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Advocacy Committee Meeting

Wed, 17 Mar 2010 17:00:00 GMT

Advocacy Committee Meeting
Start Date: 17-Mar-10 1:00 PM
End Time: 17-Mar-10 2:00 PM
Speaker: Kristin Klein

Event Details:

Phone: 1-800-377-8846

Pin: 80311923

Board of Directors Meeting

Fri, 16 Apr 2010 13:00:00 GMT

Board of Directors Meeting
Start Date: 16-Apr-10 7:00 AM
End Time: 16-Apr-10 12:00 PM
Location: Salt Lake City Marriott Downtown

Salt Lake City Marriott Downtown

Pediatric Chronic Disease Specialty Conference

Fri, 16 Apr 2010 19:00:00 GMT

Pediatric Chronic Disease Specialty Conference
Start Date: 16-Apr-10 1:00 PM
End Time: 18-Apr-10 12:30 PM
Location: Salt Lake City Marriott Downtown, Salt Lake City, UT 84101
Speaker: Stephen R. Covey

Event Details:

The Pediatric Chronic Disease Specialty Conference will offer continuing education sessions on the medication management of seizure disorders, dermatology, transplant, sickle cell, pain, HIV, and mental health issues. A full educational agenda is forthcoming.

For the full conference agenda, travel information, and continuing education information please visit the Conference website at www.ppag.org/sc10.

Salt Lake City Marriott Downtown

75 South West Temple

Salt Lake City, UT US 84101

19th Annual Pediatric Pharmacy Conference and Annual Meeting

Thu, 07 Oct 2010 17:00:00 GMT

19th Annual Pediatric Pharmacy Conference and Annual Meeting
Start Date: 7-Oct-10 12:00 PM
End Time: 10-Oct-10 12:00 PM
Location: St. Charles Convention Center/Embassy Suites, Saint Charles, MO 63301-2855
Event Details:

Historic St. Charles, Missouri will host the 19th Annual Pediatric Pharmacy Conference and PPAG Annual Meeting. St. Charles is located in the heart of the Midwest. It is only 20 minutes from downtown St. Louis and only 10 minutes from the St. Louis Lambert International Airport. St. Charles is known for its Historic District which houses over 125 specialty and antique shops along with the 25 quaint restraurants and attractions that line the Missouri River. In St. Charles, you'll walk in the footsteps of Lewis and Clark and exprience part of America's history.

PPAG has secured a special room rate of $139.00 per night at the Embassy Suites St. Louis-St. Charles Hotel and Spa. Reservations can be made by calling the Hotel directly at 636-946-6644 or Embassy Suites Brand Reservations at 1-800-EMBASSY. Conference participants must identify themselves as being with the Pediatric Pharmacy Advocacy Group at the time the reservation is made in order to receive the group rate.

Reservations must be made on or before September 5, 2010 at 12:00 midnight (central time) to receive the discounted rate. After the cut-off date, reservations will be subject to availability and room-rate increases. PPAG cannot guarantee any reservations after September 5, 2010.

St. Charles Convention Center/Embassy Suites

230 South Main Street

Saint Charles, MO USA 63301-2855

PPAG Recognizes Local Network

Matthew Helms — Thu, 18 Feb 2010 18:00:00 GMT

PPAG is pleased to announce that the Cleveland-Akron Area Pediatric Pharmacists (CAAPP) has been officially recognized by as a Local Community and Network (LCN).

The purpose of the Cleveland Akron Area Pediatric Pharmacists (CAAPP) is to support local pediatric practitioners by providing an avenue to exchange ideas and practices and provide additional educational opportunities for Continuing Pharmacy Education. CAAPP offers networking opportunities, idea swaps, Journal Club sessions, social events, and volunteer opportunities. The geographical scope of CAAPP includes the Greater Cleveland and Akron/Canton area. JoEllen Hanigosky, PharmD, Clinical Coordinator at Akron's Childre's Hospital, is the Chair of CAAPP.

"We are excited to recognize CAAPP as an official PPAG Local Network," said Michael Christensen, PharmD, Chair of the PPAG Board of Directors. "The Local Network recognition program allows us to acknowledge what our members are doing locally and connects PPAG with those efforts."

The Local Communities and Networks of the Pediatric Pharmacy Advocacy Group help make strong peer-to-peer connections that can make a real different in your career and practice.

Through networking events, local programming, regional news and volunteer opportunities, the Local Networks build a community of peers, advance careers and offer volunteer opportunities within the pediatric pharmacy community.

For more information about the Local Communities and Network (LCN) Recognition Program, click here.

18-Feb-10 12:00 PM

Be a Member Reporter: Submit Your Stories

Matthew Helms — Thu, 18 Feb 2010 14:00:00 GMT

Become a reporter for PPAG! We need to know what you know!

PPAG encourages all members to submit news and stories for the organization's newsletter and website.

Do you have a new job? Have you recently become Board Certified? Is your hospital or institution doing something new or unique? Has a colleague received an award? Do you need to promote something interesting? Let us know! Your stories will appear in the newsletter and/or website.

To sumit your news online, click here.

18-Feb-10 8:00 AM

Member of the Month: Catherine Tom-Revzon, BS, PharmD

Matthew Helms — Mon, 08 Feb 2010 22:00:00 GMT

Catherine Tom-Revzon, BS, PharmD

Catherine Tom-Revzon, BS, PharmD is a former associate professor of pharmacy practice at the Arnold & Marie Schwartz College of Pharmacy and Health Sciences at Long Island University. Her practice site was at the Children's Hospital at Montefiore as a clinical pharmacy manager in pediatrics. She was also adjunct assistant clinical instructor at the Columbia School of Nursing.

Catherine has published manuscripts in such journals as Pediatrics, the Journal of Perinatal and Neonatal Nursing, Clinical Therapeutics, and US Pharmacist.

She advocates for awareness of pediatric pharmacy through interviews with the mass media, such as The New York Times, Parents magazine, NPR, The Today Show, and Reader's Digest.

Catherine is coordinating PPAG's KidsMeds website (www.kidsmeds.info). Catherine and other members of PPAG's Advocacy Committee publish useful medication and health information and tips for parents. Catherine has served PPAG is various capacities throughout the years. She has most recently served as VP of Advocacy.

Catherine also blogs about children's health issues and parenting at http://www.babiesrx.blogspot.com/.

Because of her dedication to PPAG and parent education, we decided to "sit down" with Catherine and ask a few questions.

