DiversityNursing Blog

By Michelle Healy

Let them sleep!

That's the message from the nation's largest pediatrician group, which, in a new policy statement, says delaying the start of high school and middle school classes to 8:30 a.m. or later is "an effective countermeasure to chronic sleep loss" and the "epidemic" of delayed, insufficient, and erratic sleep patterns among the nation's teens.

Multiple factors, "including biological changes in sleep associated with puberty, lifestyle choices, and academic demands," negatively impact teens' ability to get enough sleep, and pushing back school start times is key to helping them achieve optimal levels of sleep – 8½ to 9½ hours a night, says the American Academy of Pediatrics statement, released Monday and published online in Pediatrics.

Just 1 in 5 adolescents get nine hours of sleep on school nights, and 45% sleep less than eight hours, according to a 2006 poll by the National Sleep Foundation (NSF).

"As adolescents go up in grade, they're less likely with each passing year to get anything resembling sufficient sleep," says Judith Owens, director of sleep medicine at Children's National Medical Center in Washington, D.C., and lead author of the AAP statement. "By the time they're high school seniors, the NSF data showed they were getting less than seven hours of sleep on average."

Chronic sleep loss in children and adolescents "can, without hyperbole, really be called a public health crisis," Owens says.

Among the consequences of insufficient sleep for teens, according to the statement:

Napping, extending sleep on weekends and caffeine consumption can temporarily counteract sleepiness, but they do not restore optimal alertness and are not a substitute for regular, sufficient sleep, the AAP says.

Delaying school start time is a necessary step, but not the only step needed to help adolescents get enough sleep, Owens says. "Other competing priorities in most teenagers' lives are also components of this problem," she says, including homework, after-school jobs, extracurricular activities and electronic media use. Computers and television screens, she adds, "produce enough light to suppress melatonin levels and make it more difficult to fall asleep."

"The bottom line is if school starts at 7:20 there is no way for the average adolescent to get the 8½ to 9½ hours of sleep they need," Owens says

Research on student performance in schools that have reset the start clock, including Minneapolis Public Schools, "shows benefits across the board," says Kyla Wahlstrom, director of the Center for Applied Research and Education Improvement at the University of Minnesota.

"We've found statistically significant evidence that attendance is improved, tardiness is decreased and academic performance on core subjects, English, math, social studies and science, is improved. And now we have evidence that on national standardized tests such as the ACT, there's improvement there, too," Wahlstrom says.

Obstacles commonly cited to changing school start schedules, include curtailed time for athletic practices and games, reduced after-school employment hours for students and significant impact on bus scheduling and other transportation arrangements, she says, adding, "This is a major policy change that schools have to grapple with if they want to embrace the research about what we know about teens."

According to U.S. Department of Education statistics approximately 43% of the more than 18,000 public high schools in the U.S. have a start time before 8 a.m.; just 15% started at 8:30 a.m. or later.

In some school districts that transport students great distances, buses are picking up students as early as 5:45 a.m., "so there's also a safety element" to early start times, says Terra Ziporyn Snider, executive director of the advocacy group Start School Later.

Other major health organizations, including the American Medical Association and the Centers for Disease Control and Prevention, have all highlighted insufficient sleep in adolescents as a serious health risk, as has U.S. Education Secretary Arne Duncan, Snider says.

"What's unique about the American Academy of Pediatrics' statement is that it's very specific," she says. "It says very clearly that high school and middle schools should not start before 8:30 a.m. for the sake of the health and sleep of our children. They draw the red line."

Source: http://www.usatoday.com

By Devetta Blount

A baby is already a viral sensation and hasn't even born yet. And It's all because of a gesture in an ultrasound photo.

The fetus was captured flashing what looks like the thumbs-up sign in an ultrasound picture taken last week.

The ultrasound image on Reddit was posted on August 28 under the username meancloth, saying "ultrasound result looks good."

Some have nicknamed the baby the "Fonzie fetus," after the iconic cool guy character in the classic television series Happy Days, according to AOL.com.

The father, Brandon Hopkins, told HLN-TV that his wife is expecting twins and the babies are due to arrive in January. The couple will find out the sex of the babies soon. Hopkins said his brother called and told him, 'Your babies are famous'!

