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Media advisory The Honourable Sean Fraser, Minister of Immigration, Refugees and Citizenship, on behalf of the Honourable Jean-Yves Duclos, Minister of Health, and the Honourable Barbara Adams, Nova Scotia’s online pharmacy viagra Minister of Seniors and Long-term Care, will announce support for safe long-term care in Nova Scotia. February 23, 2022, Chester, N.S. €“ The Honourable Sean Fraser, Minister of Immigration, Refugees and Citizenship, on behalf of the Honourable Jean-Yves Duclos, Minister online pharmacy viagra of Health, and the Honourable Barbara Adams, Nova Scotia's Minister of Seniors and Long-term Care, will announce support for safe long-term care in Nova Scotia. They will be joined by Darren Fisher, Parliamentary Secretary to Canada's Minister of Seniors and Member of Parliament for Dartmouth—Cole Harbour, and the Honourable Michelle Thompson, Nova Scotia's Minister of Health and Wellness.There will be a media availability immediately following the announcement. DateFebruary 24, 2022 Time10:00 AM (AST) Location The event will be held in person at:50 Shoreham Village CrescentChester, Nova online pharmacy viagra Scotia, B0J 1J0Note.

This event will take place outdoors and proof of vaccination is required to attend as per Nova Scotia erectile dysfunction (erectile dysfunction treatment). Restrictions and online pharmacy viagra guidance - Gathering limits.Media may also join by Zoom:https://ca01web.zoom.us/j/62466324407Passcode. 651044 Media Inquiries:Marie-France ProulxOffice of the Honourable Jean-Yves DuclosMinister of Health613-957-0200Media RelationsHealth Canada613-957-2983media@hc-sc.gc.ca.

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Like other physician practices across the country, DuPage Medical Group in west-suburban Chicago has been managing the care viagra side effects blood pressure of erectile dysfunction treatment patients who are recovering at home. The patients—particularly those at high risk for negative outcomes from the erectile dysfunction—would often ask the physicians at DuPage if there are treatments available to encourage a faster recovery and less severe symptoms.But because the erectile dysfunction’ strain is new, and viagra side effects blood pressure well-researched treatments were not available, physicians didn’t have much to offer. Motivated to give patients remedies, a team at DuPage began looking into the recent data on hospitalized erectile dysfunction patients to see if something could be offered to patients that may improve their chances of recovery.The result was a new treatment protocol involving aspirin and supplements such as vitamin D, zinc and iron. €œGenerally in healthcare, we wait for all the data to be perfect before incorporating it, but now in the viagra side effects blood pressure midst of this viagra, we needed to take bold action with courage to try to do something to help patients during this terrible time,” said Dr.

Mathew Philip, internal medicine physician and medical director of clinical innovation at DuPage. Philip and his colleagues arrived at aspirin as a treatment after viagra side effects blood pressure reviewing data showing those who died from erectile dysfunction treatment in the hospital largely died from blood clots and inflammation. Blood thinners and steroids also helped decrease mortality, the data showed. Aspirin is one of the viagra side effects blood pressure most recognized, over-the-counter treatments to prevent blood clots.

Additionally supplements like zinc and iron are well-researched remedies for viral s, said Dr. Mia Taormina, chair viagra side effects blood pressure of the medical group’s infectious disease department. The team that developed the protocol included an infectious disease physician, two pulmonary critical-care specialists, two emergency department physicians and an internal medicine doctor. The doses viagra side effects blood pressure involved in the treatment are at normal levels.

€œThis is all driven by physicians,” Taormina said.DuPage implemented the treatment protocol initially in October with its high-risk erectile dysfunction treatment patients. Philip said that of viagra side effects blood pressure the 20 patients who received the treatment in his practice, all recovered and only one required an inpatient hospitalization. Patients have had minimal side effects from the medications and the feedback has been positive, he added. Given viagra side effects blood pressure the results, DuPage recently expanded the treatment protocol to all its adult patients that test positive for erectile dysfunction treatment.

The protocol is now part of the electronic health record, which allows the physician to order it during in-person or virtual visits with patients. The physician can also modify the remedy based on the patient’s needs, for 
instance, if the patients can’t take one viagra side effects blood pressure of the supplements. The treatment can be picked up at the patient’s local pharmacy. The protocol offers guidance to physicians who were likely already considering providing these treatments to patients or recommending viagra side effects blood pressure them, Taormina said.

€œMaybe we had a doctor already recommending vitamin C across the board or already telling patients to take zinc,” she said. €œTo streamline and centralize these recommendations, viagra side effects blood pressure to give an approach systemwide allows patients who go anywhere within our system to know that their provider has been given 
the information that we support and endorse.”Since the treatment protocol has been developed, research has come out about the benefits of aspirin on hospitalized erectile dysfunction treatment patients. Taormina said she is aware of nursing homes that have implemented treatment protocols similar to DuPage’s. €œAs the data and viagra side effects blood pressure evidence continues to evolve, I think that the concept of doing these types of strategies is going to be more widespread,” she added.All signs point to the Food and Drug Administration quickly authorizing the emergency use of several highly effective treatments for erectile dysfunction treatment.

This is an extraordinary scientific achievement given only a year has passed since the deadly erectile dysfunction emerged in central China.It will take an equally extraordinary effort to convince enough Americans to take the shots. Public confidence in viagra side effects blood pressure the two agencies responsible for guaranteeing treatment safety and effectiveness and their fair distribution—the FDA and the Centers for Disease Control and Prevention—has reached a nadir.In polls taken a few months before the election, two-thirds of Americans believed the treatment approval process had been tainted by politics. More than a third of the public—including substantial numbers of front-line healthcare workers—said they wouldn’t get vaccinated.It’s easy to understand how two agencies once considered gold standards in their fields were brought low. The outgoing administration did everything in its power to undermine their credibility.The FDA caved viagra side effects blood pressure to the president’s demand to grant emergency use for a drug that eventually proved useless in fighting the disease.

