By Alice Gomstyn
How do you pass the time when cancer treatment means you're largely confined to your hospital room for weeks on end?
Tom Gillin, a 19-year-old college student, chose a less-than-obvious choice: He filmed a funny rap video channeling Jay-Z via the cancer ward.
"Some of the other videos I've seen about cancer patients are somewhat depressing," said Gillin, who was diagnosed with the pediatric cancer acute myeloid leukemia in April. "We wanted to flip the switch and do something that was the opposite of that."
Gillin teamed with several staffers at The Children's Hospital of Philadelphia to create "Bald So Hard." The video's title refers to Gillin's chemotherapy-related hair loss but is also a play on the phrase "ball so hard" featured prominently in a hit song by Jay-Z and Kanye West. The song is parodied in Gillin's video, as is Jay-Z's "Empire State of Mind."
The rollicking video — promoted on Twitter with the hashtag #BaldSoHard — is full of swagger. Gillin is seen mouthing lyrics such as "bald so hard my head got shiny" while dancing with his oncologist, playing basketball and even steering a "boat," a cardboard cutout made by hospital art therapist Abbien Crowley. (The actual rap was performed, mostly off camera, by University of Pennsylvania medical student David Blitzer.)
But Gillin didn't shy away from the fatigue and boredom confronting hospital cancer patients. It took him and his hospital pals some two months to complete the three-minute video since chemotherapy treatments often left him too weak to shoot.
The song's lyrics, written by Gillin and CHOP music therapist Mike Mahoney, manage to make light of it: "They gave me sleeping meds all day and I was dozing/When I got up I was so bored that I watched 'Frozen.'"
Gillin said his main motivation for making the video was to raise awareness of pediatric cancer, though he'd also appreciate it if Jay-Z — one of the teen's favorite rappers — took note of the unusual homage and paid the hospital a visit.
But don't expect Gillin to use the video to launch his own hip hop career. "I'm not that musically inclined," he insists.
Instead, he's looking forward to completing his final round of chemotherapy in a couple of weeks and ultimately returning to student life at the University of California, Los Angeles, where he's studying civil engineering.
For now, he's enjoying the happy reactions to his video, which has generated more than 20,000 views on YouTube since it debuted late last month. The Jigga Man himself hasn't yet weighed in but plenty of others say they love Gillin's jam, with one YouTube user dubbing it "best medicine in the world."
It's the mother of all hackathons — a group of MIT researchers are bringing together engineers, designers, health experts and parents with the goal of building a better breast pump. "We really want to bring the breast pump out of the lactation closet," said Alexis Hope, a research assistant at the MIT Media Lab. "If you talk to moms about something that makes the first part of having a baby miserable, they always say the breast pump. They're loud, they have a million parts, they're impossible to clean, heavy. They're completely impractical for the realities of your life."
In May, a small group from the lab came together to brainstorm, and a blog post about their efforts drew so much interest the organizers — who include four moms — decided to expand. They expect up to 80 people to join forces Sept. 20 and 21 and work all weekend "to make the breast pump not suck." Participants will split into five-person teams and then pitch their prototypes to the group at the end. Hope said it's "just a starting point," but ideally some of the innovations will catch the eye of pump manufacturers.
Half of all new moms in the United States now breastfeed for the six months recommended by pediatricians. Many of them use pumps to produce milk for when they return to work or are away from the baby. Studies have shown breast milk and nursing has health benefits for both the infant and the mother.
For three young siblings, eating is a life or death proposition, thanks to a rare white blood cell disease, reported KSL.
The Frisk children— Jaxen, age 9; Tieler, age 7; Boston, age 4— have spent weeks in the hospital and are allergic to pets, pollens and multiple foods. The siblings all have eosinophilic gastrointestinal disorder (EGID), an abnormal build-up of eosinophil white blood cells in their GI tracts that can cause inflammation and tissue damage in response to foods and allergens. While the disease is relatively rare, it has increased in prevalence over the past decade affecting one in 2,000 people, according to the American Partnership for Eosinophilic Disorders.
"You need food to survive. But it is also what can kill you in our house," their mother, Jenny Frisk, told KSL.
When they’re exposed to their triggers, the children could have an anaphylactic reaction— potentially fatal allergic symptoms throughout the body.
"Tieler had one sip of milk when she was 1-year-old, and instantly started projectile vomiting and got hives all over her body," her father, Gary, told KSL. "It's a life and death situation at birthday parties, or religious events, or anywhere we go, because food is such a big part of our culture."
Between the three children, they’ve endured 11 surgeries and eight extended hospital stays, with more expected in the future.
On top of the children’s health issues, Gary battled cancer two years ago and Jenny had to have several surgeries due to serious adrenal insufficiencies that were unrelated to EGID.
