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He Mayday Scholars Program for 20012002 provided an opportunity to boards of nursing to present their experiences in monitoring the prescribing practices of advanced practice nurses and to research ways for improving their own investigation processes as professional disciplinary agencies for prescribing practices related to pain management.1 The Alabama Board of Nursing was interested in participating in the program based on its commitment to accountability for public protection. A gradual increase in disciplinary cases involving violations of prescribing practices by certified registered nurse practitioners CRNPs ; 2 prompted our inquiry as to whether a proactive monitoring system was needed to determine compliance with regulations for advanced practice nurses in collaborative practice. In this article, we discuss selected elements related to pain management and regulatory factors, including nursing, that affect the treatment of pain. We present a brief overview of the evolution of advanced practice nursing, with an emphasis on the nurse practitioners movement, and prescription practices and pain management by nurse practitioners. Next, we present research results about nurse practitioners approved for practice in Alabama, their perceptions of their preparation for prescriptive practice in pain management, and their experiences in collaborative practice related to prescriptive authority for pain management. Then, we share the experiences of the Alabama Board of Nursing in monitoring and investigating nurse practitioners for compliance with prescriptive authority. Finally, we show how evidence obtained from research can have rapid application to regulatory concerns, and conclude with an open agenda for future research related to pain management and regulation. Journal of Law, Medicine & Ethics, 31 2003 ; : 101118. 2003 by the American Society of Law, Medicine & Ethics.
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1st dam RIDE WEST, by Gone West. Unplaced in 1 start. Dam of 3 named foals of racing age, including a 2-year-old of 2006, one to race-Mucho Salt g. by Salt Lake ; . Winner at 3 and 4, placed at 5, 2006, , 106. 2nd dam RIDE SALLY, by Raja Baba. 12 wins at 3 and 4, 2, 226, Top Flight H. [G1], Distaff H. [G3], Betsy Ross H. [L] GS, , 350 ; , Amerigo Lady S. [L], [Q] at Aqueduct, Miami Beach S. HIA, , 070 ; , Wistful S. GP, , 585 ; , 2nd Bowl of Flowers S. [L], Quixotic Lady S. [O], Candy Eclair S. GP, , 172 ; , 3rd Hempstead H. [G1], Shuvee H. [G1], Prioress S. [G3], Imperial Hill S. [L], [Q] at Belmont Park, Miami Beach S. HIA, , 163 ; . Dam of 2 winners-Salydar. 3 wins at 4, , 810. Sire. Happy Dixie. Winner at 2 in Japan. 3rd dam SYLVAN'S GIRL, by Restless Native. 9 wins at 3 and 4, 4, 590, Grey Flight H. Dam of 5 foals to race, all winners, including-RIDE SALLY. Black type winner, see above. PERFECT ROUX. 6 wins at 2 and 3, 6, 160, Davona Dale S. [O], 2nd Mongo Queen S. [O], Pontalba S. [O], 3rd Laughing Gull S. [O]. Dam of-Arromanches. 31 wins, 7, 924, 3rd Paumonok H. [L] AQU, , 135 ; . Shorten Sail. 7 wins, 3 to 6, 6, 770. Set ntr. Silver Head. Placed at 2 and 3 in France; 9 wins, 4 to 6, , 509 in N.A. 4th dam SUMMER CLOUD, by Summer Tan. Placed at 2. Half-sister to YLA dam of SHAMIRAH ; , KARIM. Dam of 5 winners, including-SYLVAN'S GIRL. Black type winner, see above. Laura H. 12 wins, , 570. Granddam of PROJECT BULLET 3, 275 ; . Pea Goose. 3 wins, , 794. Producer. G'dam of CASCADE CASEY 8 wins to 8, 2005, 1, 697 ; , I'M A SOCCER BOY to 6, 2006 ; , Dancing Goose, Fergie's Fantasy at 2, 2005 ; . Quadray. Unraced. Dam of REST THE QUADRANT 16 wins, 0, 384 ; . G'dam of DEVILISH TOUCH [G2] 8 wins, 7, 955 ; , BARE WITH ME 9, 466 ; , GRECIAN TOUCH 2, 526 ; , OSCAR DANCER, etc. KTDF.
