DiversityNursing Blog

Gifts Nurses Could REALLY Use

Posted by Erica Bettencourt

Wed, Apr 29, 2015 @ 10:39 AM

BY 

http://scrubsmag.com 

salad 131399660 resized 600Pens that don’t work? Socks that cut off your circulation? Cheap key chains? Yep, those sound like some Nurses Week gift failures to me!

I have some suggestions for gifts I think every nurse would appreciate for Nurses Week. Here are two major ones (you can thank me later!):

A real lunch break

  • You know, the kind of lunch break that involves leaving the nursing unit, or even leaving the premises all together. The kind where you actually taste your meal instead of inhaling it on the go. Maybe even a full hour-long lunch so we could enjoy the food we eat and take our time getting back on shift.

IOU: A time out

  • A certificate that allows you the ability to just call a time out. I’m talking stopping everything, putting your hands in the air and taking a “Calgon moment.” No explanation necessary, just produce the IOU. We should be able to use this IOU whenever the need arises. You could even put an expiration date on it, although I doubt it would take long to use this one up.

Here are a few more random ideas for gifts:

  • A valet ticket for parking
  • A free lunch (or more than one)
  • IOU: One time you get to leave work early
  • IOU: One time you get to come to work late
  • IOU: One request for a new pot of coffee be made (when the pot is empty)
  • IOU: One admission paperwork completion
  • IOU: A free breakfast

Don’t get me wrong, I’m always appreciative of the recognition, but I think if we’re going to celebrate all things nursing, then the gifts should be worth the year-long wait!!

Any other suggestions? What would be a great gift for you this Nurses Week?

Topics: clinic, gifts, nursing, health, healthcare, nurse, nurses, medical, hospital, Nurses Week

Insuring Undocumented Residents Could Help Solve Multiple US Health Care Challenges

Posted by Erica Bettencourt

Mon, Mar 30, 2015 @ 10:36 AM

Source: University of California - Los Angeles

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Latinos are the largest ethnic minority group in the United States, and it's expected that by 2050 they will comprise almost 30 percent of the U.S. population. Yet they are also the most underserved by health care and health insurance providers. Latinos' low rates of insurance coverage and poor access to health care strongly suggest a need for better outreach by health care providers and an improvement in insurance coverage. Although the implementation of the Affordable Care Act of 2010 seems to have helped (approximately 25 percent of those eligible for coverage under the ACA are Latino), public health experts expect that, even with the ACA, Latinos will continue to have problems accessing high-quality health care.

Alex Ortega, a professor of public health at the UCLA Fielding School of Public Health, and colleagues conducted an extensive review of published scientific research on Latino health care. Their analysis, published in the March issue of the Annual Review of Public Health, identifies four problem areas related to health care delivery to Latinos under ACA: The consequences of not covering undocumented residents. The growth of the Latino population in states that are not participating in the ACA's Medicaid expansion program. The heavier demand on public and private health care systems serving newly insured Latinos. The need to increase the number of Latino physicians and non-physician health care providers to address language and cultural barriers.

"As the Latino population continues to grow, it should be a national health policy priority to improve their access to care and determine the best way to deliver high-quality care to this population at the local, state and national levels," Ortega said. "Resolving these four key issues would be an important first step."

Insurance for the undocumented

Whether and how to provide insurance for undocumented residents is, at best, a complicated decision, said Ortega, who is also the director of the UCLA Center for Population Health and Health Disparities.

For one thing, the ACA explicitly excludes the estimated 12 million undocumented people in the U.S. from benefiting from either the state insurance exchanges established by the ACA or the ACA's expansion of Medicaid. That rule could create a number of problems for local health care and public health systems.

For example, federal law dictates that anyone can receive treatment at emergency rooms regardless of their citizenship status, so the ACA's exclusion of undocumented immigrants has discouraged them from using primary care providers and instead driven them to visit emergency departments. This is more costly for users and taxpayers, and it results in higher premiums for those who are insured.

In addition, previous research has shown that undocumented people often delay seeking care for medical problems.

"That likely results in more visits to emergency departments when they are sicker, more complications and more deaths, and more costly care relative to insured patients," Ortega said.

