2013年9月28日星期六

Enteral access devices: selection, insertion, and maintenance considerations. In: A.S.P.E.N. enteral nutrition practice


GUIDELINE TITLE
Enteral access devices: selection, insertion, and maintenance considerations. In: A.S.P.E.N. enteral nutrition practice recommendations.

BIBLIOGRAPHIC SOURCE(S)
Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J, Lyman B, Metheny NA, Mueller C, Robbins S, Wessel J. Enteral access devices: selection, insertion, and maintenance considerations. In: A.S.P.E.N. enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr 2009 Mar-Apr;33(2):143-9. [65 references]




GUIDELINE STATUS
This is the current release of the guideline.


open here to see the full-text:
Enteral access devices: selection, insertion, and maintenance considerations. In: A.S.P.E.N. enteral nutrition practice


Is asthma a disease of sunlight/vitamin D deficiency?

Yes. Asthma, to a great extent, is caused by sun avoidance and consequent vitamin D deficiency.


Asthma, a devastating respiratory illness, is increasing rapidly in the US. The latest statistics I have show that the overall prevalence of asthma increased 75% from 1980-1994, and asthma rates in children under the age of five increased more than 160%.[1]


There is little doubt that the profound increase in asthma in the last few decades has been caused to a great extent by our societal exodus from sunlight exposure along with the increased use of sunscreen, which can inhibit up to 99% of vitamin D production by the skin.[2]


Drs Litonjua and Weiss, in a medical hypothesis presented in 2007, made a strong case for vitamin D deficiency as a major player in the increase in asthma incidence among both children and adults.[3] They hypothesized the following:


1. “… as populations grow more prosperous, more time is spent indoors, and there is less exposure to sunlight, leading to decreased cutaneous vitamin D production.”
2. “Vitamin D has been linked to immune system and lung development in utero, and our epidemiologic studies show that higher vitamin D intake by pregnant mothers reduces asthma risk by as much as 40% in children 3 to 5 years old.”
3. “Vitamin D deficiency has been associated with obesity, African American race (particularly in urban, inner-city settings), and recent immigrants to westernized countries, thus reflecting the epidemiologic patterns observed in the asthma epidemic.”


Other research demonstrates that vitamin D reduces the production of inflammatory chemicals (chemokines) in the respiratory passages,[4] which would dampen the asthmatic response.


Another study assessed the asthma risk of children whose mothers had the highest vitamin D consumption during pregnancy, and compared them to children whose mother had the lowest levels. The high-vitamin D group showed an impressive reduced risk of asthma of 52-67%.[5] The researchers believe that inadequate vitamin D levels in the fetus leads to improper development of the lungs and immune system.


Still other research, conducted on three-year old children whose mothers were in the highest quartile (fourth) of vitamin D consumption during pregnancy, showed them to have a 61% reduced risk of a “recurrent wheeze,” a symptom of asthma, when compared to those whose mothers were in the lowest quartile.[6] Each 100-IU increase in vitamin D consumption resulted in a 19% risk reduction. That’s about the amount that could be produced in the summer sunlight in one minute, or a good tanning bed in half a minute! How sad that these women have been frightened out of the sunlight, the natural way to produce vast quantities of vitamin D.


[1] Centers for Disease Control. Surveillance for Asthma – United States, 1960-1995, MMWR. 1998; 47 (SS-1).
[2] Matsuoka, L. et al. sunscreens suppress cutaneous vitamin D3 synthesis. Journal Clini Endocrinol Metab 1987; 64:1165-68.
[3] Litonjua AA, Weiss ST. Is vitamin D deficiency to blame for the asthma epidemic? J Allergy Clin Immunol 2007;120:1031–1035.
[4] Banerjee, A. et al. Vitamin D and glucocorticoids differentially modulate chemokine expression in human airway smooth muscle cells. Br J Pharmacol 2008; 155: 84–92.
[5] Devereux, G. et al. Maternal vitamin D intake and early childhood wheezing. Am J Clin Nutr 2007;85:853-59.
[6] Camargo, C. et al. Maternal intake of vitamin D during pregnancy and risk of recurrent wheeze in children at 3 y. Am J Clin Nutr 2007;85:788-95.


