AARC Times - May 2013

RC Currents

George Gaebler 2013-04-08 20:40:49

IN THE NEWS The AARC Needs You To Volunteer for Your Profession During my first term as AARC president, I realize it’s important to receive vital assistance from my colleagues — AARC members — in order to achieve everything the AARC, its membership, and the patients we care for need. I am now asking you to volunteer your time and expertise to our professional organization. Having RT volunteers not only facilitates our growth as a profession and association but also presents all volunteers with the opportunity to develop and advance their leadership skills, increase their professional contacts, and give back to the profession, as well as to the patients we serve. Volunteers have always been the heart of the AARC and its leadership. Our strength and advancement comes from the countless hours of support volunteers provide through their time and knowledge toward the betterment of their patients, colleagues, and profession. There are many people like you who need and use the professional tools the AARC provides. Why not get in on the ground floor and collaborate with your fellow RTs to develop new tools to help RTs continually improve and grow as respiratory care professionals? We need you to volunteer your expertise and skills to work on various committees in order for the important work of the Association to be accomplished. Although the AARC has a staff to do a lot of the work, it is really members like you — who volunteer to serve on committees, accept appointments, or offer their assistance in a variety of ways — who are the backbone of this profession. There is enormous momentum and potential for our profession right now. No one individual can accomplish everything we need to do, but I know that dedicated RTs supporting the AARC’s efforts can make vast strides for assuring quality patient care in the continuum of care and securing the respiratory therapist’s rightful place in the changing health care system. This is your Association, and now is the time to volunteer. We look for a balance of experienced and new members on all of our committees. It is this special mixture that makes it possible for the AARC to continue being the vital professional organization it always has been by mentoring in new talent. It also ensures the future of the respiratory therapist in the health care environment as we witness some of the most sweeping changes in history. Please consider this a friendly challenge — and think about how you can help your Association, the profession, and the patients we serve. Take time now to network with your fellow AARC members — perhaps someone active in your state society — whom you believe could contribute special talents or services to the AARC. Encourage them to volunteer so that we can capitalize on the vast amount of expertise available in our Association membership. You can write to me at the AARC Executive Office: 9425 N. MacArthur Blvd., Suite 100, Irving, TX 75063; or email kuykendall@aarc.org. Tell me how you would like to serve and provide a copy of your résumé so I can consider how to best use your talents. I am confident we can continue to reach milestones in the respiratory care profession if we all work together. Thank you for supporting your professional organization, the AARC. I look forward to working with you. AARC PACT Advocates on Capitol Hill By now you’ve seen the AARC website and read the stories about the 14th annual AARC Hill Advocacy Day. This is the event where respiratory therapists from across the country go to Washington, DC, to lobby Congress on legislative issues important to the profession and the pulmonary patient. This year 115 respiratory therapists from 46 states and the District of Columbia “hit the Hill” seeking support for the Medicare Respiratory Therapist Access Act. RTs were joined by over a dozen pulmonary patients sponsored by the COPD Foundation. In addition, over 30 RT students enrolled in respiratory therapy education programs from around the DC region also attended and had the chance to see what dedicated RTs are actively doing for the profession outside of their own respiratory care working world. We can write a lot about the Hill Day — but as they say, a picture is worth a thousand words. Here are some snapshots of respiratory therapists and patients in action on Capitol Hill. First Prizes Awarded in Membership Campaign Earlier this year the AARC launched a new membership campaign with some great prizes to be awarded on a quarterly basis to renewing and new members alike. Now the first drawing has taken place, and two lucky members are enjoying a couple of pretty cool electronic devices. Buff Harvey, CRT, won the iPad in the drawing for renewing members, and the first Kindle Fire went to Deb Sheffield, CRT. Read the full story online at www.aarc. org/headlines/13/02/prize/. Three more drawings for iPads and Kindle Fires are scheduled this year, so be sure to renew your membership and get the word out to your colleagues who have yet to join you in the Association. AARC Mourns C. Everett Koop The AARC joins the rest of the country in mourning the recent loss of C. Everett Koop, surgeon