text: CLICK & CLACK Dear Tom and Ray: My daughter needs a lug wrench and jack for her 2003 VW Jetta. I don't want to give an arm or a leg to a VW dealership for these items, but I can't find them anywhere. Can you give me some particulars on these items, such as size needed and where I might purchase them at a reasonable cost? Will a jack from Wal-Mart work, or one from an auto-parts store? Are they called something else besides "hard to find"? -- Tommy RAY: Well, I'm sure there's a good story behind how your daughter managed to lose the original jack, Tommy. But clearly, you're not inclined to entertain us with it. TOM: If you want the same jack that she used to have, the easiest place to get it is at a junkyard. Oops, I mean "auto recycling center." RAY: Right. You'll find one that may have been used just once. Or never. Or, even if it was used 20 times, it's still perfectly good. TOM: But I'm going to suggest that you pick up only the jack at the junkyard, and replace the lug wrench with something better. RAY: Volkswagens and Audis use bolts to secure their wheels instead of just nuts, like most other cars. They're notoriously difficult to remove -- especially when they get overtightened, which they always do. TOM: So instead of that little 6-inch lug wrench that came with the car, you should go to your local Sears or auto-parts store and get a 17-mm impact socket and an 18-inch breaker bar. RAY: The impact socket fits over the wheel bolt, and then the breaker bar slips onto the socket and gives you leverage to twist the bolt. TOM: You could also get a better-quality jack to replace the VW jack, but the new one will almost certainly be bigger and heavier, and won't store easily in the trunk. So I'd get the jack at the junkyard -- sorry, auto recycling center -- or, if you can't find one there, from the dealer. And then pick up a socket and breaker bar somewhere else. RAY: That'll give your daughter a better set of tools -- which will make the next person she "lends" them to much happier. Dear Tom and Ray: My wife and I have been married for three wonderful years. I love her with all my heart and soul. When we got married, I was driving a 1987 Honda Accord that had almost 300,000 miles on it. She had a 1995 Chevy S-10 pickup with 119,000 miles and suggested that we buy a new car for me to drive. I suggested we buy her a new car and I could drive the Chevy pickup. She agreed, and we purchased a 2001 Honda Accord that had 12,000 miles, and I started driving her pickup. At the time we got married, she was living near Kansas City, Mo., and I was in Wyoming doing construction work. I went back to Wyoming to complete a project I was working on in Jackson Hole. One morning while driving over the mountains to work, I hit a moose with her truck. There was only minor damage (a glancing blow), and I was able to continue on to work that day, intending to seek an estimate for repairs later. The next day while driving over the same mountain road, a herd of elk was in the road, and I hit one of them. This time the damage was total, with the truck beyond repair. These two accidents occurred in Teton National Park and were investigated by the same National Park Police officer. The officer asked me what animal I intended to hit the next day -- a buffalo? I replied, "None; I think I'll go back to Missouri." Of course, my lovely wife blames me for destroying her truck, even though there was nothing I could do to avoid the animals. Which brings us to my need for marital help. She continues to bring up the subject of my destroying her pickup -- even three years later! Is there a statute of limitations on how long a beautiful wife, who is loved and adored beyond words, can continue to blame her loving husband for an unavoidable accident? -- Michael TOM: Oh, Michael. The statute of limitations in a marriage is: forever. RAY: Or at least it seems like forever! TOM: But I sympathize with you, man. She is carrying a serious grudge here. She really ought to show a little more forgiveness. First of all, her truck protected you and you weren't hurt, which is a wonderful blessing. Second, it was a 1995 compact pickup truck with 119,000 miles on it. So it's not like you destroyed something of great value. RAY: The appropriate mourning period for a possession of that nature should be about 45 minutes. Followed by elation that you finally have an excuse to get something better. TOM: So there's something deeper going on here, Michael. There must be another reason why she won't let this go. Maybe she's feeling powerless in the relationship? Maybe she's made compromises in the marriage that she now regrets? Maybe she's having trouble letting go of her life before marriage, which the truck symbolizes? Or maybe she just likes to bust 'em? RAY: You guys need to have a heart-to-heart about this, Michael. I agree that it's time to deal with this and put it behind you. You don't want her shaking her fist at you about the S-10 pickup from her bed at the nursing home in 60 years. TOM: If it turns out that it really is all about the truck, and it did have some special sentimental value to her, then you have to replace it. Whatever it takes, find her another 1995 S-10 pickup, same color, same everything, and give it to her. I'd be shocked if it costs you more than $3,000 -- or a small fraction of what a divorce will set you back, Michael. (c) 2006 by Tom and Ray Magliozzi and Doug Berman Distributed by King Features Syndicate Inc.


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Friday, October 29, 2010
cauliflower and caramalised onion tart
I had a 3 week old head of organic cauliflower just blankly looking at me from the fridge every time I opened the door. I FINALLY SNAPPED, Googled cauliflower and found this wonderful recipe. Well, inspiration because the only common ingredients is cauliflower, onions and mustard. This pie was jaw droppingly delicious, as well, we all know how I feel about pie, this is definitely a cookbook contender but I could NOT BE SO SELFISH AS TO NOT SHARE IT WITH YOU IMMEDIATELY. Enjoy.
1 medium head of cauliflower
3 tbsp of olive oil
2 large brown onions
1 tbsp of sugar
1 300gm packet of silken or soft tofu
2 tbsp of nutritional yeast
1 tbsp of dijon mustard
1 sheet of puff pastry
1/4 cup of cheezly*
1. Trim the cauliflower into florets, toss in 2 tbsps of olive oil, season with salt and pepper and roast at 200 degrees until they go golden (about 20 minutes).
2. While the cauliflower is roasting, slice the onions into thin rings, drizzle with remaining 1 tbsp of oil and cook on medium high heat in a heavy bottom pan, being careful not to brown them too much. Once the onion has wilted, turn the heat onto low, add the sugar, toss and cover the pan with a lid or a heat proof bowl, checking and stiring every 10 minutes or so. The onions should be done around the 30 minute mark, they will be soft, sweet and a deep golden brown.
3. Drain the tofu and whizz in a food processor with the nuritional yeast and 1/2 of the caramalised onions.
4. Line your pie pan (I use a 9 inch) with your pastry, prick the bottom about 10 times, then smear the dijon on the base.
5. Put the onions on the mustard then roughly chop your roasted cauliflower and arrange in the pie shell and smear the tofu mixture over the top, knocking the pie onto your bench a few times to make sure it fills all the little nooks and crannies.
6. Sprinkle with Cheezly and bake at 200 for about 30 minutes or until the top goes golden brown. Pie is best left to sit for about 10 minutes before slicing for the tofu to set.
Notes: Cheezly is optional, if you don't have access to Cheezly or Sheese don't bother with any other vegan cheeses. If you find your pie shells go too soggy, blind bake them before you put the filling in. You could sub the nooch for 1 tbsp of light miso paste. This pie is amazing as a warm brunch item and cold at midnight straight out of the fridge.