PPAG: Tell us about your blog, BabiesRx.

CT-R: As a clinical pharmacist, I offered medication education to families. It was such a well-received service that requests were later incorporated into the hospital's CPOE system as a "pharmacy consult." In addition to requests for discharge counseling, there were also times when we would be asked to dispel myths about using opioids, vaccines, stimulants, inhaled steroids, etc. I became a patient advocate and I enjoyed that part of my job tremendously. So when I decided to take time off from working, I needed a medium that would allow me to continue educating the public about the role of pharmacists and keeping parents abreast of current issues related to pediatric medication. The answer was starting a blog. BabiesRx, www.babiesrx.blogspot.com, serves to blend my knowledge and experiences as a pediatric pharmacist, an educator, and a parent. I post my views about relevant topics that pertain to the care of not only babies but older children and adolescents, too. Interesting discoveries are shared with fellow health care practitioners. And I alert caregivers about recalls of medications or side effects to be aware about. I subscribe to multiple listservs generated by the CDC, NIH, FDA, AAP, and other reputable sites, including online newspapers, so I get my topics from them. I also read blogs by fellow pharmacists and other health care professionals to get information. Believe it or not, Twitter is another great source. Personal accounts are also included in my blog as they occur in my life as a mom. It is also a fun blog where I find videos to educate children about topics like the flu.

PPAG: As a mom, do you practice what you preach as a "pharmacist blogger?"
CT-R: I do 99.9% of the time. We’ve occasionally missed doses of medicine.

PPAG: Speaking of social media, what role do you see this playing in the efforts here at PPAG?

CT-R: Social media has an incredible role for PPAG and KidsMeds. Outlets like Twitter, Facebook, and weblogs can help increase our visibility as an organization and enhance our ability to communicate and interact with a broader audience in a more timely manner. With over 700 members of PPAG, many of our members have not yet been able to match faces or voices to other fellow members, let alone share ideas with one another. Establishing groups and fan pages for PPAG and KidsMeds on Facebook has allowed more of our members to interact with PPAG and with colleagues who live in different time zones on a more regular basis. Twitter is not only a great resource for information, it is also a means for PPAG and KidsMeds to build relationships with other organizations who share our passion. While the internet is still how the majority of the PPAG and KidsMeds members access our websites, many of them are using their phones to look up information on the web and disseminate breaking news to their colleagues and friends via email. It's amazing how powerful these gadgets are! In fact, one can access and post Facebook and Twitter entries using these gadgets. Blog posts to raise awareness of pertinent issues can also be made in a matter of minutes. Furthermore, our reputation as the primary source for effective drug therapy in children can be further developed with the use of social media. [Editors Note: Follow PPAG on Twitter at www.twitter.com/theREALppag and KidsMeds at www.twitter.com/KidsMeds.]

PPAG: You are clearly passionate about being a pediatric pharmacist. Why did you choose pediatric pharmacy in the first place?
CT-R: Growing up I found that I connect with children easily. Given that gift and my thirst for challenges, I decided to specialize in pediatric pharmacy. I wanted to help treat children and provide education. I also really like compounding different dosage forms.

PPAG: What do you find most unique about pediatric patients as compared to adult patients?
CT-R: If they are able to express themselves, pediatric patients are more honest about whether something works or not. If the analgesic is not working, you’ll know. Whereas, an adult may want to hide how they really feel because of cultural differences. It’s also more challenging when interacting with children. You really need to get down to their level, engage them with their favorite cartoon characters, and gain their trust before you can start teaching them about their medications.

PPAG: Describe your most significant accomplishment as a pediatric pharmacist.

CT-R: When I first started at the Children's Hospital at Montefiore as a clinical pharmacy manager, I volunteered to help organize the education table for the Pharmacy Department when the Children's Health Fair was reinstated. In addition to educational pamphlets and giveaways, I wanted to leave an impression with the families we were going to encounter. So, I took the medicine vs. Candy poster that the Poison Control Center distributes and brought it to life. I sought colorful pills and matched them to candy look-alikes. Then I glued them on a large poster board and made it into an interactive game. It was such a hit that the CEO of the hospital wanted to see it grow into something bigger. The next few weeks I was meeting with the marketing, Public relations, and health education departments of the hospital to design a more permanent display and a brochure. Although the game board did not become a permanent display in the hospital, it was featured on the John Walsh Show and has been a popular piece for various health fairs, poison prevention events, and departmental functions. It has even traveled to different elementary schools to teach children that medicine is not candy. For this creation and other outreach efforts, I won Pharmacist of the Year and Clinical Practitioner of the Year from local pharmacy organizations and began to get more media requests through the PR department. I was happy to be able to tell the public about pediatric pharmacists and what we’re capable of doing in contributing to their care.

PPAG: Your passion clearly inspired others to take action. What advice would you offer pharmacy students and residents interested in pursuing a career in pediatrics?
CT-R: Let your dream and passion to become a pediatric pharmacist be known to everyone you interview with (advisors, mentors, residency coordinators). Even as a student, your clerkships can be selected to cultivate this interest. When you're looking for a pharmacy practice residency, find out if the program offers pediatric rotations/electives and flexibility; the residency can sometimes be tailored to suit your needs. Finally, don't give up. If you don't match with your dream residency or job the first time, find out what you can do to increase your chances next time and try again. [Editors note: Check out PPAG's Residency Directory: click here.]

PPAG: Why did you join PPAG?
CT-R: I joined PPAG as a resident, though my first interaction with PPAG was as a student at the ASHP Midyear meeting. I remember sitting at the CE program that PPAG was presenting and thinking, “Wow! I want to be a part of this group! I want to make a difference with others who also like pediatric pharmacy.” As a member, I wanted to learn everything I could about pediatric pharmacy and then contribute back to the organization.

PPAG: Now, for some fun questions. If you were a drug, which one would you be and why?
CT-R: I would be a vaccine, because the pieces of knowledge that I share with colleagues, caregivers, and patients provoke a reaction and a memory so that the next time a similar situation is encountered, they will know how to deal with it. There’s sometimes a shortage of me, too.

PPAG: Name one thing your colleagues might not know about you.
CT-R: I own over 500 books (mostly novels) that I haven't read, yet.

PPAG: Thanks, Catherine, for your time. It's been an enjoyable conversation.

CT-R: Thank you. It's been a pleasure.

