Holiday Hellth!

For many of us the holidays mean family, feasting and fun.  But for our nation’s 18 million health care workers  – 28% of whom will be working on Thanksgiving, all celebrations will be placed on hold while they help those who are sick or injured.

And, as Christmas approaches, things don’t get any better.  The number of 911 calls and hospital visits spike as the temperatures plummet. For example, around 5,800 people are treated for holiday decorating injuries alone, each year. On top of this, the number one day for cardiac deaths is December 25th with December 26th and January 1st coming in a close second and third.

To raise awareness of the strain put on healthcare workers during the holiday season and some ways they can address it, Carrington College, has released these infographics:

Whatever you end up doing tomorrow, let’s not forget to say a word of thanks to our healthcare professionals. And if you do end up in their care be thankful they’re there.

www.Can-I-Help-You-With-That?

There’s days when reading the news makes you feel old. Today is one of those days.

It started out with the realization that the world wide web just celebrated its 20^th birthday. Can it really be 20 years ago?  At launch, there were only 17 “subjects” on the Web, including music, law, religion, and literature. Today the internet is so ubiquitous that we take it for granted…unless of course it goes down, at which point we literally become paralyzed.

Next, I heard that Apple has just declared the first iPhone obsolete.  Really?  What was considered so cutting edge a few short years ago is now obsolete!

So I guess I shouldn’t have been that surprised to hear that robots are ready to take over patient care.  Yes, I know that many of them already perform surgery, but hands-on patient care?

Apparently, roboticists are developing machines that can help patients with tasks, such as housework, feeding and walking. And, according to a Georgia Institute of Technology study, more than half of healthcare providers said that if they were offered an assistant, they would prefer it to be robotic rather than human.

However, they don’t want robots to help with everything.  Activities of daily living such as helping with housework and reminding patients when to take medication, were acceptable, but activities involving direct, physical interactions such as bathing, getting dressed and feeding, were considered better for human assistants.

This study mirrored the lab’s earlier research that found older people are generally willing to accept help from robots, but their preferences depended on the task. These tech-savvy seniors said they preferred robotic help over human help for chores such as cleaning and doing laundry. However, they preferred human help with bathing and getting dressed.

“One open question was whether healthcare providers would reject the idea of robotic assistants out of fear that the robots would replace them in the workplace,” said Tracy Mitzner, one of the study’s leaders and the associate director of Georgia Tech’s Human Factors and Aging Laboratory. “This doesn’t appear to be a significant concern. In fact, the professional caregivers we interviewed viewed robots as a way to improve their jobs and the care they’re able to give patients.”

For instance, nurses preferred a robot to help them lift patients from a bed to a chair. They also indicated that robotic assistants could be helpful with some medical tasks such as checking vitals. Just like the internet it seems robots are going to take over our lives.

Not sure that I’m looking forward to a future where doctors have been replaced by nurses who have been replaced by robots…

Coping with the challenges of cancer…one bead at a time

Childhood cancer is almost always devastating for the patient, their family and friends. But now, in an innovative program patients at St. Jude Children’s Research Hospital, are using beads to help them put everything in perspective.  The beads help to commemorate the cancer journey and come to represent treatment milestones, such as losing their hair to completing chemotherapy.

The Legacy Bead program was launched in 2009. In the first year alone the hospital purchased more than 90,000 beads.  If placed end-to-end, this string of baubles would have extended longer than six football fields. And the program has been growing ever since.

When eight year old Kayla Dehnert tells friends and family in Northern California about life as a St. Jude Children’s Research Hospital patient, she pulls out a string of beads taller than she is.  “This is a learning-to-take medicine bead,” Kayla explains, fingering the bumps of a bluish-lavender bead and working her way down the long strand. “This yellow bead is the change-the-bandage bead, and the tiger bead is the losing-your-hair bead.”

Kayla, is just one of the hundreds of St. Jude patients who have participated in the program. Patients and their families discover a tangible way to illustrate their journeys using 55 glass beads as unique as they are.  Patients receive vivid green cylindrical beads for blood transfusions; sapphire round beads for lumbar punctures; tear-drop beads in assorted colors for homesickness; and blue, triangle-shaped beads for clinic visits. Other beads mark triumphs such as the completion of radiation or chemotherapy or challenges ranging from cancer’s return to the death of a friend.

“Each bead represents an important part of her journey,” said Denny Dehnert, Kayla’s father. “They’ve made some harder days more bearable.”

According to Shawna Grissom, author of a newly published paper that outlines the benefits of the program, some patients use the beads to express how they are feeling about their treatment. Other patients have the beads as a memory of what happened during this step in their journey of life and still others will leave the string as a memory for their families to have and pass on.

Because patients collect the beads throughout the hospital, Grissom said the program also gives staff the opportunity to talk to patients about their care, including, for example, why needle sticks are necessary.

