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Announcement
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| The ISRC, like other organizations and people in general,
needs to economize in its expenditures. The ISRC Board of Directors has
decided that one place where some money can be saved is in distributing
Mountain Air electronically, instead of by the US mail. Although the AARC
Board of Directors has decided not to make their list of email addresses
of our members available to the affiliates (ISRC), they will do a mass
emailing to all our members with a link to the newsletter on our website.
The AARC did give us a list of the members without email addresses who
will receive Mountain Air by classic mail. If you have any questions or
concerns about this change contact the editor. |
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ISRC
Web Site
www.idasrc.org
Education
- Resources - Employment
- Meetings/Events - Scholarships
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ISRC
Board Meeting
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September
11th
Owyhee
Plaza
Boise,
Idaho
During
Lunch at Conference
All
board meetings are open meetings and all members are welcome and appreciated.
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Contact
Brandi Johnson for more information at johnsonb@slrmc.org
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Conference
2008
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Brandi
Johnson, President
| Hello, fellow RTs. I wanted to update you all on the
2008 ISRC Conference that will be held in Boise on September 11th and 12th
at the Owyhee Plaza hotel. There will be speakers with vast knowledge
from all over the country. Some of these include Dr. James Souza of Idaho
Pulmonary Associates in Boise, Dr. Mark McConnell, a PICU Intensivist at
St. Luke’s Boise, Dr Mark Rasmus, a pulmonologist specializing in sleep
in Boise and Brian Walsh, RRT-NPS, RPFT, Clinical Research for Boston's
Children’s Hospital. I have been in contact with Dr. Neil MacIntyre
along with Dr. Forrest Bird and am hoping for confirmation that they could
join us in Boise. We will have a vendor reception night with appetizers
and drinks along with a drawing for door prizes on Thursday evening which
has proved to be most enjoyable. We are hoping to get enough interest
in putting on a Sputum Bowl so please email me, or Tom Gable with names.
Registration fees will be average but cheaper for AARC members. Please
save the date and come get your CEUs in Boise. I hope to see you there. |
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Donna
Wainwright Memorial
Respiratory
Scholarship
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Student
in a formal CRT or RRT program and residing in the State of Idaho
Completed
one year of an RT program
An
AARC member
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Deadline
to apply for $500 scholarship: August 1
http://www.idasrc.org/scholarship_application_form.htm
Contact
Brandi Johnson for more information at johnsonb@slrmc.org
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Member
Spotlight
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Dixie
Durham, RRT-NPS
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| I have a new job. I have practiced respiratory therapy
at St. Luke’s Boise since 1983. I am a graduate of Boise State’s respiratory
therapy program, and am currently enrolled in the master’s of health science
program with a research emphasis. I hope to graduate in December 2008. |
| For the past twenty years, I have worked primarily in
the Children’s Hospital at St. Luke’s. I am also one of the therapists
in the Cystic Fibrosis Clinic at St. Luke’s. This CF Clinic oversees the
care of 80 children and adults with CF, ranging in age from four months
to seventy years. We are an affiliate of University of Utah’s Intermountain
Cystic Fibrosis Center. |
| The adult team from Utah comes to see adult patients
quarterly. Pediatric patients are seen either by the clinic director, a
pediatric gastroenterologist, the assistant director, a pediatrician, or
the clinic’s family medicine physician. Adults are also seen at pediatric
clinic. A respiratory therapist, a social worker, a dietician, and a nurse
also see each patient. Having a pediatric gastroenterologist in clinic
is unusual, as most pediatric CF clinics are managed by pediatric pulmonologists.
Idaho has no pediatric pulmonologists, so we rely on our GI doctor. |
| The CF clinic has attempted to get involved with research
for several years. Last summer, we were awarded a grant from the national
CF Foundation to hire and train a research coordinator. Because of my interest
in research, I changed jobs in December and became the research coordinator
for the CF clinic. Most research coordinators are registered nurses; there
are but a handful of research coordinator respiratory therapists. Being
a research coordinator for the CF clinic is a good fit for a respiratory
therapist. There are over 30 drugs in development in CF research, and the
majority of these are inhaled. Some of these will be given with the
eFlow, a new nebulizer from Pari that is a vibratory mesh nebulizer. Drugs
currently in Phase III testing include dry powder inhalations of Cipro,
Tobi, and mannitol. Clinical trials involving inhaled drugs require
sputum collection and pulmonary function testing. |
| As a research coordinator, I field study solicitations
from sponsors, most of who are pre-approved by the CF Foundation’s Therapeutic
Development Network. I scrutinize protocol summaries to see which ones
would be a good fit for our clinic. I analyze our patient population to
see if we have an adequate number for the study, and ask one of the three
doctors if they have an interest in the study. One of them must take on
the role of primary investigator. We then tell the sponsor if we are interested
or not. I then take care of the paperwork involved and schedule a pre-study
visit. If we are accepted for the study, there are large quantities of
paperwork to be done to follow federal and international guidelines for
research on human subjects. Once the study is up and going, I help recruit
patients, obtain informed consent and schedule the study visits. During
the actual study visit, I obtain vitals and labs, do PFT’s, get drugs from
the pharmacy, and do the charting. |
| So far the learning curve has been quite steep, but I
should have the hang of it in a few years. The work has already been very
rewarding. The first study we are involved with is a new pancreatic enzyme.