Getting Records for a Child SSI Disability Claim


I’ve only said this about a thousand times here. Disability cases boil down to what’s in the records. Typically, that means medical evidence in medical records. However, for an SSI child disability claim, records can also include school records, and this can be the case whether the child’s impairment is physical or is a mental impairment.


Why would you have to gather school records for a child who is applying for disability on the basis of, say, ADHD, autism, a learning disability, or impaired cognitive functioning (mental retardation, or borderline intellectual functioning)? Because child disability claims are very different from adult cases.


For adults who file for disability, the deciding factor will be whether or not the individual can engage in work activity, either past work or some type of other work.


For child disability claims (SSI), cases are decided on the basis of whether not the claimant can engage in age-appropriate activities. This typically boils down to intellectual and academic performance in comparison to one’s peers. And, of course, even a physical impairment, such as seizure disorder or asthma, can have an effect on things like this. One has simply to remember that the social security administration is chiefly concerned with functionality. The reason why (i.e. the condition itself) is largely irrelevant.


What type of academic records do you gather for a child SSI disability claim and how do you gather them? Let’s discuss the “how” first. This can vary tremendously, depending on the school district. Sometimes, record requests are sent to a centralized records department for a school district, sometimes they are sent to a school’s guidance office, sometimes they are sent to a school’s main office (the principal’s office), and sometimes, less frequently, they are sent to the direct attention of a teacher.


How will you know where to send the record request to? There’s really only one way, especially since protocol can vary even between different schools in the very same school district. You should call the school in question and ask them where a request for records on a student in attendance should be sent. As always, of course, send a release form and make sure the request is detailed enough so that you’ll actually get back the records you need (otherwise, you could end up getting nothing but grade reports when what you really need is achievement and IQ records).


Problems you may run into in gathering records from a school may include A) general incompetence and B) the school’s operating schedule. Regarding A, it can be difficult to gather academic records because many schools (this may or may not surprise people) are run poorly from an administrative standpoint. Regarding B, it can be very difficult to obtain records when a school is on break. Summer breaks can literally mean an inability to obtain records for months at a time, which can be extremely problematic for a disability hearing that is being held in a summer month.


What type of records will be requested on a child SSI Disability claim? Really, anything that may point to functionality and impaired functioning. Logically, this includes grade reports, IEPs, and copies of specialized testing, such as intelligence testing and academic achievement testing. However, it can, and should, also include completed questionaires from a child’s teacher, or teachers. Such questionaires can deliver (to an administrative law judge holding a hearing) a detailed first-hand account from the one individual who is uniquely qualified to report on a child’s ability to engage in age-appropriate activities in a school setting; namely, the child’s teacher.


How do you send such a questionaire to a teacher? You may first wish to determine which teacher to send the form to. If the child has a single teacher, the choice is obvious. If the child has multiple teachers such as in higher grade levels, this may be a matter of sending multiple questionaires in the hope that at least one teacher will fill one out and return it.


Where are teacher’s questionaires obtained? This is not the type of form that is used by the social security administration, which is odd considering that SSA will obtain reports on a adult claimant’s ADLs, or activities of daily living. However, SSA also does not send RFC, or residual functional capacity forms, to a claimant’s doctors, so this should not be too surprising.


Teacher’s questionaires are typically sent out by a claimant’s disability attorney, and generally this effort is only made in preparation for a disability hearing.


As this is the case, a parent who is filing for child disability benefits may actually wish to ask their chosen disability representative if an attempt will be made to obtain such a questionaire. Not doing so is equivalent to being less prepared for a hearing than ideally would be the case. And for this reason, a parent who learns that their child’s attorney will not attempt to gather such information may wish to find other representation.