11 comments:
YUM! love your pies.ReplyDelete
definitely a cookbook contender - love it even more than deb's because it is not as rich but still full of flavourReplyDelete
- AnonymousNovember 1, 2010 at 1:06 PM
PIES ARE SO GOOD!ReplyDelete
Your pie looks delicious :)! I was just wondering what size pie dish you used?
Hi Carla. Thanks for the recipe. I made this last night for my non-vegan housemates and friends. It was a huge success and yet another win for vegan food. I added a little thyme to the mix for a spin on things and it turned out a treat. We all devoured it and ran back for seconds.ReplyDelete
cheers :)
- AnonymousFebruary 24, 2011 at 4:35 PM
hi bonnie! thanks for the comment! yes! this recipe is definitely a winner, I should take it into work sometime!ReplyDelete
- AnonymousMay 30, 2012 at 3:46 PM
made this the other day - yummo! As a precaution I added few spoons of besan (chickpea flour) & corn flour to the tofu mix to make sure it wasn't too sloppy. Didn't really need a whole head of cauliflower (maybe mine was very big?). Had enough for one 8 inch pie, and a single serve pie. Will definitely be making this, and variations on the theme, again.ReplyDelete
Also used, for the first time, Sheese strong chedder - sooo yum (i'd given up on vegan cheese). It doesn't melt though, so next time i'll combine with notzarella. thanks!
- AnonymousJune 2, 2012 at 9:12 PM
i have made this three times since discovering your recipe! so yum. i blind baked the pastry a bit first, as it went a bit soggy the first time. i also used wholegrain mustard instead of dijon. so delicious, thanks so much for the recipe!ReplyDelete
this was delicious, i ate it all myself.ReplyDelete
Suggestions for which type of Cheezly for this recipe? I prefer something which melts and browns.ReplyDelete

subset: commoncrawl


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Encore Resort Announces March Concert Lineup
February 28, 2012 by Justin Leighty - () Comments Off on Encore Resort Announces March Concert Lineup
Tucson, Ariz., residents and RV enthusiasts from across the country can enjoy a wide variety of musical acts at the concert series, according to a news release. All shows will be in the ballroom and begin at 7 p.m.
- The Friday Night Concert Series begins March 2 with These Three Tenors. Hailing from New York, These Three Tenors have a varied repertoire from operatic and Italian classics to Broadway favorites.
- The Friday series continues March 16 with Highway Legends. Jeff Dayton and Mike & T Smith use their extensive experience performing on the road with country music legends to bring audiences the best of country, pop and R&B music.
- The Southwest Surfers kicks off the Wednesday Night Concert Series March 7 playing hit songs from The Beach Boys, including "Surfin' Safari", "Barbara Ann" and "Help Me, Rhonda."
- Fans of gospel will enjoy How Great Thou Art featuring Robert Shaw March 14. Along with his 12-piece band and a gospel quartet, Shaw keeps Elvis' spirituality alive by performing inspirational hits, including "Amazing Grace" and "How Great Thou Art."
- Paying tribute to some of the world's finest music, the 3 International Tenors continue the Wednesday series March 21.
- The Wednesday Night Concert Series comes to a close March 28 with the musical act, Bernie and Red. The husband-and-wife team brings a fresh and original format using song and humor to entertain audiences.
Ticket prices range from $10 to $18 and can be purchased at the Activities Office at Voyager RV Resort (8701 S. Kolb Road, Tucson).


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Barbeques, family, friends, get togethers, parties, food, hamburgers/hotdogs, potato salad, snacks, music, television, movies, backyard games, swimming, corn hole, ladder ball, horseshoes, bocce ball, bean bag toss, basketball in the driveway, backyard volleyball, throwing footballs, slip n' slides, chasing young children around a swing set, slides, diving boards, jacuzzi, indoor games, playing catch phrase, karaoke, board games, card games, a day of relaxing… what does all of these things have in common?
Well, it just might be Labor Day! A great holiday some of us are afforded, to take the day off of work and spend with family and friends. Some of us stay at home, and have people over. Some of us go over to spend time with our special loved ones. Whether you are the one hosting and having people over, remember at some point they will inevitably go home. Please make sure that they are in a position to get home safely. If you are the one that is traveling to other's homes, please make sure that you are in a position to get home safely as well.
According to statistics, during the month of September in 2005 alone, there were 3, 422 fatal car crashes. These are accidents in which a death occurred. And on Labor Day 2005 alone that year, there were 506 deaths on that one day! These statistics are not including car accidents which did not have a fatality; these are just the ones where a death had occurred! Very scary folks! Please enjoy your holiday, but please enjoy it safely!
Gerber Collision and Glass is reminding you to please drive safely and have a joyous Labor Day holiday!


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The bulk of the musical talk
Observations from DC
Biggest surprise... The tornister euphonium is quite good, and that hot mess of jumbled tubing that people have been calling a tuba and posting about here on tubenet is actually decent!
Biggest disappointment. The packer 3/4 4 valve BBb. Not ready for prime time yet. I had high hopes it would be great (based on my experience with other packers)
The wessex Chicago horns were good, with the presence feeling a little more nimble and the full York having a richer tone, but I thought both were good.
Yes the Eastman York is as good as advertised.
There is a old piggy at Dillon calling my name. Son of a bitch that thing plays good
Between the MRP and a tuono, I have to give a slight edge to the tuono. It was the first time I got to play both of those back to back
The Eastman Eb has MUCH better intonation than before and seems to play nice, but I didn't like the small bell. They said the large bell version will be at tmea
More tomorrow!
Re: Friday observations from DC
Thanks Mark -- can you give the Miraphone Hagen (any models) a try, if possible?
Re: Friday observations from DC
I enjoyed that Piggy when it was in my care. But it wanted to get played, and alas, I had no use for it. Oink!
Re: Friday observations from DC
This is the hot mess horn. Not a wessex, sold by Dillon. Surprisingly fun to play
Re: Friday observations from DC
I didn't see the 5/4 here. Not sure they brought one, I'll ask today. This review is based on me playing one last year at tmea
I would say the comparison between the 5/4 and 6/4 would be the same between the new wessex Chicago models. (not a comparison between the miraphone and the wessex)
The 5/4 is nimble and graceful with a great sound. The 6/4 is just a bit less graceful with a even bigger/richer sound. The 5/4 is one of, if not the most impressive BBb tubas I've ever played. Especially for the massive difference in cost, I couldn't see buying the 6/4. We're talking about a $5000 to 6000 difference
Re: Friday observations from DC
Mark, you were temped by my piggy when I sold it last year.... and it was silver, magic silver at that.
Eric Hunter
186CC 5U (gone)
Rudy Meinl 5/4 CC (gone)
Silver CC Piggy (gone)
Meinl Weston F Model 45 (Gone)
B&S 5/4 CC Prototype
Yamaha 822F
York 6/4 CC (yes a real York BAT)
Re: Friday observations from DC
Yeah, yours was so unique. Never seen a silver piggy before. This one is from the late 60's and the metal is a lot thicker than the piggies from the 80's. It just plays so solid and responsive. Nice narrow slots, and the best intonation I've ever seen in a Piggy.