There was a lot of interest in enrolling in this study. |
| Your respiratory therapy job can take you places that
you never dreamed! |
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Camp
Super Breathers
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Michele Andrew, Past
President
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| We always knew we were doing good
things for our asthmatic kids at camp but now there has been a study to
prove it. From the December 2007 Annals of Allergy, Asthma and Immunology
comes a study of "Clinical profile, health-related quality of life and
asthma control in children attending US asthma camps”. The researchers
used a Health History tool and polled 1,783 campers from 24 camps in 17
states. Attendees had moderately severe asthma. "Children who
had attended camp the previous year reported better use of asthma management
tools, were more likely to be using their controller therapy, and had more
responsibility for taking their medications". We here in Idaho have
seen this and heard stories from parents of how much their children have
benefited from camp. |
| Please support our camp.
Personal donations can be sent to me at St. Als Cardiac/Pulmonary
Rehab, 3025 W Cherry Lane, Meridian, Idaho 83642 or to the American Lung
Association, designated for Camp Super Breathers. Encourage your
hospitals to donate as well. It costs us $500 per child to put on
camp but we only charge a registration fee of $50 and we can waive that
if need be. We hope to have 50 kids at camp this year. |
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CF
Warning
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Care Center Staff Encouraged to Remind Patients
Not to Change or Add to Treatments
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| This warning was posted in January from the Cystic Fibrosis
Foundation Network News: |
| A sobering incident in the Northwest serves as a strong
reminder to stress to patients the importance of following nebulizer instructions. |
| Recently, a person with CF used peppermint oil in a nebulizer
to treat a minor exacerbation without consulting care center staff. The
patient had read on the Internet that it may help alleviate congestion
when used as aromatherapy in humidifiers. The patient's FEV1, which had
been at 60 percent predicted, dropped to 15 to 18 percent predicted after
four weeks of IV antibiotics and is not improving. Consider emphasizing
to patients that they must consult with their care center staff before
changing or adding treatments, especially alternative therapies that have
not undergone adequate, reliable research. |
| While this incident happened to a patient with cystic
fibrosis, something like this could happen to anyone with a chronic disease
who uses the Internet. Respiratory therapists should consider asking
their patients what prescribed and alternative medications they take.
Patients can also be referred to reliable medical websites, such as that
of the AARC or the American Lung Association. Further information
about CF can be found at www.cff.org. |
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Let's
Try Again - PFT Survey
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Tom
Gable
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| In January, Lande Lambert from the Pulmonary Lab at St.
Luke’s Magic Valley Medical Center presented a survey form in this newsletter
to try to glean information on PF testing statewide. Lande was very disappointed
in the response. He actually would like every ISRC member to fill out a
survey, whether they perform PFTs or not. As you will see, if you do not
do PFTs as part of your job, there are only a very few questions to respond
to. Please find the survey form with this newsletter on the ISRC website
and fill it out. Lande and myself will be very appreciative. |
Click here
to link to Acrobat Reader pdf form on-line. Please complete the survey
(even if you are not involved in PFT).
FAX the form to 208-737-2687.
