DiversityNursing Blog

By Laura Smith-Spark

Lawmakers on Tuesday voted in favor of a law that sets the stage for the United Kingdom to be the first country in the world to allow a pioneering in vitro fertilization technique using DNA from three people.

The technique could prevent mitochondrial diseases but also raises significant ethical issues.

The measure was passed in the House of Commons, 382 to 128, Speaker John Bercow said.

A further vote must be held in the UK's upper house, the House of Lords, before the measure can become law.

Passage of the law is opposed by Catholic and Anglican church leaders, in part because the process involves the destruction of an embryo.

One in 6,500 babies in the United Kingdom are thought to develop a serious mitochondrial disorder, which can lead to health issues such as heart and liver disease, respiratory problems, blindness and muscular dystrophy.

Problems with mitochondria, the "powerhouse" cells of the body, are inherited from the mother, so the proposed IVF treatment would mean an affected woman could have a baby without passing on mitochondrial disease.

But the cutting-edge IVF technique, which involves transferring nuclear genetic material from a mother's egg or embryo into a donor egg or embryo that's had its nuclear DNA removed, raises ethical questions.

The new embryo will contain nuclear DNA from the intended father and mother, as well as healthy mitochondrial DNA from the donor embryo -- effectively creating a "three-parent" baby.

The amount of donor DNA in the mitochondria will, however, be much less than the parental DNA in the nucleus, which determines the baby's characteristics.

Called an ethical watershed

The Church of England's national adviser on medical issues, the Rev. Dr. Brendan McCarthy, described the step as representing an ethical watershed and said more research and wider debate were needed.

"We accept in certain circumstances that embryo research is permissible as long as it is undertaken to alleviate human suffering and embryos are treated with respect. We have great sympathy for families affected by mitochondrial disease and are not opposed in principle to mitochondrial replacement," he said.

"Our view, however, remains that we believe that the law should not be changed until there has been further scientific study and informed debate into the ethics, safety and efficacy of mitochondrial replacement therapy."

Bishop John Sherrington, in a statement posted online by the Catholic Church in England and Wales, urged lawmakers not to rush into taking such a serious step.

"It seems extraordinary that a licence should be sought for a radical new technique affecting future generations without first conducting a clinical trial," he said. "There are also serious ethical objections to this procedure which involves the destruction of human embryos as part of the process."

The California-based Center for Genetics and Society, in an open letter to UK lawmakers last month, said that although the proposed goal was noble, "the techniques will in fact put women and children at risk for severe complications, divert resources from promising alternatives and treatments, and set a policy precedent that experimentation on future generations is an acceptable biomedical/fertility development."

Incurable diseases

A team at the Wellcome Trust Centre for Mitochondrial Research, led by professor Doug Turnbull and based at Newcastle University in northern England, has been leading the research into the pioneering IVF technique.

The center points out that mitochondrial diseases cannot be cured and that in many families, several people are affected.

A Wellcome Trust fact sheet states that "nuclear DNA is not altered, and so mitochondrial donation will not affect the child's appearance, personality or any other features that make a person unique -- it will simply allow the mitochondria to function normally and the child to be free of mitochondrial DNA disease.

"The healthy mitochondria will also be passed on to any children of women born using the technique."

According to the latest estimates from the research team, published in The New England Journal of Medicine, almost 2,500 women of childbearing age in the UK are at risk of transmitting mitochondrial disease to their children, while in the United States, the number is more than 12,400.

This equates to an average of 152 births per year in the UK, and 778 births per year in the United States, the team said. 

In a Newcastle University news release, Turnbull said his team's findings had considerable implications for other countries considering the technique. Allowing it would give "women who carry these mutations greater reproductive choice," he said.

Source: www.cnn.com

The Food and Drug Administration has approved the use of an attention deficit/hyperactivity disorder drug to treat binge eating.

Should ADHD medication be prescribed to help cut compulsive overeating?

The drug, Vyvanse, is usually used for ADHD but it's been shown to help control binge-eating disorder, the FDA said.