HHS Secretary Alex Azar took away health agencies’ authority to issue new rules, then sought to block the FDA’s new guidelines governing emergency use authorizations—all to further his boss’ re-election.The CDC leadership stood by silently as political appointees censored its flagship publication. CDC scientists viagra side effects blood pressure and Dr. Anthony Fauci at the National Institutes of Health were “disappeared” from erectile dysfunction task force briefings. The White House repeatedly contradicted CDC guidelines while state public health officials in some parts of the country worked under death threats.It will take a sustained effort by the incoming Biden administration to rebuild viagra side effects blood pressure trust in America’s public health infrastructure.

It begins by his appointing new leaders at HHS, and the CDC and FDA who are fully committed to insulating agency scientists from political pressure.After Biden’s inauguration, the administration should viagra side effects blood pressure rapidly push legislation to permanently restore independence at science-based agencies. Such legislation should give the heads of all such agencies—not just at HHS but throughout the government—fixed terms of office whose expiration does not coincide with a presidential election year.The legislation should also guarantee scientific judgments at agencies can not be overruled by political appointees. Government scientists should be given the right to speak publicly and publish their findings without viagra side effects blood pressure prior restraint or political editing.This is not a call for science uber alles. Congress still gets to decide what needs regulatory oversight when it comes to our food and drug supply, our air and water, and our workplace protections.

Agencies still have to viagra side effects blood pressure give notice, allow comment and respond publicly when issuing rules and guidelines. Outside advisory committees will still serve as an additional layer of oversight and still be made up of independent scientists, members of the public and relevant stakeholders. But even viagra side effects blood pressure here, some new laws are called for. Many scientists have financial ties to regulated industries, especially in the medical field.

Current law merely calls for disclosure of such conflicts of interest.The time has come for a total ban on individuals with ties to industry from serving on viagra side effects blood pressure advisory committees. To encourage more independent scientists to volunteer for these oversight roles, and to increase diversity in their ranks, Congress should provide modest reimbursement—say about $20,000 or comparable to a drug company consulting fee—for their two-year terms. Everyone wants the treatment rollout viagra side effects blood pressure to succeed. But for that to happen, the government must first restore trust in its public health agencies.That mission will be greatly advanced by guaranteeing that power-hungry politicians and self-interested corporations will never again be allowed to override science in determining what best serves the public interest.There’s widespread concern that the erectile dysfunction viagra will exacerbate symptoms of anxiety and depression that millions already experience due to seasonal affective disorder, or SAD.

€œFeeling trapped and isolated is a common part of both viagra stress and seasonal depression—and when you are dealing with both at once, it’s easy to feel viagra side effects blood pressure overwhelmed and defeated,” Mental Health America notes on its website.This year has been among the most challenging in recent memory, especially from the perspective of a healthcare worker. As a chaplain at Orlando Health, I have personally witnessed the societal impact of widespread grief.Amid the holiday season, nobody needs to remind us that we are living in unprecedented times and facing unprecedented challenges. We’ll only overcome our collective viagra side effects blood pressure grief through support and understanding.In a year with more loss and turmoil than most, the grieving process has been interrupted for many. Changes to hospitals’ visitation policies mean some families have not been able to visit ailing loved ones, whether their diagnosis is related to erectile dysfunction treatment or not.Even when families can visit a patient critically ill from erectile dysfunction treatment, contact is through a barrier.

There is no hand-holding, no kissing, no whispered prayers or “I love you.” Some families have watched loved ones die through a pane of glass.We’ve watched the scene too many times in 2020, and it’s one of viagra side effects blood pressure the most emotionally exhausting experiences imaginable. The weight of these moments is heavy on everyone.It is a grim reality when you become aware of the trajectory and likely outcome for a patient because you’ve been down this road before. You anticipate that death is coming, which triggers anticipatory viagra side effects blood pressure grief. Often, we are in the position of serving as substitutes for family members who cannot be with a dying patient.

We are often the last human contact viagra side effects blood pressure they have.The constant and chaotic disruption of our typical processes leads to delayed grief for everyone involved, especially for healthcare workers. We’re not able to express our grief because we must soldier on. People need us.We don’t have the luxury to find a corner and have a good cry—that simply does not happen.We also have a country dealing with disenfranchised grief, which is unacknowledged or unvalidated by societal norms viagra side effects blood pressure. Many of us are not just dealing with the loss of loved ones, but with the loss of a way of life and the normalcy we took for granted as businesses fold or announce layoffs.This overwhelming grief manifests itself in different ways.

Many healthcare workers experience absent grief, which often just looks like a viagra side effects blood pressure blank stare. It’s a response that allows us to avoid emotional realities, convincing ourselves that we do not have feelings about what is happening.That is why, in addition to the overwhelming number of grieving family members I’ve ministered to this year, I’ve also found myself prioritizing time to care for my colleagues. We’ve had nurses broken by this viagra and viagra side effects blood pressure physicians pushed to their limits. We’ve lost team members and stood by helplessly as loved ones die.Witnessing these losses has led to battle fatigue, compassion fatigue, mental exhaustion and acute soul injury.It is important to acknowledge the difficulty our whole country is facing as we head into the holidays.

This season viagra side effects blood pressure is always challenging—mental health crises typically increase during the holidays. Unfortunately, this year we are likely to experience a worsening of the grief process over the next few weeks and months as the holidays look different for everyone.As the holidays near and 2020 comes to a close, remember to reach out to loved ones, especially those who have experienced loss and anyone in the healthcare industry.Be conscious of allowing others to grieve in their own way, whether that’s quiet reflection or overt sobbing.Everyone is experiencing grief differently. No one is doing it wrong or needs to “get over it.” Grief doesn’t come with an viagra side effects blood pressure expiration date and we all need to learn how to sit with others in their pain.We are in a global viagra that will not disappear overnight. As we await the healing of our world through commonsense measures and treatments, I encourage everyone to be patient with ourselves, others and our new way of life..

Like other physician practices across the country, DuPage Medical Group in west-suburban Chicago has http://terrassen-gartenmoebel.de/2018/07/16/hallo-welt/ been managing the care online pharmacy viagra of erectile dysfunction treatment patients who are recovering at home. The patients—particularly those at high risk for negative outcomes from the erectile dysfunction—would often ask the physicians at DuPage if there are treatments available to encourage a faster recovery and less severe symptoms.But because the erectile dysfunction’ strain is new, and well-researched treatments online pharmacy viagra were not available, physicians didn’t have much to offer. Motivated to give patients remedies, a team at DuPage began looking into the recent data on hospitalized erectile dysfunction patients to see if something could be offered to patients that may improve their chances of recovery.The result was a new treatment protocol involving aspirin and supplements such as vitamin D, zinc and iron. €œGenerally in healthcare, we wait for all the data to be perfect before incorporating it, but now in the midst of this viagra, we needed to take bold action with courage to try to do online pharmacy viagra something to help patients during this terrible time,” said Dr. Mathew Philip, internal medicine physician and medical director of clinical innovation at DuPage.