I'm going to be struggling all day today with the option of buying it. It's a great horn, but I don't need it, which is the reason I sold the piggy I owned for almost 20 years
Re: Friday observations from DC
Did you honk on the new Wessex contrabass trombone prototype? Also interested in your impression of their big 6/4 BBb "Grand".
And of course their French tuba!
Re: Friday observations from DC
The "Michigan Pig" is calling you, Mark...
Re: Friday observations from DC
Did anybody get a chance to play the Eastman 562 BBb (looks similar to the GR 51)?
Re: Friday observations from DC
Contrabass... Improvement over the old one, seemed to play a little foggy and stuffy all over the horn, instead of very stuffy on just that one F in the staff. They are still tweaking the leadpipe, so hopefully productions horns are better. The valves are SO MUCH BETTER
The grand. Lovely sound, quick response, for me, I had to put the tuning slide in a middle area. The Bb's were sharp and the F and D were flat, maybe 15 cents each way
Your milage may vary
Re: Friday observations from DC
The onion rings at the bowling alley are top notch!!
I want to see the JMU Brass Band this afternoon.
Who needs four valves??
Mack Brass Artiste
MackBrunner 210L
Re: Friday observations from DC
Sgt Thiele of the USMC Band (tuba)joined the JMU Brass Band for a feature. I'm glad I went. I also went back for more onion rings!!
Who needs four valves??
Mack Brass Artiste
MackBrunner 210L
Re: Observations from DC
More thoughts from Saturday as I'm waiting for my flight
The concert on Saturday night was worth the trip. Absolutely phenomenal. There is the video on the army band Facebook page already, and a YouTube video should be available shortly
So many great tubas. The gap between the high level Chinese and the mainstream horns has closed so much that it's all personal preference now. I went back and forth between an Eastman 191 copy, a meinl 51, and a meinl 55, and they were all amazing, but slightly different. The Eastman was $3000 less than the 55, but it felt to be every bit its equal
The wessex calvary Eb might be my favorite horn that they offer. I liked it better than the Eastman, and "maybe" the besson 983, but it was really close. Great job Jonathan! Eastman is going to bring a compensating Eb with a larger bell to TMEA, so round two of the shootout will be in two weeks
First time I've played the 3+1 packer sterling Eb. Loved everything about it. It just felt solid and well built, intonation was as close to perfect as I could hope for, and it was comfortable to hold, even for someone my height
No, I didn't buy the piggy. I had to remind myself why I sold Mine in the first place. If I every start playing in a quintet I'll probably regret not having it
Amazing tuba
Went back and forth between the hagen 5/4 and the 6/4. The 5/4 is probably the best BBb I've ever played, the 6/4 might be the 2nd best. I hope that I can talk some of the schools I teach for into the 5/4 for the next round of purchases
MRP vs tuono shootout. Both amazing tubas, but for the exact same money, I'd go for the tuono. I thought the tone was broader and had more core. The MRP had a lot more overtones and more personality in the tone. My friend Zach (army band) liked the MRP, I liked the tuono.
The festivo was very nice. It played so much better than the prototype at ITEC 18 months ago. If you want a front action euphonium, buy without hesitation
God, I played so many horns I know I'm forgetting to talk about 90% of them. Ask away if you are wondering about something that is there.
It was GREAT having so many people come up and say hi to me. That's the nice thing abut being easy to spot in a crowd. I loved meeting every one of you
And I got meet Farah! (not Sean unfortunately) Zach and I ate lunch at the bowling alley on Saturday, and it was great catching up. Yeah, we got a pic of the two of us. Had to, I'm almost two feet taller than her. I'll post it later.
That's it for now, if you have any questions, fire away. This was by far my favorite experience at a conference. Something about having the army band there for the final concert just made it unbelievable event. I'll be back next year, and I encourage you all to be there too if possible
Re: Friday observations from DC
I played one that looked like a 191 that I thought was great, but I didn't see the GR 51 copy. I'll look at tmea
Re: Observations from DC
Anyone give the BMB revised CC 6/4 a blow?
Re: Observations from DC
Let's not ignore the obvious as well, that there's a gigantic difference playing a certain horn in a convention hall with no acoustics, and a million people around you talking loudly and other horns, drums, instruments playing anything and everything versus how it sounds "in the mix" with the ensemble you normally would play with either outdoors or in a concert hall. I've played amazing "sounding" horns that were perfect I thought in every way at NAMM once and had the chance to use the same one in my normal day to day group and it wasn't the same sound I heard in the convention environment. I guess it's truly up to preference nowadays as to what country you want building your horn.
202N 4-Valve Rotary Tuba
76' Precision Bass Guitar
Re: Observations from DC
It's a global economy. Your Buffet umbrella horn may already have Chinese valves in it...
Re: Observations from DC
Yeah, I said many times this weekend that it's hard to evaluate a symphony tuba without getting to try it in your hall with your section. For some situations the overtones of the MRP might be best, in others the 6/4 Eastman or Hagen that had core to the bone might be what you are wanting. Radically different tuba sounds
Re: Observations from DC
...but not your Miraphone!
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text:
Tips for Organizing Your Home/
Home Organization Tips
Living in a cluttered, messy home can be nerve-wracking and dangerous.
When you do not organize your home, you run the risk of damaging it, as well as possibly injuring yourself by falling over clutter. However, organizing your home to eliminate personal and home damages is not as difficult as many people assume.
Organize your storage.
Many people simply pack things and store the boxes in the garage or attic. However, if you do not store the boxes properly, they can fall and end up damaging your house or injuring someone. Consider putting your stored belongings in plastic containers. Not only do plastic containers stack better than cardboard boxes, but they also help protect your belongings better. When you store your belongings label every box or container clearly. This can also help you by reducing the amount of boxes you have to move to get to the items you need.
Keep your kitchen and bathroom items organized.
The kitchen and the bathroom seem to be two places that are always disorganized. Whether you accidentally drop an item down the sink and clog the drain or accidentally spill something on the floor, it can become costly to repair when renter's insurance does not cover it.
To avoid problems in the bathroom, place items such as toothpaste, nail polish, and other small items in a drawer. Throw out old products to keep your bathroom drawers or cabinet clean. To keep your kitchen organized, throw out all old products and avoid too much clutter on the counters. You should also keep all rags and sponges in a special area, and not in the sink.


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Create an Account - Increase your productivity, customize your experience, and engage in information you care about.
The City of Montpelier Public Works Department solicited proposals from qualified firms to compile and implement a comprehensive Federal ADA Self-Evaluation and Transition Plan for City buildings, parks, parking lots, and programmatic compliance (i.e. websites, Human resources etc.). The Request for Proposals (RFP) sought to secure the most qualified consultant to perform field investigations within the City right of way and of City facilities in order to identify barriers limiting accessibility, describe methods to improve accessibility and specify a schedule for achieving ADA compliance per PROWAG (Public Rights of Way Accessibility Guidelines). The City of Montpelier has chosen to consult with the Institute for Human Centered Design.
Institute for Human Centered Design Presentation
Institute for Human Centered Design
Meeting the Challenge - CB&Y Co.


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Design project -- 2
Бюджет $10-30 USD
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Lancaster County Fire Box
At 0055 hours, Rescue 21 was alerted for the Rapid Intervention Team assignment to assist the Quarryville Fire Company (57) on a working Building Fire at CL Self Storage in the 100 block of South Lime Street in the Quarryville Borough.