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Photo
Gallery
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Tom
Gable
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Faces of the ISRC
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June Board Meeting Meridian
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President Brandi Johnson
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President-elect Nikkie Stephens & Delegate
Ramona Sailor
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Board Member Dana Hagestad & Delegate
Kelly Dwello
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Student Rep Heather VanOrden
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Treasurer Carrie Massie & Rob DeVinaspre |
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John Stockwell
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Dixie Durham
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President Johnson & Vice President TJ Wing |
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Dana Hagestad
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The Board at Work
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Editor Tom Gable |
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Highway Cleanup by Rob DeVinaspre, Mark &
Marilyn Wood, John Morgan
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Case
Report
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Tom
Gable
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| The personnel of the pulmonary lab at St. Luke’s Boise
Medical Center are involved with gastrointestinal diagnostics as well as
pulmonary diagnostics. Specifically, we perform GI manometric (pressure
monitoring) studies and ambulatory esophageal pH monitoring. |
| A recent patient had a 24-hour esophageal pH recording,
the results of which might be of interest to respiratory care practitioners. |
| The patient is a 59-year-old registered nurse. She was
being assessed for gastroesophageal reflux (GER), thus an ambulatory pH
study was performed. A pH electrode probe was inserted nasally with the
probe’s acid sensing surface at a point in the distal esophagus 5 cm above
the gastroesophageal junction. A data-logger was connected to the electrode
probe and esophageal pH was recorded every 6 seconds during a 24 hour data
collection period. The recorder module has some buttons for the patient’s
documentation of symptoms, meal periods and body position (specifically
recumbency). |
| I preparation for the ambulatory test, the patient was
instructed to stop acid suppression therapy for several days prior to the
study to allow re-acidification of gastric fluid. The acidity of the gastric
fluid is the indicator for the test. This particular patient complained
that severe reflux symptoms returned following discontinuance of her acid
suppression with Protonix. These symptoms included heartburn and chest
pain. |
| This patient also has obstructive sleep apnea that is
treated with nasal CPAP at 14 cmH2O. She inquired at the time of probe
placement whether her use of nocturnal CPAP would cause any problems with
the pH study. She was assured that there were no contraindications for
that, as long as her full-face mask would seal around the 1.5 mm diameter
probe wire that protruded from her nose and was taped to her cheek. |
| When the patient returned for probe removal, she indicated
that her monitored day was very unpleasant due to frequent and long lasting
periods of both heartburn and chest pain. She did note, however, that her
symptoms were less during the nocturnal sleep period when she was using
her CPAP device. |
| Analysis of her 24 hours of pH data showed that she had
acid in her esophagus 12% of the time. The upper limit of normal is about
3 to 4%, so this was a markedly positive study for the occurrence of GER.
Further analysis of the data showed she spent 56% of the monitored period
in a recumbent position. The percent reflux in that position was 14%. While
in the upright position she had acid in her esophagus 9% of the time. A
closer look at the data showed the patient had a 2-hour nap in the early
afternoon with several prolonged reflux events. Another 2-hour nap in the
early evening had the same pattern. During her overnight sleeping period,
from about midnight to 05:00, she had only one very brief reflux event.
She was using her CPAP device at this time. After being up for about
1.5 hours, the patient took another 2-hour recumbent nap without use of
CPAP. This period had the same characteristics as the 2 previous naps without
CPAP, showing several prolonged reflux events. |
| This patient’s comments and the objective data from the
pH recording seem to indicate that nasal CPAP might have a protective effect
with regard to inhibiting GER. Others have observed this effect of nasal
CPAP. Several small studies have shown increased esophageal and LES pressures,
reduction in esophageal acid contact time and/ or decreased symptoms of
GER with CPAP use. The explanations for the effect are surmised and include
abatement of the highly negative intrathoracic and intraesophahgeal pressures
caused by increased respiratory effort during obstructive ventilatory events.
With CPAP the resulting higher intrathoracic, and therefore intraesophageal
pressure, may be physically retarding gastric acid reflux. Another suggested
mechanism is CPAP somehow causes a reflex increase in lower esophageal
sphincter (LES) pressure. In one study, there was a greater protective
effect the higher the CPAP pressure. Another study also showed that nocturnal
treatment of OSA lessened the daytime, upright occurrence of GER. No mechanism
for this observation is suggested. |
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BOD
Meeting Minutes
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June
2, 2008
Boise
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| 1830: Meeting called to order
by President Brandi Johnson |
| Last meeting minutes read by TJ Wing and approved |
| Treasurer Report: Carrie
Massey reported 2nd quarter expenses |
| Committee Reports: |
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HOD Report: Kelly Dwello discussed
the recommendations for resolution topics at the Summer forum this July
in Phoenix & are as follows:
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#????? MN, Resolve membership should
share email addresses of AARC member lists to improve communication but
state societies will not be able to access the email just notified if there
is a current one on file, costs of supporting the extra updates do not
support the need. (vote NO)
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#440802 MN, Our AARC CRCE application
process does not differentiate the information to include the course name.
Some state licensing boards require specific requirements & AARC is
currently not meeting those requirements by listing the types of courses
the member took. (vote YES) Challenge will be on the costs
associated.
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#060803 PA, AARC to increase membership
dues by $5.00 as no increase has occurred since 2002 will generate increased
revenue to help support new services provided. Will still keep dues
under $100.00 & it will help to increase resources provided by the
AARC. (vote YES)
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#220804 HI, Create Ad-hoc committee
for a student leadership program to help replace and train the new generation
of RT’s to guide and support them to become better leaders, learn about
the professionalism associated with and to strengthen them as they will
be replacing the “baby-boomers” (too vague to vote on)
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#290805 FL, Engage the NBRC to reduce
costs of registry exam, costs of RRT are double the CRT and is not required
to obtain a position at some facilities, believed that this is reducing
participation. (vote YES in concept)
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PACT Report: Con Colby &
Renie Johnson not present- defer.