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A practitioner shall not prescribe, order, dispense, administer, sell or transfer any amphetamine or sympathomimetic amine designated as a Schedule II controlled substance for use in weight management, dieting or any other anorectic purpose, or for the treatment of fatigue. b ; A practitioner may prescribe, dispense or administer amphetamine or sympathomimetic amine drugs or compounds designated as Schedule II controlled substances, only as follows: 1. For the treatment of the following conditions: i. Narcolepsy established by recognized diagnostic criteria; ii. Idiopathic Central Nervous System Hypersomnia established by recognized diagnostic criteria; iii. Attention Deficit Disorder established by recognized diagnostic criteria; iv. Drug-induced brain dysfunction; v. Epilepsy; vi. Depression shown to be refractory to other therapeutic modalities; and vii. Senile apathetic behavior; 2. For immediate use in a hospital for acute conditions such as depression associated with illness or surgery; 3. For the differential diagnostic psychiatric evaluation of depression; or 4. For the clinical investigation of the effects of such drugs or compounds in which case, in addition to other requirements of applicable law, prior application therefor shall have been made to the Board and approval granted before any such investigation is begun. c ; A practitioner who prescribes, dispenses or administers amphetamines or sympathomimetic amines shall prepare and maintain patient medical records which accurately reflect the utilization of any drug subject to this section, the specific diagnosis, the information upon which the diagnosis is based, including testing and consultations, and the treatment objectives for which the drug is being prescribed. d ; The following list, although not exhaustive or exclusive, includes many of the generic and brand-name Schedule II drugs which are subject to this section: Adderall Amphetamine Desoxyn Dexedrine Dextroamphetamine Methamphetamine Methylphenidate Ritalin 13: 35-7.9 Prohibitions and special limitations on prescribing, administering or dispensing anabolic steroids a ; Unless an accepted medical necessity exists, a practitioner shall not prescribe, order, dispense, administer, sell or transfer any anabolic steroid or human growth hormone, for the purpose of hormonal manipulation intended to increase muscle mass, strength or weight. Body building, muscle enhancement, or increasing muscle bulk or strength through the use of anabolic steroid or human growth hormone by a person in good health for the intended purpose of improving performance in any form of exercise, sport or game is not a valid medical purpose.
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By Todd Stern It's that time of the year again! The ACCM Bowling League is getting ready to be up and running in full force. Actually, the league has been in existence for many years. It began as a way for PHAs and their caregivers to get together on a weekly basis and participate in an activity that is fun, inexpensive, gives people a chance to meet others and to get exercise. Viau has been running the bowling league, and doing a splendid job! The first day of bowling will be September 9, 2006, from 2: 30 till 5: 00 at Iberville Bowling 5650 Iberville street.
Developing malnutrition, aspiration pneumonia, and dehydration. The objective of treatment for swallowing dysfunction in patients with MS is to maintain or improve the nutritional state of the patient. Areas for intervention include changes to the environment in which the patient feeds himself, food texture, attitude during the feeding process, changes in the neuromuscular process, and changes in the feeding methods developed as compensatory techniques. The effectiveness of these interventions has been evaluated in a study, the objective of which was to assess the swallowing function in 143 patients with progressive MS on whom an endoscopy was performed. It was found that 49 34.3% ; had this abnormality. The compensatory rehabilitation techniques were sufficient to eliminate dysphagia in 46 93.8% ; of the cases, thus decreasing the potential risk of inhalation and malnutrition. In respect to the risk of inhalation, videofluoroscopy studies showed at least 10% of patients with dysphagia exhibit signs of inhalation. This result showed the need of a complete assessment of the swallowing function in patients with MS who have dysphagia, especially those with brainstem damage and in those patients with progressive MS with severe disability. Although the risk of inhalation is approximately 10%, the compensatory rehabilitation techniques are effective, allow better nutrition for the patient, and avoid respiratory complications. Respiratory insufficiency usually is described as the final stage in MS, with a lethality of 8%. However, in the majority of cases, poor and inadequate attention is given to the progressive aspect of the restrictive nature of the respiratory component of MS. Generally, therapeutics starts late, when the restrictive respiratory failure worsens in association with an obstructive component. Therefore, an early professional assessment and continuous treatment are needed, starting with an adequate classification of the respiratory failure and the use of noninvasive respiratory techniques. The application of noninvasive respiratory techniques on these patients is important to avoid or worsen respiratory failure. Clinical trials have confirmed the efficacy of a training program and dihydroergotamine.
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