Rescue 21 (Safety Officer Booth) responded with a crew of four (4). Prior to arrival, Rescue 21 was re-assigned from RIT to assist with opening up and overhaul operations.
Upon arrival, the crew went to the rear of the fire building and assisted in opening up the wall with saws. Once that task was completed, the Crew assisted with removing items of the affected storage units.
Rescue 21 remained on the scene until being returned to service at 0433 hours.
During this incident, the Union Fire Company No. 1 responded to an Odor Investigation inside a house in the Century Oak section of East Nottingham Township and assisted the Community Fire Company of Rising Sun (8) with an Engine and Ambulance and Motor Vehicle Collision with multiple people trapped at the intersection of US Route 1 and Red Pump Road in Cecil County, Maryland.
*** THANK YOU to Tom Amico for some the Photos. ***


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- As noted earlier, Scott Hall went in for hip replacement surgery this morning. The surgery was said to have went well, and Hall has been tweeting since the surgery ended. He wrote on his Twitter earlier this afternoon, "Twitter World Order recovering in the hospital. So many prayers answered. Thanks... Egg whites soon..."
- Kazuchika Okada defeated Hiroshi Tanahashi this past weekend for the IWGP World Heavyweight Title at New Japan's Invasion Attack show. The title change ended Tanahasi's 295 day reign as champion.
- Hulk Hogan and his original mentor Superstar Billy Graham were re-united at Wrestlecon this past weekend. They exchanged hugs and confirmed that past tension is water under the bridge.
- John Morrison's fitness program, Out of Your Mind Fitness, starts shipping out next week. There are 7 days or pre-sales left, you can get more information at ooymfitness.com.
Starship-Pained.Com and Jesse Collings contributed to this article.


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This is a very nice and emotional track. Pleasant combination of sounds.This song will leave you a good impression and moves to the island paradise.This is perfect as a background for movies, film, video, promo, advertisement, trailers, presentations, projects and so on. It can also fit as a convincing soundtrack in any kind of situation where this type of music is needed.
Includes high quality .mp3 and .wav files.


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MARYLAND DOGS made a good showing in breed competitions Sunday when more than 8,000 spectators watched an entry of 3,260 dogs and their handlers compete in the Baltimore County Kennel Club's 55th all-breed dog show and obedience trials held in the Cow Palace at the State Fairgrounds in Timonium.
Better than one-quarter of the entries were Maryland dogs, and the remainder were from all over the World.
Best in Show was a saucy wire fox terrier, Champion Registry's Lonesome Dove, owned by Marion W. and Samuel B. Lawrence of Orlando, Fla. He was chosen from the seven group winners by Best in Show Judge Michele L. Billings from Ft. Lauderdale, Fla.
In group competitions, several Maryland dogs took wins.
No. 1 in the Herding group was Champion Whisperwoods War Lord, an Old English sheep dog owned by Joyce Wetzler of Reisterstown. Called Cameron, the 4-year-old has had several group wins this year and also took a Best in Breed at the Westminster Kennel Club show in New York in February. Cameron lives with the Wetzlers and is co-owned by Catherine Cargo from Virginia.


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NEW TITLE (March 2017) — "A Compass For Catholics"
Click On A Title Below
1. Sicut in Cælo et in Terra
2. Attention Catholics
3. Those Who Serve God Should Not Follow The Fashions
4. The Novus Ordo Question
5. Mortalium Animos (On Religious Unity)
6. We Have Found The True Faith
7. The Mystery Of The Wizard Clip
8. A Soul in Hell: The Story of Annette
9. The Holy Name of Mary
10. For Consecrated Souls
11. For Those Called to the Holy State of Matrimony
12. The Last Times
13. A Compass For Catholics — Our lastest title (March 2017)!
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But these joys come with challenges, ranging from language barriers to homesickness to cultural misunderstandings and more.
Through in-depth research and data from a variety of sources, researchers from the Center for Applied Research in the Apostolate (CARA) provide insight into:
The research presented in this one-of-a-kind book will help everyone-bishops, priests, Church leaders, and all laity-to understand and appreciate the ministry of these men and learn how to work together even more effectively.
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So just what do you know about keeping your bones healthy? If we drink enough milk, we will stay strong right? Unfortunately, this isn't the whole truth. So what can we do?
We have been told for years that drinking our milk everyday would lead to strong bones and reduce our risk of osteoporosis. But drinking dairy milk might actually cause our bones to release stored calcium to neutralize the acid from the dairy milk which is really the opposite effect we are looking for. Really, milk is not all it's talked up to be. Yes, we do get a nice dose of calcium but with today's milk and cows being pumped full of hormones, we are not getting what we imagine when we picture a dairy maid squirting milk into a tin pail! I recently read about a Swedish study that showed that milk correlated with a higher increase in hip fractures! My point is, don't rely on milk for your calcium needs! Check out these statistics below and let's come up with some better ways to maintain bone mass!! Prevention is so important, because unfortunately surgery for osteoporosis can cause major problems. Just this year, the FDA issued a recall for one of the more popular knee replacement devices called the Zimmer Knee Persona. Let's get out in front of these disease by eating right and exercising properly!
So How Can We Maintain Bone Mass?
1. Reduce Dairy Milk Intake
Replace your dairy milk with delicious alternatives such as almond milk or coconut milk! I promise, after some time, you won't even notice that you have switched! When you are out getting your next coffee, ask if they have a milk alternative. Most coffee shops do. I found a fantastic coffee shop in Dublin who made THE best almond milk latte I have ever tasted! (Coffee Angel- I've mentioned it before. Find it and GO!) But even soy milk is a better alternative to keeping your bones healthy than dairy milk. And if you keep reminding yourself of the osteoporosis statistics, then it might be even easier. Truthfully, there are many harmful things about dairy milk consumption that I won't go into today but just promise me you will think about your intake, ok?
2. Eat your calcium
You literally could make a Calcium Salad! Kale is my favorite source of calcium. Throw on some tofu, broccoli, chickpeas, almonds and maybe some yummy avocado and boom, there's your calcium supply! Not only will you be getting your much needed calcium, but you will also be getting a TON of other necessary nutrients as well.
3. Exercise!
Weight bearing exercises help to retain and build bone mass. When bones sense the strain, they respond by making the bone denser and therefore stronger. Weight bearing exercises include things like walking/running, weight lifting, dancing (hey hey hey!), and hiking! These exercises also promote better muscle coordination which can help your reaction if you do have a fall.
4. Watch your Alcohol (and stop smoking!)
Alcohol can interfere with calcium absorption and can also damage bone forming cells. So it's best to stick to just a couple of drinks per week. Studies also show that smoking can result in lower bone density and it's just overall a fantastic idea just to stop for overall health reasons. We know smoking kills. There is no question.