general of the United States in the 1980s. The Association worked closely with Dr. Koop in 1983 as we fought to get better care for ventilator-dependent patients. Dr. Koop authored an article in AARC Times based on a December 1983 workshop presentation he gave focused on ventilator-dependent children and adults. Additionally, Dr. Koop lent his support to a series of workshops that the AARC held on advancing care and reimbursement for ventilator patients. He also aggressively attacked tobacco use — and the rate dropped from 33%–26% of U.S. citizens during his tenure. “Dr. Koop was a strong supporter of the AARC and our profession, especially our efforts to help consumers and patients alike to quit smoking,” says Thomas J. Kallstrom, MBA, RRT, FAARC, AARC executive director. “His tireless efforts as a health care provider and patient advocate will be missed by all of us throughout the world. Dr. Koop helped put respiratory therapists on the health care roadmap since he was the first Surgeon General of the United States to attend our annual meeting to challenge us to do more for our patients.” The “New Members” Column Is Online The “New Members” column can now be accessed at www.AARC.org/new_members. Current AARC members are encouraged to check this site on the first of each month to view the names of individuals who have been approved as “Active Members” of the Association. Any current member may object to a new membership by filing a written objection with the AARC Executive Office at info@aarc.org within 30 days. AHA Clarifies ACLS Policy Collaboration between the American Heart Association, AARC members, and the AARC Executive Office has resulted in clarification on who is eligible to take ACLS (advanced cardiac life support) and PALS (pediatric advanced life support) courses as well as become an instructor for these courses — and respiratory therapists will continue to be recognized in both areas. There had been misinterpretation about RTs fulfilling the requirements in order to take the advanced life support courses and become regional faculty to teach the advanced courses. After receiving several inquiries from respiratory therapists, the AARC used its liaisons and contacts to work directly with the leadership of the American Heart Association to clarify the role of the respiratory therapist. “We want to thank AHA leaders for taking our concerns seriously and working collaboratively with us,” said Thomas J. Kallstrom, MBA, RRT, FAARC, the AARC’s executive director. Based on that conversation, the AHA has published an unequivocal definition that includes RTs among the health care providers eligible for the ACLS and PALS training and to be eligible for consideration as instructors. “We thank the AHA for working with us to provide a strong statement for our respiratory therapists,” says George Gaebler, MSEd, RRT, FAARC, AARC’s president. To read the notice published by the AHA, go to www.aarc.org/headlines/13/02/aha_clarifies_policy.cfm/. AARC Summer Forum — Where Challenges Become Opportunities Respiratory care managers and educators will meet this summer in Orlando, FL, to gain powerful new insight through learning and interacting, all while enjoying a great summer destination. In addition to the concurrent management and education tracks on July 15–17, AARC will hold a pre-Summer Forum session on July 14 titled “Clinical Preceptor and Inter-Rater Reliability Workshop.” This four-hour interactive workshop will reinforce practices of effective preceptors with emphasis on adult learning, mentoring, and evaluating learner performance. See all the details in the full Summer Forum Program in this issue. AARC Now Accepting Applications for the 2013 International Fellowship Program If you provide respiratory care outside of the United States and would like to share and expand your knowledge, please consider applying for our International Fellowship Program. The International Fellowship Program is a sponsored activity of the AARC. Since 1990, health professionals from more than 50 countries have shared experiences, knowledge, and lasting friendships through this exceptional program. The three-week program takes each participant to two host cities in the United States and concludes with attendance and acknowledgement at AARC Congress 2013 to be held Nov. 16–19 in Anaheim, CA. Learn more and apply at www.aarc.org/resources/international_fellows/. For more information, contact April Lynch at lynch@aarc.org. Educators: Help Recognize Outstanding Students The American Respiratory Care Foundation (ARCF) is accepting applications for its undergraduate and postgraduate Education Recognition Awards now through June 15 and is asking RC educators to help get the word out to their students. So check out the list of available awards and then encourage your best and brightest students to apply. The ARCF offers awards to students who are currently enrolled in accredited respiratory care educational programs and to respiratory therapists who are pursuing an advanced degree. Awards include registration and airfare to attend AARC Congress 2013, to be held Nov. 16– 19 in Anaheim, CA. To see all of the awards bestowed by the ARCF every