The family has been bankrupted twice by medical bills. While they make too much income to qualify for help, they don’t make enough to pay for their children’s medical needs. Friends and family have started a GoFundMe account to raise money to pay for genetic testing and treatment.
"When we're looking at an illness that is not curable, and the treatment isn't covered (by insurance), the light at the end of the tunnel is really far away," Jenny said.
By David McNamee
Recently, Medical News Today reported on a breakthrough in xenotransplantation - the science of transplanting functional organs from one species to another. Scientists from the Cardiothoracic Surgery Research Program of the National Heart, Lung and Blood Institute (NHLBI) demonstrated success in keeping genetically engineered piglet hearts alive in the abdomens of baboons for more than a year.
While that is a sentence that might sound absurd, or even nightmarish to some, xenotransplantation is a credible science involving the work of leading scientists and respected organizations like the NHLBI and the Mayo Clinic, as well as large private pharmaceutical firms such as United Therapeutics and Novartis.
What is more, xenotransplantation is not a new science, with experiments in cross-species blood transfusion dating as far back as the 17th century.
Why transplant the organs of animals into living humans?
The reason why xenotransplantation is a burning issue is very simple: because of a crippling shortage of available organs for patients who require transplants, many people are left to die.
US Government information on transplantation reports that an average of 79 people receive organ transplants every day, but that 18 people die each day because of a shortage of organs.
The number of people requiring an organ donation in the US has witnessed a more than five-fold increase in the past 2 decades - from 23,198 in 1991 to 121,272 in 2013. Over the same period, the number of people willing to donate has only doubled - 6,953 donors in 1991, compared with 14,257 donors in 2013.
Although some researchers are attempting to solve this shortage by developing mechanical components that could assist failing organs, these devices are considered to increase the risk of infection, blood clots and bleeding in the patient.
Stem cell research is also actively pursuing the goal of growing replacement organs, but despite regular news of breakthroughs, the reality of a functional lab-grown human organ fit for transplant is a long way off.
As the NHLBI's Dr. Muhammad M. Mohiuddin, who led the team responsible for the baboon trial, explained:
"Until we learn to grow organs via tissue engineering, which is unlikely in the near future, xenotransplantation seems to be a valid approach to supplement human organ availability. Despite many setbacks over the years, recent genetic and immunologic advancements have helped revitalized progress in the xenotransplantation field.
Xenotransplantation could help to compensate for the shortage of human organs available for transplant."
Xenotransplantation's eccentric history
The earliest known example of using animal body parts to replace diseased or faulty components of human bodies dates back to the 17th century, when Jean Baptiste Denis initiated the clinical practice of animal-to-human blood transfusion.
Perhaps predictably, the results were not successful and xenotransfusion was banned in Denis' native France.
Fast forward to the 19th century and a fairly unusual trend for skin xenotransplantation had emerged. Animals as varied as sheep, rabbits, dogs, cats, rats, chickens and pigeons were called upon to donate their skin, but the grafting process was not for the squeamish.
Medical records show that, in order for the xenosurgeons of the time to be satisfied that the donor skin had vascularized (developed capillaries), the living donor animal would usually have to be strapped to the patient for several days. However, the most popular skin donor - the frog - was typically skinned alive and then immediately grafted onto the patient.
Despite several reputed successes, modern physicians are skeptical that these skin grafts could have been in any way beneficial to the patient.
The first corneal xenotransplantation - where the cornea from a pig was implanted in a human patient - took place as early as 1838. However, scientists would not look seriously again at the potential for xenotransplantation until the 20th century and the first successes in human-to-human organ transplantation.
In 1907, the Nobel prize-winning surgeon Alexis Carrel - whose work on blood vessels made organ transplantation viable for the first time - wrote:
"The ideal method would be to transplant in man organs of animals easy to secure and operate on, such as hogs, for instance. But it would in all probability be necessary to immunize organs of the hog against the human serum. The future of transplantation of organs for therapeutic purposes depends on the feasibility of hetero [xeno] transplantation."
These words have been described as "prophetic" because Carrel is describing the exact line of research adopted by xenotransplantation scientists a century later.
A few years later, another leading scientist, Serge Voronoff, would also predict modern science's interest in using the pancreatic islets of pigs to treat severe type 1 diabetes in human patients. However, other xeno experiments by Voronoff have not endured critical reappraisal quite so well.
Voronoff's main scientific interest was in restoring the "zest for life" of elderly men. His attempt to reverse this element of the aging process was to transplant slices of chimpanzee or baboon testicle into the testicles of his elderly patients.
Incredibly, this surgery proved quite popular, with several hundred operations taking place during the 1920s in both the US and Europe.
