[] As nurseries, preschools, kindergartens, and schools reopen, increased access to childhood vaccinations is essential to ensuring children can return. Notwithstanding any State or local scope-of-practice legal requirements, (1) qualified licensed pharmacists are identified as qualified persons to order and administer ACIP-recommended vaccines and (2) qualified State-licensed or registered pharmacy interns are identified as qualified persons to administer the ACIP-recommended vaccines ordered by their supervising qualified licensed pharmacist.[] Both the PREP Act and the June 4, 2020 Second Amendment to the Declaration define “covered countermeasures” to include qualified pandemic and epidemic products that “limit the harm such pandemic or epidemic might otherwise cause.” [] The troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by Start Printed Page 52140COVID-19 as set forth in Sections VI and VIII of this Declaration.[] Hence, such vaccinations are “covered countermeasures” under the PREP Act and the June 4, 2020 Second Amendment to the Declaration.

Nothing in this Declaration shall be construed to affect the National Vaccine Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National Vaccine Injury Compensation Program authorized under 42 U.S.C. 300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program.

All other terms and conditions of the Declaration apply to such covered countermeasures. Section VIII. Category of Disease, Health Condition, or Threat As discussed, the troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by COVID-19. The Secretary therefore amends section VIII, which describes the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures, to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures is not only COVID-19 caused by SARS-CoV-2 or a virus mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by COVID-19, SARS-CoV-2, or a virus mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases.

Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against COVID-19. Sections V and VIII of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against COVID-19, as amended April 10, 2020 and June 4, 2020, are further amended pursuant to section 319F-3(b)(4) of the PHS Act as described below. All other sections of the Declaration remain in effect as published at 85 FR 15198 (Mar. 17, 2020) and amended at 85 FR 21012 (Apr.

15, 2020) and 85 FR 35100 (June 8, 2020). 1. Covered Persons, section V, delete in full and replace with. V.

Covered Persons 42 U.S.C. 247d-6d(i)(2), (3), (4), (6), (8)(A) and (B) Covered Persons who are afforded liability immunity under this Declaration are “manufacturers,” “distributors,” “program planners,” “qualified persons,” and their officials, agents, and employees, as those terms are defined in the PREP Act, and the United States. In addition, I have determined that the following additional persons are qualified persons. (a) Any person authorized in accordance with the public health and medical emergency response of the Authority Having Jurisdiction, as described in Section VII below, to prescribe, administer, deliver, distribute or dispense the Covered Countermeasures, and their officials, agents, employees, contractors and volunteers, following a Declaration of an emergency.

(b) any person authorized to prescribe, administer, or dispense the Covered Countermeasures or who is otherwise authorized to perform an activity under an Emergency Use Authorization in accordance with Section 564 of the FD&C Act. (c) any person authorized to prescribe, administer, or dispense Covered Countermeasures in accordance with Section 564A of the FD&C Act. And (d) a State-licensed pharmacist who orders and administers, and pharmacy interns who administer (if the pharmacy intern acts under the supervision of such pharmacist and the pharmacy intern is licensed or registered by his or her State board of pharmacy), vaccines that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule. Such State-licensed pharmacists and the State-licensed or registered interns under their supervision are qualified persons only if the following requirements are met.

The vaccine must be FDA-authorized or FDA-approved. The vaccination must be ordered and administered according to ACIP's standard immunization schedule. The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines.

The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines. The licensed pharmacist and licensed or registered pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.

The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers vaccines, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (vaccine registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a vaccine must review the vaccine registry or other vaccination records prior to administering a vaccine. The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate. Nothing in this Declaration shall be construed to affect the National Vaccine Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National Vaccine Injury Compensation Program authorized under 42 U.S.C.

300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other Start Printed Page 52141terms and conditions of the Declaration apply to such covered countermeasures. 2.

Category of Disease, Health Condition, or Threat, section VIII, delete in full and replace with. VIII. Category of Disease, Health Condition, or Threat 42 U.S.C. 247d-6d(b)(2)(A) The category of disease, health condition, or threat for which I recommend the administration or use of the Covered Countermeasures is not only COVID-19 caused by SARS-CoV-2 or a virus mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by COVID-19, SARS-CoV-2, or a virus mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases.

Start Authority 42 U.S.C. 247d-6d. End Authority Start Signature Dated. August 19, 2020.

Alex M. Azar II, Secretary of Health and Human Services. End Signature End Supplemental Information [FR Doc. 2020-18542 Filed 8-20-20.

4:15 pm]BILLING CODE 4150-03-PToday, the U.S. Department of Health and Human Services released Healthy People 2030, the nation's 10-year plan for addressing our most critical public health priorities and challenges. Since 1980, HHS's Office of Disease Prevention and Health Promotion has set measurable objectives and targets to improve the health and well-being of the nation.This decade, Healthy People 2030 features 355 core – or measurable – objectives with 10-year targets, new objectives related to opioid use disorder and youth e-cigarette use, and resources for adapting Healthy People 2030 to emerging public health threats like COVID-19. For the first time, Healthy People 2030 also sets 10-year targets for objectives related to social determinants of health."Healthy People was the first national effort to lay out a set of data-driven priorities for health improvement," said HHS Secretary Alex Azar.

"Healthy People 2030 adopts a more focused set of objectives and more rigorous data standards to help the federal government and all of our partners deliver results on these important goals over the next decade."Healthy People has led the nation with its focus on social determinants of health, and continues to prioritize economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context as factors that influence health. Healthy People 2030 also continues to prioritize health disparities, health equity, and health literacy."Now more than ever, we need programs like Healthy People that set a shared vision for a healthier nation, where all people can achieve their full potential for health and well-being across the lifespan," said ADM Brett P. Giroir, MD, Assistant Secretary for Health. "COVID-19 has brought the importance of public health to the forefront of our national dialogue.

Achieving Healthy People 2030's vision would help the United States become more resilient to public health threats like COVID-19."Healthy People 2030 emphasizes collaboration, with objectives and targets that span multiple sectors. A federal advisory committee of 13 external thought leaders and a workgroup of subject matter experts from more than 20 federal agencies contributed to Healthy People 2030, along with public comments received throughout the development process.The HHS Office of Disease Prevention and Health Promotion leads Healthy People in partnership with the National Center for Health Statistics at the Centers for Disease Control and Prevention, which oversees data in support of the initiative.HHS Secretary Alex M. Azar II, ADM Brett P. Giroir, MD, Assistant Secretary for Health, and U.S.

Surgeon General Jerome M. Adams, MD, MPH, and others from HHS and CDC will launch Healthy People 2030 during a webcast on August 18 at 1 pm (EDT) at https://www.hhs.gov/live. No registration is necessary. For more information about Healthy People 2030, visit https://healthypeople.gov..

Start Preamble lasix 40mg tablet price in canada Notice of amendment. The Secretary issues this amendment pursuant to section 319F-3 of the Public Health Service Act to add additional categories of Qualified Persons and amend the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures. This amendment to the Declaration published on lasix 40mg tablet price in canada March 17, 2020 (85 FR 15198) is effective as of August 24, 2020. Start Further Info Robert P. Kadlec, MD, MTM&H, MS, Assistant Secretary for Preparedness and lasix 40mg tablet price in canada Response, Office of the Secretary, Department of Health and Human Services, 200 Independence Avenue SW, Washington, DC 20201.

Telephone. 202-205-2882. End Further Info End Preamble Start Supplemental Information The Public Readiness and Emergency Preparedness Act (PREP Act) authorizes the Secretary of Health and Human Services (the Secretary) to issue a Declaration to provide liability immunity to certain individuals and entities (Covered Persons) against any claim of loss caused by, arising out of, relating to, or resulting from the manufacture, distribution, administration, or use of medical countermeasures (Covered Countermeasures), except for claims involving “willful misconduct” as defined in the PREP Act. Under the PREP Act, a Declaration may be amended as circumstances warrant. The PREP Act was enacted on December 30, 2005, as Public Law 109-148, Division C, § 2.

It amended the Public Health Service (PHS) Act, adding section 319F-3, which addresses liability immunity, and section 319F-4, which creates a compensation program. These sections are codified at 42 U.S.C. 247d-6d and 42 U.S.C. 247d-6e, respectively. Section 319F-3 of the PHS Act has been amended by the Pandemic and All-Hazards Preparedness Reauthorization Act (PAHPRA), Public Law 113-5, enacted on March 13, 2013 and the Coronavirus Aid, Relief, and Economic Security (CARES) Act, Public Law 116-136, enacted on March 27, Start Printed Page 521372020, to expand Covered Countermeasures under the PREP Act.

On January 31, 2020, the Secretary declared a public health emergency pursuant to section 319 of the PHS Act, 42 U.S.C. 247d, effective January 27, 2020, for the entire United States to aid in the response of the nation's health care community to the COVID-19 outbreak. Pursuant to section 319 of the PHS Act, the Secretary renewed that declaration on April 26, 2020, and July 25, 2020. On March 10, 2020, the Secretary issued a Declaration under the PREP Act for medical countermeasures against COVID-19 (85 FR 15198, Mar. 17, 2020) (the Declaration).

On April 10, the Secretary amended the Declaration under the PREP Act to extend liability immunity to covered countermeasures authorized under the CARES Act (85 FR 21012, Apr. 15, 2020). On June 4, the Secretary amended the Declaration to clarify that covered countermeasures under the Declaration include qualified countermeasures that limit the harm COVID-19 might otherwise cause. The Secretary now amends section V of the Declaration to identify as qualified persons covered under the PREP Act, and thus authorizes, certain State-licensed pharmacists to order and administer, and pharmacy interns (who are licensed or registered by their State board of pharmacy and acting under the supervision of a State-licensed pharmacist) to administer, any vaccine that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule (ACIP-recommended vaccines).[] The Secretary also amends section VIII of the Declaration to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures includes not only COVID-19 caused by SARS-CoV-2 or a virus mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by COVID-19, SARS-CoV-2, or a virus mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Description of This Amendment by Section Section V.

Covered Persons Under the PREP Act and the Declaration, a “qualified person” is a “covered person.” Subject to certain limitations, a covered person is immune from suit and liability under Federal and State law with respect to all claims for loss caused by, arising out of, relating to, or resulting from the administration or use of a covered countermeasure if a declaration under subsection (b) has been issued with respect to such countermeasure. €œQualified person” includes (A) a licensed health professional or other individual who is authorized to prescribe, administer, or dispense such countermeasures under the law of the State in which the countermeasure was prescribed, administered, or dispensed. Or (B) “a person within a category of persons so identified in a declaration by the Secretary” under subsection (b) of the PREP Act. 42 U.S.C. 247d-6d(i)(8).[] By this amendment to the Declaration, the Secretary identifies an additional category of persons who are qualified persons under section 247d-6d(i)(8)(B).[] On May 8, 2020, CDC reported, “The identified declines in routine pediatric vaccine ordering and doses administered might indicate that U.S.

Children and their communities face increased risks for outbreaks of vaccine-preventable diseases,” and suggested that a decrease in rates of routine childhood vaccinations were due to changes in healthcare access, social distancing, and other COVID-19 mitigation strategies.[] The report also stated that “[p]arental concerns about potentially exposing their children to COVID-19 during well child visits might contribute to the declines observed.” [] On July 10, 2020, CDC reported its findings of a May survey it conducted to assess the capacity of pediatric health care practices to provide immunization services to children during the COVID-19 pandemic. The survey, which was limited to practices participating in the Vaccines for Children program, found that, as of mid-May, 15 percent of Northeast pediatric practices were closed, 12.5 percent of Midwest practices were closed, 6.2 percent of practices in the South were closed, and 10 percent of practices in the West were closed. Most practices had reduced office hours for in-person visits. When asked whether their practices would likely be able to accommodate new patients for immunization services through August, 418 practices (21.3 percent) either responded that this was not likely or the practice was permanently closed or not resuming immunization services for all patients, and 380 (19.6 percent) responded that they were unsure. Urban practices and those in the Northeast were less likely to be able to accommodate new patients compared with rural practices and those in the South, Midwest, or West.[] In response to these troubling developments, CDC and the American Academy of Pediatrics have stressed, “Well-child visits and vaccinations are essential services and help make sure children are protected.” [] The Secretary re-emphasizes that important recommendation to parents and legal guardians here.

If your child is due for a well-child visit, contact your pediatrician's or other primary-care provider's office and ask about ways that the office safely offers well-child visits and vaccinations. Many medical offices are taking extra steps to make sure that well-child visits can occur safely during the COVID-19 pandemic, including. Scheduling sick visits and well-child visits during different times of the Start Printed Page 52138day or days of the week, or at different locations. Asking patients to remain outside until it is time for their appointments to reduce the number of people in waiting rooms. Adhering to recommended social (physical) distancing and other infection-control practices, such as the use of masks.

The decrease in childhood-vaccination rates is a public health threat and a collateral harm caused by COVID-19. Together, the United States must turn to available medical professionals to limit the harm and public health threats that may result from decreased immunization rates. We must quickly do so to avoid preventable infections in children, additional strains on our healthcare system, and any further increase in avoidable adverse health consequences—particularly if such complications coincide with additional resurgence of COVID-19. Together with pediatricians and other healthcare professionals, pharmacists are positioned to expand access to childhood vaccinations. Many States already allow pharmacists to administer vaccines to children of any age.[] Other States permit pharmacists to administer vaccines to children depending on the age—for example, 2, 3, 5, 6, 7, 9, 10, 11, or 12 years of age and older.[] Few States restrict pharmacist-administered vaccinations to only adults.[] Many States also allow properly trained individuals under the supervision of a trained pharmacist to administer those vaccines.[] Pharmacists are well positioned to increase access to vaccinations, particularly in certain areas or for certain populations that have too few pediatricians and other primary-care providers, or that are otherwise medically underserved.[] As of 2018, nearly 90 percent of Americans lived within five miles of a community pharmacy.[] Pharmacies often offer extended hours and added convenience.

What is more, pharmacists are trusted healthcare professionals with established relationships with their patients. Pharmacists also have strong relationships with local medical providers and hospitals to refer patients as appropriate. For example, pharmacists already play a significant role in annual influenza vaccination. In the early 2018-19 season, they administered the influenza vaccine to nearly a third of all adults who received the vaccine.[] Given the potential danger of serious influenza and continuing COVID-19 outbreaks this autumn and the impact that such concurrent outbreaks may have on our population, our healthcare system, and our whole-of-nation response to the COVID-19 pandemic, we must quickly expand access to influenza vaccinations. Allowing more qualified pharmacists to administer the influenza vaccine to children will make vaccinations more accessible.

Therefore, the Secretary amends the Declaration to identify State-licensed pharmacists (and pharmacy interns acting under their supervision if the pharmacy intern is licensed or registered by his or her State board of pharmacy) as qualified persons under section 247d-6d(i)(8)(B) when the pharmacist orders and either the pharmacist or the supervised pharmacy intern administers vaccines to individuals ages three through 18 pursuant to the following requirements. The vaccine must be FDA-authorized or FDA-approved. The vaccination must be ordered and administered according to ACIP's standard immunization schedule.[] The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training Start Printed Page 52139program must include hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines.[] The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines.[] The licensed pharmacist and licensed or registered pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation.[] The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period.[] The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers vaccines, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (vaccine registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a vaccine must review the vaccine registry or other vaccination records prior to administering a vaccine.[] The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregivers accompanying the children of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate.[] These requirements are consistent with those in many States that permit licensed pharmacists to order and administer vaccines to children and permit licensed or registered pharmacy interns acting under their supervision to administer vaccines to children.[] Administering vaccinations to children age three and older is less complicated and requires less training and resources than administering vaccinations to younger children.

That is because ACIP generally recommends administering intramuscular injections in the deltoid muscle for individuals age three and older.[] For individuals less than three years of age, ACIP generally recommends administering intramuscular injections in the anterolateral aspect of the thigh muscle.[] Administering injections in the thigh muscle often presents additional complexities and requires additional training and resources including additional personnel to safely position the child while another healthcare professional injects the vaccine.[] Moreover, as of 2018, 40% of three-year-olds were enrolled in preprimary programs (i.e. Preschool or kindergarten programs).[] Preprimary programs are beginning in the coming weeks or months, so the Secretary has concluded that it is particularly important for individuals ages three through 18 to receive ACIP-recommended vaccines according to ACIP's standard immunization schedule. All States require children to be vaccinated against certain communicable diseases as a condition of school attendance. These laws often apply to both public and private schools with identical immunization and exemption provisions.[] As nurseries, preschools, kindergartens, and schools reopen, increased access to childhood vaccinations is essential to ensuring children can return. Notwithstanding any State or local scope-of-practice legal requirements, (1) qualified licensed pharmacists are identified as qualified persons to order and administer ACIP-recommended vaccines and (2) qualified State-licensed or registered pharmacy interns are identified as qualified persons to administer the ACIP-recommended vaccines ordered by their supervising qualified licensed pharmacist.[] Both the PREP Act and the June 4, 2020 Second Amendment to the Declaration define “covered countermeasures” to include qualified pandemic and epidemic products that “limit the harm such pandemic or epidemic might otherwise cause.” [] The troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by Start Printed Page 52140COVID-19 as set forth in Sections VI and VIII of this Declaration.[] Hence, such vaccinations are “covered countermeasures” under the PREP Act and the June 4, 2020 Second Amendment to the Declaration.

Nothing in this Declaration shall be construed to affect the National Vaccine Injury Compensation Program, including an injured party's ability to obtain compensation under that program. Covered countermeasures that are subject to the National Vaccine Injury Compensation Program authorized under 42 U.S.C. 300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other terms and conditions of the Declaration apply to such covered countermeasures.

Section VIII. Category of Disease, Health Condition, or Threat As discussed, the troubling decrease in ACIP-recommended childhood vaccinations and the resulting increased risk of associated diseases, adverse health conditions, and other threats are categories of harms otherwise caused by COVID-19. The Secretary therefore amends section VIII, which describes the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures, to clarify that the category of disease, health condition, or threat for which he recommends the administration or use of the Covered Countermeasures is not only COVID-19 caused by SARS-CoV-2 or a virus mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by COVID-19, SARS-CoV-2, or a virus mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Amendments to Declaration Amended Declaration for Public Readiness and Emergency Preparedness Act Coverage for medical countermeasures against COVID-19. Sections V and VIII of the March 10, 2020 Declaration under the PREP Act for medical countermeasures against COVID-19, as amended April 10, 2020 and June 4, 2020, are further amended pursuant to section 319F-3(b)(4) of the PHS Act as described below.