year, go to the Foundation’s Grants, Awards and Fellowships page at www.arcfoundation.org/awards/. For more information, contact April Lynch at lynch@aarc.org. A New Lease on Life Julie Morgan Along with the other RTs and nurses here at Deaconess Hospital in Evansville, IN, I had helped care for Deon Smoot many times over the years when he had come in to be treated for exacerbations of his COPD. A 60–70 pack-per-year smoker, he had quit smoking several years before but was suffering with severe endstage COPD, required continuous home oxygen, chronic prednisone use, inhaled medications, etc. He also had spontaneous pneumothoraces requiring bilateral pleurodesis. With the help of David Harris, MD, one of our local pulmonologists, Deon was able to get on the lung transplant list. About a year later, he received a call from the transplant center that they had two new lungs for him (from a 25-year-old). This was a few days before Halloween in 2011. The picture you see here was taken on the day he was released to return to our Better Breathers support-group meeting — only three months after transplant. We had originally planned to celebrate his November birthday at our November meeting; however, after the transplant he was able to celebrate the birthday — his 65th — in a much bigger way. He was able to breathe again! When his wife called me and told me they were going to come to the January meeting, I called a local bakery and ordered this 3D lung cake. Deon came to the meeting without oxygen, and today he no longer takes bronchodilators and does not even have oxygen in his home. We went to the YMCA for our last support group meeting, and he walked on the treadmill at a fast pace without a problem. He is an amazing person; and so is his loving wife Melodie, who has supported him every step of the way. Julie Morgan, RRT, AE-C, is a respiratory therapist at Deaconess Hospital in Evansville, IN. Request for OPEN FORUM Abstracts for AARC Congress 2013 The AARC invites you to submit abstracts for the OPEN FORUM at AARC Congress 2013. Considered by many to be the premier event at the AARC Congress, the OPEN FORUM is your opportunity to gain national and international recognition for your research in cardiorespiratory care by submitting an original abstract for presentation at the Congress and having it published in RESPIRATORY CARE. The deadline to submit abstracts for the OPEN FORUM is June 1 at http://aarc2013.abstractcentral.com/. International Fellowship Program Looking for City Hosts Every year the AARC sponsors an International Fellowship Program that brings physicians, therapists, and nurses from other countries to our shores to learn more about American-style respiratory care in two cities. It can’t happen without city hosts in each of the localities, and now is the time to step up and volunteer. Learn more about the program and apply by the June 1 deadline at www.aarc.org/resources/international_fellows/. The fellowships take place in the fall just prior to AARC Congress 2013, scheduled this year for Nov. 16–19 in Anaheim, CA. For more information, contact April Lynch at lynch@aarc.org. Enter the 2013 AARC Photo Contest AARC Times is looking for creative members to enter our AARC Photo Contest. Finalists will receive a free one-year membership renewal and have their photo entered into our Photo-of-the-Year Contest with the chance of it being chosen to appear on the March 2014 cover. For instructions and guidelines, select the AARC Times icon at www.AARC.org and click on the “Photo-of-the-Year Contest” link. Deadline to submit photos is Oct. 15, 2013. AARC Leaders Attend Meetings Throughout the year, AARC leaders and members of the Executive Office staff attend meetings of the Association’s state societies as well as other special meetings. In addition to making AARC representatives available for speaking engagements at meetings, the Association funds a special program to help some state societies partially pay for the travel costs of the speakers. Below are some activities AARC representatives are involved in: Thomas J. Kallstrom, AARC Executive Director/CEO • Presenting the Keynote Address at the Colorado Society for Respiratory Care meeting in Vail, CO • Co-hosting with the Saudi Society for Respiratory Care a pre-course on asthma and COPD in Jeddah, Saudi Arabia. Also presenting at the Saudi Society meeting. • Participating in the COPD8USA Conference in Chicago, IL Douglas S. Laher, AARC Associate Executive Director • Speaking on Health Care Reform and Its Impact on the Respiratory Profession at the Children’s Hospital Association’s Respiratory Therapy Forum in Houston, TX Timothy R. Myers, AARC Associate Executive Director • Co-hosting with the Saudi Society for Respiratory Care a pre-course on asthma and COPD in Jeddah, Saudi Arabia. Also presenting at the Saudi Society meeting. Shawna Strickland, Associate Executive Director of Education • Speaking on Maximizing Patient Education and AARC Membership, Professionalism and the Future of the Profession at the Missouri Society for Respiratory Care’s annual conference in Lake of the Ozarks, MO Honoring Military RTs If you are a respiratory therapist currently serving