5. Vitamin D and Vitamin K
Intake of Vitamin D is just as important as calcium and also helps your body to better absorb calcium. A great source of Vitamin D?? The SUN!! About 15 minutes of sun exposure can help satisfy our daily requirements. However, this can be hard to do here in England as our sun likes to hide and during the winter and we all look like the ghost version of ourselves! So supplements can be another option for you. I drink Zeal for Life daily which supplies me with a whopping 95% of Vitamin D...done and done! And no Seasonal Affective Disorder (SAD) for this gal :)
Vitamin K has also shown to help with bone formation. This vitamin can be found in darker leafy greens, So if you eat that Calcium Salad, you will be getting your necessary bone sustaining nutrients!
Bone loss can and will happen as we age, but there are many ways that we can reduce the amount of bone loss. Find your inner Popeye and eat your greens. Watch your sodium intake. Reduce your dairy and find other nutritious calcium sources. And let's get moving!
What is your favorite source of calcium?
What is your favorite source of calcium?
This post is in partnership with American Recall Center to help spread osteoporosis awareness! Share with someone who you think mught need some tips!


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Career Pearls: Days in the Lives of Health System Pharmacists
- Darrell Bennett
- 3 years ago
- Views:
1 Career Pearls: Days in the Lives of Health System Pharmacists Shhhhhhh #ASHPmidyear Who are Health System Pharmacists? Education B.S. or Pharm.D. Licensure Post Graduate Training Residencies and Fellowships Residencies: PGY 1 and/or PGY 2 Fellowships: Industry or Research Masters Programs Business Administration Hospital Administration Public Health Doctoral Programs (Ph.D.) 1
2 Where do Health System Pharmacists Practice? Hospitals Ambulatory Care Clinics Home Care Long term Care Facilities Health Maintenance Organizations Universities and Academic Health Centers Government and Uniformed Services Other components of the health system What do Health System Pharmacists do? Recommend safe and effective therapy Assist in the management and prevention of medication errors Advise physicians and other health care practitioners Counsel patients and caregivers on proper medication use Supervise medication storage, dispensing and distribution Maintain medication supplies Why Health System Pharmacy? Health system pharmacy allows for: Collaborative approach to medication management Hands on decision making Direct patient care Provides pharmacists with opportunities to meet the challenges of today s health care environment while advancing the pharmacy profession 2
3 PEARLS Goal provide you with pearls of wisdom (we wish we would have known) to help with you select the best career path for you! Group 1 Critical Care Specialist: Stacey Folse, PharmD, MPH, BCPS Management and Administration: Michael Nnadi, PharmD, MHS Academia: Lindsey Elmore, PharmD, BCPS Pediatric Specialist: Lisa M. Lubsch, PharmD, AE C Small/Rural Hospital Practice: Debbie Cameron Sisson, RPh, MS, PharmD OR/Anesthesia Specialist: Christopher G. Murray, PharmD, MS Clinical Specialist Stacey L. Folse, PharmD, MPH, BCPS Clinical Pharmacy Specialist, MICU 3
4 About Me Stacey L. Folse Credentials : MPH, PharmD, BCPS Position/Title : Medical ICU Clinical Pharmacy Specialist and PGY 2 Critical Care Residency Director Organization : Emory University Hospital Primary Specialty : Medical Intensive Care Unit Other Specialties : Critical Care Overview of Clinical Specialist Education/Training Required Doctor of Pharmacy Mercer University School of Pharmacy and Health Sciences in Atlanta, GA in 2005 Post Graduate Training PGY 1 Residency at The Johns Hospital in Baltimore, MD in 2006 PGY 2 Critical Care Residency at Virginia Commonwealth University in Richmond, VA in Overview of Clinical Specialist Type of patient population served Sepsis Pneumonia Hypertensive crisis Alcohol withdrawal Diabetic ketoacidosis Complications of solid organ transplant Oncologic emergencies Drug overdose Pulmonary hypertension Asthma, COPD, and heart failure exacerbations Complications of cirrhosis Infectious disease 4
5 Overview of Clinical Specialist Responsibilities and Roles Clinical Round with multidisciplinary team Provide recommendations for patients pharmacotherapy regimens to other healthcare providers Speak with patients and families regarding patients home medications, allergies, and current drug therapy Educate physicians, medical and pharmacy residents and students, and nurses Overview of Clinical Specialist Responsibilities and Roles Administrative Member of institutional committees Develop and implement institutional protocols Research and Scholarship Conduct clinical research Involved in medical writing Advice for Students Pursuing this Career Path Have a passion for what you do and for learning Take advantage of every opportunity Find a mentor or mentors Pursue post graduate training Get involved with pharmacy organizations as a student and stay involved as a practitioner Constantly changing profession therefore stay current in the literature 5
6 Management and Administration Michael Nnadi, Pharm.D., MHS, D.Sc. (Hons) Corporate Vice President Pharmacy Services Novant Health About Me Position/Title: Corporate VP Pharmacy Services Organization: Novant Health (13 hospital health system) Presence in 3 states Primary Specialty: Pharmacy Administration Specialties: Provide leadership in core functional areas of pharmacy: People; Medication Safety; Clinical services Operation; Business development; Information technology Financial management; Regulatory compliance Pharmacy administration Education/Training Required BS, PharmD, MHA Leadership, financial management, human resources courses Type of patient population served All Responsibilities and Roles Provide leadership for 13 hospital pharmacies; ~3000 beds; >450 employees Roles Strategic planning Operation; Medication Safety; Clinical services Quality Assurance Business development; Information technology Financial management; Regulatory compliance 6
7 How I got here.. Hard work, Taking every opportunity to learn Set reasonable goals and deliver Held numerous positions Clinical manager; Director System director; Regional director Operation director; Consultant Senior Director And now VP Pharmacy Services Challenge myself and set the bar higher Passion for getting things done and for improvement Where do you start? Turn every opportunity into a learning experience Residency in pharmacy administration Get involved with ASHP section of pharmacy leaders MHA/ MBA with focus on health care administration will help Find role models or mentors Volunteer to lead or help with projects and do a good job Learn from your mistakes and improve Develop good relationships with the staff, your department leaders, hospital leaders, and possibly everyone Administration what else do I do? Care for my family ASHP section of pharmacy managers Teach at various schools of pharmacy Member of two schools of pharmacy dean s advisory board State pharmacy association (NCAP) Local university MBA/MHA program advisory board Local community colleges technician advisory boards 7
8 Advice for Students Pursuing Administration Have a passion for leadership Is a promise Process of moving a group of people in a direction that is in their long term best interest Develop personal goals and work hard to achieve them Never go on a journey unprepared Network with other leaders and peers Get involved with ASHP section of pharmacy practice leaders A leader has to have knowledge; also behavior. Your behavior says everything about you. Advice for Students Pursuing Administration Be humble Commit to life long learning Develop others as you grow Be willing to be challenged Ethical rightness Be persistently consistent Be resilient My Contact Information Michael Nnadi, Pharm.D., MHS, D.Sc (Hons) Corporate Vice President Pharmacy Services Novant Health 1900 S Hawthorne Road Suite 201 Winston Salem, NC Tel: C:
9 Academic Pharmacy Career Pearl Lindsey Elmore, PharmD, BCPS My Current Position McWhorter School of Pharmacy Private, Christian university in Birmingham, AL Assistant Professor of Pharmacy Practice Director of Community Pharmacy Residency Program 100% employed Practice Site FMS Pharmacy Independent community pharmacy in Bessemer, AL Part of a chain of 3 independent pharmacies Mostly Medicare, African American population My Training Graduated BS, Chemistry; University of Alabama Birmingham PharmD; University of California San Francisco Licensure Alabama, California, North Carolina Post Graduate Residency Training PGY1, Princeton Baptist Medical Center. Birmingham, AL PGY2, New Hanover Regional Medical Center. Wilmington, NC Certifications Board Certified Pharmacotherapy Specialist 27 9
10 How am I evaluated? Teaching Didactic teaching in the classroom and online Precepting at practice site Scholarship Published peer reviewed manuscripts Posters Invited platform question Service Much more nebulous Residency program direction, education of residents Care for ambulatory care patients, grant writing School, university, local, state, national committee work Where do I spend my time? Theoretical % Effort Actual % Effort Teaching Scholarship Service Teaching Scholarship Service What do I do during the day? 8:00 am 9:00 am 10:00 am Monday Tuesday Wednesday Thursday Friday Preceptor Series FMS Pharmacy 11:00 am 12:00 pm FMS Pharmacy FMS Pharmacy 1:00 pm IRB Committee 2:00 pm Lecture Department practice meeting P&T 3:00 pm session Meeting Conference Conference 4:00 pm Call Office Hours Call 5:00 pm Edits Edits FMS Pharmacy Headache Lecture #1 Meeting with students Proctor exam Interview P&T Planning Headache Lecture #1 Residency seminar 10
11 What does my to do list look like? Teaching Scholarship Service 1. Submit HA test questions 2. Motivational interviewing patient cases 3. Post office hours on online system 4. Teaching reflection 5. Trend data 1. Edit coconut oil paper 2. Write intro to HIV paper 3. Copyright release for preceptor paper 4. Submit slides for influenza talk 5. Grant due November Posters for next meeting 7. Peer review paper Other 1. Turn in time off, request additional time off for spring 2. Prep P&T dossier 3. Give ASHP rep $$ for t shirt 1. Edit resident abstract 2. Review IRB application 3. Edit APPE student blog post 4. Create 2 week objectives for 6 week rotation 5. Poll for residency dinner How do I become an academic pharmacist? Make connections early and often Complete residency training. Likely PGY1 and PGY2 Take advantage of opportunities to teach. Aim for diversity Get a few publications Ask for feedback about teaching style and content and evaluation questions Be persistent! Academic Pharmacy Career Pearl
12 Pediatric Pharmacy: all the Cool Kids do it Lisa Lubsch, PharmD, AE C About Me Lisa Lubsch, PharmD, AE C BCPPS coming soon (hopefully) Specialties are General Pediatrics, Pulmonology Pediatric Clinical Pharmacy Specialist, Cardinal Glennon Children s Medical Center Clinical Associate Professor, Southern Illinois University School of Pharmacy Overview of Pediatric Pharmacy Postgraduate year 1 accepted, postgraduate year 2 preferred Vast population to care for Neonates infants toddlers children adolescents Variety of specialties Neonatal Critical Care Nutrition Hematology / Oncology Infectious Disease Cardiology Pulmonology Transplant Ambulatory Care Leadership Other: safety, investigational, neurology, emergency 12
13 Advice for Students Pursuing this Career Path Get Involved, Get Involved, Get Involved Network Work Pharmacy Experience Volunteer Research Stop being boring and be on the path that leads to awesome ~ Kid President Small and Rural Hospital Pharmacist s Day Debbie Cameron Sisson About Me Debbie, R.Ph., M.S., Pharm.D. Pharmacist Grand Itasca Hospital, Grand Rapids Minnesota Generalist Volunteer Pharmacist at Project Care 13
14 Overview of Small and Rural Hospital Education/Training Required Small Town Neighbors, friends, coworkers Vacationers/Tourists Dispensing pharmacist, Infusion pharmacist, clinical pharmacist, ED Pharmacist, Peds pharmacist, IT pharmacist, anything that needs to get done pharmacist Advice for Students Pursuing this Career Path Be a team player Know your neighbors You are part of the healthcare community Get involved Be engaged Be flexible Keep in touch with your friends in BIG, Urban, hospitals Operating Room & Post anesthesia Care Unit Clinical Pharmacist Presenter: Christopher G. Murray, PharmD, MS 14
15 Christopher G. Murray About Me Credentials: PharmD, MS Position/Title: Manager, Perioperative Services Organization: Duke University Hospital Primary Specialty: Surgery and Anesthesia Overview of OR Clinical Pharmacist Education/Training Required PharmD/BSPharm Hampton University School of Pharmacy / William R. Harvey Leadership Institute University of North Carolina School of Pharmacy (Master of Science in Health System Pharmacy Administration) Optional Residency (PGY1 and/or PGY2) Type of patient population served Adult & pediatrics Elective procedures, trauma, transplant General, Ortho, Cardiac, Neuro, OHN, Plastics, Uro, Gyn, Eye Responsibilities & Roles Locations covered OR & PACU Offsite areas (ECT suite, EP, radiology [vascular/interventional]) Operational Drug distribution Sterile compounding preparation & checking Controlled substance reconciliation Clinical Order verification Non traditional rounding service Drug information resource Formulary and policy review Medication safety event reporting oversight Research 15
16 My Day At A Glance Morning Rush!!! Dispense drug kits Verify pre operative orders Dispense anesthesia specific drips and antibiotics Check automated dispensing cabinet (ADC) meds Provide dosing recommendations for patient specific compounding needs (IV acetaminophen, DDAVP, antibiotics) Check patient specific compounded products The Rest of the Day Reconcile controlled substances (ADC reports and product returns) Check sterile compounded batch Answer drug information questions What is the particle size of Hextend? Can you give lactated ringers with someone on a ketogenic diet? Advice for Students Pursuing this Career Path Predictably unpredictable Amenable to change Fast paced environment High tolerance for stressful situations Majority interactions are interdisciplinary (Anesthesia [ ologist, CRNAs, techs], Surgeons, OR nurses, PACU nurses, patients, family members) Group 1 Panel Discussion 16
17 Group 2 Oncology Specialist: Bradley Burton, PharmD, BCOP, CACP Ambulatory Care: Mary Ann Kliethermes, BS, PharmD Emerging Sciences Pharmacogenomics: Kristine Crews, Pharm.D., BCPS Emergency Medicine Specialist: Melinda J. Ortmann, PharmD, BCPS Informatics: David P. Mulherin, PharmD, BCPS Medication Safety: Jaclyn A. Jeffries, PharmD Oncology Pharmacy Presenter: Bradley Burton, PharmD, BCOP, CACP About Me Bradley Burton, PharmD, BCOP, CACP Position: Clinical Pharmacy Specialist Employer: The Johns Hopkins Hospital Primary Specialty: Medical Oncology Other Specialties: Oncology Anticoagulation 17