All other sections of the Declaration remain in effect as published at 85 FR 15198 (Mar. 17, 2020) and amended at 85 FR 21012 (Apr. 15, 2020) and 85 FR 35100 (June 8, 2020). 1. Covered Persons, section V, delete in full and replace with.

V. Covered Persons 42 U.S.C. 247d-6d(i)(2), (3), (4), (6), (8)(A) and (B) Covered Persons who are afforded liability immunity under this Declaration are “manufacturers,” “distributors,” “program planners,” “qualified persons,” and their officials, agents, and employees, as those terms are defined in the PREP Act, and the United States. In addition, I have determined that the following additional persons are qualified persons. (a) Any person authorized in accordance with the public health and medical emergency response of the Authority Having Jurisdiction, as described in Section VII below, to prescribe, administer, deliver, distribute or dispense the Covered Countermeasures, and their officials, agents, employees, contractors and volunteers, following a Declaration of an emergency.

(b) any person authorized to prescribe, administer, or dispense the Covered Countermeasures or who is otherwise authorized to perform an activity under an Emergency Use Authorization in accordance with Section 564 of the FD&C Act. (c) any person authorized to prescribe, administer, or dispense Covered Countermeasures in accordance with Section 564A of the FD&C Act. And (d) a State-licensed pharmacist who orders and administers, and pharmacy interns who administer (if the pharmacy intern acts under the supervision of such pharmacist and the pharmacy intern is licensed or registered by his or her State board of pharmacy), vaccines that the Advisory Committee on Immunization Practices (ACIP) recommends to persons ages three through 18 according to ACIP's standard immunization schedule. Such State-licensed pharmacists and the State-licensed or registered interns under their supervision are qualified persons only if the following requirements are met. The vaccine must be FDA-authorized or FDA-approved.

The vaccination must be ordered and administered according to ACIP's standard immunization schedule. The licensed pharmacist must complete a practical training program of at least 20 hours that is approved by the Accreditation Council for Pharmacy Education (ACPE). This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines. The licensed or registered pharmacy intern must complete a practical training program that is approved by the ACPE. This training program must include hands-on injection technique, clinical evaluation of indications and contraindications of vaccines, and the recognition and treatment of emergency reactions to vaccines.

The licensed pharmacist and licensed or registered pharmacy intern must have a current certificate in basic cardiopulmonary resuscitation. The licensed pharmacist must complete a minimum of two hours of ACPE-approved, immunization-related continuing pharmacy education during each State licensing period. The licensed pharmacist must comply with recordkeeping and reporting requirements of the jurisdiction in which he or she administers vaccines, including informing the patient's primary-care provider when available, submitting the required immunization information to the State or local immunization information system (vaccine registry), complying with requirements with respect to reporting adverse events, and complying with requirements whereby the person administering a vaccine must review the vaccine registry or other vaccination records prior to administering a vaccine. The licensed pharmacist must inform his or her childhood-vaccination patients and the adult caregiver accompanying the child of the importance of a well-child visit with a pediatrician or other licensed primary-care provider and refer patients as appropriate. Nothing in this Declaration shall be construed to affect the National Vaccine Injury Compensation Program, including an injured party's ability to obtain compensation under that program.

Covered countermeasures that are subject to the National Vaccine Injury Compensation Program authorized under 42 U.S.C. 300aa-10 et seq. Are covered under this Declaration for the purposes of liability immunity and injury compensation only to the extent that injury compensation is not provided under that Program. All other Start Printed Page 52141terms and conditions of the Declaration apply to such covered countermeasures. 2.

Category of Disease, Health Condition, or Threat, section VIII, delete in full and replace with. VIII. Category of Disease, Health Condition, or Threat 42 U.S.C. 247d-6d(b)(2)(A) The category of disease, health condition, or threat for which I recommend the administration or use of the Covered Countermeasures is not only COVID-19 caused by SARS-CoV-2 or a virus mutating therefrom, but also other diseases, health conditions, or threats that may have been caused by COVID-19, SARS-CoV-2, or a virus mutating therefrom, including the decrease in the rate of childhood immunizations, which will lead to an increase in the rate of infectious diseases. Start Authority 42 U.S.C.

247d-6d. End Authority Start Signature Dated. August 19, 2020. Alex M. Azar II, Secretary of Health and Human Services.

End Signature End Supplemental Information [FR Doc. 2020-18542 Filed 8-20-20. 4:15 pm]BILLING CODE 4150-03-PToday, the U.S. Department of Health and Human Services released Healthy People 2030, the nation's 10-year plan for addressing our most critical public health priorities and challenges. Since 1980, HHS's Office of Disease Prevention and Health Promotion has set measurable objectives and targets to improve the health and well-being of the nation.This decade, Healthy People 2030 features 355 core – or measurable – objectives with 10-year targets, new objectives related to opioid use disorder and youth e-cigarette use, and resources for adapting Healthy People 2030 to emerging public health threats like COVID-19.

For the first time, Healthy People 2030 also sets 10-year targets for objectives related to social determinants of health."Healthy People was the first national effort to lay out a set of data-driven priorities for health improvement," said HHS Secretary Alex Azar. "Healthy People 2030 adopts a more focused set of objectives and more rigorous data standards to help the federal government and all of our partners deliver results on these important goals over the next decade."Healthy People has led the nation with its focus on social determinants of health, and continues to prioritize economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context as factors that influence health. Healthy People 2030 also continues to prioritize health disparities, health equity, and health literacy."Now more than ever, we need programs like Healthy People that set a shared vision for a healthier nation, where all people can achieve their full potential for health and well-being across the lifespan," said ADM Brett P. Giroir, MD, Assistant Secretary for Health. "COVID-19 has brought the importance of public health to the forefront of our national dialogue.

Achieving Healthy People 2030's vision would help the United States become more resilient to public health threats like COVID-19."Healthy People 2030 emphasizes collaboration, with objectives and targets that span multiple sectors. A federal advisory committee of 13 external thought leaders and a workgroup of subject matter experts from more than 20 federal agencies contributed to Healthy People 2030, along with public comments received throughout the development process.The HHS Office of Disease Prevention and Health Promotion leads Healthy People in partnership with the National Center for Health Statistics at the Centers for Disease Control and Prevention, which oversees data in support of the initiative.HHS Secretary Alex M. Azar II, ADM Brett P. Giroir, MD, Assistant Secretary for Health, and U.S. Surgeon General Jerome M.

Adams, MD, MPH, and others from HHS and CDC will launch Healthy People 2030 during a webcast on August 18 at 1 pm (EDT) at https://www.hhs.gov/live. No registration is necessary. For more information about Healthy People 2030, visit https://healthypeople.gov..

What may interact with Lasix?

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

Does lasix lower your blood pressure

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Father and son, Paolo and does lasix lower your blood pressure Giovanni Camici talk to CardioPulse about you could try this out what brings them together and what sets them apart Paolo Camici MD is Professor of Cardiology at the Vita-Salute University San Raffaele in Milan, Italy. He previously held several senior roles in a long association with Hammersmith Hospital and Imperial College, London, UK.‘I was born in Genoa, a port in the north west of Italy and perhaps because of this I have always been attached to the sea and enjoyed water sports. My father was an ophthalmologist, my uncle was an internist, and my grandfather was a does lasix lower your blood pressure general practitioner.

Whenever the family got together around the table for Sunday lunch, they would always be talking about medicine, so its in my blood.When I was around four or five, my father was keen to go back to his native Tuscany, so we moved to Pisa and I completed my education in a liceo classico. When it came to university, it seemed as natural as breathing does lasix lower your blood pressure to go into medicine and I enrolled at medical school in Pisa. After gaining my medical degree I was not sure what I wanted to do.

Psychiatry was popular at that time, but after a 6-month internship, I decided I did not want to be a psychiatrist. I was quite interested in research and physiology and I got an interview with Luigi Donato, a well-known professor for a position at the new does lasix lower your blood pressure Institute of Clinical Physiology at the University of Pisa. I was offered a job and assigned to Attilio Maseri who suggested I work with cardiologist Antonio L’Abbate.

It was here that I spent several years while doing my internship in cardiology and internal medicine.In the late 1960s, I first visited London as a tourist which was a big thing does lasix lower your blood pressure for me as the city was the centre of everything at that time and I was a huge fan of rock music and sang in a band. I later returned to the city in 1977 to train in clinical pharmacology, then in 1980 Maseri announced that he was leaving Pisa for London and a professorship at Hammersmith Hospital. This was a big blow to me as he was a big influence, so the following year, I began to commute between London and Pisa to carry out research.

I got to know physicist Terry Jones who does lasix lower your blood pressure oversaw the cyclotron unit at Hammersmith Hospital and in 1990 he called me to say they were opening a new group for PET in cardiology and needed a young leader ready to come to London. It took about 10 s to say yes, and I took leave from my assistant professorship at Pisa and moved to London where I eventually received a Medical Research Council (MRC) tenure and was appointed to a professorship at Imperial College. Giovanni was born in Pisa does lasix lower your blood pressure in 1976 and moved to the UK when he was 13.

He attended the European School in Culham, Oxford where he did the European Baccalaureate before studying for a Biology BSc at Queen Mary University of London. After he graduated, he worked in London for a bit and was later accepted as a member of Tom Lüscher’s group at the University of Zurich in Switzerland. That was 17 years ago and during that time Giovanni completed a PhD in Fribourg and became Director does lasix lower your blood pressure of the Center for Molecular Cardiology.

Although I discussed career options when Giovanni was looking to specialize in biological sciences, I wanted him to make his own decisions. I did not want him to be influenced by me in the way I was influenced by my own family or in the way that some children are influenced by parents who think they know what is best for their does lasix lower your blood pressure child. Although our work roles are different, there are some similarities, but I think what we have in common is our attitude towards working life in that the human aspect is very important for us.

We both find it easy to communicate and get on well with people and although we love our work and enjoy teaching and research, we are not obsessed with it and we make time for other things such as hobbies, family, and friends.I do not think that his career was necessarily easier than mine because I feel there were more options for me, and the field was not as competitive as it is today. We have never looked for the does lasix lower your blood pressure opportunity to work together, but of course we talk about science and our work and exchange ideas. One of the main differences I see with my son’s life in comparison to mine is that he is a much better father than I was, in that he devotes much more time to his family than I did.

We are good friends as father and son and have many hobbies in common such as vintage cars does lasix lower your blood pressure and music. And together with my daughter Valeria, Giovanni’s sister, who chose a career as a music teacher and a singer, we get along very well and enjoy each other’s company.Giovanni Camici PhD spent his early years in Italy and later attended school and university in England. He is the Director of the Center for Molecular Cardiology at the University of Zurich which was set up in 2015 to focus on different aspects of cardiovascular research, including vascular ageing and stroke.

€˜When I was growing up, I thought the work does lasix lower your blood pressure that my father and relatives did was fascinating. I was always attracted by academia in general and although it is very different now, I still enjoy it and find it as fascinating as when I was a child. By the time I moved to England in 1990, I had already been exposed to the world of science and biology does lasix lower your blood pressure because of my father’s work as a clinician-scientist.

You could say I had the concept of science running through my veins from previous generations. Thanks to an inspiring biology teacher at school, I began to enjoy science for the first time on my own account and that continued, although I was not so good at subjects such as chemistry. At college does lasix lower your blood pressure in London, I was initially interested in neuroscience and general physiology.

However, when I finished university, I did a work placement for 18 months in a muscular dystrophy laboratory at Imperial College and I began to have doubts whether neuroscience was for me. My intention was to return to Italy, but after I got an offer to work in the research group of Thomas Lüscher, that was it.When I look back over does lasix lower your blood pressure the last 17 years in Zurich, I believe I have made considerable progress according to the usual parameters of success. However, the most important goal in life is to be happy with what I do, and I am flattered to be paid to use my brain to produce knowledge.

One of the things I am most proud of, is having set up the new laboratory in 2015. Before this, we were based on a different campus and although it took me a year’s work, I does lasix lower your blood pressure am proud of that and of having become the Director. Molecular cardiology is a discipline which is of great relevance to humanity.

Although we have made major advances, cardiovascular diseases are still the main cause of death worldwide and this means there is still a huge need for progress in does lasix lower your blood pressure the field and this is a strong motivation for me. I have a very special relationship with my father in the sense that we have tended to go our own way as far as work is concerned. However, this has changed quite a lot since I became a professor, so over the last 3 or does lasix lower your blood pressure 4 years, we have developed a much closer relationship professionally.

In the past, he wanted me to choose my own way, although he was always there for important things. I think he also wanted to avoid using his high profile and professional reputation to influence my career too much. Now I consult him and ask for advice much more often, although my reference professionally remains Professor Lüscher.Its difficult to compare my does lasix lower your blood pressure career path with that of my father, but one thing I am aware of is how much society is now largely governed by interests that concern money and this means there isn’t much space for the academic environment.

Universities are non-profit organizations so there is less funding for them and less opportunity to work in them. Its OK in the early stages of your career, but there is a pyramid structure with very few positions available and as soon as you have a PhD it really is a huge struggle to get on.You also need to does lasix lower your blood pressure be a very complete and well-rounded person to be able to do well in science. I do not know of any other jobs where you have to decide what to do, find the money to do it, carry out the project and sell it.

Then if it does not work, you are out. In comparison my father gained a permanent academic position in his mid-30s does lasix lower your blood pressure and had opportunities and security which would be impossible for my generation. We certainly have more technological means compared to the past, but things are much more complex than they were two or three decades ago.

If I was asked for advice, I would probably recommend the career of a physician over that of a researcher because you can be a physician at many different levels and in different situations and you can choose whether to does lasix lower your blood pressure do research or not. For a full-time scientist however, the struggle is a bit too harsh and I cannot see it getting better in the future unless people start to understand that investing in science is important. The reality is that you must raise funds to do science, to collect data and to publish.

It really is publish or perish, its a vicious circle.Although I do not think it was always easy for my father to keep his distance and not to come and lend a hand at times does lasix lower your blood pressure in my career, I cannot imagine that if I had grown up next to him that I would have become the person I am, maybe I would have sweated a bit less, but I do not think I would have become as confident or as well-developed. Although I did not always understand it at the time, I am thankful to my father for this now and I can appreciate what he did for me’. Conflict of interest does lasix lower your blood pressure.

None declared. Published on behalf of the European Society of Cardiology. All rights does lasix lower your blood pressure reserved.

© The Author(s) 2019. For permissions, does lasix lower your blood pressure please email. Journals.permissions@oup.com.LVTS is the present avatar of a long standing and highly productive multidisciplinary cardiovascular French institute created in 2005 by Dr Jean-Baptiste Michel and Dr Martine Jandrot-Perrus and headed since 2014 by Dr Didier Letourneur (Director) and Dr Antonino Nicoletti (Deputy Director).

Https://lvts.fr/ With 150 tenured researchers and engineers and around 60 post-docs, Master and PhD students (Figure 1), Laboratory for Vascular Translational Science (LVTS) is affiliated with Inserm and CNRS, the Paris University and University Paris 13 and the Greater Paris University Hospitals (AP-HP). Figure 1Members of LVTS.Figure 1Members of LVTS.The Institute is located north of Paris on the Bichat campus that harbours a 900-bed university hospital, a medical school, and a does lasix lower your blood pressure research hub. This location has fostered long-lasting and highly dynamic interactions between the institute and the hospital.

These have led to numerous common research projects and the establishment of a cardiovascular (CV) biobank from the collection does lasix lower your blood pressure of a large range of human samples (blood, tissue, and cells) from different forms of CV diseases, including atherothrombotic and non-atherothrombotic diseases (notably thoracic and abdominal aortic aneurysms, carotid artery diseases). The CV biobanking activities are integrated in the national Biobank network (Biobank Infrastructure), which are partners of EU BBMRI (www.bbmri.eu).LVTS has a pluri- and transdisciplinary approach with the objective to fight vascular pathologies. The medical questions raised pertain to new pathophysiological targets, in order to advance diagnosis and treatment of diseases.

The general objectives are the understanding of the physiological mechanisms by basic science does lasix lower your blood pressure approaches but also through large clinical trials, development of new diagnostic (markers and imaging), and new therapeutic/biomaterial strategies. Identification of new targets, development of new molecules, validated by clinical trials. To carry out these projects, translational human and technological skills include clinical databases and assays, translational clinical investigations (carotid stenosis, aneurysms, and dissections of the ascending aorta, Biocore), human tissue and cell biobanks, numerous experimental models of disease (transgenic mice, rats, rabbits), new methods in molecular does lasix lower your blood pressure and cell biology (genetics and genomics, proteomics, protein engineering, flow cytometry), chemistry of biopolymers, elaboration of biomaterials and nano systems, and imaging technologies in small animals and in humans [nuclear imaging, ultrasound, and magnetic resonance imaging (MRI)].Research is performed through six teams (Figure 2).

Their current research topics are briefly presented in the following paragraphs. Figure 2LVTS teams, their leaders, and their research areas.Figure 2LVTS teams, their leaders, and their research areas. Team 1The does lasix lower your blood pressure Cardiovascular Immunobiology team (Team 1, G.

Caligiuri and A. Nicoletti, Refs1–5) works on the mechanisms by which does lasix lower your blood pressure the immune system interacts with diseased vessels and designs new http://sw.keimfarben.de/how-do-you-get-lasix/ vasculoprotective immune interventions. The main recent contributions from this team have been.

The decryption of local immune responses around atherothrombotic vessels and description does lasix lower your blood pressure of new pathogenic immune pathways in vascular diseases. We have shown that recruited neutrophils can dictate the issue of complicated atheroma and that their activity is enhanced at sites of plaque erosion and also by infectious agents that harbour tropism for atherothrombotic sites. We are currently trying to dampen the myeloid cell-driven vascular damage in the brain, the heart, the lungs, and the intestine, upon ischaemia–reperfusion.