Source: http://www.usatoday.com

Mary Lou doesn't know that she's being tracked.

The 77-year-old is in the middle stages of Alzheimer's and though she lives on her own, her family keeps close tabs on her. If she leaves her Washington D.C. home between 9 p.m. and 6 a.m., a silent sensor on her front door texts her daughter an alert.

There is a sensor on each of Mary Lou's two key chains that detects when she goes outside her condo's grounds. A motion sensor in the kitchen helps monitor her eating habits, and another in the bedroom notes when she wakes up in the morning and catches any sleeping issues. There is even a flood sensor in the laundry room.

All the sensors are made by SmartThings and relay the information back to a small wireless hub. Her two daughters, who act as her caretakers, can monitor it all on a smartphone app and set up special notifications.

"It's kept her to the point where we haven't even had to have in-home care yet. Our goal is to keep her in her home for as long as possible," said her daughter Cathy Johnson.

Caregivers like Johnson are increasingly turning to smart-home technology and wearable devices to monitor family members with Alzheimer's and dementia, helping them live independently longer. One of the first things Alzheimer's patients lose is the ability to learn new things. It makes getting their bearings and adjusting to a new residence especially difficult. But living alone can pose its own dangers, such as leaving a stove on, wandering off or forgetting to take medication.

"Often, decisions about care are made when safety becomes an issue" said said Beth Kallmyer, vice president of constituent services for the Alzheimer's Association. Tools like these sensors "can allow people to feel more comfortable" and ease the transition.

Finding the right system

SmartThings is a DIY home automation system that connects sensors and smart devices with a wireless hub. In addition to sensors like those in Mary Lou's home, the system can loop in smart thermostats, smart plugs, door locks and surveillance cameras.

SmartThings is highly customizable and works easily with third-party sensors, which makes it appealing to people like Cathy Johnson. It also doesn't require a monthly fee, unlike many other systems. (Samsung recently purchased the company for $200 million.)

The elder care tech industry is still young, but Laurie Orlov, an industry analyst, predicts it could be a $20 billion business by 2020. This means that both startups and big-name brands are getting in on the action.

Lowe's, Home Depot, Best Buy, AT&T and Staples all have their own connected home systems and sell starter kits that you can expand by purchasing sensors à la carte.

Systems Lively and BeClose offer senior-specific accessories such as bed, toilet and pillbox sensors. GrandCare offers connected blood pressure, weight and glucose monitoring devices.

Wearable devices can also track health and behaviors, and built-in accelerometers can pick up on physical changes or tell when a wearer has fallen. Tempo is a wristband for seniors that picks up on lapses in routine or changes in gait that might indicate mental or physical deterioration. The device is due out this winter.

"Pet doors, water heaters, you name it we've either got it connected right now or we're in the process of connecting it," said Kevin Meagher, the vice president and general manager of Lowe's smart-home system, IRIS.

Watching without invading privacy

With any device that collects data, privacy can become an issue.

"We want to respect people's autonomy, respect their desire for how they want their care to go. One of the reasons we think people should get diagnosed early is so they can be a part of the conversation," said Kallmyer.

Phil D'Eramo chose to tell his parents about the Lively system he set up in their senior housing. He uses sensors to make sure they take their pills and tracks how many times his father goes to the bathroom at night, information that gets passed on to his doctor. His father, who has Alzheimer's, said it makes him feel more comfortable to know his son is monitoring him.

It helps that Lively includes a social element that appeals to seniors. Caregivers can upload photos, texts and notes to the Lively app from their phones, and once a month Lively will print out and mail the messages and photos to the seniors in a bright orange envelope.

"I compare it to the analog version of Facebook for seniors," said D'Eramo. "It helps them be connected to the digital social world."

The future of memory care

Connected home and wearable technology isn't enough to replace professional care or personal attention from family members. However, it can extend the amount of time a person is able to live independently, and the technology is constantly improving.

"We're just touching the surface of the technology," said D'Eramo. "I think in the future, the Lively base unit could interact with the person, almost like an electronic caregiver."

Source: http://www.cnn.com

By Jeffrey Donovan

Nicknamed “The Flying Squirrel," 6-year-old Quincy Symonds is making waves not only for her incredible surfing skills, but also for her courage while coping with a genetic condition called congenital adrenal hyperplasia.