Insuring the undocumented would help to minimize these problems and would also have a significant economic benefit.

"Given the relatively young age and healthy profiles of undocumented individuals, insuring them through the ACA and expanding Medicaid could help offset the anticipated high costs of managing other patients, especially those who have insurance but also have chronic health problems," Ortega said.

The growing Latino population in non-ACA Medicaid expansion states

A number of states opted out of ACA Medicaid expansion after the 2012 Supreme Court ruling that made it voluntary for state governments. That trend has had a negative effect on Latinos in these states who would otherwise be eligible for Medicaid benefits, Ortega said.

As of March, 28 states including Washington, D.C., are expanding eligibility for Medicaid under the ACA, and six more are considering expansions. That leaves 16 states who are not participating, many of which have rapidly increasing Latino populations.

"It's estimated that if every state participated in the Medicaid expansion, nearly all uninsured Latinos would be covered except those barred by current law -- the undocumented and those who have been in the U.S. less than five years," Ortega said. "Without full expansion, existing health disparities among Latinos in these areas may worsen over time, and their health will deteriorate."

New demands on community clinics and health centers

Nationally, Latinos account for more than 35 percent of patients at community clinics and federally approved health centers. Many community clinics provide culturally sensitive care and play an important role in eliminating racial and ethnic health care disparities.

But Ortega said there is concern about their financial viability. As the ACA is implemented and more people become insured for the first time, local community clinics will be critical for delivering primary care to those who remain uninsured.

"These services may become increasingly politically tenuous as undocumented populations account for higher proportions of clinic users over time," he said. "So it remains unclear how these clinics will continue to provide care for them."

Need for diversity in health care workforce

Language barriers also can affect the quality of care for people with limited English proficiency, creating a need for more Latino health care workers -- Ortega said the proportion of physicians who are Latino has not significantly changed since the 1980s.

The gap could make Latinos more vulnerable and potentially more expensive to treat than other racial and ethnic groups with better English language skills.

The UCLA study also found recent analyses of states that were among the first to implement their own insurance marketplaces suggesting that reducing the number of people who were uninsured reduced mortality and improved health status among the previously uninsured.

"That, of course, is the goal -- to see improvements in the overall health for everyone," Ortega said.

Topics: US, study, UCLA, clinic, diversity, health, healthcare, hospital, care, residents, undocumented, language barrier, health centers, Insuring

Fertility Clinic Courts Controversy With Treatment That Recharges Eggs

Posted by Erica Bettencourt

Tue, Mar 10, 2015 @ 02:36 PM

ROB STEIN

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Melissa and her husband started trying to have a baby right after they got married. But nothing was happening. So they went to a fertility clinic and tried round after round of everything the doctors had to offer. Nothing worked.

"They basically told me, 'You know, you have no chance of getting pregnant,' " says Melissa, who asked to be identified only by her first name to protect her privacy.

But Melissa, 30, who lives in Ontario, Canada, didn't give up. She switched clinics and kept trying. She got pregnant once, but that ended in a miscarriage.

"You just feel like your body's letting you down. And you don't know why and you don't know what you can do to fix that," she says. "It's just devastating."

Melissa thought it was hopeless. Then her doctor called again. This time he asked if she'd be interested in trying something new. She and her husband hesitated at first.

"We eventually decided that we should give it one last shot," she says.

Her doctor is Dr. Robert Casper, the reproductive endocrinologist who runs the Toronto Center for Advanced Reproductive Technology. He has started to offer women a fertility treatment that's not available in the United States, at least not yet. The technique was named Augment by the company that developed it, and its aim is to help women who have been unable to get pregnant because their eggs aren't as fresh as they once were.

Casper likens these eggs to a flashlight that just needs new batteries.

"Like a flashlight sitting on a shelf in a closet for 38 years, there really isn't anything wrong with the flashlight," he says. "But it doesn't work when you try to turn it on because the batteries have run down. And we think that's very similar to what's happening physiologically in women as they get into their 30s."

In human eggs, as in all cells, the tiny structures that work like batteries are called mitochondria. Augment is designed to replace that lost energy, using fresh mitochondria from immature egg cells that have been extracted from the same woman's ovaries.