By the 1960s, despite limited availability, the transplantation of kidneys from deceased to living humans had been established by French and American surgeons.
Dialysis was not yet in practice and given that, in the absence of an available donor kidney, his renal failure patients were facing certain death, the Louisiana surgeon Keith Reemtsma took the unprecedented step of transplanting animal kidneys. He chose chimpanzees as the donor animals, due to their close evolutionary relationship with humans.
Although 12 of his 13 chimpanzee-to-human transplants resulted in either organ rejection or infectious complications within 2 months, one patient of Reemtsma continued to live and work in good health for 9 months, before dying suddenly from acute electrolyte disturbance. Autopsy showed that the chimpanzee kidneys had not been rejected and were working normally.
Experiments in the xenotransplantation of essential organs continued in living patients until the 1980s - without lasting success. However, the procedures attracted widespread publicity, with some attributing a subsequent rise in organ donation to the failed attempt to transplant a baboon heart into a baby girl in 1983.
Where does research currently stand?
Despite the more obvious similarities between humans and other primates, pigs are now considered to be the most viable donor animal for xenotransplantation.
Despite diverging from humans on the evolutionary scale about 80 million years ago, whole genome sequencing of the pig has shown that humans and pigs share similar DNA, while the pig's organs - in size and function - are anatomically comparable to humans.
However, perhaps the main advantage of the pig as donor is in its availability - potentially providing an "unlimited supply" of donor organs. If transplantation is viable, pig donors would provide an immediate solution for the organ shortage problem.
Xenotransplantation optimists also believe that the process can improve on the existing success rate of transplantation of human organs. By keeping the pigs healthy, regularly monitored for infection, and alive right until the point when the required organs are excised under anesthesia, the adverse effects associated with transplantation from deceased donors - such as non-function of organs or transmission of pathogens - would be much less likely, this group argues.
However, there are still significant scientific barriers to the successful implementation of xenotransplantation.
The company United Therapeutics - who moved into xenotransplantation research after the daughter of CEO Martine Rothblatt was diagnosed with pulmonary hypertension, a condition with a 90% shortage rate of available lung donors - claim to be making progress with eliminating these barriers.
MedIcal News Today spoke to Rothblatt, who once claimed that the company will have successfully transplanted a pig lung into a human patient "before the end of the decade."
"For a first clinical trial, which was my goal, I think we are on track," she told us. "I said our goal by end of decade is to transplant a xeno lung into a patient with end-stage lung disease and bring them safely back to health."
As well as pioneering lung xenotransplants, the company has ambitions of making pig kidneys, livers, hearts and corneas available for human transplant.
"All are years away, but lung may well be most difficult," admits Rothblatt. "We call it the canary in the coal mine."
In order to make pig lungs compatible with humans, Rothblatt has estimated that 12 modifications need to be made to the pig genome that will prevent rejection. She claims United Therapeutics have now succeeded in making six of these genome modifications.
Also, it was United Therapeutics' genetically modified piglets that provided the world record-beating pig hearts for the NHLBI study in baboons.
Opposition to xenotransplantation
However, science is not the only obstacle to xenotransplantation. Despite clearing all steps of the research with ethics committees at every step, Rothblatt - who has a doctorate in medical ethics - admits there will be unforeseeable regulatory dilemmas and ethics conversations before xenotransplantation can be accepted into clinical practice.
In 2004, the UK's Policy Studies Institute conducted the first major survey of public attitudes towards potential solutions for the organ shortage crisis. The public perception of xenotransplantation was shown to be overwhelmingly negative.
Indeed, response to animal-to-human transplantation was so hostile that some respondents demanded that it be removed as an option on the survey. Although many respondents considered xenotransplantation unethical, the major concern was that animal viruses could infect humans and spread into the population.
Following the survey, an intriguing debate over the ethics of xenotransplantation took place in the pages of Philosophy Now. Making the case against xenotransplantation, Laura Purdy - professor emerita of philosophy at Wells College in Aurora, NY - commented that "the xeno debate proceeds as if saving lives is our top moral priority." She argues that, from this perspective, it suggests that the lives lost down the line as a result of perfecting xenotransplantation do not count.
"What about the 11 million babies and children who die every year from diarrhea, malaria, measles, pneumonia, AIDS and malnutrition?" she questioned. "What about the half-million women who die every year during pregnancy and childbirth when simple measures could save most of them?"
We asked Prof. Purdy why the fact that people die from matters unrelated to transplantation issues would morally preclude science from attempting to also solve the issue of organ donor shortages.
"I agree that, other things being equal, saying that people are dying from other causes doesn't show why we should not also tackle this cause," she replied.