We are investigating the mechanisms through which periodontal diseases can deflect the innate immune response thereby impacting on the issue of atherothrombotic events.The demonstration that CD31 is a does lasix lower your blood pressure pacification molecule of the blood vessel interface thereby showing that it is a promising molecular target in inflammatory and thrombotic diseases. We have filed seven patents, six licensed to Tridek-One Therapeutics, a spin-off of our laboratory that aims at developing first-in-class immunomodulatory products targeting the CD31 pathway to down-modulate inappropriate immune responses.The revision of the processes initiating atherogenesis and vascular/valvular calcifications where we have shown that endothelial breaches in territories subjected to high haemodynamic stress allow the entry of red blood cells and constitute a key pathogenic mechanism underlying atherogenesis. In addition to mechanical stress, we are exploring the role of does lasix lower your blood pressure temperature, a neglected feature of inflammation.

We have found that temperature is different at sites of atherogenesis and can profoundly impact vascular and immune cell biology. Team 2The Vascular structural diseases team (Team 2, G. Jondeau and does lasix lower your blood pressure C.

Boileau, Refs6–11) focuses on the study of pathophysiogenic mechanisms associated with aortic aneurysms, valves and coronary artery disease (CAD) in an uninterrupted continuum from genetics to pathophysiology and patient care. The team does lasix lower your blood pressure focuses on inherited human model diseases. Thoracic aortic aneurysms (TAAD) in Marfan’s syndrome and associated diseases and autosomal dominant hypercholesterolaemia.

These models also provide means to identify the genetic modifiers that account for great clinical variability, between and within families. The identification does lasix lower your blood pressure of these modifiers should enable identification of predictors of disease aggressiveness. Research relies on a close collaboration with the National reference Center for Marfan syndrome (www.marfan.fr) and is part of the national large-scale translational research project CHOPIN (CHolesterol Personalized Innovation, https://rhuchopin.fr/).

In TAAD, we developed the paradigm shift that TGF-β canonical pathway has a protective effect during aneurysm does lasix lower your blood pressure formation. We are leaders in the discovery of new disease genes involved in familial TAAD. By cross-mapping the results of several genome-wide studies, we detected the existence and mapped 9 modifier loci that are being investigated.In familial hypercholesterolaemia (FH), we postulated further genetic heterogeneity and demonstrated the role of rare GOF mutations in the PCSK9 gene.

Our work identified a totally unrecognized actor of cholesterol homeostasis and opened up a new field of basic research and the does lasix lower your blood pressure development of anti-PCSK9 agents. Another paradigm shift showed that mutations in the APOE gene resulted in FH, as well as the existence of other FH disease genes. Team 3The Cardiovascular does lasix lower your blood pressure Bio-Engineering team (Team 3, D.

Letourneur, Refs12–18) is well-integrated in LVTS research, industrial development, clinical translation, and education. The team has a long-standing expertise in biomaterials and nanotechnologies and is developing research in e-health objects.Biomaterials—3D porous scaffolds for tissue engineering Innovative technology enables the development of different polysaccharide scaffolds for bone regeneration, skin regeneration, three-dimensional cell culture, and cellular or molecular delivery. Thanks to multiphysic and multiscale characterizations, our goal is to develop does lasix lower your blood pressure biomaterials for tissue regeneration in vivo.

Based on four patents, a company (SILTISS) was created for industrial transfer and is expected to launch clinical trials in 2021.Nanotechnologies for imaging and therapy We have developed a GMP fucoidan and several nanosystems for the early diagnosis of CV diseases with clinical imaging and the establishment of appropriate therapeutic strategies. Fucoidans are marine sulfated polysaccharides and previous studies have demonstrated the capacity of fucoidan to does lasix lower your blood pressure bind to P-selectin as a relevant marker of atherothrombosis and endothelial ischaemia. A GMP microdose radiopharmaceutical based on 99mTc-fucoidan has been validated in Phase I and Phase II clinical trials for single-photon emission computed tomography (SPECT) imaging of human thrombosis and heart ischaemia (FP7-NMP-Large-6-‘Nanoathero’).

We focus on three major areas. The development of soft nanosystems of does lasix lower your blood pressure which the core materials are polysaccharides. These are used as contrast agents for molecular imaging of CV disease by computed tomography (CT), MRI, SPECT, positron emission tomography (PET), ultrasonography, optical imaging, or some combination of these modalities.The development of ligands able to aim nanoparticles at molecular relevant targets, such as fucoidan for P-selectin.The development of therapeutic strategies by optimizing loading capacities and physicochemical properties well adapted to antioxidative molecules.

Team 4The Cardiovascular imaging team (Team does lasix lower your blood pressure 4, F. Rouzet, Refs19–23) aims at developing imaging agents and procedures from preclinical proof of concept to clinical validation. The preclinical imaging platform gathers all the modalities dedicated to small animals (ultrasounds, MRI, PET/MRI, SPECT/CT, and a radiolabelling lab) and is a member of the French Life Imaging network.

Our team has developed expertise does lasix lower your blood pressure in radiolabelling probes, nanoparticles, or cells with gamma and positron emitters (Gallium-68 and Copper-64) and more recently in multiparametric magnetic resonance (MR). Our research is fuelled by a strong interaction with other teams of LVTS for the development of novel imaging agents and takes advantage of the wide range of fully characterized animal models available onsite for in vivo validation (Figure 3). Figure 3Radiolabelled Fucoidan SPECT/CT in does lasix lower your blood pressure a rat model of myocardial ischaemia–reperfusion.

Fucoidan is a P-selectin-targeted imaging agent designed to identify the biological imprint of a transient ischaemic episode a few hours after its resolution. A focal uptake of the imaging agent is detectable at the left ventricular apex (green arrow) 2 h does lasix lower your blood pressure after reperfusion (left panel). Immunostaining demonstrates the endothelial expression of P-selectin (green fluorescence) at the endothelial surface (lectin) in the area at risk (right panel).Figure 3Radiolabelled Fucoidan SPECT/CT in a rat model of myocardial ischaemia–reperfusion.

Fucoidan is a P-selectin-targeted imaging agent designed to identify the biological imprint of a transient ischaemic episode a few hours after its resolution. A focal uptake of the imaging agent is detectable at does lasix lower your blood pressure the left ventricular apex (green arrow) 2 h after reperfusion (left panel). Immunostaining demonstrates the endothelial expression of P-selectin (green fluorescence) at the endothelial surface (lectin) in the area at risk (right panel).The clinical research including preliminary studies in humans takes place at Bichat hospital.

The proximity between does lasix lower your blood pressure LVTS and the hospital facilitates the interplay between clinical challenges and fundamental research. The main research topics of the team are centred on, biological activities associated with arterial thrombi such as pro-coagulant activity and serine proteases,tracking or detection of cells involved in inflammation/infection, andthree tissue biomechanical properties obtained from MR elastography.We are currently developing a multimodal approach combining the molecular information derived from PET, tissue contrast from MRI, and viscoelastic properties from MR elastography. This comprehensive characterization is developed in animal models of myocardial inflammation and fibrosis and will be translated to humans with the installation of a clinical PET/MR system by the end of 2020.

Team 5The atherothrombotic disease does lasix lower your blood pressure in heart and brain team (Team 5, P.G. Steg, Refs24–30) focuses on clinical epidemiology of CAD (P. Gabriel Steg) does lasix lower your blood pressure and stroke (P.

Amarenco), via the design, conduct and analysis of large-scale observational registries and of randomized clinical trials. The team recently received French government funding for an integrated research programme on innovations in atherothrombosis science (RHU IVASC, www.ivasc.eu) which involves ongoing epidemiologic studies and interventional studies to establish the relationship(s) between chronic periodontitis, sleep disordered breathing, and atherothrombosis. The TIA.org registry established the benefit of rapid management of transient ischaemic attacks through specialized centres worldwide, initially and at 5-year follow-up.Recent trials have studied the impact of lipid lowering interventions after acute coronary syndromes (using alirocumab, a PCSK9 inhibitor, in the ODYSSEY OUTCOMES trial) or after does lasix lower your blood pressure ischaemic stroke in patients with atherothrombosis (comparing two target LDL cholesterol levels, in the TST trial which established the clinical benefit of targeting LDL to <70 mg/dL rather than 100 mg/dL).

A large-scale trial, THEMIS (the largest randomized trial in diabetes) established the value of dual antiplatelet therapy with ticagrelor and aspirin in patients with stable CAD and diabetes, particularly if they have a prior history of percutaneous coronary intervention. Team 6The does lasix lower your blood pressure Haemostasis, Thrombo-Inflammation, Neurovascular Repair team (Team 6, M.C. Bouton and N.

Kubis, Refs31–35) focuses its research on the interaction between actors of haemostasis and thrombo-inflammation in the vessel wall to extend knowledge on cardio- and neurovascular diseases. The main themes does lasix lower your blood pressure of the team are. Heart failure.

Increased protease activities within the myocardium is involved in the does lasix lower your blood pressure development of heart failure. We have previously demonstrated that protease nexin-1, a major tissue antiprotease, constitutes a key factor in the responses of vessels to injury, via its antithrombotic and antifibrinolytic properties. We now aim to determine its potential role in cardiac pathophysiology.Intracranial aneurysm.

The pathophysiology does lasix lower your blood pressure evolution of intracranial aneurysm events seems driven by complex cellular interactions between different cell types including platelets, leucocytes, and vascular cells. Our main objective is to decipher platelet mechanisms during intracranial aneurysm formation and rupture.Stroke. We investigate how cellular actors of inflammation and molecular actors of haemostasis contribute to the does lasix lower your blood pressure pathophysiology of ischaemic stroke.

Our approach combines the analysis of thrombi and plasma samples recovered from stroke patients (Figure 4), and the use of animal models. We showed that thrombi from patients have thrombolysis- resistant areas,large vessel occlusion triggers downstream micro thrombosis, andDNAse can help improve thrombolysis. Figure 4Thrombus does lasix lower your blood pressure retrieved by mechanical thrombectomy from patients with ischaemic stroke.

Platelets (green) and neutrophils (red) immunostaining.Figure 4Thrombus retrieved by mechanical thrombectomy from patients with ischaemic stroke. Platelets (green) and neutrophils (red) immunostaining.Our work has set the basis for the development of clinical trials developing a personalized stroke care in emergency situations (BOOSTER consortium) and testing the efficacy of new drugs does lasix lower your blood pressure such as a novel anti-platelet drug (Phase Ib/IIa clinical trial ACTIMIS, Acticor Biotech, a spin-off company located in LVTS and created by Dr Martine Jandrot-Perrus, https://acticor-biotech.com/). ReferencesReferences are available as supplementary material at European Heart Journal online.Conflict of interest.

None declared. Published on behalf of the European Society of does lasix lower your blood pressure Cardiology. All rights reserved.

© The Author(s) 2020. For permissions, please email. Journals.permissions@oup.com..

Father and son, Paolo and Giovanni Camici talk to CardioPulse about what brings them together and what lasix treatment for congestive heart failure sets them apart Paolo Camici MD is lasix 40mg tablet price in canada Professor of Cardiology at the Vita-Salute University San Raffaele in Milan, Italy. He previously held several senior roles in a long association with Hammersmith Hospital and Imperial College, London, UK.‘I was born in Genoa, a port in the north west of Italy and perhaps because of this I have always been attached to the sea and enjoyed water sports. My father lasix 40mg tablet price in canada was an ophthalmologist, my uncle was an internist, and my grandfather was a general practitioner.

Whenever the family got together around the table for Sunday lunch, they would always be talking about medicine, so its in my blood.When I was around four or five, my father was keen to go back to his native Tuscany, so we moved to Pisa and I completed my education in a liceo classico. When it came to university, it seemed as natural as breathing to go into medicine and I enrolled lasix 40mg tablet price in canada at medical school in Pisa. After gaining my medical degree I was not sure what I wanted to do.

Psychiatry was popular at that time, but after a 6-month internship, I decided I did not want to be a psychiatrist. I was quite lasix 40mg tablet price in canada interested in research and physiology and I got an interview with Luigi Donato, a well-known professor for a position at the new Institute of Clinical Physiology at the University of Pisa. I was offered a job and assigned to Attilio Maseri who suggested I work with cardiologist Antonio L’Abbate.

It was here that I spent several years while doing my internship in cardiology and internal medicine.In the late 1960s, I first visited London as a tourist lasix 40mg tablet price in canada which was a big thing for me as the city was the centre of everything at that time and I was a huge fan of rock music and sang in a band. I later returned to the city in 1977 to train in clinical pharmacology, then in 1980 Maseri announced that he was leaving Pisa for London and a professorship at Hammersmith Hospital. This was a big blow to me as he was a big influence, so the following year, I began to commute between London and Pisa to carry out research.

I got to know physicist Terry Jones who oversaw the cyclotron unit at Hammersmith Hospital and in lasix 40mg tablet price in canada 1990 he called me to say they were opening a new group for PET in cardiology and needed a young leader ready to come to London. It took about 10 s to say yes, and I took leave from my assistant professorship at Pisa and moved to London where I eventually received a Medical Research Council (MRC) tenure and was appointed to a professorship at Imperial College. Giovanni was born in Pisa in 1976 and moved to the UK when lasix 40mg tablet price in canada he was 13.

He attended the European School in Culham, Oxford where he did the European Baccalaureate before studying for a Biology BSc at Queen Mary University of London. After he graduated, he worked in London for a bit and was later accepted as a member of Tom Lüscher’s group at the University of Zurich in Switzerland. That was 17 years ago and during that time Giovanni completed a PhD in Fribourg and became Director of lasix 40mg tablet price in canada the Center for Molecular Cardiology.

Although I discussed career options when Giovanni was looking to specialize in biological sciences, I wanted him to make his own decisions. I did not want him to be influenced by me in the way I was influenced by my own family or in the way that some children are influenced by parents who think they know what is best for lasix 40mg tablet price in canada their child. Although our work roles are different, there are some similarities, but I think what we have in common is our attitude towards working life in that the human aspect is very important for us.

We both find it easy to communicate and get on well with people and although we love our work and enjoy teaching and research, we are not obsessed with it and we make time for other things such as hobbies, family, and friends.I do not think that his career was necessarily easier than mine because I feel there were more options for me, and the field was not as competitive as it is today. We have never looked for the opportunity to work together, but of lasix 40mg tablet price in canada course we talk about science and our work and exchange ideas. One of the main differences I see with my son’s life in comparison to mine is that he is a much better father than I was, in that he devotes much more time to his family than I did.

We are good friends as father and son and have many hobbies in common such as vintage cars and music lasix 40mg tablet price in canada. And together with my daughter Valeria, Giovanni’s sister, who chose a career as a music teacher and a singer, we get along very well and enjoy each other’s company.Giovanni Camici PhD spent his early years in Italy and later attended school and university in England. He is the Director of the Center for Molecular Cardiology at the University of Zurich which was set up in 2015 to focus on different aspects of cardiovascular research, including vascular ageing and stroke.

€˜When I was growing up, I thought the work that lasix 40mg tablet price in canada my father and relatives did was fascinating. I was always attracted by academia in general and although it is very different now, I still enjoy it and find it as fascinating as when I was a child. By the time I moved to lasix 40mg tablet price in canada England in 1990, I had already been exposed to the world of science and biology because of my father’s work as a clinician-scientist.

You could say I had the concept of science running through my veins from previous generations. Thanks to an inspiring biology teacher at school, I began to enjoy science for the first time on my own account and that continued, although I was not so good at subjects such as chemistry. At college in London, I was initially interested in neuroscience and lasix 40mg tablet price in canada general physiology.

However, when I finished university, I did a work placement for 18 months in a muscular dystrophy laboratory at Imperial College and I began to have doubts whether neuroscience was for me. My intention was to return to Italy, but after I got an offer to work in the research group of Thomas Lüscher, that was it.When I look back over the last 17 years in Zurich, I believe I lasix 40mg tablet price in canada have made considerable progress according to the usual parameters of success. However, the most important goal in life is to be happy with what I do, and I am flattered to be paid to use my brain to produce knowledge.

One of the things I am most proud of, is having set up the new laboratory in 2015. Before this, we were based on a different campus and although it took lasix 40mg tablet price in canada me a year’s work, I am proud of that and of having become the Director. Molecular cardiology is a discipline which is of great relevance to humanity.

Although we have made major advances, cardiovascular diseases are still the main cause of death worldwide and this means there is still a huge need for progress in lasix 40mg tablet price in canada the field and this is a strong motivation for me. I have a very special relationship with my father in the sense that we have tended to go our own way as far as work is concerned. However, this has changed quite a lot since I became a professor, so over the lasix 40mg tablet price in canada last 3 or 4 years, we have developed a much closer relationship professionally.

In the past, he wanted me to choose my own way, although he was always there for important things. I think he also wanted to avoid using his high profile and professional reputation to influence my career too much. Now I consult lasix 40mg tablet price in canada him and ask for advice much more often, although my reference professionally remains Professor Lüscher.Its difficult to compare my career path with that of my father, but one thing I am aware of is how much society is now largely governed by interests that concern money and this means there isn’t much space for the academic environment.

Universities are non-profit organizations so there is less funding for them and less opportunity to work in them. Its OK in the early lasix 40mg tablet price in canada stages of your career, but there is a pyramid structure with very few positions available and as soon as you have a PhD it really is a huge struggle to get on.You also need to be a very complete and well-rounded person to be able to do well in science. I do not know of any other jobs where you have to decide what to do, find the money to do it, carry out the project and sell it.

Then if it does not work, you are out. In comparison my father gained a permanent academic position in his mid-30s and had opportunities lasix 40mg tablet price in canada and security which would be impossible for my generation. We certainly have more technological means compared to the past, but things are much more complex than they were two or three decades ago.

If I was asked for advice, I would probably lasix 40mg tablet price in canada recommend the career of a physician over that of a researcher because you can be a physician at many different levels and in different situations and you can choose whether to do research or not. For a full-time scientist however, the struggle is a bit too harsh and I cannot see it getting better in the future unless people start to understand that investing in science is important. The reality is that you must raise funds to do science, to collect data and to publish.

It really is publish or perish, its a vicious circle.Although I do not think it was always easy for my father to keep his distance and not to come and lend a hand at times in my career, I cannot imagine that if I had grown up lasix 40mg tablet price in canada next to him that I would have become the person I am, maybe I would have sweated a bit less, but I do not think I would have become as confident or as well-developed. Although I did not always understand it at the time, I am thankful to my father for this now and I can appreciate what he did for me’. Conflict of lasix 40mg tablet price in canada interest.

None declared. Published on behalf of the European Society of Cardiology. All rights lasix 40mg tablet price in canada reserved.