"The idea was to get mitochondria from these cells to try to, sort of, replace the batteries in these eggs," Casper says.

Here's how it works. A woman trying to get pregnant goes through a surgical procedure to remove a small piece of her ovary, so that doctors can extract mitochondria from the immature egg cells. In a separate procedure, doctors remove some of the woman's mature eggs from her ovaries. They then inject the young mitochondria into the eggs in the lab, along with sperm from the woman's partner; except for adding mitochondria to the mix, the process is the same one that's followed with standard in vitro fertilization. The resulting embryo can then be transferred into her womb.

The extracted mitochondria "look exactly like egg mitochondria," Casper says. "And they're young. They haven't been subjected to mutations and other problems."

So they should have enough power to create a healthy embryo, he says — at least in theory. The company that developed the procedure, OvaScience Inc. of Cambridge, Mass., has reported no births from the procedure so far. The technique adds about $25,000 to the cost of a typical IVF cycle.

OvaScience hopes to eventually bring the technique to infertile couples in the United States. But the Food and Drug Administration has blocked that effort — pending proof that the technique works and is safe. Meanwhile, the firm is already offering the technology in other countries, including the United Arab Emirates, Turkey — and in Canada, at Casper's Toronto clinic.

"We're pretty excited about it," Casper says.

Not everyone in Canada is excited about it. Endocrinologist Neal Mahutte, who heads the Canadian Fertility and Andrology Society, notes that no one knows whether the technique works. And he has many other questions.

"It's a very promising, very novel technique," he says. "It may one day be shown to be of tremendous benefit. But when you amp up the energy in the egg, how much do we really know about the safety of what will follow?"

"Is there a chance that the increased energy source could contribute later to birth defects?" Mahutte wonders. "Or to disorders such as diabetes? Or to problems like cancer? We certainly hope that it would not. But nobody knows at this point."

He and some other experts say it's unethical to offer the procedure to women before those questions have been answered.

"There are processes that are set up to ensure that products which are offered for clinical use in humans have undergone rigorous testing for safety and efficacy, based on well-established scientific and ethical testing criteria," says Ubaka Ogbogu, a bioethicist and health law expert at the University of Alberta. "To circumvent this process is to use humans as guinea pigs for a product that may have serious safety concerns or problems."

Casper defends his decision to offer his patients the treatment, saying a New Jersey fertility clinic briefly tried something similar more than 15 years ago; in that case, he says, the resulting babies seemed fine, and there have been no reports of problems since. In addition, Casper says he has done a fair amount of research on mitochondria.

"I think there's very little chance that there would be any pathological or abnormal results," he says. "So I feel pretty confident this is not going to do any harm."

Casper's first patient to try the technique — Melissa — says she's comfortable relying on the doctor's judgment.

"I think there's always risk with doing any sort of procedure," Melissa says. "IVF — I mean, there was lots of controversy and risk when that first came out. For me, and from what I've discussed with my doctor, I don't see it being a big risk to us."

And she's thrilled by the outcome so far: She's pregnant with twins.

"You know, I couldn't believe it," she says. "I still don't believe it a lot of the time. There are no words for it — it's incredible. We're very excited."

Casper says 60 women have signed up for Augment at his clinic. He has treated 20 of the women, producing eight pregnancies, he says. The first births — Melissa's twins — are due in August.

Source: www.npr.org

Topics: birth, clinic, health, healthcare, pregnancy, nurse, medical, hospital, treatment, doctor, fertility, eggs

'Bionic' Eye Allows Man To See Wife For First Time In A Decade

Posted by Erica Bettencourt

Mon, Mar 02, 2015 @ 01:54 PM

 James McIntosh

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A blind man is now able to see objects and people again, including his wife and family, for the first time in a decade. How? With the help of a bionic eye implant. 

Affected by a degenerative condition known as retinitis pigmentosa, Allen Zderad was effectively blind, unable to see anything but a bright light. As the condition has no cure, Zderad, from Minneapolis-Saint Paul, MN, was forced to quit his professional career. 

He made adjustments to his lifestyle and was able to continue woodworking through his sense of touch and spatial awareness. However, with the help of his new retinal prosthesis, Zderad is now able to make out the outlines of objects and people, and could even register his reflection in a window.