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New Student Rep Heather VanOrden introduced
by Carrie & welcomed by all.
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Election committee: Dana Hagestad
is trying to network other facilities for suggestion on people that may
be a candidate for our board members whose terms are approaching an end.
No responses from any others & Michele hasn’t heard of any yet either.
We must have nominees immediately please email suggestions to Dana ASAP.
Nikkie Stephens & Carrie Massey have a couple of suggestions they will
contact and send information to Dana. Need secretary, Vice president,
delegate (Kelly considering) and director at large.
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Membership committee: Ramona
Sailor & Brandi Johnson have created postal cards sent out to the members
whose membership is to expire this September, 120 cards were mailed.
Postal service has a very intuitive program that Brandi was able to manipulate
easily to facilitate the cards sent for an economical figure. It
was suggested to utilize the program quarterly for all members, all agreed.
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Nominations: Dana will work closely
with Michele to have this completed.
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Newsletter: Tom Gable has sent
the final copy to Pam about 3 weeks ago but she has been very busy with
school ending she has not had time to post electronically.
She is hopeful to have completed by June.
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Disaster: Lande was not present
but the High Desert Pulmonary Conference is on June 13th in Boise &
is focused on Chest trauma & Disaster preparedness
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435 plan: Defer, Con is not present
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AARC BOD suggestions: Kelly????
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Student Rep Heather asked to offer
a little information about herself, she comes to us from East Idaho &
is a student at Idaho State University and in her 2nd year of the program.
Welcome!! Tom Gable recognized that she is a full board member with
voting capabilities and that we are the only state that has a student board
member, but feel it helps to teach them the professionalism associated
with our field. TJ also mentioned that the AARC offers free membership
to students when all the school’s faculty are AARC members.
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AARC vouchers available that the board
can purchase in bulk at discounted rates to sell to coworkers, other hospitals,
DME companies, etc. they may help increase membership & generate revenue
for the board suggested by Brandi. Can be used for up to 1 year and
used for renewals we can buy at wholesale pricing and sell at AARC pricing
for profit or at the discounted price.
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How do we propose to sell the tickets?Suggested
to not offer vouchers in lieu of increased marketing strategies that are
not readily available without increased burden, we do not have the man
power to support.
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Suggested to have the vouchers available
at the conference & to also look into a bulk purchase savings currently
offered by the AARC.
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Journal club: TJ to provide an
article for the club & to look into the CRCE requirements suggested
by Nikkie. He will post an exam and a Pro / Con approach with Kelly.
FUN!!!!
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Conference:
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Speaker ideas? Neil MacIntyre
interested in coming, Steve Siobal confirmed, Brian Walsh coming to discuss
benefits of AARC membership. Lectures on asthma, sleep medicine &
Dennis Bing from Washington also lined up.
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Door prizes: Please try to get
anything from your vendors & give to Brandi.
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Offering a free AARC membership as
a raffle prize- YES
Other: |
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Continue to utilize Dr. Charan as our
medical director. ISRC recently sent flowers to Dr. Charan to show our
sympathy for the untimely death of their son.
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Tom announced 5 people showed up to
pick up trash for the ISRC state road clean-up last week & TJ commented
that BSU & the students pick up every fall! Great Job guys!!!
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Senator Crapo will be interviewed and
Brandi & TJ were asked to quote the state society’s stance on the issues
presented & they even got their pictures submitted. They
are now world famous!!!
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| Meeting adjourned & next meeting is Sept 11th at
lunch during the conference in Boise at the Owyhee Plaza!!! See you
all there. |
| Respectfully submitted,
Carrie Massey
Treasurer |
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Need Respiratory Care Professionals?
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2008
ISRC Board of Directors
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Brandi Johnson (Boise), President
Nikkie Stephens (Twin Falls),
President elect
Michele Andrew (Boise), Past
President
T. J. Wing (Boise), Vice
President
Elena Ilyusha (Boise), Secretary
Carrie Massey (Idaho Falls),
Treasurer |
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Ramona Sailor (Twin Falls),
Delegate
Kelly Dwello (Boise), Delegate
Dana Hagestad (Lewiston), Director
at Large
Steve Schaal (Rupert), Director
at Large
Dr. Nirmal Charan (Boise), Medical
Director
Heather VanOrden (Pocatello),
Student Representative |
Visit http://www.idasrc.org/contact_us.htm
to contact a Board Member.
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The Mountain Air newsletter
editor is Tom Gable. If you would like to contribute information/articles,
please contact Tom by e-mail:gablet@slrmc.org,
or fax (208) 381-3498.
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