Return to the Social Security Disability SSI Benefits Blog


Social Security Disability and SSI, what is the difference?
Can I win my social security disability claim?


Introducing Asthma

      Asthma is a disease that effects the lungs due to inflammation of the airways. Symptoms of asthma are episodes of breathlessness, chest tightness, and wheezing. These symptoms make breathing a challenge and in the United States this affects nearly 25 million individuals, this accounts for both adults and children alike (CDC, 2009.) While there is no cure for asthma right now there are ways to limit the severity of the onset of asthma “attacks.” Some ways of doing this are through awareness of possible asthma triggers as pertaining to the individual and with the help of medicine which will further be discussed.




Clinical implications suggest that examining the ecological context may enable practitioners to identify social and environmental factors that challengethe management of childhood asthma. (Yinusa-Nyahkoon 2007)

Asthma: “Inflammation of the air passages resulting in the temporary narrowing of the airways that transport air from the nose and mouth to the lungs. Asthma symptoms can be caused  by allergens or irritants that are inhaled into the lungs, resulting in inflamed, clogged and constricted airways. Symptoms include difficulty breathing, wheezing, coughing tightness in the chest. In severe cases, asthma can be deadly.”
(AAFA; Asthma and Allergy Foundation of America)



  • There is no cure for asthma, but asthma can be managed with proper prevention and treatment.

  • Asthma has a genetic component. If only one parent has asthma, chances are 1 in 3 that each child will have asthma. If both parents have asthma, it is much more likely (7 in 10) that their children will have asthma.

  • More Americans than ever before say they are suffering from asthma. It is one of this country’s most common and costly diseases.


Every person who struggles with asthma needs to recognize the catalyst of an attack via coughing, chest tightness, wheezing, and trouble breathing (symptoms.) Every person has their own personal triggers that set off an asthma attack. It is important for individuals to be knowledgeable of their particular triggers in order to avoid or at least reduce attack situations.(CDC)

Common triggers:

                           Dust mites

                           Secondhand smoke

                           Strenuous Physical Activity

                           Outdoor air pollution

                           Cockroach allergen

                           Pets

                           Mold



Here is an interesting link that will guide to a well done and informative brochure titled “You Can Control Asthma” CLICK HERE



Parent-Child:
Overall, four routines are looked at and managed by both the children and parents of the children with asthma. These routines are adapted by both the children and adults to which they adjust treatment recommendations to be utilized within their personal ecological context.
          1. Child with asthma given responsibility for medication use
          2. School nurse availability monitored
          3. Air quality analyzed managed at best efforts
          4. Home environment cleaned often
(Yinusa-Nyahkoon, 2007)


Family/Friends:
The education of family and friends on the topic of asthma is very important. If an individual diagnosed with asthma is surrounded by people unaware of the triggers of that individual then that individual will suffer. It is also important that the diagnosed individual is not the only person monitoring their use of medication/inhaler. The more aware and educated the family and friends are of the diagnosed individual the more likely that person will be able to live at a higher quality of life.




Social Support:
The more support and understand that surround the diagnosed individual the more they will accept their condition themselves. As an adolescent it can be viewed as embarrassing to be wheezing and struggling to breath in front of their peer group. With this embarrassment can come the lack of using an inhaler and being physically active (if a trigger.)




Support groups for both adults and children are much more readily active and available then one might think. Through the Asthma and Allergy Foundation a variety of support groups can be found. By clicking on SUPPORT GROUPyou will be able to find out more about support groups and what they offer as well as locate a possible local and convenient support group for yourself or someone you know.






In response to the growing asthma problem the United States Environmental Protection Agency (EPA) created a national asthma education and outreach program.While there is no cure, asthma can be controlled through medical treatment and management of environmental triggers.




THE GOAL: Reduce exposure to indoor asthma triggers and improve the quality of life for 6.5 million people by 2012.