"I would like to say I think he's a remarkable man, when you consider what he's overcome in dealing with his visual disability," says Dr. Raymond Iezzi Jr., an ophthalmologist from the Mayo Clinic. "To be able to have offered him the retinal prosthesis to enhance what he can already do was a great honor for me." 

Retinitis pigmentosa is an inherited condition that causes the degeneration of specific cells in the retina called photoreceptors. The disease can cause some people to lose their entire vision. Mr. Zderad's grandson has the disease in its early stages and, after seeing him, Dr. Iezzi asked if he could meet his grandfather.

The eye implant that Zderad now has works by bypassing the damaged retina and sending light wave signals directly to the optic nerve. A small chip was attached to the back of the eye with multiple electrodes offering 60 points of stimulation.

'Not like any form of vision that he's had before'

Wires from the device on the retinal surface connect to a pair of glasses worn by Mr. Zderad. The glasses have a camera at the bridge of the nose that relay images to a small computer worn in a belt pack. These images are then processed and transmitted as visual information to the implant which in turn interprets them, passing them on to the retina and eventually the brain. 

"Mr. Zderad is experiencing what we call artificial vision," explains Dr. Iezzi. "It's not like any form of vision that he's had before. He's receiving pulses of electrical signal that are going on to his retina and those are producing small flashes of light called electro-phosphenes. These small flashes of light are sort of like the points of light on a scoreboard at a baseball game."

There are only 60 of these flashes of light, but it is enough for Zderad to reconstruct scenes and objects. Although he will not be able to see the details of faces or read, Mr. Zderad will now be able to navigate through crowded environments without the use of a cane, significantly improving his quality of life.

Dr. Iezzi would like to see the technology expanded to patients who have lost the use of their eyes, such as wounded soldiers or people with advanced diabetes or glaucoma.

"In addition, while Mr. Zderad has 60 points of stimulation, if we were able to increase that number to several hundred points of stimulation, I think we could extend the technology so that patients could recognize faces and perhaps even read," he concludes. 

"It's crude, but it's significant," said Zderad happily, as he first used the device. "It'll work."

Zderad will now be able to see his family again, including his 10 grandchildren and his wife, Carmen. And how does he distinguish her, having not seen her for a decade? "It's easy," says Zderad, "she's the most beautiful one in the room."

At the end of last year, Medical News Today reported on the story of a woman with quadriplegia who is now able to use her mind to move a robotic arm, demonstrating "10° brain control" of the prosthetic.

Source: www.medicalnewstoday.com

Topics: medical technology, clinic, technology, health, healthcare, hospital, patient, blind, bionic eye, retinitis pigmentosa, ophthalmologist, implant, senior, nerve, optic nerve

Cannabis: A New Frontier In Therapeutics

Posted by Erica Bettencourt

Mon, Feb 16, 2015 @ 11:12 AM

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While debate about recreational marijuana use continues, researchers are investigating the effectiveness of cannabis for treating pain, spasticity, and a host of other medical problems. In a symposium organized by the McGill University Health Centre (MUHC) as part of the 2015 American Association for the Advancement of Science Annual Meeting held this week in San Jose, California,  experts from North America and the U.K. share their perspectives on the therapeutic potential of medical cannabis and explore the emerging science behind it.

"We need to advance our understanding of the role of cannabinoids in health and disease through research and education for patients, physicians and policy-makers," says Dr. Mark Ware, director of clinical research at the Alan Edwards Pain Management Unit at the MUHC, in Canada.

As a pain specialist Dr. Ware regularly sees patients with severe chronic pain at his clinic in Montreal, and for some of them, marijuana appears to be a credible option. "I don't think that every physician should prescribe medical cannabis, or that every patient can benefit but it's time to enhance our scientific knowledge base and have informed discussions with patients."

Increasing numbers of jurisdictions worldwide are allowing access to herbal cannabis, and a range of policy initiatives are emerging to regulate its production, distribution, and authorization. It is widely believed that there is little evidence to support the consideration of cannabis as a therapeutic agent. However, several medicines based on tetrahydrocannabinol (THC), the psychoactive ingredient of cannabis, have been approved as pharmaceutical drugs.