"But once one has taken on board the larger risks to society, both from the research as well as the deployment of the technology, as well as the probability that this is merely a bridge technology that, hopefully will be made obsolete by future developments (such as partial or whole artificial hearts) or advances in public health (making headway against diabetes) and the probability that both research and implementation will be very expensive, that seriously erodes the case for proceeding.
Resources for health are far from infinite. There is a great deal that we could be doing now to advance human health that does not have these downsides - why not focus more there?"
Whether public attitudes toward xenotransplantation have mellowed in the decade since the Policy Studies Institute's survey is not currently known.
However, as the technology advances and the likelihood of implementation draws closer, so too must the public conversation over the perceived rights and wrongs of animal organ transplantation advance in order to hold the science accountable.
Do you have a view on this issue? If so, use our comments box to join the debate.
By Maureen Salamon
Pediatricians prescribe antibiotics about twice as often as they're actually needed for children with ear and throat infections, a new study indicates.
More than 11 million antibiotic prescriptions written each year for children and teens may be unnecessary, according to researchers from University of Washington and Seattle Children's Hospital. This excess antibiotic use not only fails to eradicate children's viral illnesses, researchers said, but supports the dangerous evolution of bacteria toward antibiotic resistance.
"I think it's well-known that we prescribers overprescribe antibiotics, and our intent was to put a number on how often we're doing that," said study author Dr. Matthew Kronman, an assistant professor of infectious diseases at Seattle Children's Hospital.
"But as we found out, there's really been no change in this [situation] over the last decade," added Kronman. "And we don't have easily available tools in the real-world setting to discriminate between infections caused by bacteria or viruses."
The study was published online on Sept. 15 in the journal Pediatrics.
Antibiotics, drugs that kill bacteria or stop them from reproducing, are effective only for bacterial infections, not viruses. But because doctors have few ways of distinguishing between viral or bacterial infections, antibiotics are often a default treatment.
To determine antibiotic prescribing rates, Kronman and his colleagues analyzed a group of English-language studies published between 2000 and 2011 and data on children 18 and younger who were examined in outpatient clinics.
Based on the prevalence of bacteria in ear and throat infections and the introduction of a pneumococcal vaccine that prevents many bacterial infections, the researchers estimated that about 27 percent of U.S. children with infections of the ear, sinus area, throat or upper respiratory tract had illnesses caused by bacteria.
But antibiotics were prescribed for nearly 57 percent of doctors' visits for these infections, the study found.
"I thought it was really a clever study, actually, to get a sense of the burden of bacterial disease and what the antibiotic usage is," said Dr. Jason Newland, medical director of patient safety and system reliability, and associate professor of pediatrics at University of Missouri-Kansas City School of Medicine.
Newland, former director of the Antimicrobial Stewardship Program at Children's Mercy Hospital and Clinics in Kansas City, cited the 2013 "threat report" by the U.S. Centers for Disease Control and Prevention that indicated 23,000 Americans die each year due to antibiotic-resistant infections.
"We all know when we use antibiotics that we increase the chance of resistance because bacteria evolve," he said. "We need to use them well and not in such excess doses. We have to do way better."
A rapid strep test is currently available to distinguish between bacterial or viral throat infections. But other than that test, physicians have no other clinical tools to tell the cause of most upper respiratory infections, according to background information in the study. Kronman said he hopes the new research will not only help encourage the development of more such tools, but also spur clinicians to think more critically about prescribing antibiotics unless clearly needed.
Kronman added that prior research indicates that parents -- who often pressure pediatricians into prescribing antibiotics -- respond to alternate suggestions to alleviate their children's upper respiratory symptoms, such as using acetaminophen and humidifiers, instead of doctors simply saying they won't prescribe antibiotics.
"We have to take this [problem] on as a society," Newland said. "The reality is that the excess, unnecessary use of antibiotics is really putting us at great risk of not having these antibiotics [work] in the future."
By Debra Wood
Modern Healthcare readers selected four nurses in leadership roles to be ranked on this year’s 100 Most Influential People in Healthcare list, based on their effect on the industry.
“It’s great for nursing, because we do this together,” said Marla J. Weston, PhD, RN, FAAN, chief executive officer of the American Nurses Association, who made the magazine’s annual list for the first time, ranking 45th.
“I’m honored to be recognized,” she continued, “but I realize this is not about me. It’s about the hundreds and thousands of nurses working together to make the American Nurses Association a powerful force, to make nursing a powerful force, and to help our colleagues in health care and the general public understand the impact of nursing practice. I am the lucky person to be in the CEO role, but there are a lot of people making this happen.”