your country in the military, AARC Times would like to publish a story and photo about your service or deployment. Please go online at www.AARC.org/go/mm where you will find an online form you can fill out to provide information about your deployment. You can also download your photo there. Once we receive your information, we may use it to prepare an “RC Currents” story about your service in the military. The AARC honors those who serve, and we would like to share your story with your respiratory care colleagues here and abroad. National Health Observances • National Asthma and Allergy Awareness Month; May; Asthma and Allergy Foundation of America; (800) 727-8462; info@aafa.org • World Asthma Day; May 7; Global Initiative for Asthma; www.ginasthma.com • Air Quality Awareness Week; April 29–May 3; National Oceanic and Atmospheric Administration; (301) 713-1867; www.airquality.noaa.gov • World No Tobacco Day; May 31; Pan American Health Organization; (202) 974-3000; www.who.int/tobacco/wntd/en Members, Send Us Your Human Interest Stories Have you been active in a ventilator-dependent kids’ summer camp? Have you helped an elderly patient in need? Have you saved a life outside of a health care facility? AARC Times is always searching for stories from AARC members that relate special experiences. If you have a human interest story to share with our readers, please contact AARC Times Editor Marsha Cathcart at cathcart@aarc.org. Correction The February AARC Times Clinical Perspectives article titled “Unusual Cases in Blood Gas Analysis” contained an error. In case study #1, beginning on page 20 in column 1, we noted the blood glucose units incorrectly as mmol/L. It should have been mg/dL. We regret the error. Is a New Strain Causing the Surge in Whooping Cough Cases? Researchers from the Centers for Disease Control and Prevention (CDC) joined fellow investigators in authoring a brief report earlier this year in The New England Journal of Medicine outlining the first confirmed cases of a new pertussis strain in the United States. The strain, which was initially identified in France and now accounts for 14% of the whooping cough cases there, was identified in 12 cases of the disease in Philadelphia over the past two years. The investigators believe the strain may be playing a role in the resurgence of whooping cough seen over the past few years in America. Last year, 41,880 cases and 18 deaths were reported to the CDC — the worst year for whooping cough in six decades. Noting that the rapid test U.S. physicians generally rely on to make the diagnosis does not identify the strain, the researchers call for additional study to determine if more extensive testing should be performed on a routine basis to uncover the new strain. “Mr. Gibbs” — A Little Girl’s Best Friend Alida Knobloch was diagnosed with a rare disorder called neuroendocrine cell hyperplasia of infancy when she was just eight months old, a condition that causes her to be unable to breathe on her own for more than about 45 minutes at a time. Luckily she has a great friend who willingly trails behind her with her oxygen tanks on his back. The 60-pound golden doodle, named “Mr. Gibbs,” remains by the child’s side whether she’s playing at home, eating in her high chair, or even riding around on her bike. According to an article published recently in Readers Digest, Alida’s parents worked closely with a dog trainer to provide their young daughter with the skills she would need to control the service dog. Bronchiectasis in COPD Raises Mortality Risk Spanish researchers publishing in the online ahead-ofprint edition of the American Journal of Respiratory and Critical Care Medicine last January linked the presence and severity of bronchiectasis to a significant increase in all-cause mortality in patients with moderate-to-severe COPD. The finding held true independent of other known risk factors, including pulmonary function and comorbidities. The multicenter prospective observational study was conducted among 201 consecutive patients, of whom 115 were diagnosed with bronchiectasis by high-resolution computed tomography (CT) scan of the chest. Fifty-one patients died during a median follow up of 48 months — 43 of them in the bronchiectasis group. “If the prognostic value of bronchiectasis in patients with moderate-to-severe COPD that we found is confirmed in further and larger studies, it would have an important clinical impact,” study author Miguel Ángel Martínez-García, MD, noted. “Bronchiectasis can be reliably diagnosed with high-resolution CT scanning; and effective treatments are available, potentially reducing the risk of mortality in patients with COPD.” Mouse Study Sheds Light on Pulmonary Hypertension Researchers from the National Institutes of Health have discovered that a protein that regulates iron levels in the body may also play a role in the development of pulmonary hypertension. Results of their study, published in Cell Metabolism, found that mice lacking the iron-regulating protein 1 (Irp1) gene produced high levels of hypoxia inducible factor 2-alpha (HIF2 alpha). HIF2 alpha is a protein produced in response to low oxygen conditions, and it also spurs