Editors Note: Each month, PPAG will feature a member doing outstanding things in pediatric pharmacy practice and/or in the community. To nominate someone to be featured, please contact the PPAG office.

8-Feb-10 4:00 PM

Stephen Covey to Give Keynote Address at Specialty Conference

Matthew Helms — Sat, 23 Jan 2010 02:00:00 GMT

Stephen R. Covey, author of The 7 Habits of Highly Effective People will provide the Keynote Address at the Pediatric Chronic Disease Specialty Conference on April 16, 2010 in Salt Lake City, Utah.

In 1996, Stephen R. Covey was recognized as one of Time magazine's 25 most influential Americans and one of Sales and Marketing Management's top 25 power brokers.

Dr. Covey is the author of several acclaimed books, including the international bestseller, The 7 Habits of Highly Effective People. It has sold more than 15 million copies in 38 languages throughout the world. Other bestsellers authored by Dr. Covey include First Things First, Principle-Centered Leadership, with sales exceeding one million, and The 7 Habits of Highly Effective Families.

Dr. Covey's newest book, The 8th Habit: From Effectiveness to Greatness, which was released in November 2004, has risen to the top of several bestseller lists, including New York Times, Wall Street Journal, USA Today Money, Business Week, and Amazon.com and Barnes & Noble. The 8th Habit has sold more than 360,000 copies.

In 2002, Forbes named The 7 Habits of Highly Effective People one of the top 10 most influential management books ever.
A survey by Chief Executive Magazine recognized The 7 Habits of Highly Effective People as one of the two most influential business books of the twentieth century.
The 7 Habits of Highly Effective People audiobook on tape is the best-selling nonfiction audio in history, selling more than 1.5 million copies.
Over two million copies of First Things First have been sold. Simon & Schuster expressed the opinion, "...First Things First is the best-selling time management book ever."
Dr. Covey's book The 7 Habits of Highly Effective Families was released in October 1997 and ranked fourth on the New York Times list within three months of its release date. It is the No. 1 best-selling hardcover book on family.

Dr. Covey is cofounder and vice chairman of FranklinCovey, the leading global professional services firm with offices in 123 countries. FranklinCovey shares Dr. Covey's vision, discipline and passion to inspire, lift and provide tools for change and growth of individuals and organizations throughout the world.

Dr. Covey's organizational legacy to the world is Covey Leadership Center. On May 30, 1997, a merger of Covey Leadership Center with Franklin Quest created FranklinCovey. Dr. Covey's vision of empowering organizations to implement "principle-centered" leadership in their cultures continues to be an important focus of FranklinCovey.

For more information and to register for the Pediatric Chronic Disease Specialty Conference, please click here.

22-Jan-10 8:00 PM

Committee Spotlight: The Advocacy Committee

Matthew Helms — Thu, 07 Jan 2010 15:00:00 GMT

The Advocacy Committee, co-chaired by Kristin Klein, PharmD and Tara Smith, PharmD, accomplished many things in 2009 and is looking forward to a terrific 2010!

The flagship program of the Advocacy Committee is a website for parents called KidsMeds (www.kidsmeds.info). Coordinated by Catherine Tom, PharmD, the websites provides relevant and current information related to children's health. The wesbite continues to grow and expand content. Some new topics that you'll soon see on the site include information regarding tick borne illnesses, use of epi pens, use of insect repleents in children, and information regarding black box warning on medications for children.

KidsMeds also launched a twitter account (www.twitter.com/KidsMeds). This new resource for parents allows parents and practitioners to follow the happenings on KidsMeds. It also provides information from a variety of health information sources, such as the FDA, CDC. It is multidisciplinary in nature, and brings together content from pharmacists, nurses, physicians and other health care providers. Follow KidsMeds on twitter!

The Committee plans to promote KidsMeds to other health care and parent organizations and parent publications throughout the year.

The Advocacy Committee continues to provide position statements and reviews on behalf of PPAG. This past July, the Committee released a position regarding the use of antidepressants in children. The Committee is currently working on positions regarding Heparin use in pediatric patients, as well as, medications for the obese patient.

If you are interested in joining the Advocacy Committee, please contact Kristin Klein at kriklein@umich.edu or Tara Smith at tsmith@shhpens.org.

7-Jan-10 9:00 AM

Accepting 2010 FPPAG Applications

Matthew Helms — Wed, 06 Jan 2010 20:30:00 GMT

Application Deadline: June 1, 2010

PPAG is currently accepting applications from individuals who qualify for Fellowship in the Pediatric Pharmacy Advocacy Group.

In 2008, the Board of Directors approved the Fellowship in Pediatric Pharmacy Advocacy Group Recognition Program. This program is designed to recognize excellence in pediatric pharmacy practice and to publically promote those pharmacists who have distinguished themselves.

The general criteria for FPPAG recognition is as follows:

Candidate must demonstrate sustained practice excellence and professionalism in pediatric pharmacy practice for 10 years or greater.
Candidate shall have contributed to the total body of knowledge in pediatric pharmacy practice.
Candidate must be involved in and committed to educating practitioners in pediatric pharmacy practice and/or pharmacotherapy.
Candidate must demonstrate active involvement and leadership in professional activities, especially the Pediatric Pharmacy Advocacy Group.

To learn more about the criteria for recognition and the application procedures, please go to:

http://www.ppag.org/fppag/.

The application Deadline is June 1, 2010.

6-Jan-10 2:30 PM

Call for Abstracts: Residency Project Showcase

Matthew Helms — Wed, 06 Jan 2010 19:30:00 GMT

The PPAG Board of Directors is pleased to announce an opportunity for Post-doctoral trainees (residents and fellows) to present their projects to pediatric pharmacy practitioners from across North America.

Residents will be able to present their projects at the Pediatric Chronic Diseases Conference in Salt Lake City Utah on Saturday, April 17, 2010.

Presentations will be 10 minutes long.

The format for the presentations will be similar to the format utilized at the regional residency conferences. Presentations can be on any pediatrics-based project and may be a work-in-progress report.

Abstracts must not be more than 500 words and should contain the following sections: Title, Authors, Purpose, Methods, Results (if any), Conclusions/Discussion. The PPAG Research Committee has provided a "How To" document to assist you in writing your abstract. To view the document, please click here.

The abstract submission deadline is March 10, 2010.

Abstacts must be submitted in MSWord format (.doc or .rtf). Please send your abstracts to Julie Clyce at julie.clyce@ppag.org.