18 Required education: Pharmacy degree Residency experience (?) Overview of Oncology Population served: Adult inpatients and outpatients with solid malignancies Patients with cancer and thromboembolic disorders End of life Direct patient care Responsibilities and roles Teaching Patients and caregivers Students Residents Other pharmacy colleagues Research Advice for Students Pursuing this Career Path Keep an open mind Research your specialty before you specialize Be flexible, open minded, and ready for change Prepare to become a lifelong learner 18
19 Advice for Students Pursuing this Career Path Prepare to become a lifelong learner Oncology Drug Approvals from January 2012 through October 2013 Bosutinib Enzalutamide Liposomal vincristine Ziv aflibercept Carfilzomib Pertuzumab Vismodegib Axitinib Glucarpidase Dabrafenib Afatinib Ponatinib Abiraterone Cabozantinib Omacetaxine Ado trastuzumab emtansine Ambulatory Care Pharmacist Presenter: Mary Ann Kliethermes, BS, PharmD About Me Mary Ann Kliethermes, BS, PharmD Vice Chair Ambulatory Care, Associate Professor Chicago College of Pharmacy, Midwestern University Downers Grove, IL Primary Specialty: Adult Primary Care Other Specialties: Medication Therapy Management Patient Centered Medical Home Accountable Care Organizations Medication Adherence Drug Related Problems 19
20 Overview of Ambulatory Care Pharmacist Education/Training Required: PharmD degree Residencies in ambulatory care (PGY1, PGY2) desirable Type of patient population served: Any patient population is primary care Needs may be more with the elderly or disadvantaged Responsibilities and Roles Medication management Clinic management Quality measurement and fiscal responsibility Medication Management Collect Monitor or transition Assess Evaluate Develop plans Implement Access Adherence Med Rec Medication Monitoring Patient Education ADEs Multiple Hospitalizations Disease state Management Dose Escalation Medication Adjustments Drug Interactions Other? EBM adherence Drug Information High Risk Medications Quality/cost prescribing Patient Conditions Top 10 Average 5 6 conditions 1. Hypertension 2. Hyperlipidemia 3. Diabetes Type 2 4. Stoke/CVA 5. Depression 6. Anemia 7. Heart Failure 8. Obesity 9. Osteoarthritis 10. Coronary Artery Disease 20
21 Advice for Students Pursuing this Career Path Have passion Enjoy interacting with patients Thrive on every day being different Strong communication skills Keep abreast of health care changes Enjoy problem solving ( it is never like the book!) Have vision you may be starting something brand new! Clinical Pharmacogenomics as a Career Path Kristine R. Crews, Pharm.D., BCPS St. Jude Children s Research Hospital About Me Kristine R. Crews, Pharm.D., BCPS Translational Research Laboratory Director St. Jude Children s Research Hospital, Memphis TN Specialty: Clinical pharmacogenomics Secondary Specialty: Translational research 21
22 Move promptly to ensure that a high level of expertise in pharmacogenomics resides within the pharmacy department. ~From ASHP publication, Pharmacy Forecasts : Strategic Planning Advice. How is Pharmacogenomics Integrated into Clinical Practice? A patient is a CYP2D6 ultra rapid metabolizer: can she safely receive codeine for pain? # What is the correct starting dose of warfarin in a patient with CYP2C9 *1/*3 and VKORC1 ( 1639G>A) AA genotypes?* A patient with acute coronary syndrome requires antiplatelet therapy. His CYP2C19 genotype is *2/*2. What are the choices for therapy? # No choose another analgesic. *0.5 2 mg/day warfarin Pa ent should not receive clopidogrel reduced platelet inhibition Roles Clinical pharmacogenomics specialists serve as liaisons between lab based researchers and clinicians. Interpret pharmacogenetic results and advise other clinicians how drug therapy is affected My daily roles include: Analyze research data Interpret patient pharmacogenomic results make recommendations for therapy Present educational seminars/lectures Write manuscripts for publication Train residents 22
23 Advice for Students Pursuing Pharmacogenomics as a Career An understanding of translational research is helpful. Pursue residency training and consider fellowship training. St. Jude Children s Research Hospital has the first ASHPaccredited PGY2 Residency in Clinical Pharmacogeneticsnow training our 3 rd resident. Having more training will not hurt your career path! Pharmacists will emerge as the natural leaders in individualized medicine through pharmacogenomics. Emergency Medicine Melinda J Ortmann, Pharm.D., BCPS The Johns Hopkins Hospital Baltimore, MD About Me Melinda J Ortmann, Pharm.D., BCPS Position: Clinical Pharmacy Specialist, Emergency Medicine Program Coordinator, PGY 2 Emergency Medicine Pharmacy Residency at JHH Adjunct Faculty at the University of Maryland School of Pharmacy and the University of Pittsburgh School of Pharmacy Organization: The Johns Hopkins Hospital, Baltimore MD Primary Specialty: Emergency Medicine Other Specialties: Pediatrics 23
24 Overview of Emergency Medicine Clinical Specialist Education/Training Required PGY 1 Pharmacy Practice Residency PGY 2 Emergency Medicine Residency (Recommend) Developing field of practice, so PGY 2 opportunities are a mix of accredited and unaccredited programs Board Certification with BPS (Strongly Recommend) Overview of Emergency Medicine Clinical Specialist My Story Completed PGY 1 Pharmacy Practice Residency with a focus in Pediatrics Clinical Pharmacist position at a Children s Hospital in Tampa with a focus in PICU and Pediatric Oncology (5.5 years) Transitioned to Adult Emergency Medicine with some Pediatric EM practice (5 years) Overview of Emergency Medicine Clinical Specialist Type of patient population served EVERYONE! Primarily adult patients of all acuity levels Acute and chronic disease state management Toxicologic emergencies and drug overdose Urgent care needs Critically ill patient resuscitation trauma and medical All socioeconomic classes 24
25 Responsibilities and Roles Resuscitation Resuscitation General ED Population The Other General Stuff. ED Population The Other Stuff Teaching Responsibilities and Roles Resuscitation General ED Population Teaching The Other Stuff Medical /trauma resuscitation Stroke/ MI Response Team Clinical consultation, drug information and therapy recommendations in critical situations Provide assistance with medication procurement and admixture Prospective/retrospective patient profile review Clinical consultation, drug information services for both provider and nursing staff (DM, HTN, Pain, ID) Patient interview and education Medication reconciliation IPPE/APPE students PGY 1 and PGY 2 residents EM physician resident education Nursing education Institutional service on various ED and Pharmacy Committees Protocol and policy development Medication safety Information systems maintenance Research Publications Organization participation Advice for Students Pursuing this Career Path Ask yourself why? (It s not just another Critical Care option) Rotation during your APPE experiences If this is not an option, take initiative and set up a shadowing experience Interview pharmacists working in the ED in different hospital settings Identify PGY 1 residency programs with this rotation experience Talk to current PGY 1 and PGY 2 residents about their ED experiences Strongly consider PGY 1 and PGY 2 residency training 25
26 Pharmacy Informatics David Mulherin, PharmD, BCPS About Me David Mulherin, PharmD, BCPS, HIT Pro CP Assistant Professor of Pharmacy Practice Lipscomb University College of Pharmacy Practice Site: Clinical Informatics Systems, Vanderbilt University Medical Center Primary Specialty: Clinical Informatics Pharmacist & Academia Other Specialties: CPOE, Clinical Decision Support (CDS) Overview of Pharmacy Informatics Education/Training Required PharmD University of Tennessee College of Pharmacy PGY1 Pharmacy Practice Regional Medical Center at Memphis PGY2 Pharmacy Informatics University of Michigan Hospitals and Health Systems Available options Residency training PGY2 Pharmacy Informatics PGY1/PGY2 Combined residencies Fellowships Masters or PhD degrees Certifications 26