Other nurses in leadership who made the list included Marilyn Tavenner, agency administrator with the Centers for Medicare & Medicaid Services (CMS), listed fifth; Sister Carol Keehan, DC, MS, RN, president and CEO of Catholic Health Association in Washington, D.C., 34th; and Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI) in Cambridge, Mass., 50th.
“The four nurses on Modern Healthcare’s 100 Most Influential People list this year are transformative and visionary leaders, and some of the brightest lights in the nursing world,” said Susan B. Hassmiller, PhD, RN, FAAN, the Robert Wood Johnson Foundation senior adviser for nursing. “They are role models.”
Weston was one of 19 new people to join the list, which is dominated by elected and appointed government officials, top executives of health care industry corporations and physicians. Anyone can nominate a candidate. The magazine received 15,000 submissions for 2014. The top 300 nominees, including 10 nurses, were presented to Modern Healthcare readers for voting. Half of the candidates are selected through the reader votes and the other half by the magazine’s editors.
While not a nurse, RoseAnn DeMoro, executive director of National Nurses United (NNU), with 185,000 members, made the list again, at 41st.
“With the disproportionate economic influence of the hospital and insurance giants in particular, it is especially gratifying to see the name of RoseAnn and NNU on this list,” said NNU Co-president Deborah Burger, RN.
With the relatively small showing for nursing on this year’s list, opportunity exists for more nurses to move up to positions of leadership and influence.
“Nurses spend the most direct time with patients and, therefore, offer a vitally important perspective,” Keehan said. “As a nurse myself who moved into leadership, I encourage nurses to lend their voice to management decisions and consider leadership roles in their units or hospitals. It may not feel natural for some nurses to assert themselves, but the future of health care requires that we listen to their ideas and concerns. I hope to see many more nurses bring their passion for patient care and support of staff to the work of making health care better for everyone.”
Weston pointed out that nurses practice throughout the health care system, not only in hospitals but in home health, public health, primary care and long-term care. They observe when the system works and when it doesn’t for patients.
“That gives nurses the capacity to help make the system work for patents and communities and to redesign the system to transform and improve care,” Weston said. “Nurses are stepping forward to be leaders, and people are understanding nurses are not just functional doers of things, but thoughtful strategists.”
Weston expects more nurses will make the list in the years ahead. She encourages nurses to talk more about the work they do and the effect it has on people.
“The more we highlight the impact we are making, the more people will understand the great strategists and decision makers that nurses are,” Weston said. “There are a lots of pockets of innovation being led by nurses that are improving the quality of care, reducing the cost of health care and improving the access. We need to support each other in taking those pockets of innovation and spreading them.”
Weston has forged partnerships with other disciplines when delivering clinical care and when transforming the health care system.
“Health care is a team sport,” Weston said. “The degree we can work together catalyzes the work getting done.”
Increasing the number of nurses in leadership positions is one of the key recommendations of the Institute of Medicine’s groundbreaking Future of Nursing report and a central goal of the Campaign for Action.
“As the largest group of health professionals, and as those who spend the most time with patients, nurses have unique insight into health care,” Hassmiller said. “We need that insight at the highest levels of our health care system--on the boards of health care systems and hospitals; leading federal, state and local agencies; and more.”
Two members of the Campaign for Action’s strategic advisory committee made the 2014 Most Influential People in Healthcare list: Leah Binder, president and CEO of The Leapfrog Group, and Alan Morgan, CEO of the National Rural Health Association. Additionally, several members of organizations on the Champion Nursing Council and Champion Nursing Coalition were recognized.
“Health care transformation is underway in our country,” Hassmiller concluded. “Nurses possess the skills to ensure that the perspectives of people, families and communities remain front and center in any health decisions that get made.”
Meet the ‘Most Influential’ Nurses¹
5. Marilyn Tavenner, agency administrator with the Centers for Medicare and Medicaid Services, began her career as a nurse at Johnson-Willis Hospital in Richmond, Va., and spent 25 years working in various positions for HCA Inc., culminating as group president for outpatient services. Tavenner was one of several people in government to make Modern Healthcare’s annual list of the 100 Most Influential People in Healthcare.
34. Sister Carol Keehan, DC, MS, RN, president and CEO of Catholic Health Association, started out as a nurse and served in the 1980s as Providence Hospital's vice president for nursing, ambulatory care, and education and training. She joined the Catholic Health Association in 2005. She told NurseZone that she hopes many more nurses will bring their passion for patient care to make health care better for everyone.
45. Marla J. Weston, PhD, RN, FAAN, chief executive officer of the American Nurses Association, has held a variety of nursing roles, including direct patient care in intensive care and medical-surgical units, nurse educator, clinical nurse specialist, director of patient care support and nurse executive. She has served as executive director of the Arizona Nurses Association and deputy chief officer of the Veteran’s Affairs Workforce Management Office. Weston reported that she has had great role models and mentors in her nursing career.
50. Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement, began as a staff nurse in 1973 at Quincy City Hospital, moved up and became chief operating officer in 1986, before joining IHI. Bisognano is one of many quality improvement leaders on this year’s Most Influential list.
A study in the current issue of Policy, Politics & Nursing Practice estimates 17.5% of newly licensed RNs leave their first nursing job within the first year and 33.5% leave within two years, according to a news release. The researchers found that turnover for this group is lower at hospitals than at other healthcare settings.
The study, which synthesized existing turnover data and reported turnover data from a nationally representative sample of RNs, was conducted by the RN Work Project, funded by the Robert Wood Johnson Foundation. The RN Work Project is a 10-year study of newly-licensed RNs that began in 2006. The study draws on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas. The RN Work Project is directed by Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University, and Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo.
“One of the biggest problems we face in trying to assess the impact of nurse turnover on our healthcare system as a whole is that there’s not a single, agreed-upon definition of turnover,” Kovner said. “In order to make comparisons across organizations and geographical areas, researchers, policy makers and others need valid and reliable data based on consistent definitions of turnover. It makes sense to look at RNs across multiple organizations, as we did, rather than in a single organization or type of organization to get an accurate picture of RN turnover.”
According to the release, the research team noted that, in some cases, RN turnover can be helpful — as in the case of functional turnover, when a poorly functioning employee leaves, as opposed to dysfunctional turnover, when well-performing employees leave. The team recommends organizations pay attention to the kind of turnover occurring and point out their data indicate that when most RNs leave their jobs, they go to another healthcare job.
“Developing a standard definition of turnover would go a long way in helping identify the reasons for RN turnover and whether managers should be concerned about their institutions’ turnover rates,” Brewer said in the release. “A high rate of turnover at a hospital, if it’s voluntary, could be problematic, but if it’s involuntary or if nurses are moving within the hospital to another unit or position, that tells a very different story.”
The RN Work Project’s data include all organizational turnover (voluntary and involuntary), but do not include position turnover if the RN stayed at the same healthcare organization, according to the release.
McBaine, a bouncy black and white springer spaniel, perks up and begins his hunt at the Penn Vet Working Dog Center. His nose skims 12 tiny arms that protrude from the edges of a table-size wheel, each holding samples of blood plasma, only one of which is spiked with a drop of cancerous tissue.
The dog makes one focused revolution around the wheel before halting, steely-eyed and confident, in front of sample No. 11. A trainer tosses him his reward, a tennis ball, which he giddily chases around the room, sliding across the floor and bumping into walls like a clumsy puppy.
McBaine is one of four highly trained cancer detection dogs at the center, which trains purebreds to put their superior sense of smell to work in search of the early signs of ovarian cancer. Now, Penn Vet, part of the University of Pennsylvania’s School of Veterinary Medicine, is teaming with chemists and physicists to isolate cancer chemicals that only dogs can smell. They hope this will lead to the manufacture of nanotechnology sensors that are capable of detecting bits of cancerous tissue 1/100,000th the thickness of a sheet of paper.
“We don’t ever anticipate our dogs walking through a clinic,” said the veterinarian Dr. Cindy Otto, the founder and executive director of the Working Dog Center. “But we do hope that they will help refine chemical and nanosensing techniques for cancer detection.”
Since 2004, research has begun to accumulate suggesting that dogs may be able to smell the subtle chemical differences between healthy and cancerous tissue, including bladder cancer, melanomaand cancers of the lung, breast and prostate. But scientists debate whether the research will result in useful medical applications.
Dogs have already been trained to respond to diabetic emergencies, or alert passers-by if an owner is about to have a seizure. And on the cancer front, nonprofit organizations like the In Situ Foundation, based in California, and the Medical Detection Dogs charity in Britain are among a growing number of independent groups sponsoring research into the area.
A study presented at the American Urological Association’s annual meeting in May reported that two German shepherds trained at the Italian Ministry of Defense’s Military Veterinary Center in Grosseto were able to detect prostate cancer in urine with about 98 percent accuracy, far better than the prostate-specific antigen (PSA) test. But in another recent study of prostate-cancer-sniffing dogs, British researchers reported that promising initial results did not hold up in rigorous double-blind follow-up trials.
Dr. Otto first conceived of a center to train and study working dogs when, as a member of the Federal Emergency Management Agency’s Urban Search and Rescue Team, she was deployed to ground zero in the hours after the Sept. 11 attacks.
“I remember walking past three firemen sitting on an I-beam, stone-faced, dejected,” she says. “But when a handler walked by with one of the rescue dogs, they lit up. There was hope.”