production of the hormone erythropoietin, which stimulates the production of red blood cells. To investigate Irp1’s role in regulating the body’s use of iron, the researchers divided the Irp1-deficient mice into two groups, feeding one group a normal diet and the other a low iron diet. Within a year, less than 40% of the mice on the low iron diet had survived. Most had died from abdominal hemorrhaging. The researchers found that the mice on the low iron diet also had high levels of HIF2 alpha in the lungs and kidney. These animals produced high levels of erythropoietin, which resulted in polycythemia. HIF2 alpha also triggered increased production of endothelin-1 in the lungs, which likely contributed to the development of pulmonary hypertension. Researchers Studying How To Regrow Alveoli Research underway at Johns Hopkins may one day lead to the first successful treatments for regrowing alveoli in people with respiratory disease. Using hepatocyte growth factor (HGF), the investigators have made progress in regrowing alveoli and restoring lung structure in mice genetically engineered to develop a human-like form of emphysema. Two recent experiments were outlined in a recent edition of PLOS Genetics. In one, adult mice were divided into two groups. Half received HGF, delivered under the skin using a special pump for two weeks. The other half received a placebo. A control group with healthy lungs was also divided in half to receive either HGF or a placebo. Mice with emphysema who received HGF developed a 17% improvement in the size of their air sacs compared to placebo-treated mice, consistent with improved lung structure and function. The HGF also prevented destruction of the alveoli by reducing the oxidative stress that contributes to lung injury. The healthy mice that received HGF showed no difference in alveolar size. The mice with emphysema that were treated with a placebo did not show any improvement. The researchers then wanted to see the effect of impaired HGF activity in young mice whose lungs were still forming. They created a mouse in which the HGF receptor, known as MET, was removed from the cells lining the alveoli. The investigators speculated that knocking out MET would result in damage to the alveoli. As predicted, the air sacs in the developing mice without the HGF receptor did not form correctly. Also, the blood vessels serving the alveoli were reduced, and scientists noted an increase in both oxidative stress and inflammation. They concluded that developing alveoli require both HGF and MET signaling in order to form normally. Your Flu Exposure May Be Greater Than You Think Current infection-control guidelines call for health care professionals who are taking care of influenza patients to use fitted respirators only during aerosol-generating procedures like bronchoscopy, intubation, and CPR. Non-fitted surgical masks are considered adequate for routine care. But a recent study from Wake Forest Baptist Medical Center calls that advice into question. Researchers there screened 94 patients for flu-like symptoms during the 2010–2011 flu season. They also tested the air for the presence of flu virus. Sixty-one of the patients tested positive for the flu, and 26 emitted the virus into the air. However, five of those patients emitted up to 32 times more virus than their peers. These patients also had a greater severity of illness, indicating the existence of a more highly infectious subgroup. Other results showed the majority of the emitted virus was contained in small particles located as much as six feet from a patient’s head. The investigators note that this finding also runs counter to conventional wisdom, which suggests most influenza virus is emitted in large particles that less easily penetrate surgical masks. The study was published in the Jan. 31 online edition of The Journal of Infectious Disease. Possible Answer Why Flu Vaccine Is Less Effective in the Elderly A study in the Feb. 6 edition of Science Translational Medicine is helping to explain why seniors appear to receive less protection from the flu shot than younger people. Ning Jenny Jiang, who led the research at Stanford University before moving to the University of Texas at Austin, used genesequencing technology to count the number of B cells in four people age 70 and older and 13 between the ages of 8 and 30 during their peak immune response to the vaccine. Results showed the older subjects had lower numbers of the antibody-producing B cells. The antibody-coding genes in their B cells also had a higher level of mutation, suggesting they had already become highly specialized. This higher level of specialization could be making them more resistant to further specialization in response to the yearly flu vaccine. Artificial Intelligence System “Thinks Like a Doctor,” Say Scientists Indiana University researchers are working on a machine learning tool that they believe may eventually be able to reduce health care costs by more than 50% while improving patient outcomes by nearly 50%. This may sound too good to be true, but the investigators believe an artificial intelligence (AI) framework combining Markov Decision Processes with Dynamic Decision