With a growing social-media following both on Instagram and YouTube, the Australian phenom might just be the best 6-year-old surfer in the world.

“I have never seen a surfer male or female this good at such an early age — and I’ve taught thousands of kids to surf,” her coach, Anthony Pope, told TODAY.com.

In March 2013, when Quincy was 4, she became fascinated by her father's love of surfing, and insisted on doing some of her own. Her mother, Kim Symonds, told TODAY.com it didn't take long for Quincy to find her balance on a surfboard.

“It was just the second or third wave she stood up on, which is apparently quite phenomenal,” she added. “Within a week, she was going across the waves and looking to make turns.”

From a coaching perspective, Pope admitted he had his doubts at the start of their first session, when they swam to 3-foot waves at the surf break known as Currumbin Alley.

"There were a lot of surfers looking at me like, 'You shouldn’t be out here with that tiny kid,'" he said. "However, after pushing her into a perfect 3-foot wave, she took off down the line, tearing the wave up. I was shocked, speechless and super excited. I knew immediately she was something very special."

Pope credits Quincy's success to her fearless nature, exceptional balance and a drive to catch the best wave.

Quincy started making international headlines this month, when Australian media outlet ABC Open featured her serious skills in a Vimeo video that's racked up almost 1 million views. In that video, her father, Jake Symonds, says he still can't believe what he's seeing. "I'm amazed by it," he said. "I'm really proud of it. But, to be honest, I can't comprehend how she does it, and how she's done it so quickly."

It's especially impressive given Quincy's medical condition. According to the Mayo Clinic, congenital adrenal hyperplasia limits adrenal glands' ability to make certain vital hormones. 

When Quincy was born, she spent many stints in the intensive-care unit of various hospitals. "On and off, we spent more time in a hospital than we spent at home," Kim Symonds told ABC Open.

The young surfer's health is more stable these days, but because her body doesn’t produce cortisone, she depends on three daily doses of steroids.

Because her illness means she'd require immediate medical care in the event of injury, “We keep emergency medication on hand always,” her mother told TODAY.com.

Despite her condition, Quincy seems fearless when she surfs or skateboards in her family’s hometown on Australia’s Gold Coast, north of Sydney.

That fearlessness led to her nickname, too.

According to ABC Open, when she was younger, she spotted a squirrel in a tree near her house and hopped off her father's SUV to mimic it. "The Flying Squirrel" was born.

As someone who's worked with pro surfers Owen Wright, Dion Agius and Stephanie Gilmore, Pope told TODAY.com he feels "privileged" to work with his young protégée.

"I feel like a better person just knowing Quincy," he said.

Source: http://www.today.com

By Eun Kyung Kim

Four students at North Carolina State University hope to tackle a problem on many campuses by developing a nail polish that can detect so-called date rape drugs by changing colors when it comes into contact with them.

Women who wear the polish can simply swirl their fingers in a drink to test it for any colorless, odorless compound that may have been slipped in.

The four male entrepreneurs behind the product, which they call Undercover Colors, have received mainly positive responses. They won an $11,000 prize from a contest on campus, where they also have met with a potential investor. 

A White House report estimates one in five women has been sexually assaulted while at college, but only 12 percent of those student victims ever report the crime.

“As a rape victim, and a mother of 3 daughters, I can not thank you enough,” one fan said in a post on the group's Facebook page, which has been “liked” by more than 26,000 users.

But some have expressed skepticism about the product, however well-intentioned it may be.

"I think it reflects the cultural reality where we actually put the blame on women,” often when they are the victims of rape,” said Elizabeth Plank, a senior editor at Mic. “We put the onus on them, to prevent rape, when we very well know that this is not an effective way of actually reducing sexual assault."

North Carolina State has encouraged the students to continue pursuing their project, providing them with lab space to experiment. It’s not clear when the nail polish will be available on the market.

Source: http://www.today.com

By SYDNEY LUPKIN

At Boston Children’s Hospital, doctors perform practice surgeries with replicas of their patients’ body parts. Though the hospital has had a simulation program for about a decade, it started 3D-printing children’s body parts about a year ago, said Dr. Peter Weinstock, director of the hospital’s simulator program.