Leading British cannabis researcher Professor Roger Pertwee, who co-discovered the presence of tetrahydrocannabivarin (THCV) in cannabis in the 70's, recently published with collaborators some findings of potential therapeutic relevance in the British Journal of Pharmacology. "We observed that THCV, the non-psychoactive component of cannabis, produces anti-schizophrenic effects in a preclinical model of schizophrenia," says Pertwee, professor of Neuropharmacology at Aberdeen University. "This finding has revealed a new potential therapeutic use for this compound."

Neuropsychiatrist and Director of the Center for Medicinal Cannabis Research (CMCR) at the University of California, San Diego Dr. Igor Grant is interested in the short and long-term neuropsychiatric effects of marijuana use. The CMCR has overseen some of the most extensive research on the therapeutic effects of medical marijuana in the U.S. "Despite a commonly held view that cannabis use results in brain damage, meta analyses of extensive neurocognitive studies fail to demonstrate meaningful cognitive declines among recreational users," says Dr. Grant. "Bain imaging has produced variable results, with the best designed studies showing null findings."

Dr. Grant adds that while it is plausible to hypothesize that cannabis exposure in children and adolescents could impair brain development or predispose to mental illness, data from properly designed prospective studies is lacking.

Source: www.sciencedaily.com

Topics: science, clinic, policy, marijuana, medical marijuana, research, medical, patients, medicine, treatment, cannabis, theraputics, herbal, plants, chronic pain

Only 23 Percent Protection From This Year's Flu Vaccine

Posted by Erica Bettencourt

Mon, Jan 19, 2015 @ 12:42 PM

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U.S. health officials have hard numbers to back up their warnings that this season's flu shots are less than perfect: A new study finds the vaccine reduces your risk of needing medical care because of flu by only 23 percent.

Most years, flu vaccine effectiveness ranges from 10 percent to 60 percent, reported the U.S. Centers for Disease Control and Prevention.

Despite the reduced effectiveness of this season's flu shot, "vaccination is still important," said lead report author Brendan Flannery, an epidemiologist with the CDC.

"But there are ways of treating and preventing flu that are especially important this season," he added. 

These include early treatment with antiviral drugs and preventing the spread of flu by washing hands and covering coughs, he said. 

Twenty-three percent effectiveness means that there is some benefit -- a little less flu in the vaccinated group. Flu is usually more common among unvaccinated Americans, Flannery said, "but this year there is a lot of influenza both in people who are vaccinated and in people who are unvaccinated."

The findings are published in the Jan. 16 issue of the Morbidity and Mortality Weekly Report.

As of early January, the middle of flu season, flu was widespread in 46 states, and 26 children had died from complications of the infection, CDC figures show. 

The vaccine's reduced effectiveness highlights the need to treat serious flu quickly with antiviral drugs such as Tamiflu or Relenza, the CDC said. Ideally, treatment should start within 48 hours of symptoms appearing.

Spot shortages of these drugs have been reported, and the CDC said that people may have to contact several pharmacies to fill these prescriptions. However, it anticipates enough supply overall to meet the high demand. 

In flu seasons when the vaccine is well matched to the circulating H3N2 strains, effectiveness has been between 50 and 60 percent, the CDC said. This year, however, about 70 percent of the H3N2 virus seen has been different from the H3N2 strains in the vaccine, which explains its reduced effectiveness, Flannery said.

Flu viruses change constantly, and this new H3N2 virus did not appear until after the flu strains were chosen for inclusion in the current vaccine, he explained.

Vaccine effectiveness is also related to the health of those getting vaccinated. The vaccine works best in young, healthy people, and is less effective in those 65 and older, the report noted.

This year's shot is most effective -- 26 percent -- for children 6 months old through 17 years. Older people get less benefit -- just 12 percent for those 18 to 49 years and 14 percent for those 50 and older, the CDC said.

Although the vaccine is less reliable than in some years, the CDC still recommends that everyone 6 months and older get vaccinated. Vaccination can prevent some infections and reduce severe disease that can lead to hospitalization and death, the agency said. 