The Bruce Parks Memorial Pediatric Pharmacy Residency Showcase was established in 2006. This showcase seeks to stimulate interest in the field of pediatric pharmacy by offering a highly competitive award for the best pediatric pharmacy resident presentation at the PPAG Spring Specialty Meeting each year.

6-Jan-10 1:30 PM

New Fellows Inducted at 18th Annual Meeting

Matthew Helms — Wed, 06 Jan 2010 19:00:00 GMT

The FPPAG designation recognizes individuals who have achieved excellence in pediatric pharmacy through education, research, professional activities, and leadership. The Fellows were introduced at the 18th Pediatric Pharmacy Conference and PPAG Annual Meeting in Cleveland, OH.

2009 Fellows: Helen Fiechtner, Marcia Buck, Kay Kyllonen, and James Dice

Marcia Buck, PharmD, FPPAG

Marcia L. Buck, PharmD, FCCP, is the Clinical Pharmacy Specialist for the University of Virginia Children’s Hospital and a Clinical Associate Professor in the Schools of Medicine and Nursing at the University of Virginia. She also serves as adjunct faculty for Virginia Commonwealth University.

She has excelled as a clinical pharmacist by serving as a caregiver in many different pediatric subspecialties including neonatology, critical care and general pediatrics. She currently has a focus in her practice on working with rehabilitating patients with brain injury, an area where new pediatric pharmacy expertise is needed.

Marcia has contributed greatly to the education of parents and other caregivers on pediatric medication use through her co-authorship of the Pediatric Medication Education Text. This is an important resource for medication counseling in pediatrics.

James Dice, PharmD, FPPAG

Jim is currently the Director of Pharmacy at Children’s Hospital of The King’s Daughters.

Jim is an ultimate professional. He brings professionalism, diligence, and intellect to all he does. He is a hard worker, believes strongly in advancing his field and works non-stop in promoting the interests of Pediatric Pharmacy expertise. He was unwilling to compromise the safety of medication delivery for the sake of maximizing automation through robotics. Total unit dose ready-to-use dispensing was a must.

Jim has a personal commitment to educating other pediatric healthcare providers that I believe can be matched by few others. Whether it is pharmacology or pharmacokinetics, medication safety or informatics, pharmacy administration or dispensing, Jim has used his outgoing personality and talent to educate pharmacists, nurses and physicians about pediatric medication management.

Helen Fiechtner, PharmD, FPPAG

Helen is a full professor with the College of Pharmacy at South Dakota State University and a Pediatric Clinical Pharmacist at Sanford Children’s Hospital in Sioux Falls, SD.

Helen has been involved in Pediatric Pharmacy Practice for over 30 years. Thus, she has a wealth of experience and knowledge. She has remained committed to the pediatric patient population. She demonstrates a passion for the profession.

Her pain management protocol / orders were developed at a time that many physicians under treated children’s pain and used the IM route. This dramatically changed the way pain was / is treated in pediatric patients at her hospital.

She is also willing to challenge decisions made by the hospital administration when that decision is not in the best interest of children.

She enriches our nursing practice and our pediatric patients are safer due to her presence.

Kay Kyllonen, PharmD, FPPAG

Kay has been a Pediatric/Neonatal Clinical Specialist at the Cleveland Clinic since 1995 and residency program director since 2006. Since 1998 she has also been a Course Coordinator and Instructor at the, Ohio College of Pediatric Medicine

Her references talked about the programs and policies that she has developed and implemented to ensure safe and cost-effective therapy in pediatric patients.

Kay has been instrumental in the development of neonatal protocols not only for our institution but in leading a roundtable of regional neonatal pharmacy practitioners to implement best practices.

Kay has trained countless pharmacy students, residents, new pharmacists in the proper and safe care of pediatric patients. Her dedication to the patient population and her vast knowledge in the area allows her to be a fine example to these young practitioners.

For more information about the Fellow in Pediatric Pharmacy Advocacy Group Program, please visit: www.ppag.org/fppag/.

6-Jan-10 1:00 PM

Erythromycin Ophthalmic Ointment Shortage

Shannon Rotolo, URMC PGY-1 Resident — Tue, 05 Jan 2010 18:00:00 GMT

Perinatal transmission of sexually transmitted diseases can lead to serious complications in the newborn patient. Neisseria gonorrhoeae and Chlamydia trachomatis are two bacterial species responsible for sexually transmitted disease, and both can pose risk to newborn infants. As they past through the birth canal perinatal transmission occurs in about 30-40% of cases of maternal cervical infection. The result is often ophthalmia neonatorum, a bacterial conjunctivitis. This condition can lead to ulceration of the cornea, scarring, and permanent blindness if left untreated. In fact, at one time it was the number one cause of blindness in the United States. Because prophylactic options have been shown to be both safe and effective in combating these bacteria, in most states it is now a law and a standard clinical practice that every newborn receive prophylactic treatment, regardless of route of delivery.

Historically, a one percent solution of silver nitrate was used to prevent ophthalmia neonatorum in newborns. Two drops would be administered in each eye, and the efficacy of this drug as prophylaxis against Neisseria gonorrhoeae was actually superior to the erythromycin we use today. However, this agent had increased risk of side effects, namely chemical conjunctivitis, and thus fell out of favor. Tetracycline in a one percent ointment has also been used with success, but like silver nitrate solution is no longer commercially available in the United States.

So with these two products off the market, and erythromycin ointment unavailable due to national manufacturer shortage, how can we provide prophylaxis to newborns? Step one, reserve current supplies for neonatal use only. When supply does fall short, one option the Centers for Disease Control (CDC) has recommended is azithromycin 1% ophthalmic solution, marketed by Inspire Pharmaceuticals under the brand name AzaSite®. Although clinical trials have not been completed to confirm the efficacy for this disease state, the CDC has made the recommendation based on current data pertaining to the pharmacology of the drug and the sensitivities of N.gonorrhoeae. One of the challenges of using this product is its formulation. As an eye drop, it is critical that the nurse administering this medication make every effort to ensure that the recommended dose of 1-2 drops reach the conjunctival sac of each eye; no easy task in a newborn. A method that may be helpful in achieving this is using a two nurse approach: one to gently hold the eye lids open, one to administer the drops.