Philip and his colleagues arrived at aspirin as a treatment after reviewing data showing those who died from erectile dysfunction treatment in the hospital largely online pharmacy viagra died from blood clots and inflammation. Blood thinners and steroids also helped decrease mortality, the data showed. Aspirin is one of the most recognized, over-the-counter online pharmacy viagra treatments to prevent blood clots. Additionally supplements like zinc and iron are well-researched remedies for viral s, said Dr. Mia Taormina, chair of online pharmacy viagra the medical group’s infectious disease department.

The team that developed the protocol included an infectious disease physician, two pulmonary critical-care specialists, two emergency department physicians and an internal medicine doctor. The doses involved online pharmacy viagra in the treatment are at normal levels. €œThis is all driven by physicians,” Taormina said.DuPage implemented the treatment protocol initially in October with its high-risk erectile dysfunction treatment patients. Philip said online pharmacy viagra that of the 20 patients who received the treatment in his practice, all recovered and only one required an inpatient hospitalization. Patients have had minimal side effects from the medications and the feedback has been positive, he added.

Given the results, DuPage recently expanded the treatment protocol to all its adult patients that test positive for erectile dysfunction treatment online pharmacy viagra. The protocol is now part of the electronic health record, which allows the physician to order it during in-person or virtual visits with patients. The physician can also modify the remedy online pharmacy viagra based on the patient’s needs, for 
instance, if the patients can’t take one of the supplements. The treatment can be picked up at the patient’s local pharmacy. The protocol offers guidance to physicians online pharmacy viagra who were likely already considering providing these treatments to patients or recommending them, Taormina said.

€œMaybe we had a doctor already recommending vitamin C across the board or already telling patients to take zinc,” she said. €œTo streamline and centralize these recommendations, to give an approach systemwide allows patients who go anywhere within our system to know that their provider has been given 
the online pharmacy viagra information that we support and endorse.”Since the treatment protocol has been developed, research has come out about the benefits of aspirin on hospitalized erectile dysfunction treatment patients. Taormina said she is aware of nursing homes that have implemented treatment protocols similar to DuPage’s. €œAs the data and evidence continues to evolve, I think that the concept of doing these types of strategies is going to be more widespread,” she added.All signs point to the Food and Drug Administration quickly authorizing the emergency online pharmacy viagra use of several highly effective treatments for erectile dysfunction treatment. This is an extraordinary scientific achievement given only a year has passed since the deadly erectile dysfunction emerged in central China.It will take an equally extraordinary effort to convince enough Americans to take the shots.

Public confidence in the two agencies responsible for guaranteeing online pharmacy viagra treatment safety and effectiveness and their fair distribution—the FDA and the Centers for Disease Control and Prevention—has reached a nadir.In polls taken a few months before the election, two-thirds of Americans believed the treatment approval process had been tainted by politics. More than a third of the public—including substantial numbers of front-line healthcare workers—said they wouldn’t get vaccinated.It’s easy to understand how two agencies once considered gold standards in their fields were brought low. The outgoing administration did everything in its power to undermine their credibility.The FDA caved to the president’s demand to grant emergency use for a drug that eventually proved useless in fighting online pharmacy viagra the disease. HHS Secretary Alex Azar took away health agencies’ authority to issue new rules, then sought to block the FDA’s new guidelines governing emergency use authorizations—all to further his boss’ re-election.The CDC leadership stood by silently as political appointees censored its flagship publication. CDC scientists and Dr online pharmacy viagra.

Anthony Fauci at the National Institutes of Health were “disappeared” from erectile dysfunction task force briefings. The White House repeatedly contradicted CDC guidelines while state public health online pharmacy viagra officials in some parts of the country worked under death threats.It will take a sustained effort by the incoming Biden administration to rebuild trust in America’s public health infrastructure. It begins by his appointing new leaders at HHS, and the CDC and online pharmacy viagra FDA who are fully committed to insulating agency scientists from political pressure.After Biden’s inauguration, the administration should rapidly push legislation to permanently restore independence at science-based agencies. Such legislation should give the heads of all such agencies—not just at HHS but throughout the government—fixed terms of office whose expiration does not coincide with a presidential election year.The legislation should also guarantee scientific judgments at agencies can not be overruled by political appointees. Government scientists should be given the online pharmacy viagra right to speak publicly and publish their findings without prior restraint or political editing.This is not a call for science uber alles.

Congress still gets to decide what needs regulatory oversight when it comes to our food and drug supply, our air and water, and our workplace protections. Agencies still have to give notice, allow comment and respond publicly when issuing rules and online pharmacy viagra guidelines. Outside advisory committees will still serve as an additional layer of oversight and still be made up of independent scientists, members of the public and relevant stakeholders. But even here, online pharmacy viagra some new laws are called for. Many scientists have financial ties to regulated industries, especially in the medical field.

Current law merely calls for disclosure of such conflicts of interest.The time has come for a total ban on individuals with ties to online pharmacy viagra industry from serving on advisory committees. To encourage more independent scientists to volunteer for these oversight roles, and to increase diversity in their ranks, Congress should provide modest reimbursement—say about $20,000 or comparable to a drug company consulting fee—for their two-year terms. Everyone wants the treatment rollout to online pharmacy viagra succeed. But for that to happen, the government must first restore trust in its public health agencies.That mission will be greatly advanced by guaranteeing that power-hungry politicians and self-interested corporations will never again be allowed to override science in determining what best serves the public interest.There’s widespread concern that the erectile dysfunction viagra will exacerbate symptoms of anxiety and depression that millions already experience due to seasonal affective disorder, or SAD. €œFeeling trapped and isolated is a common part of both viagra stress and seasonal depression—and when you are dealing with both at once, it’s easy to feel overwhelmed and defeated,” Mental Health America notes on its website.This online pharmacy viagra year has been among the most challenging in recent memory, especially from the perspective of a healthcare worker.