"In binge-eating disorder, patients have recurrent episodes of compulsive overeating during which they consume larger amounts of food than normal and experience the sense that they lack control. Patients with this condition eat when they are not hungry and often eat to the point of being uncomfortably full," the FDA said in a statement.

"Patients may feel ashamed and embarrassed by how much they are eating, which can result in social isolation. Binge-eating disorder may lead to weight gain and to health problems related to obesity."

The drug is not approved for weight loss, and it's a Schedule II controlled substance because it has high potential for abuse and dependence. But any doctor can write a prescription for any approved drug for any use he or she sees fit.

"The concern in our country especially is the desperation to lose weight," said NBC's diet and nutrition editor Madelyn Fernstrom. "Everyone will say, 'Oh, I have binge eating disorder'. I think there's a huge potential for abuse in our country."

Source: www.nbcnews.com

By Chris Serico

Larry Stogner, a retiring news anchor for an ABC affiliate in North Carolina, stunned viewers on Friday when he revealed he has ALS.

"For nearly four decades, I have met you right here, usually at 6," the WTVD anchor said during a Jan. 23 broadcast, as a slideshow of his life and career appeared on a screen behind him. "Boy, we've seen a lot of change over those years, but we have to stop meeting this way. I am sure that in recent months, you've noticed a change in my voice; my speech, slower. Many of you were kind enough to email me ideas about what it might be, or just to show concern, and I truly appreciate that. As it turns out, I have ALS, Lou Gehrig's disease."

Stogner added that, last summer, he'd participated in an Ice Bucket Challenge video to help raise awareness and money for the cause. "Little did I know, it was about to change my life," he said. "There is no cure. My career in broadcast journalism is coming to an end."

Married with six children, Stogner joined WTVD in 1976. In addition to conducting one-on-one interviews with Barack Obama, John McCain and other prominent political figures, the Air Force veteran reported live from Raleigh-Durham and beyond — including a 2002 assignment in Afghanistan, according to his ABC11 bio.

In the final minute of the broadcast, Stogner called his WTVD position "the best job in the world," and shared plans to take two weeks of vacation with his wife before returning in early February to share "a few final thoughts and a more personal goodbye."

Flanked by four of his WTVD colleagues, he concluded, "And now more than ever, I say to you, for all those 39 years: Thanks for the company. Have a good night."

Source: www.today.com

Should the legal age for smoking be raised from 18 to 21? That’s the question being pondered by lawmakers in California, where a growing contingent of health advocates are seeking to make their state’s minimum smoking age the highest in the United States.

Known as Bill 151, the legislation, which was proposed by Democrat Senator Ed Hernandez last Thursday, is designed to limit tobacco smoking among young people. Hernandez says it’s about preventing people from becoming addicted to cigarettes when they’re most vulnerable.

“Tobacco companies are aware that people tend to become addicted to smoking if they start it at young age,” Hernandez said. “Senate Bill 151 proposes to increase the legitimate smoking age in California from 18 to 21 years in an offer to restrain tobacco smoking in children and teenagers.”

Hernandez has evidence to support his cause. According to the American Lung Association, nine in ten smokers take up the habit right around the time they reach age eighteen. Overall, it’s estimated that about 36,000 California children begin smoking each year.

Hernandez says it’s time to take a tougher approach when it comes to preventing young people from smoking. “We can no more bear to sit on the sidelines while huge tobacco markets to our children and gets another era of youngsters snared on an item that will at last kill them,” Hernandez said.

California is not the first state to make this venture. Utah, New Jersey, Maryland, and Colorado have all tried to raise the smoking age from 18 to 21, with every attempt ending in failure.

Source: www.activebeat.com

Nurses are an important part of the medical workforce. They provide crucial supplementary services and are primary caregivers in a lot of industries. As such, the demand for nurses is high, though there are variations according to different states. As the country’s population and access to medicine continues to grow, the demand for nurses does as well.

Source: http://online.adu.edu

BY EMMANUELLE SALIBA

After a howling blizzard with hurricane-force winds socked Boston with 21 inches of snow on Tuesday, some nurses and doctors hitched rides with police or put on skis and snowshoes to get to work.