Networks could achieve these goals. The system employs sequential decision making to simulate numerous alternative treatment paths out into the future, maintain beliefs about patient health status over time even when measurements are unavailable or uncertain, and continually plan/re-plan as new information becomes available. In other words, it “thinks like a doctor.” Using clinical data from 500 randomly selected patients with major clinical depression diagnoses, 65–70% of whom had comorbidities like diabetes, hypertension, and cardiovascular disease, the researchers compared actual physician performance and patient outcomes against sequential decision-making models. They found great disparity in the cost per unit of outcome change when the AI model’s cost of $189 was compared to the treatment-as-usual cost of $497. Specifically, the AI approach resulted in a 30%–35% increase in improved patient outcomes, and adjustments to the system revealed that those improvements could be enhanced to about 50%. The authors believe the system could be used with any diagnosis or disorder. “The framework here easily outperforms the current treatment-as-usual, case-rate/fee-for-service models of health care,” study author Casey Bennett was quoted as saying. However, he and his colleagues stop short of suggesting that the system replace clinicians. “Even with the development of new AI techniques that can approximate or even surpass human decision-making performance, we believe that the most effective long-term path could be combining artificial intelligence with human clinicians. Let humans do what they do well, and let machines do what they do well. In the end, we may maximize the potential of both.” The research appeared in a recent issue of Artificial Intelligence in Medicine. Heavy Smoking May Not Rule Out Lung Donation Ideally, patients awaiting lung transplants will receive lungs from healthy nonsmokers. But given the shortage of donated lungs, some physicians have opted for lungs from smokers. However, lungs from heavy smokers — defined as a pack a day for 20 years or more — are typically avoided. New research, however, suggests those lungs might fare just as well as those from light-to-moderate smokers. Investigators from Temple University Hospital in Philadelphia analyzed data from 5,900 double-lung transplant recipients recorded in the United Network for Organ Sharing database between 2005–2011. Transplants from heavy smokers composed 13% (766) of the double-lung transplants. Results showed that short- and medium-term survival was similar in patients who received lungs from carefully selected donors with a history of heavy smoking and patients who received donor lungs from non-heavy smoking donors. Amazingly, lung function was found to be no worse when using heavy smoking donors, and the number of deaths due to malignancy was also about the same. “Our findings demonstrate that the current criteria for lung transplantation can potentially be revised to include donors with a heavy smoking history,” study author Sharven Taghavi, MD, noted. “This may help decrease the shortage of donor lungs and decrease waiting list mortality.” The study was presented at the latest meeting of the Society of Thoracic Surgeons. More studies are needed. You can submit news about AARC members by going to www.AARC.org/transitions. Is Your Company Listed in the AARC Online Buyer’s Guide for Respiratory Care? If so, you need to update your listing before April 23 to have your current information included in the printed Buyer’s Guide, which will appear in the July issue of AARC Times. If your company is not listed, log on today to http://buyersguide.aarc.org and enroll for your free listing. Just look for the "click here!" link on the home page. For more information, contact buyersguide@aarc.org. Transitions The AARC mourns the loss of Roy Wagner, RRT, of Dallas, TX, who recently lost his battle with cancer. In addition to serving on numerous committees for the Texas Society for Respiratory Care (TSRC) and for the AARC, he also served as president and delegate for the TSRC. He was recognized for his excellence in professionalism with the AARC’s Delegate of the Year award in 2007. Roy was a true professional, a patient advocate, and a friend. He will be missed. — John Hiser, MEd, RRT, FAARC Michael Tracy, BA, RRT-NPS, passed away in March. Tracy spent the past 25 years in the pediatric respiratory care and pediatric pulmonary function departments at Rainbow Babies & Children’s Hospital in Cleveland, OH. An AARC member since 1981, he became a Neonatal- Pediatric Specialist in 1994 and was a member of both the Neonatal- Pediatrics and Management Sections. He was awarded the Neonatal-Pediatric Specialty Practitioner of the Year in 1998 and served as chair of the Neonatal-Pediatrics Section from 2005–2007. He was a member of the AARC Clinical Practice Guidelines Committee and Board of Directors from 2005–2009. His colleagues will remember him for his attention to detail, stern disciplined demeanor, and love for the profession. You can submit news about AARC members by going to www.AARC.org/transitions.

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