As a chaplain at Orlando Health, I have personally witnessed the societal impact of widespread grief.Amid the holiday season, nobody needs to remind us that we are living in unprecedented times and facing unprecedented challenges. We’ll only overcome our collective grief through support and understanding.In a year with more loss and turmoil than most, the grieving process has been online pharmacy viagra interrupted for many. Changes to hospitals’ visitation policies mean some families have not been able to visit ailing loved ones, whether their diagnosis is related to erectile dysfunction treatment or not.Even when families can visit a patient critically ill from erectile dysfunction treatment, contact is through a barrier. There is no hand-holding, no kissing, no whispered prayers or “I love you.” Some families have watched loved ones die through a online pharmacy viagra pane of glass.We’ve watched the scene too many times in 2020, and it’s one of the most emotionally exhausting experiences imaginable. The weight of these moments is heavy on everyone.It is a grim reality when you become aware of the trajectory and likely outcome for a patient because you’ve been down this road before.

You anticipate that death is online pharmacy viagra coming, which triggers anticipatory grief. Often, we are in the position of serving as substitutes for family members who cannot be with a dying patient. We are often the last human contact they have.The constant and chaotic disruption of our typical processes online pharmacy viagra leads to delayed grief for everyone involved, especially for healthcare workers. We’re not able to express our grief because we must soldier on. People need us.We don’t online pharmacy viagra have the luxury to find a corner and have a good cry—that simply does not happen.We also have a country dealing with disenfranchised grief, which is unacknowledged or unvalidated by societal norms.

Many of us are not just dealing with the loss of loved ones, but with the loss of a way of life and the normalcy we took for granted as businesses fold or announce layoffs.This overwhelming grief manifests itself in different ways. Many healthcare online pharmacy viagra workers experience absent grief, which often just looks like a blank stare. It’s a response that allows us to avoid emotional realities, convincing ourselves that we do not have feelings about what is happening.That is why, in addition to the overwhelming number of grieving family members I’ve ministered to this year, I’ve also found myself prioritizing time to care for my colleagues. We’ve had nurses broken online pharmacy viagra by this viagra and physicians pushed to their limits. We’ve lost team members and stood by helplessly as loved ones die.Witnessing these losses has led to battle fatigue, compassion fatigue, mental exhaustion and acute soul injury.It is important to acknowledge the difficulty our whole country is facing as we head into the holidays.

This season is always challenging—mental health crises typically increase during the online pharmacy viagra holidays. Unfortunately, this year we are likely to experience a worsening of the grief process over the next few weeks and months as the holidays look different for everyone.As the holidays near and 2020 comes to a close, remember to reach out to loved ones, especially those who have experienced loss and anyone in the healthcare industry.Be conscious of allowing others to grieve in their own way, whether that’s quiet reflection or overt sobbing.Everyone is experiencing grief differently. No one is doing it wrong or needs to “get over it.” Grief doesn’t come online pharmacy viagra with an expiration date and we all need to learn how to sit with others in their pain.We are in a global viagra that will not disappear overnight. As we await the healing of our world through commonsense measures and treatments, I encourage everyone to be patient with ourselves, others and our new way of life..

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€œWould you mind viagra pill pink having a conversation http://mattjsmith.com/buy-kamagra-without-a-prescription/ with us?. € Mahoney wants to talk about abortion — not a typical topic for a conversation, especially with a stranger. But the woman, Kerry Kelchner, agrees to talk.

If this were typical door-to-door canvassing, Mahoney might ask Kelchner about a political candidate, remind her to vote and then be on her way viagra pill pink. But Mahoney is deep canvassing — a technique that employs longer conversations to move opinions on hot-button issues. Planned Parenthood in Maine has deployed the strategy for several years amid what it says are increasing threats to reproductive rights.

This year viagra pill pink alone, states have enacted more than 100 restrictions on abortion, including one in Texas that bans most abortions after six weeks. This month, the U.S. Supreme Court heard arguments in a case about a Mississippi law that could lead to the overturning of Roe v.

Wade, the landmark 1973 ruling that viagra pill pink established a constitutional right to abortion. And though state law in Maine protects abortion rights even if Roe v. Wade is overturned, abortion opponents have gained traction in the state in recent years.

So volunteers viagra pill pink like Mahoney start conversations. And they can get quite personal. Mahoney first assesses Kelchner’s baseline attitude on abortion access on a scale of 0 to 10.

A 10 means viagra pill pink the interviewee believes anyone should be able to get an abortion for any reason. Kelchner says she’s a 7. Next, Mahoney asks Kelchner a series of questions to better understand her values.

€œCan you tell me a viagra pill pink little bit about what shaped your views on abortion?. € she asks. €œHave you known anybody who’s had an abortion, a friend or a family member?.

€ “My viagra pill pink mother,” says Kelchner. She explains her parents were young when she was born, and they weren’t ready for another baby. Then Mahoney, who’s 60, shares that she also had an abortion.

€œI was viagra pill pink in my early 20s,” she says. €œI was a little conflicted about it, and I wanted to have a family. I knew I wanted to have a family, but I was in no way ready to do that.” Mahoney points out that she and Kelchner have similar views on what an unplanned pregnancy can mean.

Then she asks her opening question again, to see whether Kelchner’s feelings viagra pill pink about abortion access have shifted on the 0-to-10 scale. €œStill around 7,” Kelchner says. Mahoney probes further.

€œWhat would be the circumstances where you would say, ‘No — they shouldn’t have viagra pill pink the right to have an abortion?. €™â€ Kelchner pauses. €œThat’s a good question.” Before volunteers head out to strike up conversations with voters, Katie McClelland (in black cap) of Planned Parenthood in Maine gives a pep talk.

(Patty Wight/Maine viagra pill pink Public Radio) Planned Parenthood volunteer Sarah Mahoney checks a list of addresses to see which door to knock on next. (Patty Wight/Maine Public Radio) They talk more. Ultimately, Kelchner can’t think of any circumstance in which she believes someone should be denied an abortion.