© The Author(s) 2019. For permissions, please lasix 40mg tablet price in canada email. Journals.permissions@oup.com.LVTS is the present avatar of a long standing and highly productive multidisciplinary cardiovascular French institute created in 2005 by Dr Jean-Baptiste Michel and Dr Martine Jandrot-Perrus and headed since 2014 by Dr Didier Letourneur (Director) and Dr Antonino Nicoletti (Deputy Director).

Https://lvts.fr/ With 150 tenured researchers and engineers and around 60 post-docs, Master and PhD students (Figure 1), Laboratory for Vascular Translational Science (LVTS) is affiliated with Inserm and CNRS, the Paris University and University Paris 13 and the Greater Paris University Hospitals (AP-HP). Figure 1Members of LVTS.Figure 1Members of LVTS.The Institute is located north lasix 40mg tablet price in canada of Paris on the Bichat campus that harbours a 900-bed university hospital, a medical school, and a research hub. This location has fostered long-lasting and highly dynamic interactions between the institute and the hospital.

These have led to numerous common research projects and the establishment of a cardiovascular (CV) biobank from the collection of lasix 40mg tablet price in canada a large range of human samples (blood, tissue, and cells) from different forms of CV diseases, including atherothrombotic and non-atherothrombotic diseases (notably thoracic and abdominal aortic aneurysms, carotid artery diseases). The CV biobanking activities are integrated in the national Biobank network (Biobank Infrastructure), which are partners of EU BBMRI (www.bbmri.eu).LVTS has a pluri- and transdisciplinary approach with the objective to fight vascular pathologies. The medical questions raised pertain to new pathophysiological targets, in order to advance diagnosis and treatment of diseases.

The general objectives are the understanding of the physiological lasix 40mg tablet price in canada mechanisms by basic science approaches but also through large clinical trials, development of new diagnostic (markers and imaging), and new therapeutic/biomaterial strategies. Identification of new targets, development of new molecules, validated by clinical trials. To carry out these projects, translational lasix 40mg tablet price in canada human and technological skills include clinical databases and assays, translational clinical investigations (carotid stenosis, aneurysms, and dissections of the ascending aorta, Biocore), human tissue and cell biobanks, numerous experimental models of disease (transgenic mice, rats, rabbits), new methods in molecular and cell biology (genetics and genomics, proteomics, protein engineering, flow cytometry), chemistry of biopolymers, elaboration of biomaterials and nano systems, and imaging technologies in small animals and in humans [nuclear imaging, ultrasound, and magnetic resonance imaging (MRI)].Research is performed through six teams (Figure 2).

Their current research topics are briefly presented in the following paragraphs. Figure 2LVTS teams, their leaders, and their research areas.Figure 2LVTS teams, their leaders, and their research areas. Team 1The Cardiovascular lasix 40mg tablet price in canada Immunobiology team (Team 1, G.

Caligiuri and A. Nicoletti, Refs1–5) works on the mechanisms by which the immune system interacts with diseased vessels and designs lasix 40mg tablet price in canada new vasculoprotective immune interventions. The main recent contributions from this team have been.

The decryption of local immune responses around atherothrombotic vessels and description of new pathogenic immune pathways in lasix 40mg tablet price in canada vascular diseases. We have shown that recruited neutrophils can dictate the issue of complicated atheroma and that their activity is enhanced at sites of plaque erosion and also by infectious agents that harbour tropism for atherothrombotic sites. We are currently trying to dampen the myeloid cell-driven vascular damage in the brain, the heart, the lungs, and the intestine, upon ischaemia–reperfusion.

We are investigating the mechanisms through which periodontal diseases can deflect the innate immune response thereby impacting on the issue of atherothrombotic events.The demonstration that CD31 is a lasix 40mg tablet price in canada pacification molecule of the blood vessel interface thereby showing that it is a promising molecular target in inflammatory and thrombotic diseases. We have filed seven patents, six licensed to Tridek-One Therapeutics, a spin-off of our laboratory that aims at developing first-in-class immunomodulatory products targeting the CD31 pathway to down-modulate inappropriate immune responses.The revision of the processes initiating atherogenesis and vascular/valvular calcifications where we have shown that endothelial breaches in territories subjected to high haemodynamic stress allow the entry of red blood cells and constitute a key pathogenic mechanism underlying atherogenesis. In addition to mechanical stress, we are exploring the role of temperature, a neglected lasix 40mg tablet price in canada feature of inflammation.

We have found that temperature is different at sites of atherogenesis and can profoundly impact vascular and immune cell biology. Team 2The Vascular structural diseases team (Team 2, G. Jondeau and lasix 40mg tablet price in canada C.

Boileau, Refs6–11) focuses on the study of pathophysiogenic mechanisms associated with aortic aneurysms, valves and coronary artery disease (CAD) in an uninterrupted continuum from genetics to pathophysiology and patient care. The team lasix 40mg tablet price in canada focuses on inherited human model diseases. Thoracic aortic aneurysms (TAAD) in Marfan’s syndrome and associated diseases and autosomal dominant hypercholesterolaemia.

These models also provide means to identify the genetic modifiers that account for great clinical variability, between and within families. The identification of these lasix 40mg tablet price in canada modifiers should enable identification of predictors of disease aggressiveness. Research relies on a close collaboration with the National reference Center for Marfan syndrome (www.marfan.fr) and is part of the national large-scale translational research project CHOPIN (CHolesterol Personalized Innovation, https://rhuchopin.fr/).

In TAAD, we developed lasix 40mg tablet price in canada the paradigm shift that TGF-β canonical pathway has a protective effect during aneurysm formation. We are leaders in the discovery of new disease genes involved in familial TAAD. By cross-mapping the results of several genome-wide studies, we detected the existence and mapped 9 modifier loci that are being investigated.In familial hypercholesterolaemia (FH), we postulated further genetic heterogeneity and demonstrated the role of rare GOF mutations in the PCSK9 gene.

Our work identified lasix 40mg tablet price in canada a totally unrecognized actor of cholesterol homeostasis and opened up a new field of basic research and the development of anti-PCSK9 agents. Another paradigm shift showed that mutations in the APOE gene resulted in FH, as well as the existence of other FH disease genes. Team 3The Cardiovascular Bio-Engineering lasix 40mg tablet price in canada team (Team 3, D.

Letourneur, Refs12–18) is well-integrated in LVTS research, industrial development, clinical translation, and education. The team has a long-standing expertise in biomaterials and nanotechnologies and is developing research in e-health objects.Biomaterials—3D porous scaffolds for tissue engineering Innovative technology enables the development of different polysaccharide scaffolds for bone regeneration, skin regeneration, three-dimensional cell culture, and cellular or molecular delivery. Thanks to multiphysic and multiscale characterizations, our goal is to develop biomaterials for tissue regeneration in lasix 40mg tablet price in canada vivo.

Based on four patents, a company (SILTISS) was created for industrial transfer and is expected to launch clinical trials in 2021.Nanotechnologies for imaging and therapy We have developed a GMP fucoidan and several nanosystems for the early diagnosis of CV diseases with clinical imaging and the establishment of appropriate therapeutic strategies. Fucoidans are marine sulfated polysaccharides and previous studies have demonstrated the capacity of fucoidan to bind to P-selectin as a relevant marker of atherothrombosis and lasix 40mg tablet price in canada endothelial ischaemia. A GMP microdose radiopharmaceutical based on 99mTc-fucoidan has been validated in Phase I and Phase II clinical trials for single-photon emission computed tomography (SPECT) imaging of human thrombosis and heart ischaemia (FP7-NMP-Large-6-‘Nanoathero’).

We focus on three major areas. The development of soft lasix 40mg tablet price in canada nanosystems of which the core materials are polysaccharides. These are used as contrast agents for molecular imaging of CV disease by computed tomography (CT), MRI, SPECT, positron emission tomography (PET), ultrasonography, optical imaging, or some combination of these modalities.The development of ligands able to aim nanoparticles at molecular relevant targets, such as fucoidan for P-selectin.The development of therapeutic strategies by optimizing loading capacities and physicochemical properties well adapted to antioxidative molecules.

Team 4The Cardiovascular imaging team (Team lasix 40mg tablet price in canada 4, F. Rouzet, Refs19–23) aims at developing imaging agents and procedures from preclinical proof of concept to clinical validation. The preclinical imaging platform gathers all the modalities dedicated to small animals (ultrasounds, MRI, PET/MRI, SPECT/CT, and a radiolabelling lab) and is a member of the French Life Imaging network.

Our team has developed expertise in radiolabelling probes, nanoparticles, or lasix 40mg tablet price in canada cells with gamma and positron emitters (Gallium-68 and Copper-64) and more recently in multiparametric magnetic resonance (MR). Our research is fuelled by a strong interaction with other teams of LVTS for the development of novel imaging agents and takes advantage of the wide range of fully characterized animal models available onsite for in vivo validation (Figure 3). Figure 3Radiolabelled lasix 40mg tablet price in canada Fucoidan SPECT/CT in a rat model of myocardial ischaemia–reperfusion.

Fucoidan is a P-selectin-targeted imaging agent designed to identify the biological imprint of a transient ischaemic episode a few hours after its resolution. A focal uptake of the imaging agent is detectable lasix 40mg tablet price in canada at the left ventricular apex (green arrow) 2 h after reperfusion (left panel). Immunostaining demonstrates the endothelial expression of P-selectin (green fluorescence) at the endothelial surface (lectin) in the area at risk (right panel).Figure 3Radiolabelled Fucoidan SPECT/CT in a rat model of myocardial ischaemia–reperfusion.

Fucoidan is a P-selectin-targeted imaging agent designed to identify the biological imprint of a transient ischaemic episode a few hours after its resolution. A focal uptake lasix 40mg tablet price in canada of the imaging agent is detectable at the left ventricular apex (green arrow) 2 h after reperfusion (left panel). Immunostaining demonstrates the endothelial expression of P-selectin (green fluorescence) at the endothelial surface (lectin) in the area at risk (right panel).The clinical research including preliminary studies in humans takes place at Bichat hospital.

The proximity between LVTS and the hospital facilitates the interplay between clinical challenges and lasix 40mg tablet price in canada fundamental research. The main research topics of the team are centred on, biological activities associated with arterial thrombi such as pro-coagulant activity and serine proteases,tracking or detection of cells involved in inflammation/infection, andthree tissue biomechanical properties obtained from MR elastography.We are currently developing a multimodal approach combining the molecular information derived from PET, tissue contrast from MRI, and viscoelastic properties from MR elastography. This comprehensive characterization is developed in animal models of myocardial inflammation and fibrosis and will be translated to humans with the installation of a clinical PET/MR system by the end of 2020.

Team 5The atherothrombotic disease in heart and brain lasix 40mg tablet price in canada team (Team 5, P.G. Steg, Refs24–30) focuses on clinical epidemiology of CAD (P. Gabriel Steg) and stroke lasix 40mg tablet price in canada (P.

Amarenco), via the design, conduct and analysis of large-scale observational registries and of randomized clinical trials. The team recently received French government funding for an integrated research programme on innovations in atherothrombosis science (RHU IVASC, www.ivasc.eu) which involves ongoing epidemiologic studies and interventional studies to establish the relationship(s) between chronic periodontitis, sleep disordered breathing, and atherothrombosis. The TIA.org registry established the benefit of rapid management of transient ischaemic attacks through specialized centres worldwide, initially and at 5-year follow-up.Recent trials have studied the impact of lipid lowering interventions after acute coronary syndromes (using alirocumab, a PCSK9 inhibitor, in the ODYSSEY OUTCOMES trial) or after ischaemic stroke in patients with atherothrombosis (comparing two target LDL cholesterol levels, in the TST trial which established the clinical benefit of lasix 40mg tablet price in canada targeting LDL to <70 mg/dL rather than 100 mg/dL).

A large-scale trial, THEMIS (the largest randomized trial in diabetes) established the value of dual antiplatelet therapy with ticagrelor and aspirin in patients with stable CAD and diabetes, particularly if they have a prior history of percutaneous coronary intervention. Team 6The lasix 40mg tablet price in canada Haemostasis, Thrombo-Inflammation, Neurovascular Repair team (Team 6, M.C. Bouton and N.

Kubis, Refs31–35) focuses its research on the interaction between actors of haemostasis and thrombo-inflammation in the vessel wall to extend knowledge on cardio- and neurovascular diseases. The main themes lasix 40mg tablet price in canada of the team are. Heart failure.

Increased protease activities within the myocardium is involved in the development of heart lasix 40mg tablet price in canada failure. We have previously demonstrated that protease nexin-1, a major tissue antiprotease, constitutes a key factor in the responses of vessels to injury, via its antithrombotic and antifibrinolytic properties. We now aim to determine its potential role in cardiac pathophysiology.Intracranial aneurysm.

The pathophysiology evolution of intracranial aneurysm events seems driven by complex cellular interactions between lasix 40mg tablet price in canada different cell types including platelets, leucocytes, and vascular cells. Our main objective is to decipher platelet mechanisms during intracranial aneurysm formation and rupture.Stroke. We investigate how cellular actors of inflammation and molecular actors of haemostasis contribute to lasix 40mg tablet price in canada the pathophysiology of ischaemic stroke.

Our approach combines the analysis of thrombi and plasma samples recovered from stroke patients (Figure 4), and the use of animal models. We showed that thrombi from patients have thrombolysis- resistant areas,large vessel occlusion triggers downstream micro thrombosis, andDNAse can help improve thrombolysis. Figure 4Thrombus lasix 40mg tablet price in canada retrieved by mechanical thrombectomy from patients with ischaemic stroke.

Platelets (green) and neutrophils (red) immunostaining.Figure 4Thrombus retrieved by mechanical thrombectomy from patients with ischaemic stroke. Platelets (green) and neutrophils (red) immunostaining.Our work has set the basis for the development of clinical trials developing a personalized stroke care in emergency situations (BOOSTER consortium) and testing the efficacy of new drugs such as a novel anti-platelet lasix 40mg tablet price in canada drug (Phase Ib/IIa clinical trial ACTIMIS, Acticor Biotech, a spin-off company located in LVTS and created by Dr Martine Jandrot-Perrus, https://acticor-biotech.com/). ReferencesReferences are available as supplementary material at European Heart Journal online.Conflict of interest.

None declared. Published on behalf of the European Society of Cardiology. All rights reserved.

© The Author(s) 2020. For permissions, please email. Journals.permissions@oup.com..

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Lauren Gambill, MDPediatrician, AustinMember, Texas lasix medicament Medical Association (TMA) how to buy cheap lasix Committee on Child and Adolescent HealthExecutive Board Member, Texas Pediatric SocietyDoctors are community leaders. This role has become even more important during the COVID-19 pandemic. As patients navigate our new reality, they are looking to us to determine how to buy cheap lasix what is safe, how to protect their families, and the future of their health care. As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net. The U.S.

Census helps determine funding for those resources, and that is why it is of the upmost importance that each and every Texan, how to buy cheap lasix no matter address, immigration status, or age, respond to the 2020 U.S. Census. The deadline how to buy cheap lasix has been cut short one month and now closes Sept. 30.COVID-19 has only increased the importance of completing the census to help our local communities and economies recover. The novel coronavirus has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more.

Schools also have been stretched thin, how to buy cheap lasix with teachers scrambling to teach students online. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago. Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the pandemic’s fallout. Therefore, it is vital that all Texans be counted.The federal dollars Texas receives generally depends on how to buy cheap lasix our population. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.Take Medicaid, for example.

Federal funds pay for how to buy cheap lasix 60% of the state’s program, which provides health coverage for two out of five Texas children, one in three individuals with disabilities, and 53% of all births. The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texas’ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars. If that happens, lawmakers will have to make up the difference, with cuts in services, program eligibility, or physician and provider payments, any of which are potentially detrimental.The census data also is key to funding other aspects of a community’s social safety net:Health careThe Children’s Health Insurance Program (CHIP) provides low-cost health insurance to children whose parents make too how to buy cheap lasix much to qualify for Medicaid, but not enough to afford quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census.

Texas also uses this federal funding to study and respond to maternal mortality and perinatal depression.Food and housing how to buy cheap lasix As unemployment rises and families struggle financially, many live with uncertainty as to where they will find their next meal. Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the pandemic continues. The Central Texas Food Bank saw a 206% rise how to buy cheap lasix in clients in March. Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census.

Funding for local housing programs also is calculated via the census. An accurate count will help ensure that people who lose their homes during this economic crisis have better how to buy cheap lasix hope of finding shelter while our communities recover. Homelessness is closely connected with declines in overall physical and mental health.Childcare and educationAs we navigate the new reality brought on by coronavirus, more parents are taking on roles as breadwinner, parent, teacher, and caretaker. This stress highlights the how to buy cheap lasix desperate need for affordable childcare. The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families.

The good news is you still have time to complete the census. Visit 2020census.gov to take it how to buy cheap lasix. It takes less than five minutes to complete. Then talk to your family, neighbors, and colleagues about doing the same how to buy cheap lasix. If you are wondering who counts, the answer is everyone, whether it’s a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.Completing the census is one of the best things that you can do for the health of your community, especially during the pandemic.

Thank you for helping Texas heal and for supporting these essential safety net programs.(L to R). UTHSA medical students Swetha Maddipudi, Brittany Hansen, Charles Wang, Carson Cortino, faculty advisor Kaparaboyna Kumar, how to buy cheap lasix MD, Ryan Wealther, Sidney Akabogu, Irma Ruiz, and Frank Jung pose with the TMA Be Wise Immunize banner. Photo courtesy by Ryan WealtherRyan WealtherMedical Student, UT Health San Antonio Long School of MedicineStudent Member, Texas Medical AssociationEditor’s Note. August is National Immunization Awareness Month. This article how to buy cheap lasix is part of a Me&My Doctor series lasix for heart failure highlighting and promoting the use of vaccinations.“Can the flu shot give you the flu?.

€â€œIs it dangerous for pregnant women to get a flu shot?. €â€œCan vaccines how to buy cheap lasix cause autism?. €These were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu vaccine discussion. It is easy to see why these questions were asked, as vaccine misinformation is common today.UTHSA medical student Frank Jing (left) gets a vaccine fromKaparaboyna Kumar, MD, (right).Photo courtesy of Ryan Wealther“No” is the answer to all the questions. These were exactly the types of myths we set out to dispel at our vaccination drive.UT Health San Antonio how to buy cheap lasix Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted the vaccine drive at Alpha Home with the support of TMA’s Be Wise – Immunize℠ program, a public health initiative that aims to increase vaccinations and vaccine awareness through shot clinics and education.

Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general vaccine myths. The Alpha Home residents could ask us questions how to buy cheap lasix during the program.We were interested to see if our educational program could answer Alpha Home residents’ questions about vaccinations and allay their hesitations about getting a flu vaccination. To gauge this, we created a brief survey.(Before I discuss the results of the survey, I should define vaccine hesitancy. Vaccine hesitancy is a concept defined by the World Health Organization. It relates to when patients do not vaccinate despite how to buy cheap lasix having access to vaccines.

Vaccine hesitancy is a problem because it prevents individuals from receiving their vaccinations. That makes them more susceptible to getting sick from vaccine-preventable diseases.)We surveyed the residents’ opinions about vaccinations before and after our educational program. While opinions how to buy cheap lasix about shots improved with each survey question, we saw the most significant attitude change reflected in answers to the questions “I am concerned that vaccinations might not be safe,” and “How likely are you to receive a flu shot today?. € We had informed the residents and improved their understanding and acceptance of immunizations.Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about vaccines, after learning more about their effectiveness by trusted members of the medical community. Graph by how to buy cheap lasix Ryan WealtherWhy is this important?.

First, our findings confirm what we already knew. Education by a trusted member of the medical community can effect change. In fact, it is widely known that physician recommendation of vaccination is one of the most critical factors how to buy cheap lasix affecting whether patients receive an influenza vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me “Dr. Truth” by the end of the evening.Second, how to buy cheap lasix our findings add to our understanding of adult vaccine hesitancy.

This is significant because most of what we know about vaccine hesitancy is limited to parental attitudes toward their children’s vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults need some vaccinations as well, like the yearly influenza how to buy cheap lasix vaccine. After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu vaccine. Graph by Ryan WealtherAnother reason improving attitudes is important is that receiving a flu shot is even more timely during the COVID-19 pandemic because it decreases illnesses and conserves health care resources.

Thousands of people each year are hospitalized from the flu, and with hospitals filling up with how to buy cheap lasix coronavirus patients, we could avoid adding dangerously ill flu patients to the mix. Lastly, these findings are important because once a COVID-19 vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. Though the COVID-19 vaccine is still in development, it is not immune to how to buy cheap lasix vaccine hesitancy. Recent polls have indicated up to one-third of Americans would not receive a COVID-19 vaccine even if it were accessible and affordable. Work is already being done to try to raise awareness and acceptance.

In addition, misinformation about how to buy cheap lasix the COVID vaccine is circulating widely. (Someone recently asked me if the COVID vaccine will implant a microchip in people, and I have seen the same myth circulating on social media. It will not.) This myth, however, illustrates the need for health care professionals to answer patients’ questions and to assuage their concerns.Vaccines work best when many people in a community receive them, and vaccine hesitancy how to buy cheap lasix can diminish vaccination rates, leaving people who can't get certain vaccines susceptible to these vaccine-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots.

As the COVID-19 pandemic progresses, we need to ensure children and adults receive their how to buy cheap lasix vaccinations as recommended by their physician and the Centers for Disease Control and Prevention. I encourage readers who have questions about the vaccinations they or their child may need to talk with their physician. As health care professionals, we’re more than happy to answer your questions..

Lauren Gambill, MDPediatrician, AustinMember, Texas Medical Association (TMA) Committee on Child and Adolescent HealthExecutive Board Member, Texas Pediatric hop over to this site SocietyDoctors are community leaders lasix 40mg tablet price in canada. This role has become even more important during the COVID-19 pandemic. As patients navigate our new reality, lasix 40mg tablet price in canada they are looking to us to determine what is safe, how to protect their families, and the future of their health care. As more Texans lose their jobs, their health insurance, or even their homes, it is crucial that Texas receives the resources it needs to uphold our social safety net. The U.S.

Census helps determine funding for those resources, and that is why it is of the upmost importance that each and every Texan, no matter address, immigration lasix 40mg tablet price in canada status, or age, respond to the 2020 U.S. Census. The deadline has been cut short one lasix 40mg tablet price in canada month and now closes Sept. 30.COVID-19 has only increased the importance of completing the census to help our local communities and economies recover. The novel coronavirus has inflicted unprecedented strain on patients and exacerbated inequality as more people are out of work and are many in need of help with food, health care, housing, and more.

Schools also have been stretched thin, with teachers scrambling to teach lasix 40mg tablet price in canada students online. Yet, the amount of federal funding Texas has available today to help weather this emergency was driven in part by the census responses made a decade ago. Getting an accurate count in 2020 will help Texans prepare for the decade to follow, the first few years of which most certainly will be spent rebuilding from the pandemic’s fallout. Therefore, it is vital that all lasix 40mg tablet price in canada Texans be counted.The federal dollars Texas receives generally depends on our population. A George Washington University study recently found that even a 1% undercount can lead to a $300 million loss in funding.Take Medicaid, for example.

Federal funds pay for 60% of the state’s program, which provides health coverage for two out of five Texas children, one in three individuals lasix 40mg tablet price in canada with disabilities, and 53% of all births. The complicated formula used to calculate the federal portion of this funding depends on accurate census data. If Texas’ population is undercounted, Texans may appear better off financially than they really are, resulting in Texas getting fewer federal Medicaid dollars. If that happens, lawmakers will have to make up the difference, with cuts in services, program eligibility, or physician and provider payments, any of which are potentially detrimental.The census data also is key to funding other aspects of a community’s social safety net:Health careThe Children’s Health Insurance Program (CHIP) lasix 40mg tablet price in canada provides low-cost health insurance to children whose parents make too much to qualify for Medicaid, but not enough to afford quality coverage. Like Medicaid, how much money the federal government reimburses the state for the program depends in part on the census.Maternal and child health programs that promote public health and help ensure children are vaccinated relies on data from the census.

Texas also uses this federal funding to study and respond to maternal mortality and perinatal depression.Food and housing As unemployment rises and families struggle financially, many live with uncertainty as to lasix 40mg tablet price in canada where they will find their next meal. Already, one in seven Texans experiences food insecurity, and 20% of Texas children experience hunger. Food insecurity is rising in Texas as the pandemic continues. The Central Texas lasix 40mg tablet price in canada Food Bank saw a 206% rise in clients in March. Funding for the Supplemental Nutrition Assistance Program and school lunch programs are both determined by the census.

Funding for local housing programs also is calculated via the census. An accurate lasix 40mg tablet price in canada count will help ensure that people who lose their homes during this economic crisis have better hope of finding shelter while our communities recover. Homelessness is closely connected with declines in overall physical and mental health.Childcare and educationAs we navigate the new reality brought on by coronavirus, more parents are taking on roles as breadwinner, parent, teacher, and caretaker. This stress highlights the desperate need for affordable lasix 40mg tablet price in canada childcare. The census determines funding for programs like Head Start that provide comprehensive early childhood education to low-income families.

The good news is you still have time to complete the census. Visit 2020census.gov to take lasix 40mg tablet price in canada it. It takes less than five minutes to complete. Then talk to your family, neighbors, and lasix 40mg tablet price in canada colleagues about doing the same. If you are wondering who counts, the answer is everyone, whether it’s a newborn baby, child in foster care, undocumented immigrant, or an individual experiencing homelessness.Completing the census is one of the best things that you can do for the health of your community, especially during the pandemic.

Thank you for helping Texas heal and for supporting these essential safety net programs.(L to R). UTHSA medical students Swetha Maddipudi, Brittany Hansen, Charles Wang, Carson Cortino, faculty advisor Kaparaboyna Kumar, MD, Ryan Wealther, Sidney Akabogu, Irma Ruiz, and Frank Jung lasix 40mg tablet price in canada pose with the TMA Be Wise Immunize banner. Photo courtesy by Ryan WealtherRyan WealtherMedical Student, UT Health San Antonio Long School of MedicineStudent Member, Texas Medical AssociationEditor’s Note. August is National Immunization Awareness Month. This article is part of a Me&My Doctor series highlighting and promoting lasix 40mg tablet price in canada the use of vaccinations.“Can the flu shot give you the flu?.

€â€œIs it dangerous for pregnant women to get a flu shot?. €â€œCan vaccines cause autism? lasix 40mg tablet price in canada. €These were questions women at Alpha Home, a residential substance abuse rehabilitation center in San Antonio, asked my fellow medical students and me during a flu vaccine discussion. It is easy to see why these questions were asked, as vaccine misinformation is common today.UTHSA medical student Frank Jing (left) gets a vaccine fromKaparaboyna Kumar, MD, (right).Photo courtesy of Ryan Wealther“No” is the answer to all the questions. These were exactly the types of myths we set out to dispel at our vaccination drive.UT Health San Antonio Long School of Medicine medical students (under the supervision of Kaparaboyna Ashok Kumar, MD, faculty advisor for the Texas Medical Association Medical Student Section at UT Health San Antonio) hosted the vaccine drive at Alpha Home with the support of lasix 40mg tablet price in canada TMA’s Be Wise – Immunize℠ program, a public health initiative that aims to increase vaccinations and vaccine awareness through shot clinics and education.

Our program consisted of a vaccination drive and an interactive, educational presentation that addressed influenza, common flu shot questions, and general vaccine myths. The Alpha Home residents could ask us questions during the program.We were interested to see if our educational program could answer Alpha Home residents’ questions about vaccinations and allay their hesitations lasix 40mg tablet price in canada about getting a flu vaccination. To gauge this, we created a brief survey.(Before I discuss the results of the survey, I should define vaccine hesitancy. Vaccine hesitancy is a concept defined by the World Health Organization. It relates to when patients do not vaccinate despite having lasix 40mg tablet price in canada access to vaccines.

Vaccine hesitancy is a problem because it prevents individuals from receiving their vaccinations. That makes them more susceptible to getting sick from vaccine-preventable diseases.)We surveyed the residents’ opinions about vaccinations before and after our educational program. While opinions about shots improved with each survey question, we saw the most significant attitude change reflected in answers to the questions “I am concerned that vaccinations might not be safe,” and “How likely are you to receive a lasix 40mg tablet price in canada flu shot today?. € We had informed the residents and improved their understanding and acceptance of immunizations.Post-survey results show more residents at the Alpha Home shifted to more positive attitudes about vaccines, after learning more about their effectiveness by trusted members of the medical community. Graph by Ryan WealtherWhy is lasix 40mg tablet price in canada this important?.

First, our findings confirm what we already knew. Education by a trusted member of the medical community can effect change. In fact, it is widely known that physician recommendation of vaccination is one of the most critical factors affecting lasix 40mg tablet price in canada whether patients receive an influenza vaccination. Perhaps some added proof to this is that a few of the Alpha Home residents were calling me “Dr. Truth” by the end lasix 40mg tablet price in canada of the evening.Second, our findings add to our understanding of adult vaccine hesitancy.

This is significant because most of what we know about vaccine hesitancy is limited to parental attitudes toward their children’s vaccinations. Some parents question shots for their children, and many of the most deadly diseases we vaccinate against are given in childhood, including polio, tetanus, measles, and whooping cough shots. However, adults lasix 40mg tablet price in canada need some vaccinations as well, like the yearly influenza vaccine. After taking part in the UTHSA educational program, more residents at the Alpha Home shared more willingness to receive the flu vaccine. Graph by Ryan WealtherAnother reason improving attitudes is important is that receiving a flu shot is even more timely during the COVID-19 pandemic because it decreases illnesses and conserves health care resources.

Thousands of people each year are hospitalized from the flu, and with hospitals filling up with coronavirus patients, we could avoid adding dangerously ill lasix 40mg tablet price in canada flu patients to the mix. Lastly, these findings are important because once a COVID-19 vaccination becomes available, more people might be willing to receive it if their overall attitude toward immunizations is positive. Though the COVID-19 vaccine is lasix 40mg tablet price in canada still in development, it is not immune to vaccine hesitancy. Recent polls have indicated up to one-third of Americans would not receive a COVID-19 vaccine even if it were accessible and affordable. Work is already being done to try to raise awareness and acceptance.

In addition, misinformation about the COVID vaccine is circulating widely lasix 40mg tablet price in canada. (Someone recently asked me if the COVID vaccine will implant a microchip in people, and I have seen the same myth circulating on social media. It will not.) This myth, however, illustrates the lasix 40mg tablet price in canada need for health care professionals to answer patients’ questions and to assuage their concerns.Vaccines work best when many people in a community receive them, and vaccine hesitancy can diminish vaccination rates, leaving people who can't get certain vaccines susceptible to these vaccine-preventable diseases. For example, babies under 6 months of age should not receive a flu shot, so high community vaccination rates protect these babies from getting sick with the flu. Our educational program at Alpha Home is just one example of how health care professionals can increase awareness and acceptance of shots.

As the COVID-19 pandemic progresses, we need to lasix 40mg tablet price in canada ensure children and adults receive their vaccinations as recommended by their physician and the Centers for Disease Control and Prevention. I encourage readers who have questions about the vaccinations they or their child may need to talk with their physician. As health care professionals, we’re more than happy to answer your questions..

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€œYou are not alone.” Click Here These four words is a message to each and every canine lasix one who has ever been depressed, anxious, had suicidal thoughts or suffer from mental illness. During Suicide Prevention Month, MidMichigan Health professionals remind you that it is okay to talk about suicide and that seeking help is crucial and canine lasix never a sign of weakness.“According to the National Alliance on Mental Illness, suicide is now the tenth most common cause of death in the United States and the second leading cause of death in those 10 to 34 years old,” said Kathy Dollard, Psy.D., L.P., director of behavioral health at MidMichigan Health. €œPaying attention to warning signs and certain behaviors in individuals can be key to getting them the support and help that they need.”The warning signs before suicide aren’t always clear, nor are they universal. Suicide is often complex and usually not from a canine lasix single cause.

Still, across the board, mental health experts say certain behaviors shouldn’t be ignored.Signals that may indicate someone is in need of help can include both verbal signs and behavioral cues. Verbal signs may be talking about wanting to die or kill oneself canine lasix. Declarations of feeling trapped or having nothing to live for. Talking about great guilt or unbearable canine lasix pain.

Insistence of being a burden to others. Speaking of canine lasix revenge. Lack of communication or noticeable withdrawal.Behavioral cues that may signal an individual is in trouble can include acting anxious, agitated or restless. Increased use canine lasix of alcohol or drugs.

Sleeping too little or canine lasix too much. Suggestive actions, such as online searches or obtaining a gun. Giving away possessions canine lasix or making visits to say goodbye. Reckless conduct or extreme mood swings.Suicide can become a threat after a loss.

It could canine lasix be the death of a loved one, including a pet, or the loss of a job or relationship.Although the age of onset is usually mid-teens, mental health conditions can also begin to develop in younger children. Because they’re still learning how to identify and talk about thoughts and emotions, their most obvious symptoms in children and teens are behavioral. Symptoms may canine lasix include changes in school performance, excessive worry or anxiety, fighting to avoid bed or school, hyperactive behavior, frequent nightmares, disobedience or temper tantrums. In addition to the symptoms mentioned, teens might isolate, use substances, and have drastic personality changes.To help address mental health and the wellbeing of middle and high school youth, the ROCK Center for Youth Development was recently awarded a grant from the Midland Area Community Foundation.

The grant will be used to implement the University of Michigan’s Peer to Peer Depression Awareness Program in Midland county high and middle schools.“Middle and high school canine lasix age is when students first experience depression and anxiety symptoms, so it is important that they are able to recognize it and feel comfortable seeking help early,” explains Dollard, co-chair of a coalition for youth suicide prevention and a board member of the ROCK. €œThe Peer to Peer program includes training for school personal about mental health concerns and suicide prevention, selecting youth who will be trained and mentored as they launch a school-wide awareness campaign and establishing mental health resources for successful and timely referral when a youth is identified as needing care. The program is canine lasix built on the premise that teens are more likely to listen to their friends than a well-meaning adult. If we can help youth to know what to do when one of their friends canine lasix is struggling, we can potentially save lives.”MidMichigan Health offers a variety of behavioral health programs, including psychiatric inpatient care, outpatient care and office-based care.

Those interested in learning more may visit www.midmichigan.org/mentalhealth.Those concerned about the imminent danger of another taking their life should call 911 immediately. Those needing canine lasix assistance or have questions are recommended to call the National Suicide Prevention Lifeline at 1 (800) 273-TALK (8255). In addition, people in crisis can also text HOME to 741741 to connect with a crisis counselor.Tammy Terrell, M.S.N., R.N., system vice president and chief nursing officer, MidMichigan Health, was recognized for her excellent patient care, teamwork and the positive example she sets for other employees in a recent ceremony in which she was named this year’s recipient of the Bernard E. Lorimer Award.Tammy Terrell, canine lasix M.S.N., R.N., system vice president and chief nursing officer, MidMichigan Health, was recognized for her excellent patient care, teamwork and the positive example she sets for other employees in a recent ceremony in which she was named this year’s recipient of the Bernard E.

Lorimer Award.Her co-workers, who nominated her for the award, said Terrell is a dedicated and loyal employee who has led the health system through extraordinary challenges this year. Her leadership through canine lasix the COVID-19 crisis was calm and steady. In addition, she remained unruffled as MidMichigan Medical Center – Midland experienced a historical flood, spending both days and nights onsite to ensure patients and employees were safe.“The Lorimer Award is like being selected into our Hall of Fame,” said Greg Rogers, president, MidMichigan Medical Center – Midland, and executive vice president and chief operating officer, MidMichigan Health. €œIt’s a lifetime award for an employee’s commitment to canine lasix our Medical Center.

Tammy is very deserving of this award. She is selfless, kind, canine lasix wise, intelligent and thoughtful. She is the perfect example of what makes MidMichigan Health excellent.”Terrell has been with MidMichigan Health for 38 years, beginning her career in 1982 as a staff nurse in the Emergency Department (ED) for 14 years and later was canine lasix the nurse manager for the ED and Perioperative Services Departments at MidMichigan Medical Center – Gratiot. Then, in February 2006, she was promoted to director of nursing for the Medical Center in Alma.

Seven years later she canine lasix moved over to the director of nursing administration for MidMichigan Medical Center – Midland. In August 2018, Terrell then became the system director of emergency services in Midland and shortly after was promoted to system vice president and chief nursing officer for MidMichigan Health.The Lorimer Award was first given in 1978 and recognizes one employee each year who possesses the characteristics that Bernard E. Lorimer exemplified during his career as president of canine lasix the Medical Center in Midland. Those qualities include compassion and concern for people, loyalty and dedication to the Medical Center through extended length of service, cooperation, a positive attitude and a willingness to help others.Previous Bernard E.