If the manufacturer cannot meet demand for this product, third-line options include gentamicin ophthalmic ointment 0.3% (Gentak®), or tobramycin ophthalmic ointment 0.3% (Tobrex®). Unfortunately, since publication of these recommendations in September the FDA has received numerous reports of lid swelling and dermatitis, some being severe enough to cause blistering of the skin. All reported cases resolved in less than two weeks with no lasting sequelae. To reduce this reaction, it is important for the nurse administering drug to minimize product-to-skin contact.

As a final line of defense, should none of these options be available, ciprofloxacin ophthalmic ointment can be used. However, there is greater antimicrobial resistance to this medication, so it should only be used if none of the other products can be obtained.

5-Jan-10 12:00 PM

Updated 2009 Red Book/American Academy of Pediatrics Recommendations for Palivizumab Administration

Joy Vreeland, PharmD, BCPS — Tue, 05 Jan 2010 18:00:00 GMT

The American Academy of Pediatrics (AAP) has recently modified its recommendations for use of palivizumab (Synagis^TM) for prevention of RSV infection. The updated AAP recommendations are based on review of the most recent data. They seek to optimize the balance between identifying infants mostly likely to derive benefit and minimizing the cost of palivizumab therapy. The new policy statement, "Modified Recommendations for the Use of Palivizumab for the Prevention of Respiratory Syncytial Virus Infections,” replaces the 2003 policy statement and will be published in an upcoming issue of Pediatrics. The policy statement addresses the following changes:

Modified recommendations for date of initiation and duration of prophylaxis reflecting RSV seasonality by geographic region based on current CDC surveillance data.
Modified recommended number of doses needed for infants 32 to 35 weeks gestation to a maximum of 3 doses, rather than the 5 doses previously recommended.
Redefined risk factors associated with increased hospitalization to require only one of the following two to qualify for prophylaxis: 1) infant attends day care, 2) one or more siblings younger than 5 years old live permanently in the infant’s household. Previous recommendations required 2 of 5 risk factors.

Respiratory Syncytial Virus (RSV) is one of the most common diseases of
childhood. Nearly all children have been infected at least once by their second birthday, most within the first 12 months of life. Infection with RSV usually results in an acute upper airway infection, however RSV can cause severe lower respiratory tract infection with bronchiolitis and respiratory distress. Short and long-term complications of severe RSV disease include recurrent wheezing, reactive airway disease and changes in pulmonary function. Children at highest risk of developing severe RSV lower respiratory tract infections include preterm infants, infants with cyanotic or complex congenital heart disease (CHD), especially those causing pulmonary hypertension, and infants with chronic lung disease (CLD) or immunodeficiency disease.

Each year in the US, there are approximately 57,500 hospitalizations due to RSV in children under 5 years old. Most are healthy, term infants, however high-risk infants have hospitalization rates 4 to5 times greater than those of healthy infants. The monoclonal antibody palivizumab (Synagis^TM) provides passive immunization against RSV. Approved in 1998, it is currently is the only FDA-approved medication available for the prevention of serious lower respiratory RSV infection in high-risk pediatric patients. It is dosed at 15 mg/kg by IM injection once every 30 days. Palivizumab is not effective as treatment of RSV disease and is not approved for use in this indication.

Seasonality

Prevention of RSV disease in high risk patients with use of palivizumab is effective but costly. Cost-efficiency is maximized when the highest-risk infants are prophylaxed during the time when RSV circulation is highest. In North America, RSV seasons range in their start, peak activity, and duration. Based on surveillance of RSV circulation for the majority of the US, the peak activity occurs from November through March. Therefore, doses administered beginning in November and ending March should provide the highest levels of protection at the times of peak virus activity. In the north central and southwest regions of Florida, onset of RSV occurs in late September to early October. Regions of southeast Florida have an onset of RSV in July. The duration of the season remains equal in length despite the earlier onset. Children in these communities should receive palivizumab during the 5 months when they will be most likely to need coverage against peak RSV activity.

Palivizumab prophylaxis for infants and young children with chronic lung disease of prematurity or congenital heart disease varies on geographic location. (RedBook, 2009: p560). The earliest date for initiation of 5 monthly doses of palivizumab is as follows: Southeast Florida, July 1^st; North Central and Southwest Florida, September 15^th; most other areas of the United States, November 1^st.

Infants 32 to 35 weeks gestation / Risk factors

The primary benefit derived from palivizumab is the prevention of hospitalization due to severe RSV disease. Mortality benefits or reduction in recurrent wheezing in infants who have received immunoprophylaxis have not been demonstrated in prospective clinical trials. With the exceptions of CHD, prematurity (less than 32 weeks gestion), and CLD, risk factors for hospitalization from RSV have been inconsistently defined in clinical trials. Several studies have been conducted evaluating infants born from 32-35 weeks gestation which have helped identify the first 3 months of life as the period of highest risk for hospitalization from RSV. In development of their recommendation for 3 doses in this age group, the AAP statement cites these studies along with epidemiological data that point consistently to child care attendance and exposure to children younger than 5 years old as risk factors for hospitalizations from RSV.

Infants who are born 3 months before or during RSV season, at gestation of 32 weeks, 0 days through 34 weeks, 6 days, and who have 1 of the 2 risk factors should receive up to a maximum of 3 doses of palivizumab. These infants may receive less than 3 doses if they are born near the end of the season.

Maximum Number of Monthly Doses of Palivizumab for Respiratory Syncytial Virus Prophylaxis

Infants Eligible for a Maximum of 5 Doses	Infants Eligible for a Maximum of 3 Doses

Infants younger than 24 months of age with chronic lung disease and requiring medical therapy	Preterm infants with gestational age of 32 weeks, 0 days to 34 weeks, 6 days with at least 1 risk factor and born 3 months before or during RSV season.
Infants younger than 24 months of age and requiring medical therapy for congenital heart disease
Preterm infants born at 31 weeks, 6 days of gestation or less
Certain infants with neuromuscular disease or congenital abnormalities of the airways

*Data taken from Table 3.60. Red Book 2009: p.560

Hospitalized Patients

The AAP has also strengthened statements regarding hospitalized infants. Hospitalized infants who qualifiy for prophylaxis should receive their first dose within 48 to 72 hours of discharge, or promptly after discharge from the hospital. Infants who are hospitalized on the day their palivizumab dose is due should receive their dose on that day while they are in the hospital. Palivizumab is not recommended for controlling nosocomial RSV outbreaks in high-risk units.