Today, the Working Dog Center trains dogs for police work, search and rescue and bomb detection. Their newest canine curriculum, started last summer after the center received a grant from the Kaleidoscope of Hope Foundation, focuses on sniffing out a different kind of threat: ovarian cancer.
“Ovarian cancer is a silent killer,” Dr. Otto said. “But if we can help detect it early, that would save lives like nothing else.”
Dr. Otto’s dogs are descended from illustrious lines of hunting hounds and police dogs, with noses and instincts that have been refined by generations of selective breeding. Labradors and German shepherds dominate the center, but the occasional golden retriever or springer spaniel — like McBaine — manages to make the cut.
The dogs, raised in the homes of volunteer foster families, start with basic obedience classes when they are eight weeks old. They then begin their training in earnest, with the goal of teaching them that sniffing everything — from ticking bombs to malignant tumors — is rewarding.
“Everything we do is about positive reinforcement,” Dr. Otto said. “Sniff the right odor, earn a toy or treat. It’s all one big game.”
Trainers from the center typically notice early on that certain dogs have natural talents that make them better suited for specific kinds of work. Search and rescue dogs must be tireless hunters, unperturbed by distracting environments and unwilling to give up on a scent – the equivalent of high-energy athletes. The best cancer-detection dogs, on the other hand, tend to be precise, methodical, quiet and even a bit aloof — more the introverted scientists.
“Some dogs declare early, but our late bloomers frequently switch majors,” Dr. Otto said.
Handlers begin training dogs selected for cancer detection by holding two vials of fluid in front of each dog, one cancerous and one benign. The dogs initially sniff both but are rewarded only when they sniff the one containing cancer tissue. In time, the dogs learn to recognize a unique “cancer smell” before moving on to more complex tests.
What exactly are the dogs sensing? George Preti, a chemist at the Monell Chemical Senses Center in Philadelphia, has spent much of his career trying to isolate the volatile chemicals behind cancer’s unique odor. “We have known for a long time that dogs are very sensitive detectors,” Dr. Preti says. “When the opportunity arose to collaborate with Dr. Otto at the Working Dog Center, I jumped on it.”
Dr. Preti is working to isolate unique chemical biomarkers responsible for ovarian cancer’s subtle smell using high-tech spectrometers and chromatographs. Once he identifies a promising compound, he tests whether the dogs respond to that chemical in the same way that they respond to actual ovarian cancer tissue.
“I’m not embarrassed to say that a dog is better than my instruments,” Dr. Preti says.
The next step will be to build a mechanical, hand-held sensor that can detect that cancer chemical in the clinic. That’s where Charlie Johnson a professor at Penn who specializes in experimental nanophysics, the study of molecular interactions between microscopic materials, comes in.
He is developing what he calls Cyborg sensors, which include biological and mechanical components – a combination of carbon nanotubes and single-stranded DNA that preferentially bond with one specific chemical compound. These precise sensors, in theory, could be programmed to bind to, and detect, the isolated compounds that Dr. Otto’s dogs are singling out.
“We are effectively building an electronic nose,” said Dr. Johnson, who added that a prototype for his ovarian cancer sensor will probably be ready in the next five years.
Some experts remain skeptical.
“While I applaud any effort to detect ovarian cancer, I’m uncertain that this research will have any value,” said Dr. David Fishman, a gynecologic oncologist at Mount Sinai Hospital in New York City. One challenge, he notes, is that any cancer sensor would need to be able to detect volatile chemicals that are specific to one particular type of cancer.
“Nonspecificity is where a lot of these sort of tests fail,” Dr. Fishman said. “If there is an overlap in volatile chemicals — between colon, breast, pancreatic, ovarian cancer — we’ll have to ask, ‘What does this mean?’ ”
And even if sensors could be developed that detect ovarian cancer in the clinic, Dr. Fishman says, he doubts that they would be able to catch ovarian cancer in its earliest, potentially more treatable, stages.
“The lesions that we are discussing are only millimeters in size, and almost imperceptible on imaging studies,” Dr. Fishman says. “I don’t believe that the resolution of the canine ability will translate into value for these lesions.”
McBaine remains unaware of the debate. After correctly identifying yet another cancerous plasma sample, he pranced around the Working Dog Center with regal flair, showing off his tennis ball to anyone who would pay attention. In an industry saturated with hundreds of corporations and thousands of scientists all hunting for the earliest clues to cancer, working dogs are just another set of (slightly furrier) researchers.
By Jeroen Tas
Imagine a time when a device alerts you to the onset of a disease in your body long before it’s a problem. Or when your disease is diagnosed in Shanghai, based on the medical scan you did in Kenya. This future is far closer that you might think due to rapid advances in connected devices and sensors, big data and the integration of health services. Combined, these innovations are introducing a new era in healthcare and personal well-being.