€œThere should be no judgment,” she says. €œSo that would viagra pill pink be a 10?. € Mahoney asks.

€œYep,” says Kelchner. In the five years she’s been deep canvassing for Planned Parenthood, Mahoney said, viagra pill pink she hasn’t had a single unpleasant conversation. €œWhat we’ve found doing this is that it is an effective way to change minds about abortion,” said Amy Cookson, director of external communications for Planned Parenthood of Northern New England.

Cookson said Planned Parenthood started deep canvassing in Maine in 2015, after Paul LePage, an anti-abortion Republican, won a second term as governor. Gay rights advocates in California had used deep canvassing on the same-sex marriage viagra pill pink issue, and she wondered. €œCan it work around abortion stigma?.

€ Joshua Kalla, a political scientist at Yale University, has conducted research that found the technique can change people’s deeply held beliefs. The crucial elements are that viagra pill pink canvassers listen without judgment and share their own stories. €œSo whether the person had an abortion and is talking about their abortion story,” said Kalla, “or whether the person is an ally and is talking about a friend or family member who had an abortion and is sharing that story, the effects seem to be quite similar.” Kalla has also studied Planned Parenthood’s efforts in Maine and said the group has added something else that’s effective.

Moral reframing. Canvassers listen for the moral values a voter emphasizes and then incorporate those values into the story they share viagra pill pink. But deep canvassing is not exclusively a progressive tactic, Kalla said.

Conservative groups can use it, too, and he thinks that would improve political discourse. €œYou know, it would be good for American society if the way we had political conversation was more grounded, and listening to the other side, and being nonjudgmental, and viagra pill pink being curious.” After spending a couple of hours canvassing, volunteers with Planned Parenthood debrief about their experiences. (Patty Wight/Maine Public Radio) Back in Windham, Mahoney continues to walk through the neighborhood.

She meets a man outside his apartment building who gives only his first name, Chris. He says viagra pill pink he’s a 4 on the abortion access scale. He opposes abortion except in cases of sexual assault.

Chris tells Mahoney he had a daughter when he was 15. €œDo you talk about, viagra pill pink I’m curious, birth control and abortion?. € Mahoney asks.

€œI do with her a lot,” Chris says. She’s a teenager, he says, and he’s not sure what he’d do if viagra pill pink she got pregnant accidentally. €œIt’s her own life,” he says.

€œI don’t know if I would even try to change her mind. Because it’s her decision.” As the conversation goes viagra pill pink on, Chris seems as though he supports access to abortion. But at the end, he doesn’t budge on his rating.

Mahoney said that’s OK. Some people won’t viagra pill pink change their minds right away. €œThe worst way to think about this is that it’s some kind of Jedi mind trick,” she said, “and I’m going to let them talk about themselves and then — pow!.

— I’m going to change their mind.” What Mahoney wants most from these conversations is for people to think more deeply about the nuances around abortion and identify common ground. €œI just feel like we all need to be taking steps to hear one another and move towards each other, instead of just diving into this divisive, contrary, hostile, red and blue world.” Because of the success Planned Parenthood in Maine viagra pill pink has had with deep canvassing, it has trained volunteers in other states, including Texas and Kansas. Next year, Kansas voters will cast ballots on a referendum question that seeks to revoke abortion access as a fundamental right.

This story is part of a partnership that includes Maine Public Radio, NPR and KHN. Related Topics Contact Us Submit a Story Tip.

It’s Saturday, and Sarah Mahoney is one of several Planned Parenthood volunteers knocking on doors in Windham, Maine, a politically moderate town not online pharmacy viagra far from Portland. No one answers at the first couple of houses. But as Mahoney heads up the street, she sees a woman out for a walk. €œHey!. We’re out canvassing,” she says.

€œWould you mind having a conversation with us?. € Mahoney wants to talk about abortion — not a typical topic for a conversation, especially with a stranger. But the woman, Kerry Kelchner, agrees to talk. If this were typical door-to-door canvassing, Mahoney might ask Kelchner about a political candidate, remind her to vote and then be on her way. But Mahoney is deep canvassing — a technique that employs longer conversations to move opinions on hot-button issues.

Planned Parenthood in Maine has deployed the strategy for several years amid what it says are increasing threats to reproductive rights. This year alone, states have enacted more than 100 restrictions on abortion, including one in Texas that bans most abortions after six weeks. This month, the U.S. Supreme Court heard arguments in a case about a Mississippi law that could lead to the overturning of Roe v. Wade, the landmark 1973 ruling that established a constitutional right to abortion.

And though state law in Maine protects abortion rights even if Roe v. Wade is overturned, abortion opponents have gained traction in the state in recent years. So volunteers like Mahoney start conversations. And they can get quite personal. Mahoney first assesses Kelchner’s baseline attitude on abortion access on a scale of 0 to 10.

A 10 means the interviewee believes anyone should be able to get an abortion for any reason. Kelchner says she’s a 7. Next, Mahoney asks Kelchner a series of questions to better understand her values. €œCan you tell me a little bit about what shaped your views on abortion?. € she asks.

€œHave you known anybody who’s had an abortion, a friend or a family member?. € “My mother,” says Kelchner. She explains her parents were young when she was born, and they weren’t ready for another baby. Then Mahoney, who’s 60, shares that she also had an abortion. €œI was in my early 20s,” she says.

€œI was a little conflicted about it, and I wanted to have a family. I knew I wanted to have a family, but I was in no way ready to do that.” Mahoney points out that she and Kelchner have similar views on what an unplanned pregnancy can mean. Then she asks her opening question again, to see whether Kelchner’s feelings about abortion access have shifted on the 0-to-10 scale. €œStill around 7,” Kelchner says. Mahoney probes further.

€œWhat would be the circumstances where you would say, ‘No — they shouldn’t have the right to have an abortion?. €™â€ Kelchner pauses. €œThat’s a good question.” Before volunteers head out to strike up conversations with voters, Katie McClelland (in black cap) of Planned Parenthood in Maine gives a pep talk. (Patty Wight/Maine Public Radio) Planned Parenthood volunteer Sarah Mahoney checks a list of addresses to see which door to knock on next. (Patty Wight/Maine Public Radio) They talk more.