“They perfect what they want to do before ever bringing the child into the operating room or putting them to sleep,” Weinstock said.

The models are also used to help parents understand their children’s surgeries before the operation and to educate students afterward, Weinstock said.

The printer is precise, with a resolution of between 16 and 32 microns per layer. That means each layer is about the width of a “filament of cotton,” Weinstock said. And since the printer can print multiple resins or textures, doctors can work on replicas that model different tissue types, like brain matter and blood vessels.

The printer only takes a few hours to do their work once CT scans and other forms of imaging are collected and rendered into 3D models. A child’s finger might take three hours to print, but a chest replica they made last week took longer, Weinstock said.

The team has already printed about 100 body parts over the last year and demand is growing, Weinstock said, adding that the printer is running around the clock.

Dr. Ed Smith, a pediatric neurosurgeon at Boston Children’s, said he recently used several different 3D models to perform brain surgery on a 15-year-old patient with an abnormal cluster of veins above his optical nerve. One wrong maneuver and the patient could have gone blind.

He even used a see-through replica of the patient’s skull on a light box in the operating room as a reference.

“It’s kind of like being superman with X-ray vision where you can actually hold this up and see right through it,” Smith said.

The surgery, which would have normally taken five or six hours, wound up clocking in at 2 hours and 20 minutes, Smith said.

Though Boston Children’s hasn’t conducted any formal studies of how the models help surgeons, Smith said he’s heard anecdotally that they result in shorter surgeries because doctors know what to expect.

Source: http://abcnews.go.com

By DENISE LAVOIE Associated Press

If something good could come out of the Boston Marathon bombing, James Costello and Krista D'Agostino seem to have found it.

Sixteen months after the attack killed three people and injured more than 260, including Costello, he married D'Agostino, the nurse who helped him recover. The couple exchanged vows Saturday at the Hyatt Regency Boston in front of about 160 guests.

A photograph of Costello with his clothes ripped to shreds and parts of his body burned became one of the most recognized images of the 2013 attack. He met D'Agostino, a nurse at Spaulding Rehabilitation Hospital, while he was recovering from multiple surgeries for shrapnel injuries and serious burns that required pig skin grafts on his right arm and right leg.

After the couple became engaged, Costello said he believed he was involved in the tragedy in order to meet D'Agostino, whom he described as his best friend and the love of his life.

"One thing that she hates that I always say is I'm actually glad I got blown up," Costello said on the "Today" show in December. "I wish everyone else didn't have to, but I don't think I would have ever met her if I didn't."

Wedding planner Rachael Gross said she and the other vendors involved in the wedding donated their services.

"They are the most gracious, generous, kind, ... loving couple," Gross said. "They believe that they were meant to meet."

The wedding ceremony was held outdoors on the hotel's third-floor terrace, with blue and white hydrangeas all around. The reception was held in the hotel's grand ballroom.

"It was more like a classic Nantucket style, but without a literal nautical theme," Gross said.

Costello, of Malden, was gathered with friends near the marathon finish line, watching for another friend who was running when two bombs exploded within seconds of each another. Three of Costello's friends lost a leg, while other friends suffered burns and shrapnel injuries.

During his two-week stay at Massachusetts General Hospital, Costello was among patients who met President Barack Obama. He was later transferred to Spaulding.

Costello and D'Agostino, both 31, are honeymooning in Hawaii.

Source: http://abcnews.go.com

Emergency department nurses aren't like the rest of us - they are more extroverted, agreeable and open - attributes that make them successful in the demanding, fast-paced and often stressful environment of an emergency department, according to a new study by University of Sydney.

"Emergency nurses are a special breed," says Belinda Kennedy from Sydney Nursing School, a 15 year critical care veteran who led the study.

"Despite numerous studies about personalities of nurses in general, there has been little research done on the personalities of nurses in clinical specialty areas.

"My years working as a critical care nurse has made me aware of the difficulty in retaining emergency nurses and I have observed apparent differences in personality among these specialty groups. This prompted me to undertake this research which is the first on this topic in more than 20 years.

"We found that emergency nurses demonstrated significantly higher levels of openness to experience, agreeableness, and extroversion personality domains compared to the normal population.