Lorimer Award canine lasix recipients include. Carolyn Fraser, Mary Buffa-Tacey, Pete McKnight, Fran Mayhew, Marilyn Haeussler, Lloyd Hoag, Rea Mason, Jan Albar, Harriet Robbins, Barb Dinger, Pauline Fischer, JoAnne Johnston, Sandy Ebright, Becky Dunn, Dave Chapman, Deb Badour, Jan Penney, Dennis Bauer, Karen Calkins, Jan Morrone, Pam Gifford, Carol Campbell, Mary Jane Howe, Norm Adams, Jeanie Hepinstall, Randy Wyse, Bob Valenta, Sally Vajda, Donna Herringshaw, Kathy Squires, Mary Ann Kovacevich, Sue Haley, Andrea Frederick, Peggy Lark, Tonia VanWieren, Rich Weiler, Teresa Wakeman, Susan Janke, Kathleen Ludwig, Sasha Savage, M.D., Cheryl Meyette and Jodi Herman.Terrell attended the University of Phoenix where she received her Bachelor of Science degree in nursing in 2007. She completed her Master of Science degree in nursing at Walden University in June 2013 canine lasix. Terrell is married and resides with her husband of 37 years on their family farm in Gratiot County.

She is the mother canine lasix of four children and has five grandchildren. Her favorite pastime is being at the lake and spending time with family.Those interested in more information on MidMichigan Health may visit www.midmichigan.org..

€œYou are not alone.” These four words is a message to each and every one who has ever been depressed, anxious, had suicidal thoughts lasix 40mg tablet price in canada or suffer from mental illness. During Suicide Prevention Month, MidMichigan Health professionals remind you that it is okay to talk about suicide and that seeking lasix 40mg tablet price in canada help is crucial and never a sign of weakness.“According to the National Alliance on Mental Illness, suicide is now the tenth most common cause of death in the United States and the second leading cause of death in those 10 to 34 years old,” said Kathy Dollard, Psy.D., L.P., director of behavioral health at MidMichigan Health. €œPaying attention to warning signs and certain behaviors in individuals can be key to getting them the support and help that they need.”The warning signs before suicide aren’t always clear, nor are they universal. Suicide is often complex and usually not from a single cause lasix 40mg tablet price in canada. Still, across the board, mental health experts say certain behaviors shouldn’t be ignored.Signals that may indicate someone is in need of help can include both verbal signs and behavioral cues.

Verbal signs lasix 40mg tablet price in canada may be talking about wanting to die or kill oneself. Declarations of feeling trapped or having nothing to live for. Talking about great guilt lasix 40mg tablet price in canada or unbearable pain. Insistence of being a burden to others. Speaking of lasix 40mg tablet price in canada revenge.

Lack of communication or noticeable withdrawal.Behavioral cues that may signal an individual is in trouble can include acting anxious, agitated or restless. Increased use of alcohol or lasix 40mg tablet price in canada drugs. Sleeping too lasix 40mg tablet price in canada little or too much. Suggestive actions, such as online searches or obtaining a gun. Giving away possessions or making visits to say goodbye lasix 40mg tablet price in canada.

Reckless conduct or extreme mood swings.Suicide can become a threat after a loss. It could be the death of a loved one, including a pet, or the loss lasix 40mg tablet price in canada of a job or relationship.Although the age of onset is usually mid-teens, mental health conditions can also begin to develop in younger children. Because they’re still learning how to identify and talk about thoughts and emotions, their most obvious symptoms in children and teens are behavioral. Symptoms may include changes in school performance, excessive worry or anxiety, fighting to avoid bed or school, hyperactive behavior, frequent nightmares, disobedience or temper tantrums lasix 40mg tablet price in canada. In addition to the symptoms mentioned, teens might isolate, use substances, and have drastic personality changes.To help address mental health and the wellbeing of middle and high school youth, the ROCK Center for Youth Development was recently awarded a grant from the Midland Area Community Foundation.

The grant will be used to implement the University of Michigan’s Peer to Peer Depression Awareness Program in Midland county high and middle schools.“Middle and high school age is lasix 40mg tablet price in canada when students first experience depression and anxiety symptoms, so it is important that they are able to recognize it and feel comfortable seeking help early,” explains Dollard, co-chair of a coalition for youth suicide prevention and a board member of the ROCK. €œThe Peer to Peer program includes training for school personal about mental health concerns and suicide prevention, selecting youth who will be trained and mentored as they launch a school-wide awareness campaign and establishing mental health resources for successful and timely referral when a youth is identified as needing care. The program is lasix 40mg tablet price in canada built on the premise that teens are more likely to listen to their friends than a well-meaning adult. If we can help youth to know what to do when one of their friends lasix 40mg tablet price in canada is struggling, we can potentially save lives.”MidMichigan Health offers a variety of behavioral health programs, including psychiatric inpatient care, outpatient care and office-based care. Those interested in learning more may visit www.midmichigan.org/mentalhealth.Those concerned about the imminent danger of another taking their life should call 911 immediately.

Those needing assistance or have questions are recommended to call the National Suicide Prevention Lifeline at 1 (800) 273-TALK (8255) lasix 40mg tablet price in canada. In addition, people in crisis can also text HOME to 741741 to connect with a crisis counselor.Tammy Terrell, M.S.N., R.N., system vice president and chief nursing officer, MidMichigan Health, was recognized for her excellent patient care, teamwork and the positive example she sets for other employees in a recent ceremony in which she was named this year’s recipient of the Bernard E. Lorimer Award.Tammy Terrell, M.S.N., R.N., system vice president and chief nursing officer, MidMichigan Health, was recognized for her excellent patient care, teamwork and the positive example she sets for other employees in lasix 40mg tablet price in canada a recent ceremony in which she was named this year’s recipient of the Bernard E. Lorimer Award.Her co-workers, who nominated her for the award, said Terrell is a dedicated and loyal employee who has led the health system through extraordinary challenges this year. Her leadership through lasix 40mg tablet price in canada the COVID-19 crisis was calm and steady.

In addition, she remained unruffled as MidMichigan Medical Center – Midland experienced a historical flood, spending both days and nights onsite to ensure patients and employees were safe.“The Lorimer Award is like being selected into our Hall of Fame,” said Greg Rogers, president, MidMichigan Medical Center – Midland, and executive vice president and chief operating officer, MidMichigan Health. €œIt’s a lasix 40mg tablet price in canada lifetime award for an employee’s commitment to our Medical Center. Tammy is very deserving of this award. She is selfless, kind, wise, intelligent and lasix 40mg tablet price in canada thoughtful. She is the perfect lasix 40mg tablet price in canada example of what makes MidMichigan Health excellent.”Terrell has been with MidMichigan Health for 38 years, beginning her career in 1982 as a staff nurse in the Emergency Department (ED) for 14 years and later was the nurse manager for the ED and Perioperative Services Departments at MidMichigan Medical Center – Gratiot.

Then, in February 2006, she was promoted to director of nursing for the Medical Center in Alma. Seven years later she moved over to the director of nursing administration lasix 40mg tablet price in canada for MidMichigan Medical Center – Midland. In August 2018, Terrell then became the system director of emergency services in Midland and shortly after was promoted to system vice president and chief nursing officer for MidMichigan Health.The Lorimer Award was first given in 1978 and recognizes one employee each year who possesses the characteristics that Bernard E. Lorimer exemplified during his lasix 40mg tablet price in canada career as president of the Medical Center in Midland. Those qualities include compassion and concern for people, loyalty and dedication to the Medical Center through extended length of service, cooperation, a positive attitude and a willingness to help others.Previous Bernard E.

Lorimer Award lasix 40mg tablet price in canada recipients include. Carolyn Fraser, Mary Buffa-Tacey, Pete McKnight, Fran Mayhew, Marilyn Haeussler, Lloyd Hoag, Rea Mason, Jan Albar, Harriet Robbins, Barb Dinger, Pauline Fischer, JoAnne Johnston, Sandy Ebright, Becky Dunn, Dave Chapman, Deb Badour, Jan Penney, Dennis Bauer, Karen Calkins, Jan Morrone, Pam Gifford, Carol Campbell, Mary Jane Howe, Norm Adams, Jeanie Hepinstall, Randy Wyse, Bob Valenta, Sally Vajda, Donna Herringshaw, Kathy Squires, Mary Ann Kovacevich, Sue Haley, Andrea Frederick, Peggy Lark, Tonia VanWieren, Rich Weiler, Teresa Wakeman, Susan Janke, Kathleen Ludwig, Sasha Savage, M.D., Cheryl Meyette and Jodi Herman.Terrell attended the University of Phoenix where she received her Bachelor of Science degree in nursing in 2007. She completed her Master lasix 40mg tablet price in canada of Science degree in nursing at Walden University in June 2013. Terrell is married and resides with her husband of 37 years on their family farm in Gratiot County. She is lasix 40mg tablet price in canada the mother of four children and has five grandchildren.

Her favorite pastime is being at the lake and spending time with family.Those interested in more information on MidMichigan Health may visit www.midmichigan.org..

Lasix medication horses

NONE

Protecting the safety and health of essential workers who lasix medication horses support America’s food security—including the meat, poultry, and pork where to buy lasix water pill processing industries—is a top priority for the Occupational Safety and Health Administration (OSHA). OSHA and the Centers for Disease Control and Prevention issued additional guidance to reduce the risk of exposure to the coronavirus and keep workers safe and healthy in the meatpacking and meat processing industries —including those involved in beef, pork, and poultry operations. This new guidance provides specific recommendations for employers to meet their obligations to protect workers in these facilities, where people normally work closely together and share workspaces and equipment. Here are eight ways lasix medication horses to help minimize meat processing workers’ exposure to the coronavirus.

Screen workers before they enter the workplace. If a worker becomes sick, send them home and disinfect their workstation and any tools they used. Move workstations lasix medication horses farther apart. Install partitions between workstations using strip curtains, plexiglass, or similar materials.

To limit spread between groups, assign the same workers to the same shifts with the same coworkers. Prevent workers from lasix medication horses using other workers’ equipment. Allow workers to wear face coverings when entering, inside, and exiting the facility. Encourage workers to report any safety and health concerns to their supervisors.

OSHA is committed to ensuring that workers and employers lasix medication horses in essential industries have clear guidance to keep workers safe and healthy from the coronavirus—including guidance for essential workers in construction, manufacturing, package delivery, and retail. Workers and employers who have questions or concerns about workplace safety can contact OSHA online or by phone at 1-800-321-6742 (OSHA). You can find additional resources and learn more about OSHA’s response to the coronavirus at www.osha.gov/coronavirus. Loren Sweatt is the Principal Deputy Assistant Secretary for the U.S lasix medication horses.

Department of Labor’s Occupation Safety and Health Administration Editor’s Note. It is important to note that information and guidance about COVID-19 continually evolve as conditions change. Workers and employers are encouraged to regularly lasix medication horses refer to the resources below for updates:One in 10 people in the United States will get the flu in a given season, according to estimates from the Centers for Disease Control and Prevention. And while viruses can live all year round, flu activity tends to rise in October and then peak between December and February.

With COVID-19 a factor this year, it's even more important to take precautions to prevent the flu from spreading. Here are 10 lasix medication horses ways to keep workers safe. Recommend all workers get vaccinated. Vaccination is the most important way to prevent the spread of the flu.

It takes lasix medication horses about two weeks for flu antibodies to develop, so the time to get a shot is before peak flu season. Encourage workers to stay home if they are sick. The Centers for Disease Control and Prevention recommend that workers who have a fever and respiratory symptoms stay at home until 24 hours after their fever ends (100 degrees Fahrenheit or lower) without the use of medication. Not everyone who has lasix medication horses the flu will have a fever.

Other symptoms can include a runny nose, body aches, headache, fatigue, diarrhea or vomiting. Wash hands frequently with soap and water for 20 seconds. Use an alcohol-based hand lasix medication horses rub if soap and water are not available. When using soap and water, rub soapy hands together for at least 20 seconds, rinse with water, and dry completely.

If soap and water are not available, use an alcohol-based hand rub until you can wash your hands. Continue practicing lasix medication horses social distancing. Staying at least 6 feet apart from co-workers, whenever possible, can help prevent the spread of the flu. Cover coughs and sneezes with a tissue or upper sleeve.

Tissues should go into lasix medication horses a "no-touch" wastebasket and wash your hands after coughing, sneezing or blowing your nose. Avoid touching your face. Keep frequently touched surfaces clean. Commonly used lasix medication horses surfaces such as counters, door handles, phones, computer keyboards and touchpads should be cleaned after each use.

Limit shared equipment or clean equipment before others use it. Avoid using a co-worker's phone, desk, office, computer or other equipment unless they are cleaned with an EPA-approved disinfectant. Training is lasix medication horses knowledge. Make sure all workers understand how to stay healthy at work during flu season, including new and temporary workers.

Wear a face covering. These can help lasix medication horses limit the flu's spread. Consider alternate work arrangements. If feasible, offer options such as telework or staggered shifts for workers considered high risk for seasonal flu (such as older workers, pregnant women, and those with asthma).

Learn more about workplace safety and the lasix medication horses flu on OSHA's website. You can find additional resources and learn more about OSHA's response to the coronavirus at osha.gov/coronavirus. Workers and employers who have questions or concerns about workplace safety can contact OSHA online or by phone at 1-800-321-6742 (OSHA). Loren Sweatt is the Principal Deputy Assistant Secretary for lasix medication horses the U.S.

Department of Labor's Occupational Safety and Health Administration. Follow OSHA on Twitter at @OSHA_DOL..

Protecting the safety and health of essential workers who support America’s food security—including the meat, poultry, and pork processing industries—is a top priority for the Occupational Safety and Health lasix 40mg tablet price in canada Administration (OSHA). OSHA and the Centers for Disease Control and Prevention issued additional guidance to reduce the risk of exposure to the coronavirus and keep workers safe and healthy in the meatpacking and meat processing industries —including those involved in beef, pork, and poultry operations. This new guidance provides specific recommendations for employers to meet their obligations to protect workers in these facilities, where people normally work closely together and share workspaces and equipment. Here are eight ways to help minimize meat processing workers’ lasix 40mg tablet price in canada exposure to the coronavirus. Screen workers before they enter the workplace.

If a worker becomes sick, send them home and disinfect their workstation and any tools they used. Move workstations farther apart lasix 40mg tablet price in canada. Install partitions between workstations using strip curtains, plexiglass, or similar materials. To limit spread between groups, assign the same workers to the same shifts with the same coworkers. Prevent workers lasix 40mg tablet price in canada from using other workers’ equipment.

Allow workers to wear face coverings when entering, inside, and exiting the facility. Encourage workers to report any safety and health concerns to their supervisors. OSHA is committed to ensuring that workers and employers lasix 40mg tablet price in canada in essential industries have clear guidance to keep workers safe and healthy from the coronavirus—including guidance for essential workers in construction, manufacturing, package delivery, and retail. Workers and employers who have questions or concerns about workplace safety can contact OSHA online or by phone at 1-800-321-6742 (OSHA). You can find additional resources and learn more about OSHA’s response to the coronavirus at www.osha.gov/coronavirus.

Loren Sweatt is the Principal Deputy Assistant Secretary for the lasix 40mg tablet price in canada U.S. Department of Labor’s Occupation Safety and Health Administration Editor’s Note. It is important to note that information and guidance about COVID-19 continually evolve as conditions change. Workers and employers are encouraged to regularly refer to the resources below for updates:One in 10 people in the United States will get the flu in a given season, according to estimates from the Centers for Disease Control and Prevention lasix 40mg tablet price in canada. And while viruses can live all year round, flu activity tends to rise in October and then peak between December and February.

With COVID-19 a factor this year, it's even more important to take precautions to prevent the flu from spreading. Here are lasix 40mg tablet price in canada 10 ways to keep workers safe. Recommend all workers get vaccinated. Vaccination is the most important way to prevent the spread of the flu. It takes about two weeks for flu antibodies to develop, so the time to get a shot is before peak flu season lasix 40mg tablet price in canada.

Encourage workers to stay home if they are sick. The Centers for Disease Control and Prevention recommend that workers who have a fever and respiratory symptoms stay at home until 24 hours after their fever ends (100 degrees Fahrenheit or lower) without the use of medication. Not everyone who has lasix 40mg tablet price in canada the flu will have a fever. Other symptoms can include a runny nose, body aches, headache, fatigue, diarrhea or vomiting. Wash hands frequently with soap and water for 20 seconds.

Use an alcohol-based hand rub if lasix 40mg tablet price in canada soap and water are not available. When using soap and water, rub soapy hands together for at least 20 seconds, rinse with water, and dry completely. If soap and water are not available, use an alcohol-based hand rub until you can wash your hands. Continue practicing social distancing lasix 40mg tablet price in canada. Staying at least 6 feet apart from co-workers, whenever possible, can help prevent the spread of the flu.

Cover coughs and sneezes with a tissue or upper sleeve. Tissues should go into a "no-touch" wastebasket and wash your hands after coughing, sneezing or blowing lasix 40mg tablet price in canada your nose. Avoid touching your face. Keep frequently touched surfaces clean. Commonly used surfaces such as counters, door lasix 40mg tablet price in canada handles, phones, computer keyboards and touchpads should be cleaned after each use.

Limit shared equipment or clean equipment before others use it. Avoid using a co-worker's phone, desk, office, computer or other equipment unless they are cleaned with an EPA-approved disinfectant. Training is lasix 40mg tablet price in canada knowledge. Make sure all workers understand how to stay healthy at work during flu season, including new and temporary workers. Wear a face covering.

These can help limit the flu's spread lasix 40mg tablet price in canada. Consider alternate work arrangements. If feasible, offer options such as telework or staggered shifts for workers considered high risk for seasonal flu (such as older workers, pregnant women, and those with asthma). Learn more lasix 40mg tablet price in canada about workplace safety and the flu on OSHA's website. You can find additional resources and learn more about OSHA's response to the coronavirus at osha.gov/coronavirus.

Workers and employers who have questions or concerns about workplace safety can contact OSHA online or by phone at 1-800-321-6742 (OSHA). Loren Sweatt is the lasix 40mg tablet price in canada Principal Deputy Assistant Secretary for the U.S. Department of Labor's Occupational Safety and Health Administration. Follow OSHA on Twitter at @OSHA_DOL..