Ultimately, Kelchner can’t think of any circumstance in which she believes someone should be denied an abortion. €œThere should be no judgment,” she says. €œSo that would be a 10?. € Mahoney asks. €œYep,” says Kelchner.

In the five years she’s been deep canvassing for Planned Parenthood, Mahoney said, she hasn’t had a single unpleasant conversation. €œWhat we’ve found doing this is that it is an effective way to change minds about abortion,” said Amy Cookson, director of external communications for Planned Parenthood of Northern New England. Cookson said Planned Parenthood started deep canvassing in Maine in 2015, after Paul LePage, an anti-abortion Republican, won a second term as governor. Gay rights advocates in California had used deep canvassing on the same-sex marriage issue, and she wondered. €œCan it work around abortion stigma?.

€ Joshua Kalla, a political scientist at Yale University, has conducted research that found the technique can change people’s deeply held beliefs. The crucial elements are that canvassers listen without judgment and share their own stories. €œSo whether the person had an abortion and is talking about their abortion story,” said Kalla, “or whether the person is an ally and is talking about a friend or family member who had an abortion and is sharing that story, the effects seem to be quite similar.” Kalla has also studied Planned Parenthood’s efforts in Maine and said the group has added something else that’s effective. Moral reframing. Canvassers listen for the moral values a voter emphasizes and then incorporate those values into the story they share.

But deep canvassing is not exclusively a progressive tactic, Kalla said. Conservative groups can use it, too, and he thinks that would improve political discourse. €œYou know, it would be good for American society if the way we had political conversation was more grounded, and listening to the other side, and being nonjudgmental, and being curious.” After spending a couple of hours canvassing, volunteers with Planned Parenthood debrief about their experiences. (Patty Wight/Maine Public Radio) Back in Windham, Mahoney continues to walk through the neighborhood. She meets a man outside his apartment building who gives only his first name, Chris.

He says he’s a 4 on the abortion access scale. He opposes abortion except in cases of sexual assault. Chris tells Mahoney he had a daughter when he was 15. €œDo you talk about, I’m curious, birth control and abortion?. € Mahoney asks.

€œI do with her a lot,” Chris says. She’s a teenager, he says, and he’s not sure what he’d do if she got pregnant accidentally. €œIt’s her own life,” he says. €œI don’t know if I would even try to change her mind. Because it’s her decision.” As the conversation goes on, Chris seems as though he supports access to abortion.

But at the end, he doesn’t budge on his rating. Mahoney said that’s OK. Some people won’t change their minds right away. €œThe worst way to think about this is that it’s some kind of Jedi mind trick,” she said, “and I’m going to let them talk about themselves and then — pow!.

Average dose of viagra

Etchells E, Ho M, average dose of viagra Shojania KG. Value of small sample sizes in rapid-cycle quality improvement projects. BMJ Qual Safe 2016;25:202–6.The article has been corrected since average dose of viagra it was published online. The authors want to alert readers to the following error identified in the published version.

The error average dose of viagra is in the last paragraph of the section “Small samples can make ‘rapid improvement’ Rapid”, wherein the minimum sample size has been considered as six instead of eight.For this first (convenience) sample of 10 volunteer users, 5/10 (50%) completed the form without any input or instructions. The other five became frustrated and gave up. Table 1 tells you that, with an observed success rate of 50% and a desired target of 90%, any audit with a sample of six or more allows you to confidently reject the null hypothesis that your form is working at average dose of viagra a 90% success rate.For decades, those working in hospitals normalised the incessant alarms from medical devices as a necessary, almost comforting, reality of a high tech industry. While nurses drowned in excessive, frequently uninformative alarms, other members of the healthcare team often paid little attention.

Fortunately, times are changing and managing alarm fatigue is now a key patient safety priority in acute care environments.1Adverse patient events from alarm fatigue, particularly related to excessive physiological monitor alarms, have received widespread attention over the last decade, including from the news media.2–5 In the USA, hospitals redoubled alarm safety efforts following the 2013 Joint Commission Sentinel Event Alert and subsequent National Patient Safety Goals on alarm safety.1 2 6 We are now average dose of viagra beginning to understand how to reduce excessive non-actionable alarms (including invalid alarms as well as those that are valid but not actionable or informative),7 8 better manage alarm notifications and ultimately improve patient safety. Alarm data are readily available and measuring alarm response time during patient care is possible.7 9 Yet we have few high-quality reports describing clear improvement to clinical alarm burden, and most published interventions are of limited scope, duration or both.10 11 To demonstrate value in alarm quality improvement (QI) efforts moving forward, we need more rigorous evidence for interventions and more meaningful outcome measures.In this issue of BMJ Quality and Safety, Pater et al12 report the results of a comprehensive multidisciplinary alarm management QI project executed over 3½ years in a 17-bed paediatric acute care cardiology unit. The primary average dose of viagra project goal was to reduce alarm notifications from continuous bedside monitoring. Although limited to a single unit, the project is an important contribution to the scant literature on alarm management in paediatric settings for three reasons.

First, the initiative lasted longer than most that have been reported, which allowed for tailoring of alarm interventions to the needs of the unit and patient population and measuring the impacts and sustainability over time. Second, the scope of the intervention bundle encompassed a wide average dose of viagra variety of changes including adoption of a smartphone notification system. Addition of time delays between when alarm thresholds are violated and when an alarm notification is issued. Implementation of an alarm notification escalation algorithm after a certain amount average dose of viagra of time in alarm threshold violation.

Deactivation of numerous technical alarms (such as respiratory lead detachment). Monitoring of electrode lead replacement every average dose of viagra 24 hours. And discussion of alarm parameters on daily rounds. Third, the authors introduced a novel strategy for reducing the stress that alarms may cause patients and families by deactivating inroom alarm audio, although no outcomes were reported attributable directly to this component of the intervention.This project constitutes an important contribution average dose of viagra to the published literature.

However, Pater et al faced two challenges that are ubiquitous in the field of clinical alarm management. (1) Identification of meaningful outcome measures and (2) Lack of high-quality evidence for most interventions average dose of viagra. With regards to the first challenge, the primary outcome measure used in the study comprised ‘initial alarm notifications’, defined as the first notification of a monitor alarm delivered to the nurse’s mobile device. Although initial alarm notifications declined by 68% following the intervention, these notifications accounted for only about half of all alarm notifications.