Some recommendations remain unchanged

Recommendations have not changed for infants born at a gestational age 31 weeks, 6 days or earlier, those infants <24 months of age with CLD, or infants with hemodynamically significant CHD. Infants in these groups should receive a maximum of 5 doses of palivizumab per RSV season. Infants with congenital abnormalities of the airway or neuromuscular disease that compromises the child’s ability to handle respiratory secretions should also receive a maximum of 5 doses during their first year of life. Prophylaxis in immunocompromised children has not been studied in randomized trials. The AAP policy states that these patients may also benefit from prophylaxis, however, more specific recommendations are not made at this time.

References

Reducing RSV hospitalizations: AAP modifies recommendations for use of palivizumab in high-risk infants, young children, H. Cody Meissner, M.D., FAAP, Joseph A. Bocchini, Jr., M.D., FAAP, AAP News Vol. 30 No. 7 July 2009, p.1.

American Academy of Pediatrics. Respiratory Syncytial Virus. In: Pickering LK, ed. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2009:560-569. Available at: http://aapredbook.aappublications.org/cgi/content/full/2009/1/3.110. Accessed October 20, 2009.

POLICY STATEMENT: Modified Recommendations for Use of Palivizumab for Prevention of Respiratory Syncytial Virus Infections. AMERICAN ACADEMY OF PEDIATRICS Committee on Infectious Diseases. Accessed 10/19/09 at http://aapredbook.aappublications.org/news/RSVPolicy-082409.pdf

Special thanks to Betsy Walters Burkey, PharmD for sharing her slides from the Annual Meeting Hot Topics session.

5-Jan-10 12:00 PM

Pediatric and Staff Pharmacists

Fri, 05 Mar 2010 06:00:00 GMT

Title: Pediatric and Staff Pharmacists Description: Pediatric & Staff Pharmacists Make Banner Health an active ingredient in your pharmaceutical career. Cardon Children’s Medical Center is a new 200 bed hospital located on the campus of Banner Desert Medical Center in metro Phoenix Arizona. The campus has a total of 700 licensed beds. CCMC includes a 24 bed PICU, 24 bed Pediatric Hematology/Oncology unit, 72 General Pediatric patient beds, Pediatric outpatient treatment center and an 80 bed Level Three NICU. The pharmacy department provides progressive clinical services to our NICU, PICU, Peds/ONC and general pediatric populations. Future plans include further expansion of decentralized services to increase pharmacist interaction on the patient care team. The pharmacy department provides flexible schedule and professional growth opportunities. Available opportunities include: Pediatric Staff Pharmacists and Pediatric Clinical Specialist. Responsibilities/Duties...

Pharmacy Clinical Specialist Pediatrics

Mon, 01 Mar 2010 06:00:00 GMT

Title: Pharmacy Clinical Specialist Pediatrics Description: Lee Memorial Health System - Healthpark Medical Center In Beautiful Ft. Myers Florida in Southwest Florida near the Gulf of Mexico We are seeking a ......... Pediatric Pharmacy Clinical Specialist Represents the Pharmacy Department in a consultative and active role as the clinically oriented Pharmacist responsible for rational medication therapy in the pediatric patient population for The Children's Hospital of Southwest Florida and throughout Lee Memorial Health system. Serves as the pharmacy representative on system-wide committees requiring pediatric pharmacy expertise, interdisciplinary patient care teams, and the pharmacy leadership team. The Pediatric Pharmacy Clinical Specialist also serves as a pharmacy student and resident preceptor and supports the operations of the pharmacy as needed. The Children's Hospital of Southwest Florida is a part of HealthPark Medical Center and is comprised of 100 beds for...

Neonatal Pharmacy Resident/Fellow Research Grant

Mon, 01 Mar 2010 20:26:12 GMT

Supported by Lundbeck, Inc. Application Deadline: September 15 each year. Pediatric Pharmacy Advocacy Group is an international, nonprofit, professional association representing the interests of pediatric pharmacists and their patients. We are dedicated to improving medication therapy in children. Our sole purpose is to promote safe and effective medication use in children through communication, education, and research. Purpose The Neonatal Pharmacy Resident/Fellow Research Grant supports research in neonatal medication use conducted by pharmacy residents (e.g., PGY-1, PGY-2 pediatric pharmacy resident) and fellows. The primary purpose of the research award is to improve safe and effective use of medications in neonates. Research projects can comprise a wide range of medication-use topics, including but not limited to: technology, safety, and/or pharmacotherapy. A secondary goal of the program is to develop and strengthen the skills of pharmacy residents and fellows by...

Online CE Programs

Fri, 26 Feb 2010 20:48:20 GMT

Pediatric Age-Based Competencies For more information about Aged-based Competency Series, please click here. Group purchasing opportunities are available. TITLE HRS. ACPE # PRICE Physiologic and Pharmacokinetic Differences in Children, Fluids and Electrolytes and Dehydration in Children 2.5 0180-0000-08-002-H04-P MEM: $10.00 NonMEM: $30.00 Respiratory Syncytial Virus: Diagnosis, Treatment and Prevention 1 0180-0000-09-001-H01-P MEM: $5.00 NonMEM: $15.00 Bronchopulmonary Dysplasia: Diagnosis, Prevention, and Treatment 1 0180-0000-09-002-H01-P MEM: $5.00 NonMEM: $15.00 Management of Asthma Exacerbations 1 0180-0000-09-003-H01-P MEM: $5.00 NonMEM: $15.00 DKA & HHS 1 0180-0000-09-100-H01-P MEM: $5.00 NonMEM: $15.00 Management of Diabetes Type 1 1 0180-0000-09-102-H01-P MEM: $5.00 NonMEM: $15.00 Pumps, Pens, and other Devices 1 0180-0000-09-103-H01-P MEM: $5.00 NonMEM: $15.00 Management of Diabetes, Type...

Age-based Competencies for Pediatric Pharmacists

Fri, 26 Feb 2010 20:45:46 GMT

Competency in pediatric medication therapy is an essential goal of the Pediatric Pharmacy Advocacy Group. Both the exigencies of patient care and Joint Commission on Accreditation of Healthcare Organizations (JCAHO) require assessment of this competency. PPAG offers a one-stop shop for your Aged-based Competency education and assessment needs. We offer audio/visual lectures and supporting material. These programs are accredited by the Accredidation Council of Pharmacy Education (ACPE). To receive credit for this program, you must complete and pass a post-test. Upon successful completion of the post-test, a certificate of credit will be automatically generated by the system for you to print. Certificates are stored in the system and will be accessible later. Please note: PPAG offers special group rates for our online Continuing Education Programs. Please go to: www.ppag.org/CEgrouprate for more information. CURRENT OFFERINGS Introductory Modules (combined 3 hour...