In only a few years, mobile technologies have spawned tremendous innovation of consumer-level health tools. The emerging solutions are focusing on health conditions over a person’s lifetime and on holistic care. They generate constant insights through analytics and algorithms that identify patterns and behaviours. Social technologies enable better collaboration and interconnected digital propositions that reach out to communities of people with similar conditions, engaging them in ways which were never before possible.
We are starting to get a taste of what the consumerization of healthcare will mean in the future. In two to three years, analysing your personal health data will become commonplace for large parts of the population in many countries. Also, it is very likely that for the first time it will not be the chronically ill but the healthy people who will invest the most in managing their health.
Digitization and consumerization will rattle the healthcare industry. It is already tearing at the very fabric of the traditional healthcare companies and providers. Innovation is not only about just adding a new channel or connecting a product. It is also a complete redesign of business models, adjustment of systems and processes and, most importantly, it calls for changing the culture in companies to reflect the new opportunities – and challenges – presented by the digital world.
To drive true industry transformation, companies need to collaborate and continue to learn from each other. Great strides will be made in alliances, which, for example, will deliver open, cloud-based healthcare platforms that combine customer engagement with leading medical technology, and clinical applications and informatics.
The game will not only be played by the traditional healthcare providers. With consumerization, even companies without healthcare expertise, but with strong consumer engagement and trust, could potentially become healthcare companies. Big multinationals invest incremental budgets in developing new propositions and count on their global user bases or professional networks to gain a foothold in the market.
And in parallel, a raft of start-ups are attempting to transform the worlds of preventive or curative healthcare – in many cases, limited only by their imaginations. For example, we may see virtual reality technology moving from gaming industry to healthcare for improving patients’ rehabilitation after a stroke. Or we may see facial recognition software become common in monitoring and guiding patients’ daily medical routines.
While these new propositions tackle a number of healthcare industry’s core concerns and provide solutions to completely new areas, these propositions still need to mature. They need to become scalable, reliable, open, and the user experience needs to be harmonized.
But perhaps one of the most important challenges is related to people’s behaviour and preferences. Regardless of whether these new and existing companies are analysing health data, using virtual reality or reading people’s vital signs, they all need ample time to become trusted and accepted in the emerging digital health care space. Especially for the new entrants, obtaining the right level of credibility will be one of the key success factors.
Consumers, patients and professionals alike, will need the right motivation, reassurance and mindsets to adopt these new solutions. The companies that know how to offer us tailored, cutting-edge solutions, combined with meaningful advice and trustworthiness, will be the winners and become our trusted advisers in health.
Source: World Economic Forum
Making the transition to working nights may feel a bit intimidating, but many night nurses, myself included, have grown to love the position! It tends to be quieter and less chaotic because the patients are generally asleep, and there's a special camaraderie that develops between a team of night nurses. Put these tips into practice to survive, and even thrive, in your night shifts.
Stack several night shifts in a row: Rather than spacing out your night shifts during the week and having to switch between being up during the day and up during the night, try to put all your night shifts for the week in a row. That way, you can really get yourself onto a schedule of being awake during the nights you work and sleeping during the days in between.
Nap before work: As you transition from being awake during the day to being awake as you work at night, take a nap in the afternoon to help you go into your first night shift as rested as possible. Alternately, if your schedule allows, stay up later than usual the night before your first night shift and sleep in as late as you can the next morning.
Fuel up with healthy foods: While sugars may seem like they provide energy, they also come with a crash. Before heading into work, eat a filling meal with a healthy balance of carbohydrates, protein, and fiber. Then bring healthy snacks for the night that include protein and fiber to keep you going strong. Some options include yogurt, mixed nuts, hard boiled eggs, cheese cubes, or carrots with hummus dip
Plan caffeine carefully: It can be tempting to drink a cup of coffee anytime you feel sleepy, but you may develop an unhealthy dependence or be unable to fall asleep when you get home after your shift. Therefore, try to limit yourself to just one or two cups of coffee per shift, and drink your last one at least six hours before you plan to go to sleep.
Create a restful sleeping environment at home: The key to surviving night shifts in the long term is getting lots of restful sleep after each shift. Set up room darkening curtains and a white noise machine to help you block out signs of the day. When you get home, don't force yourself to go to bed right away. Instead, develop a routine that includes some time to bathe, read, and relax as your body winds down after work. Try to avoid bright screens, which block your body from releasing melatonin, the hormone that makes you feel sleepy.
With some attention to detail, you will probably find yourself really enjoying working at night. Many of the night nurses I know started out stuck on the shifts, but grew to prefer them. Plus, the pay differential doesn't hurt at all!