The other half included second and third notifications for alarms exceeding specified delay thresholds, which were sent both to the mobile device of the primary nurse and to ‘buddy’ nurses, average dose of viagra potentially increasing alarm burden. On the other hand, eliminating inroom audible alarms may have reduced the perceived alarm burden for nurses compared with having both bedside and mobile device notifications. Determining the true benefit of a reduction in a subset of alarms presents complex challenges.Alarm frequency is the average dose of viagra most commonly used outcome measure in alarm research and QI projects, but reduction in alarms does not necessarily indicate improved patient safety or a highly functional alarm management system. Alarm reduction could easily be achieved in an undesirable way by simply turning off alarms.

Unfortunately, most studies average dose of viagra have not been powered to statistically evaluate improvements in patient safety. (Pater et al did monitor patient safety balancing measures, which remained stable after intervention implementation). To assess change average dose of viagra in nurses’ perceptions of alarm frequency, Pater et al conducted a prepost survey, which despite the small sample size (n=38 preintervention and n=25 postintervention) managed to show improvement, with the percentage of nurses agreeing they could respond to alarms appropriately and quickly increasing from 32% to 76% (p<0.001). That said, this survey was not a validated measure of alarm fatigue.

In fact, we currently have no widely accepted, validated tool for assessing alarm fatigue.11As we look towards future evaluations of alarm management strategies, the average dose of viagra focus needs to shift away from simply reducing the frequency of alarms to more meaningful outcome metrics. In addition to alarm rates, outcomes such as response time to actual patient alarms7 9 or to simulated alarms injected into real patient care environments13 may be better indicators of whether the entire alarm response system is functioning correctly. Larger, multisite studies are needed to assess patient outcomes.In addition to meaningful outcome measures, the second challenge for alarm QI projects is the lack of good evidence for alarm management interventions. Most alarm reduction interventions have not been systematically evaluated at all or only in small studies without a control group.10 11 As a result, alarm management projects tend to involve complex and costly bundles of interventions average dose of viagra of uncertain benefit.

The cost of these interventions is due in part to the growing industry of technology solutions for alarm management. Some institutions have also made massive investments in personnel, such as monitor ‘watchers’ to help nurses identify actionable alarms, for which there is also little evidence.14Future alarm management QI initiatives will average dose of viagra benefit from a higher quality evidence base for the growing list of potential alarm management interventions. Pragmatic trials that leverage meaningful outcome measures to assess alarm interventions are warranted. In addition, we need to evaluate interventions that address the full spectrum of average dose of viagra the alarm management system.

Most alarm management interventions to date have focused primarily on filtering out non-actionable alarms. Far less emphasis has been placed on ensuring that the nurse receiving the notification is available to respond to the alarm, a prime opportunity for future work.Even if alarms are actionable, we know that nurses may not always respond quickly for a variety of reasons.7 15–17 Factors like insufficient average dose of viagra staffing, high severity of illness on the unit and unbalanced nursing skill mix all likely contribute to inadequate alarm response. In critical care, nurses have reported that the nature of their work requires that they function as a team to respond to one another’s alarms.15 Although not ideal, nurses have developed heuristics based on factors like family presence at the bedside to help them prioritise alarm response in hectic work environments.7 16 Emphasising outcomes like faster alarm response time without addressing systems factors risks trading one patient safety problem for another. We do not want to engender more frequent interruptions of high-risk activities, like medication administration,18 19 because nurses feel compelled to respond more quickly to alarms.The robust QI initiative carried out by Pater et al reflects the type of thoughtful approach needed to implement and tailor alarm management interventions average dose of viagra for a particular unit, demonstrating a generalisable process for others to emulate.

Ultimately, every alarm offers a potential benefit (opportunity to rescue a patient) and comes with a potential cost (eg, increased alarm fatigue, interruptions of other activities). This trade-off needs to be optimised in the context of the individual unit, accounting for the unit-specific and systems factors that influence the cost of each additional alarm, including non-actionable alarm rates, unit layout, severity of illness and nurse staffing.17 20 With more robust outcome measures and more evidence to support interventions, we can increase the value of alarm QI initiatives and accelerate progress towards optimising alarm management systems.AcknowledgmentsWe thank Charles McCulloch, PhD (University of California, San Francisco) for comments on an early draft..

Etchells E, Buy kamagra australia Ho online pharmacy viagra M, Shojania KG. Value of small sample sizes in rapid-cycle quality improvement projects. BMJ Qual Safe online pharmacy viagra 2016;25:202–6.The article has been corrected since it was published online. The authors want to alert readers to the following error identified in the published version.

The error is in the last paragraph of the section “Small samples can online pharmacy viagra make ‘rapid improvement’ Rapid”, wherein the minimum sample size has been considered as six instead of eight.For this first (convenience) sample of 10 volunteer users, 5/10 (50%) completed the form without any input or instructions. The other five became frustrated and gave up. Table 1 tells you that, with an observed success rate of 50% and online pharmacy viagra a desired target of 90%, any audit with a sample of six or more allows you to confidently reject the null hypothesis that your form is working at a 90% success rate.For decades, those working in hospitals normalised the incessant alarms from medical devices as a necessary, almost comforting, reality of a high tech industry. While nurses drowned in excessive, frequently uninformative alarms, other members of the healthcare team often paid little attention.

Fortunately, times are changing and managing alarm fatigue is now online pharmacy viagra a key patient safety priority in acute care environments.1Adverse patient events from alarm fatigue, particularly related to excessive physiological monitor alarms, have received widespread attention over the last decade, including from the news media.2–5 In the USA, hospitals redoubled alarm safety efforts following the 2013 Joint Commission Sentinel Event Alert and subsequent National Patient Safety Goals on alarm safety.1 2 6 We are now beginning to understand how to reduce excessive non-actionable alarms (including invalid alarms as well as those that are valid but not actionable or informative),7 8 better manage alarm notifications and ultimately improve patient safety. Alarm data are readily available and measuring alarm response time during patient care is possible.7 9 Yet we have few high-quality reports describing clear improvement to clinical alarm burden, and most published interventions are of limited scope, duration or both.10 11 To demonstrate value in alarm quality improvement (QI) efforts moving forward, we need more rigorous evidence for interventions and more meaningful outcome measures.In this issue of BMJ Quality and Safety, Pater et al12 report the results of a comprehensive multidisciplinary alarm management QI project executed over 3½ years in a 17-bed paediatric acute care cardiology unit. The primary project goal was to reduce alarm notifications from continuous bedside monitoring online pharmacy viagra. Although limited to a single unit, the project is an important contribution to the scant literature on alarm management in paediatric settings for three reasons.