Kelli O'Laughlin, one of the doctor's at Brigham and Women's Hospital who skied to work, found her ride "fun" and "exhilarating." She told NBC's Miguel Almaguer that doctors have to come in to work because"the emergency department is one of those places where 24 hours a day, 7 days a week it's always going."

"Our sincerest thanks to all employees that have gone to extraordinary lengths to get to the hospital during the storm," wrote the hospital in an Instagram post along with a photo of pathology technician Vivian Chan on snowshoes.

Source: www.nbcnews.com

Written by James McIntosh

While violence intervention programs have demonstrated that they can be an effective way of preventing violent injury, little has been known about their financial implications. A new study now suggests that these interventions could save various sectors millions of dollars.

Researchers from Drexel University have analyzed the cost-benefit ratio of hospital-based violence intervention programs (HVIPs) and report that - as well as benefiting victims' lives - HVIPs can make costs savings of up to $4 million over a 5-year period in the health care and criminal justice sectors.

"This is the first systematic economic evaluation of a hospital-based violence intervention program, and it's done in a way that can be replicated as new evidence emerges about the programs' impacts across different sectors," states lead author Dr. Jonathan Purtle.

As a major cause of disability, premature mortality and other health problems worldwide, HVIPs have a crucial role to play in helping victims from experiencing further suffering.

The provision of case-management and counseling from combinations of medical professionals and social workers has been associated with not only reducing rates of aggressive behavior and violent re-injury but also improving education, employment and health care utilization for service users.

Many HVIPs still require a sustainable source of funding

Intervention typically begins in the period immediately after a violent injury has been sustained. Not only is this a critical moment in terms of physical health, but it can also be a time when victims may start thinking about retaliation or making changes in their lives.

"The research literature has poetically referred to the time after a traumatic injury as the 'golden hour,'" says study co-author Dr. Ted Corbin.

In 2009, around six programs were in operation and, as word of their success has spread, more and more HVIPs have been initiated.

Calculating the potential financial benefits of HVIPs is crucial, as for many of these programs a stable and sustainable source of funding does not exist. Instead, many rely on a variety of different financial sources such as insurance billing, institutional funding, local government funding and private grants.

For the study, published in the American Journal of Preventive Medicine, the researchers conducted a cost-benefit analysis simulation in order to estimate what savings an HVIP could make over 5 years in a hypothetical population of 180 violently injured patients. Of these, 90 would receive HVIP intervention and 90 would not.

Costs, rates of violent re-injury and violent perpetration incidents that a population would be estimated to experience were calculated by the authors using data from 2012.

The authors made a comparison between the estimated costs of outcomes that would most likely be experienced by the 90 hypothetical patients receiving HVIP intervention - including $350,000 per year costs of the HVIP itself - and the costs of outcomes predicted for 90 patients not receiving any HVIP intervention.

The net benefit of the interventions

A total of four different simulation models were constructed by the researchers to estimate net savings and cost-benefit ratios, and three different estimates of HVIP effect size were used.

Costs that were factored into the simulations included health care costs for re-injury, costs to the criminal justice system if the victims then became perpetrators and societal costs for potential loss of productivity.

Each simulation calculated that HVIPs produced cost savings over the course of 5 years. The simulation model that only included future health costs for the 90 individuals and their potential re-injury produced savings of $82,765. The simulation model including all costs incurred demonstrated savings of over $4 million.

Dr. Purtle acknowledges that estimated lost productivity costs may have been slightly high due to an assumption in their data that all individuals in the simulation were employed. However, he believes that there are also many social benefits to HVIPs that cannot be financially quantifiable:

"Even if the intervention cost a little more than it saved in dollars and cents to the health care system, there would still be a net benefit in terms of the violence it prevented."

The authors believe that the findings of their study could be useful in informing public policy decisions. By demonstrating that HVIPs can be financially beneficial, the study suggests that an investment in HVIPs is one that pays off for everyone concerned.

Source: www.medicalnewstoday.com

By MICHELLE CASTILLO

Pets are getting some pain relief thanks to a centuries-old method that has helped some of their owners: acupuncture.