Kayla’s bead collection started December 6, 2011, the day she arrived at St. Jude for treatment of her brain tumor. Her string begins with beads that spell out her name and a bead with the hospital’s logo. While she has added many more since, the bead Kayla is most anxious to get is silver and barrel-shaped, which marks the end of chemotherapy.

The Legacy Bead program was so popular the hospital added a similar program for patient siblings. Brothers and sisters earn beads for contributions ranging from serving as bone marrow donors to traveling to St. Jude with their families.

Paola, another patient, who lost both her eyes to a rare eye cancer can identify her favorite Legacy Beads by shape, size and texture.  “This triangle bead is for a needle stick,” she says with a smile. “It’s sharp and pointed like a needle.”

As her hands wander down the necklace with practiced ease, she pauses at a round, yellow bead.  “I got this one for changing the dressing on my leg,” says Paola, who is now receiving treatment for the bone cancer osteosarcoma. With maturity that belies her years, Paola explains the significance of the beads she finds most interesting. “I strung them myself,” she proudly declares.

The St. Jude families find novel ways to display their Legacy Beads. While many end up as jewelry, others are hung from the ceiling or adorn strollers, purses or backpacks.  Teens say the beads give weight and heft to their stories, providing a tactile method for demonstrating the breadth of their experiences. They help bridge that gap as they talk with people who don’t understand what they’ve been through.

“When the times get really tough, stringing beads is a good way to get our minds off the bad things that are happening,” says the mother of Tyler, a 7 year old cancer patient.

In the past year, she has collected 307 beads, signifying operations, chemotherapy treatments and hair loss, bad days and good days, needle sticks, inpatient admissions, platelet transfusions and many other events. She plans to hang the long strings of beads in her son’s bedroom as a symbol of his treatment and a celebration of his bravery.

The Legacy Bead program is one of several methods, including journaling and memory boxes, which the St. Jude Child Life Program offers to patients and families to chronicle their journeys.

 

Nurse Practitioners Ready to Mind the Gap

‘Obamacare’ is expected to expand health insurance to 32 million Americans over the next decade. This will inevitably lead to a spike in demand for medical services; leading many people to wonder who will provide that care. Maybe we need to wonder no more.

As you read this post, nurse practitioners (NPs) are throwing their hats in the ring and gearing up to be among the front runners.

Through advertisements, public service announcements and events, the American Academy of Nurse Practitioners (AANP) will try to raise the profile of the country’s 155,000 nurse practitioners.  Their campaign aims to explain exactly what nurse practitioners do and why patients should trust them with their medical needs.

AANP will also exploit the very real, looming doctor shortage. According to the Association of American Medical Colleges  the country will have 63,000 too few doctors by 2015.

With the serious shortage of family doctors in many parts of the country, nurse practitioners  will claim, in a series of radio public service announcements, that they can provide expert, compassionate and affordable care. The AANP will follow up on the public relations blitz with state-level lobbying efforts, looking to pass bills that will expand the range of medical procedures that their membership can perform.

“A fully enabled nurse practitioner workforce will increase access to quality health care, improve outcomes and make the health-care system more affordable for patients all across America,” ­ says Penny Kaye Jensen, president of the AANP. “It is our goal to empower health care consumers in all 50 states with clear confirmation that NPs provide professional, compassionate and cost-effective primary health care, as we have done for more than forty years.”

In 16 states, “scope of practice” laws allow nurse practitioners to practice without the supervision of a doctor. Other states, however, require a physician to sign off on a nurse practitioner’s prescriptions, and/or diagnostic tests.

As the health insurance expansion looms, expanding those rules to other states has become a crucial priority for NPs. “We’re all educated and prepared to provide a full range of services,” said Taynin Kopanos, AANP’s director of state government affairs.

The nurse practitioners’ campaign, however, is unlikely to move forward without a fight. Physician groups, such as the American Medical Association (AMA), contend that such laws could put patients at risk and oppose the efforts of other professional societies to expand their medical authorities.

Nurse practitioners argue that they do have the skills necessary to treat patients with more autonomy. Unlike other nurses, all nurse practitioners hold either a master’s or doctorate degree in medical education.

Alongside the legislative push, the group also will focus on public education. Data suggest that they have their work cut out for them.

A 2010 AANP poll found that while most Americans report having been seen by a nurse practitioner, few knew that their medical expertise goes beyond that of traditional, registered nurses.

Only 14% of the adults surveyed thought that nurse practitioners could prescribe medication, an authority they have in all states and only 18% thought NPs could order diagnostic tests such as X-rays and MRIs.

“People stop at the word nurse and don’t understand the word practitioner,” Jensen said. “Obviously we are nurses, but we also have advanced education. We think there’s a misunderstanding on the patients’ behalf.”

Lend your voice to the healthcare debate by sharing with us your thoughts on NPs, their visibility, their scope of practice and their role in the healthcare of our nation.

The Whys and Wherefore’s of White-Coat Hypertension

Yesterday was Mother’s Day for our readers who live in the US.  I do, but my mother doesn’t, so rather than treat her to lunch or chocolate, I’m dedicating this blog to her instead.