First, the initiative lasted longer than most that have been reported, which allowed for tailoring of alarm interventions to the needs of the unit and patient population and measuring the impacts and sustainability over time. Second, the scope of the intervention bundle encompassed a wide variety of changes including adoption of a online pharmacy viagra smartphone notification system. Addition of time delays between when alarm thresholds are violated and when an alarm notification is issued. Implementation of an online pharmacy viagra alarm notification escalation algorithm after a certain amount of time in alarm threshold violation.

Deactivation of numerous technical alarms (such as respiratory lead detachment). Monitoring of online pharmacy viagra electrode lead replacement every 24 hours. And discussion of alarm parameters on daily rounds. Third, the online pharmacy viagra authors introduced a novel strategy for reducing the stress that alarms may cause patients and families by deactivating inroom alarm audio, although no outcomes were reported attributable directly to this component of the intervention.This project constitutes an important contribution to the published literature.

However, Pater et al faced two challenges that are ubiquitous in the field of clinical alarm management. (1) Identification of meaningful outcome measures and (2) Lack of high-quality evidence for online pharmacy viagra most interventions. With regards to the first challenge, the primary outcome measure used in the study comprised ‘initial alarm notifications’, defined as the first notification of a monitor alarm delivered to the nurse’s mobile device. Although initial alarm notifications declined by 68% following the intervention, these notifications accounted for only about half of all alarm notifications.

The other half included second and third notifications for alarms exceeding specified delay thresholds, which were sent both to the mobile device of the online pharmacy viagra primary nurse and to ‘buddy’ nurses, potentially increasing alarm burden. On the other hand, eliminating inroom audible alarms may have reduced the perceived alarm burden for nurses compared with having both bedside and mobile device notifications. Determining the true benefit of a reduction in a subset of alarms presents complex challenges.Alarm frequency is the most commonly used outcome measure in alarm research online pharmacy viagra and QI projects, but reduction in alarms does not necessarily indicate improved patient safety or a highly functional alarm management system. Alarm reduction could easily be achieved in an undesirable way by simply turning off alarms.

Unfortunately, most studies online pharmacy viagra have not been powered to statistically evaluate improvements in patient safety. (Pater et al did monitor patient safety balancing measures, which remained stable after intervention implementation). To assess change online pharmacy viagra in nurses’ perceptions of alarm frequency, Pater et al conducted a prepost survey, which despite the small sample size (n=38 preintervention and n=25 postintervention) managed to show improvement, with the percentage of nurses agreeing they could respond to alarms appropriately and quickly increasing from 32% to 76% (p<0.001). That said, this survey was not a validated measure of alarm fatigue.

In fact, we currently have no widely accepted, validated tool for assessing alarm fatigue.11As we look towards future evaluations of alarm management strategies, the focus needs to shift away from simply reducing the frequency of alarms to online pharmacy viagra more meaningful outcome metrics. In addition to alarm rates, outcomes such as response time to actual patient alarms7 9 or to simulated alarms injected into real patient care environments13 may be better indicators of whether the entire alarm response system is functioning correctly. Larger, multisite studies are needed to assess patient outcomes.In addition to meaningful outcome measures, the second challenge for alarm QI projects is the lack of good evidence for alarm management interventions. Most alarm reduction interventions have not been systematically evaluated online pharmacy viagra at all or only in small studies without a control group.10 11 As a result, alarm management projects tend to involve complex and costly bundles of interventions of uncertain benefit.

The cost of these interventions is due in part to the growing industry of technology solutions for alarm management. Some institutions have also online pharmacy viagra made massive investments in personnel, such as monitor ‘watchers’ to help nurses identify actionable alarms, for which there is also little evidence.14Future alarm management QI initiatives will benefit from a higher quality evidence base for the growing list of potential alarm management interventions. Pragmatic trials that leverage meaningful outcome measures to assess alarm interventions are warranted. In addition, we need to online pharmacy viagra evaluate interventions that address the full spectrum of the alarm management system.

Most alarm management interventions to date have focused primarily on filtering out non-actionable alarms. Far less emphasis has been placed on ensuring that the nurse receiving the notification is available to respond to the alarm, a prime opportunity for future work.Even if alarms are actionable, we know that nurses may not online pharmacy viagra always respond quickly for a variety of reasons.7 15–17 Factors like insufficient staffing, high severity of illness on the unit and unbalanced nursing skill mix all likely contribute to inadequate alarm response. In critical care, nurses have reported that the nature of their work requires that they function as a team to respond to one another’s alarms.15 Although not ideal, nurses have developed heuristics based on factors like family presence at the bedside to help them prioritise alarm response in hectic work environments.7 16 Emphasising outcomes like faster alarm response time without addressing systems factors risks trading one patient safety problem for another. We do not want to engender more frequent interruptions of high-risk activities, like medication administration,18 19 because nurses feel compelled to respond more quickly to alarms.The robust QI initiative online pharmacy viagra carried out by Pater et al reflects the type of thoughtful approach needed to implement and tailor alarm management interventions for a particular unit, demonstrating a generalisable process for others to emulate.

Ultimately, every alarm offers a potential benefit (opportunity to rescue a patient) and comes with a potential cost (eg, increased alarm fatigue, interruptions of other activities). This trade-off needs to be optimised in the context of the individual unit, accounting for the unit-specific and systems factors that influence the cost of each additional alarm, including non-actionable alarm rates, unit layout, severity of illness and nurse staffing.17 20 With more robust outcome measures and more evidence to support interventions, we can increase the value of alarm QI initiatives and accelerate progress towards optimising alarm management systems.AcknowledgmentsWe thank Charles McCulloch, PhD (University of California, San Francisco) for comments on an early draft..