Follow the provided link to access the Asthma Awareness Month Event Planning Kit (February, 2010) to kick off your activities. The Kit includes tips for:


  • Holding an asthma awareness event at a school, local hospital or clinic, library, or your state’s capitol building;

  • Distributing asthma materials and educating parents on the risks of second-hand smoke;

  • Partnering with local organizations to pool resources and increase publicity for your event;

  • Collaborating with local leaders/celebrities to boost awareness for your campaigns;

  • Garnering media attention for your event; and Much more


The growing awareness of asthma is great but it is important that those who have been made aware continue their duty by making others aware! They can do so by contributing to any of the previously listed bullet points.













Asthma in the Schools:Asthma awareness in school should be of great focus. Being aware that asthma is the most common chronic condition among children (AAFA) and knowing that children spend almost half of their days in a school setting shows that schools and their facilities can essentially contribute to half of the problem that is asthma. With that said, taking these preventative measures in the school settings can only make a positive impact.



  1. Establish and Continuously Evaluate an Indoor Air Quality – IAQ – Management Program in Your School or District.




  1. Develop an Asthma Management Plan in Your School or District.
    Incorporate school policies to encourage a safer and more stable environment for students with asthma. This could range from access to inhalers to faculty education training on the topic of asthma.





  1. Reduce Environmental Asthma Triggers.
    This can be done by inspecting the school facilities thoroughly on a regular basis. Topics of focus should be mold, moisture, and source of indoor air pollutants.



(EPA)








Facilities:
As widely discussed with asthma it is very important that individuals with asthma recognize and avoid their personal triggers. Many possible triggers can be found indoors such as mold, pets, and chemical odors. With this knowledge it is important that thorough inspections are given in any facility that the individual who has asthma finds themselves spending amounts of time in.

Racial/Demographic:
In regards to asthma and the racial disparities of outcomes of the chronic disease African-American children demonstrate poorer clinical outcomes that any other racial group. Among children with asthma a higher level of quality of life is typical for the children who live in rural areas in comparison with those from cities.







  • African Americans are three times more likely to be hospitalized from asthma. [13]

  • African Americans are three times more likely to die from asthma.  African American Women have the highest asthma mortality rate of all groups, more than 2.5 times higher than Caucasian women.


(AAFA)





The American Lung Association (ALA) worked with partners to develop the National Asthma Public Policy Agenda to reduce the suffering and death from asthma. The ALA hope that groups and individuals who care about asthma will embrace the recommendations found in the Agenda and push to get them put in place nationwide.

This agenda focuses on health-care, homes, outdoor air, public health infrastructure, schools, and workplaces. I list both health-care and home agendas to give you, the readers, an idea of the direction of ALA while you can find information on the rest of the categories and sub categories by following this link …




Health-Care:
1.All health-care systems, including public and private providers, purchasers and payers, should provide access to services and medications consistent with the National Asthma Education and Prevention Program (NAEPP) guidelines. 
The health-care needed is not provided to many people with asthma as a means of controlling it. Asthma is an individualized disease and each person needs a specific diagnosis and plan of attack in order to properly control their struggle with asthma. With that said each asthma patient should be given acces to adequate care, medications, and education.


2. Standardized national performance measures should be adopted for monitoring and evaluating asthma quality of care.
Monitoring performance measures will allow for the tracking of hopeful progress of asthma patients. In doing so not only will the patients be looked after but the quality of care for these patients will be studied.


3. Promote quality improvement activities and develop and disseminate tools that support achievement of performance goals. 
Support for these activities can help make sure the quality of care is at its best.


Homes:
1. Housing code ordinances should protect people with asthma against indoor air problems. Housing codes are an established tool that can and should be used to reduce asthma triggers in homes. However, these codes vary considerably in their requirements and are often underused.


2. Housing code enforcement should be strengthened to reduce prevalence of indoor air quality problems.  Unhealthy indoor air can be a threat to anyone at home, especially those with asthma. Reducing these risks can lead to better management of the disease.