A dachshund named Samson benefitted from the treatment. Samson was pawed aggressively by another dog at the park and needed surgery immediately. After his first procedure, it was clear he was still in some pain. Doctors recommended a second surgery, but owner Ellie Sutton wasn't so keen to make Samson go under the knife again.

"I wouldn't want to risk something like paralysis," Sutton told CBS News. She decided "to try every other kind of step first."

To her surprise, the veterinarian suggested acupuncture, the traditional Chinese medicine method of inserting needles into the skin to stimulate parts of the body.

Veterinary acupuncturists can use .2 to .3 mm needles that range in length from .5 inches to 1.5 inches on pooches.

"A lot of people come for acupuncture because they've exhausted a lot of the traditional Western medicine roots, whether it's medication or surgery," Dr. Marc Seibert, Samson's vet, told CBS News. Siebert is the owner and medical director of Heart of Chelsea Animal Hospital and Lower East Side Animal Hospital in New York City.

Seibert explained there are two main theories behind how acupuncture works. Eastern medicine teaches that energy flows through channels in the body called meridians. When the meridians are blocked, the person -- or the animal -- experiences physical pain. The acupuncture needles help direct the energy to the correct path.

Western medicine, on the other hand, suggests that acupuncture may help by bringing oxygen to the area that the doctor is trying to treat. Hormones called endorphins, which promote feelings of well-being, are released, and the anti-inflammatory parts of the immune system kick in.

"Most people think of acupuncture as a pain reliever, but it's more than that," says Dr. Ihor Basko, a holistic veterinarian in private practice in Honolulu, certified by the International Veterinary Acupuncture Society in Ft. Collins, Colo., told Paw Nation. "Acupuncture can boost the immune system and improve organ functions, and it has other benefits. It can complement conventional medicines and procedures without dangerous side effects."

Not everyone is convinced the method works. Veterinarian Craig Smith, the complementary-care expert for the American Veterinary Medical Association, told U.S. and World News Report that it's hard to know for sure if canines and felines are feeling relief from their pain.

"While many people treating pets with acupuncture report success, there isn't any data that proves it works," he said.

Ellie Sutton admitted that a lot of the "energy flow" talk is hard for her to believe. But she says Samson has definitely benefited from the treatment.

"The fact is he walks better afterwards," she said.

Source: www.cbsnews.com

By AVIANNE TAN

A Minneapolis mom who wanted a natural birth was more than 13 hours into labor when she felt she wasn't going to make it without something to take the edge off the pain. But rather than asking for an epidural or narcotics, she begged for laughing gas.

"It immediately took my fear away and helped calm me down, though I could still feel the pain," Megan Goodoien, who gave birth at the Minnesota Birthing Center this month, told ABC News today. "I didn't laugh because the labor was so intense, but I everything suddenly felt doable just when I thought I couldn't make it anymore. It's definitely a mental thing."

Though nitrous oxide has long been used in European countries and Canada, the gas is now making a resurgence in the U.S., according to medical experts.

The gas, once popular in the U.S., was sidelined after the advent of the epidural in the 1930's, midwife Kerry Dixon told ABC News, noting she believes epidurals took over because they were more profitable. Dixon did not treat Goodoien but works at the Minnesota Birthing Center.

"The average cost for a woman opting for nitrous oxide is less than a $100, while an epidural can run up to $3,000 because of extra anesthesia fees," Dixon said.

The U.S. Food and Drug Administration approved new nitrous oxide equipment for delivery room use in 2011, which could also explain the resurgence, Dixon told ABC News.

"Maybe 10 years ago, less than five or 10 hospitals used it [for women in labor]," Dr. William Camann, director of obstetric anesthetics at Brigham and Women's Hospital, told ABC News. "Now, probably several hundred. It’s really exploded. Many more hospitals are expressing interest."

He added the gas popular in dentists' offices has an "extraordinary safety record" in delivery rooms outside the U.S. But more studies are needed to confirm its safety, other doctors say.

Laughing gas works differently than an epidural or narcotic in that it targets pain more on a mental level than physical, experts said.

"It's a relatively mild pain reliever that causes immediate feelings of relaxation and helps relieve anxiety," Camman said. "It makes you better able to cope with whatever pain you’re having."