"Emergency departments (ED) are a highly stressful environment - busy, noisy, and with high patient turnover. It is the entry point for approximately 40 per cent of all hospital admissions, and the frequency and type of presentations is unpredictable.

"Emergency nurses must have the capacity to care for the full spectrum of physical, psychological and social health problems within their community.

"They must also able to develop a rapport with individuals from all age groups and socioeconomic and cultural backgrounds, in time-critical situations and often at a time when these individuals are at their most vulnerable.

"For these reasons, ED staff experience high levels of stress and emotional exhaustion, so it's understandable that it takes a certain personality type to function in this working environment.

"Our research findings have potential implications for workforce recruitment and retention in emergency nursing.

"With ever-increasing demands on emergency services it is necessary to consider how to enhance the recruitment and retention of emergency nurses in public hospitals. Assessment of personality and knowledge of its influence on specialty selection may assist in improving this.

"The retention of emergency nurses not only has potential economic advantages, but also a likely positive impact on patient care and outcomes, as well as improved morale among the nursing workforce," she said.

Since this article is from Aulstralia, do you agree that Emergency Room Nurses in the US should have the same characteristics to be successful in a US Emergency Room?

Source: http://sydney.edu.au

By Dr. Chethan Sathya

Inside the operating room, video cameras track every movement. Outside, a small computer-like device analyzes the recordings, identifying when mistakes are made and providing instant feedback to surgeons as they operate.

This is the dream of the surgical "black box." Operations could become flawless. Post-operative complications could be significantly reduced. Surgeons could review the footage to improve their technique and prep for the next big case.

Such a device isn't far from reality.

Researchers in Canada are working on a surgical tracking box -- like the ones placed in airplanes -- that records surgeons' movements and identifies errors during an operation.

By pinpointing mistakes and telling surgeons when they're veering "off course," a black box could prevent future slip-ups, says Dr. Teodor Grantcharov, a minimally invasive surgeon at St. Michael's Hospital in Toronto. Unlike the so-called black boxes in aviation, which are used after disasters occur, the surgical black box Grantcharov is creating will be used proactively to prevent major patient complications.

A number of hospitals have already expressed interest in using the device, Grantcharov says.

But the litigious medical environment may make its implementation problematic. If the recordings were used in court, they could open the floodgates to a new wave of malpractice concerns, which would be counterproductive to surgeons and patients, Grantcharov says.

"We have to ensure the black box is used as an educational tool to help surgeons evaluate their performance and improve," he says.

A work in progress

Grantcharov's black box is a multifaceted system. In addition to the actual box, it includes operating room microphones and cameras that record the surgery, the surgeon's movements and details about team dynamics.

It will allow surgeons to hone in on exactly what went wrong and why.

The black box will eventually assess everything from how surgeons stitch to how delicately they handle organs and communicate with nurses during high-stress situations. Error-analysis software within the black box will help surgeons identify when they are "deviating" from the norm or using techniques linked to higher rates of complications.

So far, Grantcharov's black box has been tested on about 40 patients undergoing laparoscopic weight-loss surgery.

"At this initial stage, we are analyzing surgeries to determine how many errors occur and which ones actually lead to bad results for patients," Grantcharov says. Not every error will result in a patient complication.

Grantcharov's initial research has shown that surgeons recognize few of their mistakes, and, on average, make about 20 errors per surgery -- regardless of experience level. Once Grantcharov's team determines which errors affect patient safety, it hopes to be able to provide this information to surgeons in real time. The team has also developed software that can synthesize the recorded data into user-friendly and interpretable information for surgeons.

The concept of using a black box in surgery isn't new. But until now, the technology never made it out of the laboratory because it lacked comprehensiveness, Grantcharov says. Earlier surgical black boxes didn't record all the important elements of the operating room, he says, leaving pieces of the puzzle missing.

"To truly understand what causes an error, you need to know all the factors that may come into play."

Recording mistakes

Grantcharov was inspired to develop the surgical black box after years of witnessing how patient complications affected surgeons.

"The feeling of not knowing what causes a complication, whether it's surgical technique, communication in the operating room or the patient's condition itself, is tormenting," Grantcharov says.

Many surgeons, however, may be uncomfortable with using a black box in the operating room, says Dr. Teodoro Forcht Dagi with the American College of Surgeons Perioperative Care Committee.