3.  Multi-unit housing should be smoke-free. Second hand smoke is a threat for people with asthma and a serious indoor air pollutant that should be eliminated. Having smoke-free housing is an important step to help those with lung disease.
(ALA)




REFERENCES





Asthma Facts and Figures. Retrieved November 13, 2010 from Asthma and Allergy Foundation of America Website: http://www.aafa.org/display.cfm?id=8&sub=42

 

CDC - Asthma - Basic Information. (2009, October 20). Centers for Disease Control and Prevention. Retrieved November 11, 2010, from http://www.cdc.gov/asthma/faqs.htm  


Yinusa-Nyahkoon, L., Cohn, E., Tickle-Degnen, L., Cortés, D., Lieu, T., & Bokhour, B. (2007). Examining
     routines to understand the ecological context: managing childhood asthma. OTJR: Occupation,
     Participation & Health
, 2797S-99. Retrieved from CINAHL with Full Text database.





(2010, October 5). May is Asthma Awareness Month. Retrieved     November 14, 2010 from U.S. Environment Protection Agency     Website: http://www.epa.gov/asthma/awm/index.html

 

(2010). Health-Care Systems and Financing. Retrieved November 14, 2010 from American Lung Association Website: http://www.lungusa.org/lung-disease/asthma/advocacy/reports/health-care-systems.html 


(2010, October22). Managing Asthma in School Environment. Retrieved November 13, 2010 from U.S. Environmental Protection Agency Website: http://www.epa.gov/iaq/schools/managingasthma.html

 

(2009, April 24). Asthma. Retrieved November 13, 2010 from Center for Disease Control and Prevention Website: http://www.cdc.gov/asthma/ 

 

Asthma, -little information...



Asthma is a common disease which affects the respiratory system. It constricts the airways and they become inflamed and lined with mucus. It can be managed well.

Many children develop asthma, which eventually they grow out of. The triggers associated with asthma include:


• Allergies
• Stress
• Exercise
• Cold air


Genes may also play a role who is getting asthma and who not.


The symptoms of asthma include:


• Wheezing
• Coughing
• Chest tightness
• Short of breath


Early detection, diagnosis and treatment is important, otherwise asthma could become a life-threatening disease.


25% of the children will develop asthma and the percentage is not increasing, but only staggering.


The children must get enough breast milk as long as possible. The antibodies and the combination itself is the best for the infant to develop its immune system. Try to avoid cow milk for the infants till 12 months and here we observe these children get less allergies and asthma. If you are not having enough breast milk, select other food, but not milk or milk powder based formulas. Now-a-days without any problems this could be done.


Good medicines are available. Theophylline is the medicine used and it belongs to the group of thioxanthenes. Caffeine also belongs to this group and is good for persons who have asthma. But there is no cumulative effect from both. If we find theophylline values in toxic levels we ask the patient to drink four cups of strong coffee and the caffeine present there helps for the quick excretion of theyphylline.


Asthma is one of the fastest growing health problems in all developed countries.


This a short article to give you quick information.



Allergy asthma


Allergy asthma

Asthma and allergy  can often go hand in hand. Asthma is a disease of the branches of the trachea (bronchi) that carry air in and out of the lungs. There are several different types of asthma. Allergic asthma is a type of asthma that is triggered by allergies (eg pollen or mold spores). According to the American Academy of Allergy, Asthma and Immunology, half of the 20 million Americans with asthma suffer from allergic asthma

Family history of allergies is an important risk factor for allergic asthma. Another risk factor is to have hay fever or other allergies. More than one in four people with hay fever also develop asthma. Although allergic asthma is the most common are other forms of asthma and active asthma such as exercise-induced asthma and allergic asthma triggered by infections or cold air or gastroesophageal reflux disease (GERD). Some people have asthma caused by more than one type of trigger.
If you have a bothersome allergy and asthma symptoms, talk with your doctor. Recognize the relationship between immune system and how the airways react has improved asthma symptoms for many. Knowing that you start, when the measures to avoid them, and work with your doctor to find the right treatment to manage symptoms to help maintain both the symptom control of asthma and allergies.