Membership FAQs

Tue, 23 Feb 2010 16:45:08 GMT

NOTE: All links provided below open a new browser window, this will allow you to read the intructions as you go step by step. Q) How long is a membership? Membership dues are good for one (1) year. You must renew your membership every year. Q) How much does membership cost? Membership is tiered. Individual and Associate Member Fee: $190.00 Resident/Fellow/Techninican fee: $60.00 Student Fee: $40.00 Q) Does membership include subscription to the Journal? Yes Q) I've moved. How can I let PPAG know my new address? You can update your contact info right here on the PPAG website! All you need is your login and password to enter user directories. Click the link provided, it will ask you for your login info before directing you [here]. Once you are on the directories search page, do a search for your name, then hit the submit button. Once you can view your record, hit the edit icon on the right side of your name (it will give you a detailed view of your...

Current Issue Cover

Tue, 16 Feb 2010 22:41:01 GMT

Volume 14 Number 4: Oct-Dec 2009 Editorial Use of Ototoxic Medications in Neonates—The Need for Follow-Up Hearing Test Tsz-Yin So, PharmD Brief Review Article Pediatric Fluid and Electrolyte Therapy Rachel S. Meyers, PharmD Review Article Women and Epilepsy Sunila E. O’Connor, MD and Mary L. Zupanc, MD Clinical Investigations Retrospective Analysis of the Initiation of Antibiotic Therapy In Severe Sepsis In Pediatric Patients Joseph M. LaRochelle, PharmD, Jill A. Morgan, PharmD, and Kristine A. Parbuoni, PharmD Improving Pediatric Outcomes through Intravenous and Oral Medication Standardization Mark W. MacKay, BSPharm, Jared Cash, PharmD, Fred Farr, PhD, Marc Holley BSPharm, Kevin Jones, BSPharm, and Sabrina Boehme, PharmD Click here for CURRENT ISSUE

Current Issue

Tue, 16 Feb 2010 22:17:06 GMT

Next Issue

Volume 15 Number 1 (Jan-Mar 2010) expected in March 2010

Homepage2

Tue, 16 Feb 2010 20:21:56 GMT

Improve your knowledge base from anywhere! We offer online continuing pharmacy education programs. You can earn CE from the comfort of your home or office. PPAG member receive a pricing discount on all courses offered. Go to Courses. Featured Online Education Programs: Core Competencies for Pediatric Pharmacists. What YOU can do for PPAG! PPAG believes in the value of every members expertise and passion. We are a member-driven organization, and those members make the difference! Contribute to PPAG! Contribute to your profession! Our Standing Committee Websites PediNet SIGs and Forums Calendar of Events/Meetings Charge-to-Committees Position Papers

Pediatric Chronic Disease Specialty Conference Objectives

Fri, 12 Feb 2010 18:56:49 GMT

Friday, April 16, 2010 Pre-conference Symposium: Pediatric Age-based Competencies for Epilepsy 1:00-2:00pm General Overview of Epilepsy 0180-0000-10-200-L01-P Kim Tallian, PharmD Psychiatry Pharmacist, UCSD Medical Center San Diego, CA At the end of this session, participants will be able to: Review the incidence of epilepsy in children. Review the epilepsy syndromes seen only in children. Discuss the medications of choice in children. Discuss patient specific factors that might make one pick one agent over another. Discuss vigabatrin, refunamide and their place in the treatment of epilepsy. 2:00-3:00pm Treatment of Status Epilepticus, 0180-0000-10-201-L01-P Elizabeth Farrington, PharmD Clinical Specialist – Pediatrics University of North Carolina Hospitals Durham, NC At the end of this session, participants will be able to: Briefly review standard treatment of status epilepticus Discuss newer treatment options for the treatment of refractory...

Pediatric Chronic Disease Specialty Conference Schedule

Fri, 12 Feb 2010 18:54:55 GMT

Friday, April 16 2010 Time Topic Speaker Pre-Conference Symposium: Pediatric Core Competencies 1:00-2:00pm General Overview of Epilepsy Kim Tallian, PharmD 2:00-3:00pm Treatment of Status Epilepticus Elizabeth Farrington, PharmD 3:00-3:15pm Break 3:15-4:15pm Adverse Effects of Antiepileptic Medications Stephanie Phelps, PharmD 4:15-5:15pm Application of Pharmacogenomics to the Treatment of the Patient with Epilepsy Collin Hovinga, PharmD Pediatric Chronic Diseases Conference Begins Now 6:00-7:30pm Keynote Address Stephen Covey 7:30-9:00pm Opening Reception Saturday, April 17 2010 Time Topic Speaker 7:00-8:00am Antidepressants and Antipsychotics in Youth: do the Benefits Outweight the Risks? Julie Dopheide, PharmD 8:00-9:00am Patient Assistant Programs 101 Kristin Fox-Smith, PharmD 9:00-9:15am Break 9:15-10:15am ...

Association Staff

Tue, 09 Feb 2010 02:12:43 GMT

Matthew R. Helms, MA, CAE Executive Director Matthew Helms has been the Executive Director of the Pediatric Pharmacy Advocacy Group since 2003. Matt earned his Bachelor of Arts degree in political science (history minor) from The University of Tennessee, Knoxville in 1998. He earned Master of Arts in Executive Leadership from Christian Brothers University in Memphis, Tennessee in 2009. Matt earned the Certified Association Executive (CAE) credential in 2009. Matt directs all day-to-day operations of PPAG. He provides direction and policy interpretation to volunteer leadership. He manages all aspects of membership services, develops new services, coordinates continuing education programs, and solicits sponsorships, grants, and donations. Prior to joining PPAG, Matt worked at The University of Tennessee, Health Science Center in Memphis. He also interned at Presidential Classroom in Washington, DC. Matt also served as the Managing Editor of the Journal for Pediatric...