Lasix water pill 20mg

NONE

Welcome to Ethics Consult lasix 20mg tablets side effects -- an opportunity lasix water pill 20mg to discuss, debate (respectfully), and learn together. We select an ethical dilemma in patient care, you vote, and then we present an expert's judgment.Last week, you voted on whether a pediatrician can ethically fire vaccine refusers. Here are the results from over 1,000 votes:Is it ethical for the doctor to deny or dismiss unvaccinated patients?.

Yes. 71%No. 29%Would your vote change if this is the only pediatrics practice in the community?.

Yes. 25%No. 75%And now, bioethicist Jacob M.

Appel, MD, JD, weighs in:As a general principle, physicians outside the emergency and hospital settings are free to choose their patients with very few restrictions. They are also allowed to "fire" current patients as long as they afford them an adequate opportunity to establish care elsewhere. However, having the legal right to do so does not necessarily make all such decisions ethical.

In this scenario, it might prove helpful to understand why the pediatrician has adopted such a policy.One explanation might be concern that unvaccinated children will expose other pediatric patients to measles -- such as in a waiting room setting. Some of the pediatrician's patients may not yet be candidates for the measles vaccine due to immature age or medical comorbidities. Others may have been vaccinated but the vaccine did not "take" and they failed to generate the immunity necessary to ward off the virus.

If enough children are vaccinated, even those in whom the vaccine does not work will be protected, because the odds of them coming into contact with infected people remain low.The pediatrician may believe he or she has a duty to protect his most vulnerable patients from those whose parents choose not to accept a safe and effective public health measure. If he or she were to continue treating unvaccinated patients, he or she might even have an ethical duty to place signs in his waiting room warning other patients of this exposure risk. While he or she could certainly configure his office and schedule to ensure the children of "anti-vax" parents did not come into contact with others, rather than refusing to see them, few ethicists would argue that he or she has an obligation http://sw.keimfarben.de/how-do-you-get-lasix/ to do so.

However, those that favor such accommodation of "anti-vaxxers" might argue that children should not be penalized for the poor choices of their parents.Another explanation might be that the pediatrician wishes to pressure parents into accepting vaccination. Before doing so, he or she would be wise to inquire why parents are rejecting these vaccines. Overwhelming evidence supports pediatric vaccination.

Many of the scourges of past generations such as polio and diphtheria have nearly been eliminated, saving thousands of lives, and claims that the measles-mumps-rubella (MMR) vaccine is connected to autism have been widely debunked as fraudulent. But well-meaning parents may be misinformed, especially when celebrities and even the current president question the medically recommended vaccine schedule.A pediatrician -- especially the only one in a community -- might have an ethical duty to attempt to educate these parents before refusing care to their children. At the same time, vaccines often do carry some rare risks to an individual child.

This creates a "collective action problem" or "dilemma of the commons" in which self-interested parents, not acting in good faith, may try to freeload off the herd immunity generated by other families who have accepted such minor risks for the common good. Such behavior is deeply problematic. However, individual physicians are not ideally situated to play a coercive role in the implementation of public health measures.What is most puzzling is why parents are allowed to refuse vaccination for their children at all when they are not allowed to reject other life-saving, health-preserving, or protective measures.

While courts generally override parents who reject essential blood transfusions or chemotherapy for their offspring, opponents of compulsory vaccination often note that the acute risk of not vaccinating is lower than these interventions. A more fitting comparison might be to require that young children ride in car seats, wear bicycle helmets, etc. The most likely explanation for different approaches to similar risks is that no political will exists to force vaccination upon the large and increasing number of resistant parents.

Unfortunately, while not using a car seat only puts one's own child at risk, refusing vaccination places the lives of other people's children in jeopardy.Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at Icahn School of Medicine at Mount Sinai in New York City. He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College.

Appel is the author of the recent book, Who Says You're Dead?. Medical &.

Here are the results from over lasix 40mg tablet price in canada 1,000 votes:Is it ethical for the doctor to deny or dismiss lasix 40mg side effects unvaccinated patients?. Yes. 71%No.

29%Would your vote change if this is the only pediatrics lasix 40mg tablet price in canada practice in the community?. Yes. 25%No.

75%And now, lasix 40mg tablet price in canada bioethicist Jacob M. Appel, MD, JD, weighs in:As a general principle, physicians outside the emergency and hospital settings are free to choose their patients with very few restrictions. They are also allowed to "fire" current patients as long as they afford them an adequate opportunity to establish care elsewhere.

However, having the legal right lasix 40mg tablet price in canada to do so does not necessarily make all such decisions ethical. In this scenario, it might prove helpful to understand why the pediatrician has adopted such a policy.One explanation might be concern that unvaccinated children will expose other pediatric patients to measles -- such as in a waiting room setting. Some of the pediatrician's patients may not yet be candidates for the measles vaccine due to immature age or medical comorbidities.

Others may have been vaccinated but the vaccine did not "take" and they failed to generate lasix 40mg tablet price in canada the immunity necessary to ward off the virus. If enough children are vaccinated, even those in whom the vaccine does not work will be protected, because the odds of them coming into contact with infected people remain low.The pediatrician may believe he or she has a duty to protect his most vulnerable patients from those whose parents choose not to accept a safe and effective public health measure. If he or she were to continue treating unvaccinated patients, he or she might even have an ethical duty to place signs in his waiting room warning other patients of this exposure risk.

While he lasix 40mg tablet price in canada or she could certainly configure his office and schedule to ensure the children of "anti-vax" parents did not come into contact with others, rather than refusing to see them, few ethicists would argue that he or she has an obligation to do so. However, those that favor such accommodation of "anti-vaxxers" might argue that children should not be penalized for the poor choices of their parents.Another explanation might be that the pediatrician wishes to pressure parents into accepting vaccination. Before doing can lasix cause uti so, he or she would be wise to inquire why parents are rejecting these vaccines.

Overwhelming evidence supports pediatric vaccination. Many of the scourges of past lasix 40mg tablet price in canada generations such as polio and diphtheria have nearly been eliminated, saving thousands of lives, and claims that the measles-mumps-rubella (MMR) vaccine is connected to autism have been widely debunked as fraudulent. But well-meaning parents may be misinformed, especially when celebrities and even the current president question the medically recommended vaccine schedule.A pediatrician -- especially the only one in a community -- might have an ethical duty to attempt to educate these parents before refusing care to their children.

At the same time, vaccines often do carry some rare risks to an individual child. This creates a "collective action lasix 40mg tablet price in canada problem" or "dilemma of the commons" in which self-interested parents, not acting in good faith, may try to freeload off the herd immunity generated by other families who have accepted such minor risks for the common good. Such behavior is deeply problematic.

However, individual physicians are not ideally situated to play a coercive role in the implementation of public health measures.What is most puzzling is why parents are allowed to refuse vaccination for their children at all when they are not allowed to reject other life-saving, health-preserving, or protective measures. While courts generally override parents who reject essential blood transfusions or chemotherapy for their offspring, opponents of compulsory vaccination often note that the acute risk of not vaccinating is lower than lasix 40mg tablet price in canada these interventions. A more fitting comparison might be to require that young children ride in car seats, wear bicycle helmets, etc.

The most likely explanation for different approaches to similar risks is that no political will exists to force vaccination upon the large and increasing number of resistant parents. Unfortunately, while not using a car seat only puts one's own child at lasix 40mg tablet price in canada risk, refusing vaccination places the lives of other people's children in jeopardy.Jacob M. Appel, MD, JD, is director of ethics education in psychiatry and a member of the institutional review board at Icahn School of Medicine at Mount Sinai in New York City.

He holds an MD from Columbia University, a JD from Harvard Law School, and a bioethics MA from Albany Medical College. Appel is the author of the recent book, Who lasix 40mg tablet price in canada Says You're Dead?. Medical &.

Ethical Dilemmas for the Curious &. Concerned.And check out some of our past Ethics Consult cases:Should Christian Clinic Provide IVF to Lesbian Couple?.

Does lasix cause hyponatremia

NONE

On 1 September 2020, we took on the roles of co-editors-in-chief for BMJ Quality and Safety, and want to take this opportunity to introduce ourselves and our vision for does lasix cause hyponatremia the journal. We represent two different continents, two different professions and two different sets of research expertise. What we have in common is a passion for conducting and publishing high-quality research and quality improvement work to benefit the quality and safety of patient care, as well as encouraging others does lasix cause hyponatremia to do likewise.We assume leadership of the journal during a major worldwide crisis brought on by the COVID-19 pandemic, which has affected almost every aspect of society.

Response to the pandemic is requiring engagement from every part of our health care systems—government policy, public health, ambulatory care, inpatient and long-term care, every type of healthcare worker, and of course patients and their care partners. Most journals, including ours, have seen a substantial increase in manuscript submissions does lasix cause hyponatremia. We have published several articles related to COVID-19 that address quality and safety issues central to the journal’s interests—including staffing levels, teamwork, how the pandemic has exposed weaknesses in healthcare systems, and how it may even stimulate efforts to address deficiencies in quality and safety.1–5We take note of the pandemic not only because of its significance but also because, like the pandemic, quality and safety problems are international issues that affect and require engagement from all parts of our healthcare systems and from all stakeholders.

These stakeholders include patients and their care partners, every type of healthcare worker, organisational leaders, policy makers and, of course, researchers and quality improvement teams. Improving quality and safety also requires engagement from experts from other disciplines and industries whose research and practice can inform our efforts to improve care.As new co-editors-in-chief, we find this comprehensive view of the stakeholders for quality and safety to be both necessary to does lasix cause hyponatremia improve care and intellectually stimulating. Of course, with so many stakeholders, there needs to be some additional focus, and we find that on BMJ Quality and Safety’s masthead6.

€˜The journal integrates the academic and clinical aspects of quality and safety in healthcare by encouraging academics to create evidence does lasix cause hyponatremia and knowledge valued by clinicians, and clinicians to value using evidence and knowledge to improve quality’.We will continue to publish research and opinion that creates ‘evidence and knowledge valued by clinicians’. To accomplish this, we will maintain high methodological standards, along with collegial communications between the journal and authors. We will also build on the current interdisciplinary focus of the journal, both from within does lasix cause hyponatremia and outside the healthcare disciplines, and are considering special articles on new methods or ideas from other areas and how they can be adapted and used within the healthcare setting.

We recognise that a strength of the journal is its international focus, although the majority of published papers are currently from North America and the UK. We would like to encourage a wider range of international submissions that meet our high standards for methodological quality and relevance for an international readership. We would like to does lasix cause hyponatremia further increase our social media presence, building on the blogs and Tweets already being led by our two social media editors.

We also want to maintain the journal’s current reputation for constructive peer review and timely publication, in which editors aim to provide personalised, specific and constructive feedback not just for papers for which revision is invited but also for those that are rejected.These are promising times for the journal. The previous co-editors-in-chief, Kaveh Shojania and Mary Dixon-Woods, are does lasix cause hyponatremia handing over a journal with a stellar reputation for rigorous research, thoughtful and challenging commentary, and timely and constructive peer review. We therefore end with our thanks to Mary and Kaveh for their strong leadership and vision, together with an incredibly strong team of senior editors, associate editors and reviewers.

We are sure that readers of BMJ Quality and Safety will does lasix cause hyponatremia echo our thanks.Patients entrust their lives to healthcare providers. Healthcare providers, in turn, aim to promote wellness, heal what can be healed and relieve suffering, all with comfort and compassion. Yet, when patients are harmed by their healthcare, too often they experience defensiveness and disregard that actually exacerbates their suffering, adding insult to injury.1 2 Communication and resolution programmes (CRP) can mitigate this further harm and avoid pouring salt on the wounds of patients whom the healthcare system has hurt instead of helped.

These programmes strive to ensure that patients and families injured by medical care receive prompt attention, honest and empathic explanations, sincere expressions of reconciliation including financial and non-financial restitution, and reassurance from efforts to prevent future harm to others.3 Decades of study and interest in CRPs seem to be resulting in increased implementation with the hope that supporting patients, families and caregivers after harm could become the norm rather than the exception.4Yet a central problem looms, and unless effective solutions are enacted, the potential of CRPs may go largely unrealised does lasix cause hyponatremia. The field is rife with inconsistent implementation, which often reflects a selective focus on claims resolution rather than a fully implemented (‘authentic’) CRP.5 Inconsistent CRP implementation means that fewer patients and families benefit from this model and opportunities for improving quality and safety are missed. Authentic CRPs, in contrast, are comprehensive, systematic does lasix cause hyponatremia and principled programmes motivated by fundamental culture change which prioritises patient safety and learning.

In an authentic CRP, honesty and transparency after patient harm are viewed as integral to the clinical mission, not as selective claims management devices.6 CRPs appear to improve patient and provider experiences, patient safety, and in many settings lower defence and liability costs in the short term and improve peer review and stimulate quality and safety over time.7–10 While the claims savings often associated with a CRP are welcome, authentic CRPs focus on a more ambitious goal. Fostering an accountable culture. Nurturing accountability produces better does lasix cause hyponatremia and safer care which serves the overall clinical mission, happily accomplishing more durable claims reduction along the way.Two thoughtful papers in this issue of BMJ Quality &.

Safety highlight barriers to effective CRP implementation and offer important insights to aid in the spread of this critical model.11 12 Below we outline four suggested strategies for realising the vision of authentic CRPs.Strategy 1. Make CRPs a critical organisational priority grounded in the clinical missionThe most important cause of inconsistent CRP implementation is the failure of institutional leaders, including boards and senior executives (‘C-suites’), to recognise them does lasix cause hyponatremia as a mission-critical component of modern healthcare. As a result, even at organisations professing to embrace accountability and transparency after patient harm, CRPs rarely receive overt leadership support or the resources and performance expectations associated with other mission-critical initiatives.13The reasons why CRPs have not been elevated to mission-critical status at healthcare organisations are complex.

Competing and distracting clinical and does lasix cause hyponatremia financial priorities abound. But a central challenge that has hampered CRPs is the tendency of many C-suites to rely on their liability insurance, risk and legal partners to direct the response to injured patients. Neither the insurance industry nor the legal profession naturally shares the same values and mission as healthcare organisations.14 Healthcare leaders need to insist that responses to injured patients align with their organisations’ clinical missions.

In the absence of such C-suite insistence, ‘deny and defend’ will remain the dominant response to injured patients.This C-suite deference to the claims expertise of the insurance industry and legal profession has additional causes, does lasix cause hyponatremia including. (A) resignation that unintended adverse outcomes will happen even with reasonable care. (B) acceptance of litigation as unavoidable and does lasix cause hyponatremia a cost of doing business.

(C) reluctance of chief executive officers/board members (who are not trial lawyers) to challenge worst-case scenarios painted by defence lawyers and insurance claims professionals. And (D) human does lasix cause hyponatremia nature that avoids confrontation and exaggerates the potential challenges of dealing with injured patients. These factors inform the attitude of some health systems that no adverse events deserve compensation and that the caregivers/organisations are the real victims.While it is encouraging to see a few large liability insurers developing CRPs and even incentivising their adoption,15 more insurers are engaging with CRPs as passive observers, with others remaining actively opposed.

Insurers and attorneys will align as CRP partners only when healthcare organisations identify CRPs as a mission-critical priority.Strategy 2. Compel institutional leaders to recognise the critical importance of CRPsWhat would persuade boards and C-suites to does lasix cause hyponatremia prioritise a CRP?. The study by Prentice et al suggests the answer lies in making institutional leaders recognise the necessity of CRPs through engagement with injured patients and their families.11Prentice and colleagues report the first truly population-based assessment of the impact of medical errors on patients.

Their results does lasix cause hyponatremia highlight the continuing emotional toll that patients and their families suffer from preventable injuries. On an encouraging note, they also document the potential that open and honest communication has for reducing emotional harm. While over half of the patients who reported does lasix cause hyponatremia experiencing medical errors 3–6 years ago described at least one emotional impact from the event, those who reported the greatest degree of open communication with healthcare providers after an error were less likely to experience persisting sadness, depression or feelings of abandonment and betrayal.

Open and honest communication after an error also predicted less doctor/facility avoidance.When boards and C-suites acknowledge the additional emotional harm inflicted on injured patients and their families (not to mention staff) when a CRP is not used or is poorly implemented, the mission-critical nature of CRPs will become paramount.16 17 The emotions of patients and families who have been harmed can be complex, intense and intimidating.18 It has been all too easy for board members and senior executives to look away and avoid direct involvement when their organisations harm the very patients they exist to serve. Patients and their families, of course, cannot enjoy the luxury of looking away.19While boards are sometimes made aware of selected high-value harm events, these cases represent only the tip of the iceberg. Cases of patient harm that are less than catastrophic are rarely shared with boards, but represent a large reservoir of patient and does lasix cause hyponatremia family suffering as well as opportunities for learning.

Many patients who experience injuries hesitate to complain, fearing their ongoing care may be adversely affected.20 21 Patients who have experienced serious harm may have difficulty garnering representation from a qualified plaintiff attorney especially if their claim is deemed to be worth under $500 000. Boards aware only of a does lasix cause hyponatremia few high-value cases will fail to appreciate the magnitude of harm caused by substandard care and falsely believe that their organisation is responding optimally to the few they know about.Engaging a patient as soon as possible after an unplanned clinical event is a CRP hallmark. Listening, with the explicit goal of understanding the experiences of patients and families who have been harmed, is invaluable to any organisation striving for patient centricity and generates insights not available to ‘deny and defend’ adherents.

Partnering with patients who have had unplanned clinical outcomes changes the way healthcare organisations value informed consent, transitions of care and communication in general. As patient does lasix cause hyponatremia engagement is normalised across organisations, boards and C-suites will readily recognise the importance to their clinical mission and the value of the return on investment in the CRP model beyond financial gains. The accountable culture which emerges has the potential to generate other benefits unthinkable in a defensive environment.

Improved staff does lasix cause hyponatremia morale with better staff retention, an open environment which values speaking up for safety, accelerated and more effective clinical outcomes and evidence-based peer review, to name a few.Strategy 3. Invest in CRP implementation tools and resourcesEquating CRPs to early claims resolution predictably yields inconsistent and selective application of the model and, worse, a failure to realise its full potential for cultural improvement.22 Even as boards and C-suites accept the mission-critical status of CRPs (the ‘why’), they may not appreciate the importance of the ‘how’. The second CRP-related paper in this issue of BMJ Quality and Safety emphasises how successful CRPs rely on the development of systems and standard work to promote consistent application.12 Mello and colleagues describe the work of the Massachusetts Alliance for Communication and Resolution after Medical Injury (MACRMI) and articulate the most important elements does lasix cause hyponatremia of their success to date.