But gas can also change awareness, said Dr. Jennifer Ashton, a senior medical contributor for ABC News and practicing OB/GYN.

"In delivering over 1,500 babies, I had never used it nor has anyone asked for [nitrous oxide]," Ashton told ABC News. "[M]ost moms want to be totally aware when they are in labor."

Mothers who have opted for nitrous oxide like that it's self-administered by the patient, who has total control over if and when it's used.

A Nashville mother said she opted for the gas during labor only after she found herself too tense to push.

"I instantly felt relaxed," Shauna Zurawski told ABC News. "Before, I was so tense. I was fighting against the contractions, which definitely wasn't good. But after the laughing gas, my body was able to do what it was supposed to. It was so neat."

Both Goodoien and Zurawski said they put a nitrous oxide machine's mouthpiece over their mouth and nose and inhaled about 30 seconds before their next contraction to get the maximum effect.

Another advantage is that the chemical gets out of your system shortly after stopping inhalation.

"With my first child, I had an epidural, I was numb for so long after the delivery and it took a while to get back to normal," Zurawski said. "But with the nitrous oxide, I was walking around and taking pictures almost right after."

Both Goodoien and Zurawski said they didn't experience any adverse side effects.

Nitrous oxide's possible side effects are usually just minor nuisances such as nausea, dizziness or drowsiness, medical experts told ABC News.

Patients can also choose to stop or get an epidural at any time if they find they don't want the laughing gas.

It's still early to tell how popular this new option will get, but in countries like New Zealand, about 70 percent of women in labor choose to use laughing gas, Dixon said.

"When I was working in New Zealand, I told one of my patients, [laughing gas] wasn't really used in the U.S. and you know what she said?" Dixon asked. "'I thought they have everything in America!'"

Source: http://abcnews.go.com

By Debra Anscombe Wood, RN

While credentials may seem like an alphabet soup after one’s name, the letters tell the world much about a nurse’s qualifications, including licensure, certifications and fellowships.  

“Credentials are not only a source of pride for the nurse, but communicate to patients, colleagues and hospital leaders the nurse’s commitment to standards of excellence,” said Mary Frances Pate, PhD, RN, CNS, associate professor at the University of Portland School of Nursing in Oregon and chairwoman of the board of directors for AACN Certification Corporation, the certification organization for the American Association of Critical-Care Nurses.

Other academic nurses agree. “Credentials matter to the public,” said Rebecca M. Patton, MSN, RN, CNOR, FAAN, Lucy Jo Atkinson Scholar in Perioperative Nursing at Case Western Reserve University in Cleveland, adding that they also demonstrate growth and lifelong learning valuable to the nurse and to nurse managers and administrators.

Depending on the position, “some nursing positions require certification demonstrating expertise, and some do not,” said Robert Hanks, PhD, FNP-C, RNC, assistant professor and clinical/FNP track director at the University of Texas Health Science Center at Houston School of Nursing. 

Marianne Horahan, MBA, MPH, RN, CPHQ, director of certification services at the American Nurses Credentialing Center, reported an increase in certification applications this year, in part because of employers’ promotion of certification. A new “Success Pays” program allows the hospital to directly pay for successful exam completion. 

Employers also seek nurses with degrees, as evidence suggests organizations with a higher percentage of BSN- or MSN-prepared nurses have greater patient outcomes, said Paulette Heitmeyer, MSN/ED, RN, CNO at Marina Del Rey Hospital in California. 

Pate said nurses whose clinical skills and judgment have been validated through certification often make patient care decisions with greater confidence, recognize problems and intervene appropriately.

While many believe credentials lead to better care and patient outcomes, research is limited. The Institute of Medicine recently released a research agenda to help fill this gap. 

Nurses should list the highest degree first, immediately after their name, then licensure, any state designations, national certifications, awards, honors and other recognitions, according to the ANCC. 

“Certification provides a foundation for lifelong learning and professional development,” Horahan said. “The purpose of certification is to assure the public that this individual has mastered the body of knowledge and acquired skills in the specialty.”

Source: http://news.nurse.com