"If there was a legal requirement to record every operation, then many surgeons would be resistant," Forcht Dagi says. He says he believes doing so would create a sense of nervousness that would paralyze a surgeon's ability to operate and end up ultimately harming patients.

"The black box needs to be used solely by surgeons for their own education, in which case I think it's a great idea," Forcht Dagi says.

Errors during surgery have generally been dealt with after the fact, and only once a complication during the patient's recovery occurs. Weeks after surgery, cases with complications are presented to a panel of experts, who weigh in on what may have gone wrong during the operation.

Yet in many cases nothing is recorded apart from an audio transcript of the operation, making it tough to identify what caused each complication. The black box would add much needed context.

"I would rush (a black box) into service immediately," says Richard Epstein, professor of law at New York University's School of Law. Since most medical lawsuits end up being "he said, she said" arguments, not knowing exactly what happened in the operating room just adds to the level of distrust, Epstein says.

In the United States, the Healthcare Quality Improvement Act prevents courts from using data that doctors and hospitals use for peer review, a self-regulation process in which experts or "peers" evaluate one another. The law allows doctors to assess each other openly and identify areas for improvement without fear of litigation.

But there are exceptions to this rule, says William McMurry, president of the American Board of Professional Liability Attorneys. For instance, cases where surgeries are recorded but don't receive any peer review can be used in court.

While McMurry says that "keeping patients in the dark about the details of their surgery is never OK," he points out that litigation concerns should not derail use of the black box. It will be an asset to the health care system regardless of whether it can be used in court, he says.

"We care about better health care, and the black box will provide surgeons with the information they need to avoid mistakes," McMurry says. "It's a win-win situation."

The surgical black box will be tested in hospitals in Canada, Denmark and parts of South America in the next few months. Talks are also under way with a number of American hospitals.

If doctors accept it, implementation in U.S. hospitals could happen quickly since the surgical black box isn't considered a medical device and doesn't require approval from the U.S. Food and Drug Administration.

Bottom line, Grantcharov says, is that even after years of practicing medicine, the black box "made me a safer surgeon and a better teacher."

Source: http://www.cnn.com

By MNT

"People tend to think that happiness in schizophrenia is an oxymoron," says senior author Dr. Dilip V. Jeste, distinguished professor of Psychiatry and Neurosciences at the University of California, San Diego School of Medicine.

"Without discounting the suffering this disease inflicts on people, our study shows that happiness is an attainable goal for at least some schizophrenia patients," he adds. "This means we can help make these individuals' lives happier."

Dr. Jeste's team surveyed 72 schizophrenia outpatients in the San Diego area - all but nine of whom were taking at least one anti-psychotic medication. Just over half of the respondents were residents in assisted-living facilities.

A comparison group was comprised of 64 healthy men and women who did not currently use alcohol or illegal drugs and who had not been diagnosed with dementia or other neurological illnesses.

The mean age for both groups was 50 years.

In the survey, the respondents answered questions on their happiness over the previous week. They were asked to rate statements such as "I was happy" and "I enjoyed life" on a scale from "never or rarely" to "all or most of the time."

The results reveal that about 37% of the schizophrenia patients were happy most or all of the time, compared with about 83% of respondents in the comparison group.

However, about 15% of people in the schizophrenia group reported being rarely or never happy, but no one in the comparison group reported such a low level of happiness.

'Patients' happiness was unrelated to the severity or duration of their illness'

The researchers compared the self-reported happiness of the respondents with other factors including age, gender, education, living situation, medication status, mental health, physical health, cognitive function, stress, attitude toward aging, spirituality, optimism, resilience and personal mastery.

The study - which is published in the journal Schizophrenia Research - suggests that the patients' levels of happiness were unrelated to the severity or duration of their illness, cognitive or physical function, age or education. This is clinically significant because, among healthy adults, all of these factors are associated with a greater sense of well-being.

Lead author Barton W. Palmer, PhD, professor in the UC San Diego Department of Psychiatry summarizes the study's findings:

"People with schizophrenia are clearly less happy than those in the general population at large, but this is not surprising.

What is impressive is that almost 40% of these patients are reporting happiness and that their happiness is associated with positive psychosocial attributes that can be potentially enhanced."

Source: http://www.medicalnewstoday.com