Also, the vaccine protects against three or four flu viruses, some of which may circulate later this season, Flannery said. 

Dr. Marc Siegel, a professor of medicine at NYU Langone Medical Center in New York City, agreed. As other flu strains included in the vaccine emerge later in the season, he predicted the vaccine's effectiveness will rise to about 40 percent. 

Flu activity so far this season has been similar to the 2012-2013 flu season, which was classified as a "moderately severe" flu, officials say. Siegel said that season "the vaccine's effectiveness was about 40 percent, so this is even worse." 

However, he agreed it's a good idea to get a flu shot. "Twenty-three percent is better than nothing, and there is no downside to getting the vaccine," Siegel said.

Source: www.nlm.nih.gov

Topics: flu, flu shot, symptoms, clinic, antiviral, nurse, CDC, medical, hospital, vaccine, treatment, shots

Nurse’s Notes: Clinics can help with dosage

Posted by Alycia Sullivan

Wed, May 29, 2013 @ 03:30 PM

 

Between 2 million and 3 million Americans take warfarin (Coumadin) to prevent blood clot formation, which is important in various medical conditions such as atrial fibrillation or after certain procedures, such as getting a new heart valve. Blood levels of a person’s international normalized ratio are measured regularly, and doses of the medication are adjusted accordingly.

Warfarin management may seem overwhelming, but anticoagulation clinics are here to help. While it may not seem like a lot goes into dosing warfarin, more goes into it than may be obvious. Nurses work with people on warfarin, and we want folks who take it to understand they play an important role in the management of their dosing.

A health care provider will start a patient on warfarin for a number of reasons. Although warfarin increases the time the body takes to form blood clots, it is a safe medicine to take when monitored appropriately. Routine follow-up for INR checks is an extremely important part of warfarin management.

During follow-up appointments, nurses will assess numerous issues with regard to your warfarin management. They will check your INR and compare it against your weekly dosing schedule. An INR reading may be outside of the optimal range for something as simple as a missed dose. However, when a patient starts or discontinues a medication, is ill, has been hospitalized or is scheduled for surgery, warfarin dosing is likely to be effected and will need to be adjusted.

It is the job of the nurse in the anti-coagulation clinic to figure out what to do with the patient’s warfarin dosing and when to safely see the patient back in the clinic to help maintain that patient within their goal range. The job of the patient taking warfarin is to notify the nurse in the anti-coagulation clinic of any changes in their medical condition or lifestyle that will affect INR readings.

This may sound simple, but many common activities can impact an INR level. What a person eats and drinks, how much a person exercises or doesn’t, any over-the-counter medications, prescription medications or herbal supplements, illnesses, whether a person smokes or doesn’t, dieting and weight changes, surgery and recovering from surgery are some of the other causes that can change a person’s INR reading. Anything out of the norm for a patient needs to be reported to the nurse at the anti-coagulation clinic immediately.

Warfarin management does not have to be confusing for the patient; supportive and knowledgeable anti-coagulation nurses can help greatly. What the nurses want you to focus on is being consistent.

Be as consistent as you can with your diet and your activity. Don’t worry about avoiding certain foods with vitamin K – except green and white tea; those are the only no-nos. If you like salads and green vegetables, eat them; they offer great health benefits. However, they can affect your INR readings, so it is important to be consistent in the quantity and regularity with which you eat these foods. Let the nurses adjust your warfarin doses around you; don’t adjust your lifestyle around warfarin.

Keep your scheduled appointment times for INR follow-up and take your warfarin as directed. Contact the anticoagulation clinic before you change, start or stop taking other medications. Always watch for signs of bleeding and or unusual bruising.

By following these basic guidelines, patients taking warfarin can live healthy, stable lives with minimal disruption caused by this life-saving medication. While it seems complex, with the help of your anti-coagulation nurse you can keep it simple!

Christin Lulow is a registered nurse in the Coumadin clinic at the International Heart Institute at St. Patrick Hospital.

Source: Missoulian

Topics: clinic, Nurse’s Notes, Chemistry, Hematology, Health_medical_pharma, Warfarin, Anticoagulant, Coumadin, nurse, medicine

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