Their findings reinforce other papers that emphasize the critical nature of having the right people, processes and systems in place.23One essential element of the MACRMI model is the commitment to a process of reviewing unplanned clinical outcomes eligible for a CRP approach. Normalising a triaged review and then faithfully using the CRP for all eligible cases, regardless of whether that case might become a claim, allows the CRP to meet patient, family and caregiver needs, as well as to drive process improvements faster on a much broader group of harm events. This systematic approach to case selection also demonstrates to clinical audiences that the CRP is not premised primarily on saving does lasix cause hyponatremia money, but is a norm expected within the clinical mission.The MACRMI experience also highlights the importance of devoting sufficient resources to planning and executing a CRP.

Many organisations focus most of their CRP efforts around training different teams to enact key steps in the CRP process. While trainings may be a necessary does lasix cause hyponatremia element, reproducible workflows and simple tools are far more important. With clear leadership support, these tools and processes must be developed with and by the people in the organisation who will actually use them, rather than imposing approaches that may have worked in another system that is organised differently.

Organisations should understand that potential litigation is an ever-present does lasix cause hyponatremia reality. Sometimes, despite the CRP’s principled assessment and engagement, reasonable minds may still differ, and in a small minority of cases litigation is required. Because the motivation for CRPs is to instil the accountable culture required for continual clinical improvement, success cannot be contingent on erasing the threat of litigation altogether.Finally, a significant element of MACRMI’s success involved a shared learning community in which organisational leaders and key managers came together to discuss CRP cases supported by unfiltered patient experiences, clinical and patient safety findings and measures of implementation.

The community does lasix cause hyponatremia acquired a moral authority which encouraged accountability, consistent application of CRP principles, and ultimately demonstrated broad results of the favourable impact on patients, providers, system learning and liability costs.Strategy 4. Deploy CRP metrics to govern CRP and track progressMetrics matter. Organisations measure what they deem important.5 At present it is rare that organisations know how many unintended clinical events occurred in the previous year, how many of the affected patients and families were treated does lasix cause hyponatremia with honesty and transparency, how many of those deemed worthy of compensation actually received it, how many of the affected providers received care, or how many of those cases resulted in clinical improvements.

The absence of these data makes it nearly impossible to assign appropriate leadership accountabilities for CRPs and to understand how well a CRP is functioning in service to the organisational mission. Measuring mainly claims and costs signals a preoccupation with money, not continual clinical does lasix cause hyponatremia improvement, and certainly not patient centricity or care for the caregiver workforce. A comprehensive suite of national CRP measures is currently being developed and refined jointly by the Collaborative for Accountability and Improvement and Ariadne Labs, and should be ready for widespread dissemination by the end of this year.ClosingHealthcare organisations exist to serve with compassion and clinical excellence the patients and their families who entrust them with their lives.

Our society expects no less. The privilege of delivering does lasix cause hyponatremia healthcare, a practice that is intrinsically dangerous, carries a heavy responsibility to minimise the risk of harm. When patients are harmed, CRPs honour patients’ trust and caregivers’ selfless dedication with honesty, transparency, best efforts at reconciliation for all and relentless determination to improve.

One thing is clear does lasix cause hyponatremia. Shedding ‘deny and defend’ in favour of a transition to an authentic CRP undoubtedly requires leadership from boards and C-suites focused on their organisations’ clinical mission. If healthcare organisations are sincere in striving to attain their clinical goals, they will insist on nothing less than elevating their CRPs to mission-critical status and using the requisite tools and resources to ensure consistent application of this model.AcknowledgmentsMany thanks to Gary S Kaplan, MD, for contributing to the concepts presented in this paper, and to Paulina H Osinska, MPH, for her assistance with manuscript preparation..

On 1 September 2020, we took lasix 40mg tablet price in canada on the roles of co-editors-in-chief for BMJ Quality and Safety, and want to take this opportunity to introduce ourselves and our vision for the journal Learn More Here. We represent two different continents, two different professions and two different sets of research expertise. What we have in common is a passion for conducting and publishing high-quality research and quality improvement work to benefit the quality and safety of patient care, as well as encouraging others to do lasix 40mg tablet price in canada likewise.We assume leadership of the journal during a major worldwide crisis brought on by the COVID-19 pandemic, which has affected almost every aspect of society. Response to the pandemic is requiring engagement from every part of our health care systems—government policy, public health, ambulatory care, inpatient and long-term care, every type of healthcare worker, and of course patients and their care partners. Most journals, including ours, have lasix 40mg tablet price in canada seen a substantial increase in manuscript submissions.

We have published several articles related to COVID-19 that address quality and safety issues central to the journal’s interests—including staffing levels, teamwork, how the pandemic has exposed weaknesses in healthcare systems, and how it may even stimulate efforts to address deficiencies in quality and safety.1–5We take note of the pandemic not only because of its significance but also because, like the pandemic, quality and safety problems are international issues that affect and require engagement from all parts of our healthcare systems and from all stakeholders. These stakeholders include patients and their care partners, every type of healthcare worker, organisational leaders, policy makers and, of course, researchers and quality improvement teams. Improving quality and safety also requires engagement from experts from other disciplines and industries whose research and practice can inform our efforts to improve care.As new co-editors-in-chief, we lasix 40mg tablet price in canada find this comprehensive view of the stakeholders for quality and safety to be both necessary to improve care and intellectually stimulating. Of course, with so many stakeholders, there needs to be some additional focus, and we find that on BMJ Quality and Safety’s masthead6. €˜The journal integrates the academic and clinical aspects of quality and safety in healthcare by encouraging academics to create evidence and knowledge valued by clinicians, and clinicians to value using evidence and knowledge to improve quality’.We will continue to publish research and opinion that creates lasix 40mg tablet price in canada ‘evidence and knowledge valued by clinicians’.

To accomplish this, we will maintain high methodological standards, along with collegial communications between the journal and authors. We will also build on the current interdisciplinary focus of the journal, both from within and outside the healthcare disciplines, and are considering special articles on new methods or ideas from other areas and how they can be adapted and used lasix 40mg tablet price in canada within the healthcare setting. We recognise that a strength of the journal is its international focus, although the majority of published papers are currently from North America and the UK. We would like to encourage a wider range of international submissions that meet our high standards for methodological quality and relevance for an international readership. We would like to further increase our social media presence, building on the blogs and Tweets already being led lasix 40mg tablet price in canada by our two social media editors.

We also want to maintain the journal’s current reputation for constructive peer review and timely publication, in which editors aim to provide personalised, specific and constructive feedback not just for papers for which revision is invited but also for those that are rejected.These are promising times for the journal. The previous co-editors-in-chief, Kaveh Shojania and Mary Dixon-Woods, are handing over a journal with a stellar reputation for lasix 40mg tablet price in canada rigorous research, thoughtful and challenging commentary, and timely and constructive peer review. We therefore end with our thanks to Mary and Kaveh for their strong leadership and vision, together with an incredibly strong team of senior editors, associate editors and reviewers. We are sure that readers lasix 40mg tablet price in canada of BMJ Quality and Safety will echo our thanks.Patients entrust their lives to healthcare providers. Healthcare providers, in turn, aim to promote wellness, heal what can be healed and relieve suffering, all with comfort and compassion.

Yet, when patients are harmed by their healthcare, too often they experience defensiveness and disregard that actually exacerbates their suffering, adding insult to injury.1 2 Communication and resolution programmes (CRP) can mitigate this further harm and avoid pouring salt on the wounds of patients whom the healthcare system has hurt instead of helped. These programmes strive to ensure that patients and families injured by medical care receive prompt attention, honest and empathic explanations, sincere expressions of reconciliation including financial and non-financial restitution, and reassurance from efforts to prevent future harm to others.3 Decades of study and interest in CRPs seem to be resulting in increased implementation with the hope that supporting patients, families and caregivers after harm could become the norm rather than lasix 40mg tablet price in canada the exception.4Yet a central problem looms, and unless effective solutions are enacted, the potential of CRPs may go largely unrealised. The field is rife with inconsistent implementation, which often reflects a selective focus on claims resolution rather than a fully implemented (‘authentic’) CRP.5 Inconsistent CRP implementation means that fewer patients and families benefit from this model and opportunities for improving quality and safety are missed. Authentic CRPs, in contrast, are comprehensive, systematic and lasix 40mg tablet price in canada principled programmes motivated by fundamental culture change which prioritises patient safety and learning. In an authentic CRP, honesty and transparency after patient harm are viewed as integral to the clinical mission, not as selective claims management devices.6 CRPs appear to improve patient and provider experiences, patient safety, and in many settings lower defence and liability costs in the short term and improve peer review and stimulate quality and safety over time.7–10 While the claims savings often associated with a CRP are welcome, authentic CRPs focus on a more ambitious goal.

Fostering an accountable culture. Nurturing accountability produces better and safer care which serves the overall clinical mission, happily accomplishing more durable claims reduction along the way.Two thoughtful papers in this lasix 40mg tablet price in canada issue of BMJ Quality &. Safety highlight barriers to effective CRP implementation and offer important insights to aid in the spread of this critical model.11 12 Below we outline four suggested strategies for realising the vision of authentic CRPs.Strategy 1. Make CRPs a critical organisational priority grounded in the clinical missionThe most important cause of inconsistent CRP implementation is the failure of institutional leaders, including boards and senior executives (‘C-suites’), to recognise lasix 40mg tablet price in canada them as a mission-critical component of modern healthcare. As a result, even at organisations professing to embrace accountability and transparency after patient harm, CRPs rarely receive overt leadership support or the resources and performance expectations associated with other mission-critical initiatives.13The reasons why CRPs have not been elevated to mission-critical status at healthcare organisations are complex.

Competing and distracting lasix 40mg tablet price in canada clinical and financial priorities abound. But a central challenge that has hampered CRPs is the tendency of many C-suites to rely on their liability insurance, risk and legal partners to direct the response to injured patients. Neither the insurance industry nor the legal profession naturally shares the same values and mission as healthcare organisations.14 Healthcare leaders need to insist that responses to injured patients align with their organisations’ clinical missions. In the absence of such C-suite insistence, ‘deny and defend’ lasix 40mg tablet price in canada will remain the dominant response to injured patients.This C-suite deference to the claims expertise of the insurance industry and legal profession has additional causes, including. (A) resignation that unintended adverse outcomes will happen even with reasonable care.

(B) acceptance of litigation as unavoidable and a cost of doing lasix 40mg tablet price in canada business. (C) reluctance of chief executive officers/board members (who are not trial lawyers) to challenge worst-case scenarios painted by defence lawyers and insurance claims professionals. And (D) human nature that avoids confrontation and exaggerates the lasix 40mg tablet price in canada potential challenges of dealing with injured patients. These factors inform the attitude of some health systems that no adverse events deserve compensation and that the caregivers/organisations are the real victims.While it is encouraging to see a few large liability insurers developing CRPs and even incentivising their adoption,15 more insurers are engaging with CRPs as passive observers, with others remaining actively opposed. Insurers and attorneys will align as CRP partners only lasix ototoxicity when healthcare organisations identify CRPs as a mission-critical priority.Strategy 2.

Compel institutional leaders to recognise lasix 40mg tablet price in canada the critical importance of CRPsWhat would persuade boards and C-suites to prioritise a CRP?. The study by Prentice et al suggests the answer lies in making institutional leaders recognise the necessity of CRPs through engagement with injured patients and their families.11Prentice and colleagues report the first truly population-based assessment of the impact of medical errors on patients. Their results highlight the continuing emotional toll that lasix 40mg tablet price in canada patients and their families suffer from preventable injuries. On an encouraging note, they also document the potential that open and honest communication has for reducing emotional harm. While over half of the patients who reported experiencing medical errors 3–6 years lasix 40mg tablet price in canada ago described at least one emotional impact from the event, those who reported the greatest degree of open communication with healthcare providers after an error were less likely to experience persisting sadness, depression or feelings of abandonment and betrayal.

Open and honest communication after an error also predicted less doctor/facility avoidance.When boards and C-suites acknowledge the additional emotional harm inflicted on injured patients and their families (not to mention staff) when a CRP is not used or is poorly implemented, the mission-critical nature of CRPs will become paramount.16 17 The emotions of patients and families who have been harmed can be complex, intense and intimidating.18 It has been all too easy for board members and senior executives to look away and avoid direct involvement when their organisations harm the very patients they exist to serve. Patients and their families, of course, cannot enjoy the luxury of looking away.19While boards are sometimes made aware of selected high-value harm events, these cases represent only the tip of the iceberg. Cases of patient harm that are less than catastrophic are rarely shared with lasix 40mg tablet price in canada boards, but represent a large reservoir of patient and family suffering as well as opportunities for learning. Many patients who experience injuries hesitate to complain, fearing their ongoing care may be adversely affected.20 21 Patients who have experienced serious harm may have difficulty garnering representation from a qualified plaintiff attorney especially if their claim is deemed to be worth under $500 000. Boards aware only of a few high-value cases will fail to appreciate the magnitude of harm caused by substandard care and falsely believe that their organisation is responding optimally to the few they lasix 40mg tablet price in canada know about.Engaging a patient as soon as possible after an unplanned clinical event is a CRP hallmark.

Listening, with the explicit goal of understanding the experiences of patients and families who have been harmed, is invaluable to any organisation striving for patient centricity and generates insights not available to ‘deny and defend’ adherents. Partnering with patients who have had unplanned clinical outcomes changes the way healthcare organisations value informed consent, transitions of care and communication in general. As patient engagement is normalised across organisations, boards and C-suites will readily recognise the importance to their lasix 40mg tablet price in canada clinical mission and the value of the return on investment in the CRP model beyond financial gains. The accountable culture which emerges has the potential to generate other benefits unthinkable in a defensive environment. Improved staff morale with better staff retention, an open environment which values speaking up for lasix 40mg tablet price in canada safety, accelerated and more effective clinical outcomes and evidence-based peer review, to name a few.Strategy 3.

Invest in CRP implementation tools and resourcesEquating CRPs to early claims resolution predictably yields inconsistent and selective application of the model and, worse, a failure to realise its full potential for cultural improvement.22 Even as boards and C-suites accept the mission-critical status of CRPs (the ‘why’), they may not appreciate the importance of the ‘how’. The second CRP-related paper in this issue of BMJ Quality and Safety emphasises how lasix 40mg tablet price in canada successful CRPs rely on the development of systems and standard work to promote consistent application.12 Mello and colleagues describe the work of the Massachusetts Alliance for Communication and Resolution after Medical Injury (MACRMI) and articulate the most important elements of their success to date. Their findings reinforce other papers that emphasize the critical nature of having the right people, processes and systems in place.23One essential element of the MACRMI model is the commitment to a process of reviewing unplanned clinical outcomes eligible for a CRP approach. Normalising a triaged review and then faithfully using the CRP for all eligible cases, regardless of whether that case might become a claim, allows the CRP to meet patient, family and caregiver needs, as well as to drive process improvements faster on a much broader group of harm events. This systematic approach to case selection also demonstrates to clinical audiences that the CRP is not premised primarily on saving money, but is a norm expected within the clinical mission.The MACRMI experience also highlights the importance of devoting sufficient lasix 40mg tablet price in canada resources to planning and executing a CRP.

Many organisations focus most of their CRP efforts around training different teams to enact key steps in the CRP process. While trainings may be a necessary element, reproducible workflows and lasix 40mg tablet price in canada simple tools are far more important. With clear leadership support, these tools and processes must be developed with and by the people in the organisation who will actually use them, rather than imposing approaches that may have worked in another system that is organised differently. Organisations should understand that potential litigation lasix 40mg tablet price in canada is an ever-present reality. Sometimes, despite the CRP’s principled assessment and engagement, reasonable minds may still differ, and in a small minority of cases litigation is required.

Because the motivation for CRPs is to instil the accountable culture required for continual clinical improvement, success cannot be contingent on erasing the threat of litigation altogether.Finally, a significant element of MACRMI’s success involved a shared learning community in which organisational leaders and key managers came together to discuss CRP cases supported by unfiltered patient experiences, clinical and patient safety findings and measures of implementation. The community acquired a moral authority which encouraged accountability, consistent application of CRP lasix 40mg tablet price in canada principles, and ultimately demonstrated broad results of the favourable impact on patients, providers, system learning and liability costs.Strategy 4. Deploy CRP metrics to govern CRP and track progressMetrics matter. Organisations measure what they deem important.5 At present it is rare that organisations know how many unintended clinical events occurred in the previous year, how many of the affected patients and lasix 40mg tablet price in canada families were treated with honesty and transparency, how many of those deemed worthy of compensation actually received it, how many of the affected providers received care, or how many of those cases resulted in clinical improvements. The absence of these data makes it nearly impossible to assign appropriate leadership accountabilities for CRPs and to understand how well a CRP is functioning in service to the organisational mission.

Measuring mainly claims and costs signals a preoccupation with money, not continual clinical improvement, and certainly not patient centricity or lasix 40mg tablet price in canada care for the caregiver workforce. A comprehensive suite of national CRP measures is currently being developed and refined jointly by the Collaborative for Accountability and Improvement and Ariadne Labs, and should be ready for widespread dissemination by the end of this year.ClosingHealthcare organisations exist to serve with compassion and clinical excellence the patients and their families who entrust them with their lives. Our society expects no less. The privilege of delivering healthcare, a practice that is intrinsically dangerous, carries a heavy responsibility lasix 40mg tablet price in canada to minimise the risk of harm. When patients are harmed, CRPs honour patients’ trust and caregivers’ selfless dedication with honesty, transparency, best efforts at reconciliation for all and relentless determination to improve.

One thing lasix 40mg tablet price in canada is clear. Shedding ‘deny and defend’ in favour of a transition to an authentic CRP undoubtedly requires leadership from boards and C-suites focused on their organisations’ clinical mission. If healthcare organisations are sincere in striving to attain their clinical goals, they will insist on nothing less than elevating their CRPs to mission-critical status and using the requisite tools and resources to ensure consistent application of this model.AcknowledgmentsMany thanks to Gary S Kaplan, MD, for contributing to the concepts presented in this paper, and to Paulina H Osinska, MPH, for her assistance with manuscript preparation..