Acthar Gel (repository corticotrophin injection) Survey

noemail@ppag.org — Mon, 26 Feb 2007 17:00:00 GMT

Objectives:

This is a survey for pharmacies that order Acthar Gel (repository corticotrophin injection). The product is currently indicated for the treatment of acute exacerbations of multiple sclerosis and other conditions, and it is used off-label for treatment of infantile spasms. The maker of Acthar Gel, Questcor, filed a supplemental new drug application for the infantile spasms indication in August 2006. The company is now trying to understand how much of Acthar Gel usage is for multiple sclerosis and how much is for infantile spasms.

PPAG has received a small grant to conduct this survey.

Release Date: 26-Feb-07 11:00 AM
Expiration Date: 10-Apr-07 4:00 PM

if you use Acthar Gel, please fill out the survey to the best of your ability. Please coordinate within your institution so we do not receive duplicate information. We are not asking for facility name or participant information (involuntarily) in order to ensure confidentiality.

Medication Administration in Schools

noemail@ppag.org — Wed, 12 Jul 2006 19:00:00 GMT

Objectives:

We are looking to identify challenges and or cases within local school system or daycare settings.

For example: "Johnny’s" school doesn’t have a nurse, the school refuses to allow any medication administration, and so a parent goes to school everyday to administer!

The results of this survey will be presented at the 15th Annual Meeting during the Advocacy Workshop.

Release Date: 12-Jul-06 2:00 PM
Expiration Date: 10-Sep-06 2:00 PM
Please read and respond to the following questions.

What are your thoughts about PediNet?

noemail@ppag.org — Tue, 08 Nov 2005 15:00:00 GMT

Objectives: The Membership Services Committee values your opinion about the services PPAG provides its members. This survey was created to get your feedback about our PediNet Member Forums.

Release Date: 8-Nov-05 9:00 AM
Expiration Date: 14-Apr-06 9:00 AM
Please answer the questions provided. There are only 8 questions to answer. It should not take that long to complete.

2006-07 Educational Needs Assessment

noemail@ppag.org — Thu, 06 Oct 2005 02:00:00 GMT

Objectives: To better understand the continuing educational needs of our members.

Release Date: 5-Oct-05 9:00 PM
Expiration Date: 3-Jan-06 9:00 PM

Please offer comments in the text boxes provided.

Antifungal Survey for Stem Cell Transplantation/ Hematology-Oncology

noemail@ppag.org — Thu, 30 Jun 2005 21:00:00 GMT

Objectives:

To evaluate the use of antifungal agents in the pediatric hematology-oncology (H/O) and 

stem cell transplant (SCT) population and to assess differences in practice among various 

institutions.

Release Date: 30-Jun-05 4:00 PM
Expiration Date: 30-Mar-06 4:00 PM
Please participate in the following survey. Any PPAG member or affiliate can take the survey. Please coordinate your response within your institution to avoid duplicity.

To climb steep hills, requires slow pace at first.

Tue, 21 Jun 2005 23:24:19 GMT

"To climb steep hills, requires slow pace at first."

William Shakespeare, Henry VIII

Hot Topics in Pediatric ID, Critical Care, and Nutrition

2009-09-27T13:00:00Z

Instructor: Jeff Cies, PharmD and Betsy Walter, PharmD

This program is a two hour Audio presentation synced with PowerPoint slides. The program contains three sections. To begin this program, please click the start icon below. You can follow along by downloading the handout below. To download the PDF documents for each section, please click the go button below. After completion of the program, you may take the post-test to receive credit.

Community-Acquired MRSA in Pediatric Patients

2009-09-26T13:00:00Z

Instructor: Kristin Klein, PharmD

This program is a one hour Audio presentation synced with PowerPoint slides. To begin this program, please click the start icon below. You can follow along by downloading the handout below. To download the PDF document, please click the go button below. After completion of the program, you may take the post-test to receive credit.

Medication Use During ECMO and Continuous Renal Replacement Therapy

2009-09-26T13:00:00Z

Instructor: Brenda Dodson

This program is a one hour Audio presentation synced with PowerPoint slides. To begin this program, please click the start icon below. You can follow along by downloading the handout below. To download the PDF document, please click the go button below. After completion of the program, you may take the post-test to receive credit.

Management of Pediatric Chemical Casualties: Are We Prepared

2009-09-25T13:00:00Z

Instructor: Elora Hilmas

This program is a one hour Audio presentation synced with PowerPoint slides. To begin this program, please click the start icon below. You can follow along by downloading the handout below. To download the PDF document, please click the go button below. After completion of the program, you may take the post-test to receive credit.

Adolescents, Sexuality, and The Pediatric Pharmacist

2009-09-25T13:00:00Z

Instructor: Veenod Chulani

This program is a one hour Audio presentation synced with PowerPoint slides. To begin this program, please click the start icon below. You can follow along by downloading the handout below. To download the PDF document, please click the go button below. After completion of the program, you may take the post-test to receive credit.

Core Competency Series: Pumps, Pens, and other Devices

2009-09-24T18:00:00Z

Instructor: Thomas Parker

This program is a one hour Audio presentation synced with PowerPoint slides. To begin this program, please click the start icon below. You can follow along by downloading the handout below. To download the PDF document, please click the go button below. After completion of the program, you may take the post-test to receive credit.

Core Competency Series: Management of Diabetes Type 1

2009-09-24T18:00:00Z

Instructor: Michelle Condren

This program is a one hour Audio presentation synced with PowerPoint slides. To begin this program, please click the start icon below. You can follow along by downloading the handout below. To download the PDF document, please click the go button below. After completion of the program, you may take the post-test to receive credit.

Core Competency Series: Management of Diabetes, Type II

2009-09-24T18:00:00Z

Instructor: Allison Blackmer

This program is a one hour Audio presentation synced with PowerPoint slides. To begin this program, please click the start icon below. You can follow along by downloading the handout below. To download the PDF document, please click the go button below. After completion of the program, you may take the post-test to receive credit.

Core Competency Series: DKA & HHS

2009-09-24T18:00:00Z

Instructor: Mark Haase

This program is a one hour Audio presentation synced with PowerPoint slides. To begin this program, please click the start icon below. You can follow along by downloading the handout below. To download the PDF document, please click the go button below. After completion of the program, you may take the post-test to receive credit.

Core Competency Series: Bronchopulmonary Dysplasia: Diagnosis, Prevention, and Treatment

2009-03-25T13:00:00Z

Instructor: Sherry Luedtke, PharmD

This program is a one hour audio recording. To begin this program, please click the start icon below. You can follow along by downloading the handout below. To download the PDF document, please click the go button below. After completion of the program, you may take the post-test to receive credit.