27 Overview of Pharmacy Informatics Type of patient population served Patients: All populations (varies by setting) Customers : Physicians, nurses, pharmacists and other healthcare providers Responsibilities and Roles Varies by practice area Design, develop, implement, maintain, and improve medication related systems (CPOE, CDS, pharmacy, BCMA, Smart Pumps, automation) Ensure safe and efficient use of information and technology to improve patient outcomes Advice for Students Pursuing this Career Path Most important qualification: Pharmacy & clinical knowledge! Prior computer science / IT / engineering experience is helpful, but certainly NOT required Must be flexible and ready for a challenge Seek opportunities for experience Introductory and Advanced Pharmacy Practice Experiences Ask questions about technology, express an interest Informatics rotations, internships, shadowing Talk to informatics specialists & get involved with research Join ASHP s Section on Pharmacy Informatics and Technology Pharmacy Safety Officer Presenter: Jaclyn A. Jeffries, Pharm.D. 27
28 About Me Jaclyn A. Jeffries, Pharm.D. Position, Title Health First Pharmacy Safety Officer Courtesy Clinical Assistant Professor, University of Florida College of Pharmacy Organization/Employer Health First Integrated Delivery Network Cape Canaveral Hospital Holmes Regional Medical Center Palm Bay Hospital Viera Hospital Health Insurance Medical Group Outpatient Services Primary Specialty Medication Safety Overview of Medication Safety Education/Training Required Graduated from the Purdue University College of Pharmacy in 2012 Completed a Medication Safety Residency in 2013 at the Purdue University College of Pharmacy Center for Medication Safety Advancement Started position as the Pharmacy Safety Officer at Health First in July 2013 Certifications PGY1 Medication Safety Residency Certificate Lean Six Sigma Yellow Belt Certificate Indiana Pharmacy Teaching Certificate Medication Safety Essentials Certificate Overview of Medication Safety Positions/Titles Medication Safety Officer, Medication Safety Manager, Medication Safety Coordinator, Pharmacy Safety Officer, etc. Report to pharmacy, risk management, quality, patient safety, or senior leadership Type of patient population served All patients admitted to the 4 hospitals within the system Pediatrics through geriatrics, cardiology, oncology, trauma, ortho 28
29 Overview of Medication Safety Responsibilities and Roles Pharmacy Safety Leader Operations and clinical practice, merged Collaboration with other disciplines More than just pharmacy Committee Involvement (Lead/Member) Lead the system wide Medication Safety Committee meeting Quality No Harm, P&T, Patient Satisfaction, Nursing Leadership, Chemo Task Force, Heparin Subcommittee, etc. Precept PGY1 Residents/PharmD Students/Interns Overview of Medication Safety Daily variety Daily review of hospital reported medication errors Trend medication errors and adverse drug reaction data Review external data/safety alert notifications Identify patterns of concern Develop action plans Develop or refine processes (policies and procedures) Collaborate to ensure regulatory compliance Utilize methodology/tools when appropriate EHR stakeholder/leveraging technology Quality assurance monitoring Education Advice for Students Pursuing this Career Path Patient centered Collaboration is key! (interdisciplinary) Seize opportunities offered to you, be open minded Use your gut (intuition) Find balance (regulatory, patient safety, employee safety, workflow) The safest option isn t always the most popular Medication safety is like an onion you just keep peeling back the layers your job is never done! It s a small world use it to your advantage! 29
30 Group 2 Panel Discussion THANK YOU! 30
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text:
The disappointment of not playing in the Olympic soccer tournament two years ago stuck with Mix Diskerud.
That had been a lifelong goal, and he was part of that U.S. team that lost its chance for a spot in the London Games with a late-game collapse during qualifying.
Diskerud is getting a shot at redemption of sorts on the international soccer stage, headed to the World Cup in Brazil next month. He showed in a 2-0 exhibition victory Tuesday night against Azerbaijan the impact he can make for coach Jurgen Klinsmann off the bench, scoring the first U.S. goal off a rebound in the 75th minute just four minutes after subbing into the game.
And he did it wearing Landon Donovan's old No. 10 jersey.
"You grow a lot from certain experiences, and definitely one like that, because that was a goal in my life to reach the Olympics," Diskerud said. "Another goal was to reach the World Cup, so now I'm part of that."
Mikkel Diskerud's parents met at Arizona State -- his father is from Norway and his mother from Arizona. He was born in Oslo and was given his nickname by his mother. His full name is Mikkel Morgenstar Palssonn Diskerud.
"When I was a little kid, I always ran around the house, and my mom said I was like a mixer," Diskerud said ahead of his U.S. national team debut in an exhibition at South Africa four years ago. "When I was a kid, I was on a team called Frigg and there were two guys named Mikkel, so one had to get a nickname. I got Mix, and it stuck."
He had dual citizenship, enabling him to play on youth national teams from both Norway and the U.S. His goal Tuesday night sparked the Americans after a listless half-and-a-half.
Following Brad Davis' free kick, Diskerud headed the ball down to Michael Bradley, whose shot was cleared off the goal line by Elvin Yunuszade. Diskerud then banged the ball in with a right-footed shot from 6 yards.
It was the third goal in 18 appearances with the national team for Diskerud, who plays for Norway's Rosenberg. While Klinsmann insists he's not superstitious about No. 10, Diskerud earned the honor for how far he has come since the Olympic near miss.
"Mix is coming from a group of guys that we had real trouble with getting to the next level, and I mean our Olympic team that was supposed to go to London," Klinsmann said. "There were a few guys, very special players coming with that team, and for whatever reason it just didn't work out the way it should have worked out. We lost a few ones on that path that should actually be part of this group now, this inner-circle group. ... All these very, very talented kids, they fell in a hole, in a deep one."
Goalkeeper Tim Howard was thrilled to see someone like Diskerud come through in the first of three World Cup tuneups.
"He's worked hard," Howard said. "He's got his opportunity to show what he can do and hopefully he can continue to do more of that the next couple games."
The Americans face Turkey at Harrison, New Jersey, on Sunday followed by a game with Nigeria six days later in Jacksonville, Florida. The Americans end their two-week stay at Stanford University on Thursday and head east.
"It's started now, this whole thing," Klinsmann said.
NOTES: Klinsmann expects F Clint Dempsey to play Sunday; the U.S. captain was a late scratch against Azerbaijan because of a sore groun. "It should be no problem at all for Turkey," Klinsmann said. ... Azerbaijan coach Berti Vogts was ready to move forward to his scouting job as a special adviser for Klinsmann. He will see the U.S. opponents in Group G: Ghana, Portugal and Germany. He liked what the Americans did Tuesday, saying, "They played very powerful."