Let me start by saying that hypertension runs in our family.  My grandmother and her mother before her had it, my mother has it and even though I was an ultra-fit marathon runner at the time, I also developed high blood pressure around the time I turned 40.

But that’s where the family trait ends. We manage our disease very differently.  I take my meds, try to eat healthily, avoid stress and exercise whenever I can. I also avoid taking my blood pressure.  If I don’t know it’s high, it’s one less thing I have to worry about!  My mom, on the other hand is a much more compliant patient and goes for regular check-ups.

The problem with that, is she worries so much about having her blood pressure taken that it’s always high when she sees her doctor.  She can’t explain why she worries about this, she knows it’s not rational, but still she worries.  And she’s not alone.

For many patients, blood pressure measurements taken in a physician’s office may not correctly characterize their typical blood pressure. Up to 25% of patients evaluated by their doctors, have blood pressure measurements higher than their typical levels. This phenomena is known as white-coat hypertension and is thought to result from anxiety related to examination by a health care professional.

So I was really interested to read a new study from the UK where, incidentally, my mom lives.  It showed that by swapping a doctor for a nurse you can eradicate white-coat hypertension.

The meta-analysis of 14 studies found that mean blood pressures measured by nurses were 8.5/4.2mmHg lower than readings from doctors. When studies with a high risk of bias were removed from the analysis, the gap was reduced but remained, with a mean difference of 4.8mmHg in systolic blood pressure (the top number) and 1.5mmHg for diastolic (the bottom number).

The study concluded that blood pressure measurements taken by primary care doctors might be ‘unreliable for clinical decisions’, and that all measurements should be delegated to nurses.

Study leader Dr Chris Clark, clinical academic fellow at the Peninsula Medical School and a GP in Witheridge, Devon, said: “The difference could affect treatment decisions, especially when the measurement is marginal, between one course of treatment and another.”

Such a recommendation also has wide-ranging implications for how medical practices organize their services.  Researchers told the European Society of Hypertension Congress that the findings meant practices should move to nurse-only or home blood pressure monitoring.

The rationale for the different blood pressure values obtained by doctors and nurses?  The researchers speculate that nurses are better at relaxing patients.

Would you be more relaxed seeing a nurse rather than a doctor?  My mom says yes!

Feeling Fruity?

I’m sure all of our readers are familiar with the old saying, “An apple a day keeps the doctor away.”

Which, of course, got us musing, what about other fruit?  Well, it turns out that “An orange a day may keep strokes away!”  At least, it seems, for women.

According to a study just published in Stroke eating high amounts of citrus fruit, such as oranges and grapefruit, reduces the risk of ischemic stroke by 19%.

Researchers say the key to the reduced risk is a certain flavinoid found in citrus – flavonones. Citrus fruits and juices are the main dietary source of flavanones.

The findings were part of the Nurses’ Health Study, which included nearly 70,000 women who were followed for 14 years and reported on their dietary intake every four years.

While the risk of stroke was lower in those who ate citrus fruit, not all of the women’s flavonoid consumption came from citrus fruit. Flavonoids are also found in other types of fruit, vegetables, tea, and best news of all…dark chocolate and red wine.

This study confirms a previous findings that vitamin C and potassium, both of which are found in citrus fruits can protect against  heart disease, ischemic stroke and intracerebral hemorrhage.

Although some experts say that further prospective studies are needed to confirm these associations, we know what we’ll be putting in our shopping carts this week.

Nurses are the Key to Reducing Revolving-Door Readmissions

Shockingly, one in five elderly patients discharged from a hospital is readmitted within a month. Seeking to address the substantial human and financial burden of revolving door hospital readmissions, the Affordable Care Act has proposed a number of initiatives to improve care and health outcomes and reduce costs for the growing population of chronically ill people in the U.S.

While transitional care is a central theme in these provisions, there is little information available to guide those responsible for implementing these important opportunities. To bridge the gap, researchers at the University of Pennsylvania School of Nursing reviewed existing programs in order to determine what works, for whom and for how long.

They discovered “a robust body of evidence” that transitional care can improve health outcomes and reduce hospital readmissions. Their paper published in a recent edition of Health Affairs, highlights a range of solutions to reduce avoidable hospitalizations and health care costs.

The team conducted a systematic review of the research literature and summarized twenty one randomized clinical trials of transitional care interventions targeting chronically ill adults. From these, they identified nine interventions that demonstrated positive effects on measures related to hospital readmissions. “All nine interventions that showed any positive impact on readmissions relied on nurses as the clinical leader or manager of care,” wrote lead author Mary Naylor, Ph.D., R.N.

The strategies they identified have been shown to result in short term benefits and effectively reduce all-cause hospital readmissions through six or 12 months. “If we capitalize on what we know, the real beneficiaries will those living with complex chronic conditions and their family caregivers,” explained Naylor.

This makes sense to us and is certainly a lot easier than trying to understand the Affordable Care Act.