Warning signs of asthma attack

The first signs begin before symptoms most influential of asthma and are the first signs of a person’s asthma. Signs and symptoms of asthma are:

  • Frequent cough, especially at night.

  • Taber breath easily or shortness of breath.

  • Feeling very tired or weak when exercising.

  • In addition to wheezing, coughing, shortness of breath rates or changes in peak expiratory flow is a measurement of air speed of your lungs when you breathe heavily signs of a cold or other respiratory infections or allergies.

  • Sleep disorders.

  • If you have any of these symptoms of asthma, seek treatment as soon as possible to avoid suffering a severe asthma attack.


Some medications for allergies and asthma, but may be different. For example, corticosteroids reduction you spray in your nose inflammation from hay fever. Corticosteroid creams applied to the skin, reduce inflammation of allergic skin reaction. And inhaled corticosteroids, which you breathe into the lungs using an inhaler device, reduce inflammation of the bronchi caused by asthma. Taken in pill form, montelukast (Singulair) is used to help with symptoms caused by allergies and asthma. Called leukotriene modifier, this drug helps regulate the immune system chemicals released during an allergic reaction. Some other drugs are much more effective for a condition for a second. Antihistamines, for example, are commonly used to treat hay fever, but does not function well in the treatment of asthma. bronchodilator inhalers, which open congested airways, are a big part of asthma treatment, but they are used to treat hay fever.











You Can Exercise, Even If You Have Asthma | Asthma Treatment Tips ...




If we have asthma, we substantially can not use properly or safely. Contrary to what many consider of this issue, there have been ways we can get fit as well as exercise, even if we have asthma.


Asthma is a chronic lung disease, which is marked with features such as coughing, wheezing, crispness of breath as well as chest tightness. Asthma tends to start in people who have been genetically or environmentally presdisposed is okay.


Some triggers which might initiate or have an conflict worse include exposure to allergens, viral respiratory infections, airway irritants, use as well as exposure to things similar to dirt mites or cockroaches.


You can forestall asthma attacks as follows:


1. Rinse your pet upon a weekly basis.


2. Do not smoke or smok
ing in your home.


3. When I imitation or Pollentia is great, we should stay indoors with air conditioning.


4. Wash bedding as well as stuffed toys weekly in hot water.


5. Wash your hands every time we get.


6. Get a influenza shot.


7. Use a headband over his mouth as well as nose in a winter months.


8. Be proactive as well as know your triggers as well as how we should avoid.


Now which we know what we know about asthma, we might wonder if a use is similar to most doctors will discuss it you, do not give up in sport or use at all. Just be smart about how to play as well as take special precautions to forestall attacks before.


Almos
t all doctors determine which a most appropriate approach to forestall attacks during use is to keep your inhaler as well as medication tighten by. You should never use a inhaler more than 3 times during a game session or practice. If we have been up a previous night with coughing as well as wheezing, it is regularly most appropriate to go light your use a next day.


Something known as IEA (exercise induced asthma), symptoms have been somewhat different, which demeanour similar to after 6-10 minutes of physical activity as well as is mostly worse in cold air or dry.


If we have IEA, there have been several activities we can enjoy such as swimming, walking, cycling, skiing as well as team sports based. There have been many activities for we to select to safeguard we get a use we need as well.


Remember which a condition of asthma is not all in your
head, is a real physiological healing diagnosis which requires diagnosis for a impediment as well as treatment. Even if a doctor is your most appropriate friend for a diagnosis of asthma, six a usually one who can equivocate a symptoms.


There is regularly a leg, take drugs as well as be proactive. Do not let which have living in misery how can we enjoy exercising similar to everyone else



weslo cadence treadmill