DiversityNursing Blog

BY CHIARA SOTTILE

Twice a day, Michele Forth drives 45 miles to the Neonatal Intensive Care Unit to visit her 4-month-old baby she affectionately calls "Miss Madilyn." She is a 6-pound fighter in pink pajamas — but to her family and the nurses who care for her day and night, she is so much more.

"Hi, pumpkin! You just waking up?" Forth coos. Nurse Adrianna "Adri" Zimmerman, wearing purple scrubs and a warm smile, hands Madilyn to her father who is quickly surrounded by his wife and two young sons.

"She fights harder than any adult that I know, let alone a 6-pound baby," says father Shane Forth, softly stroking Madilyn's delicate left foot in his hand.

It was in that spirit that the nurses chose to see Madilyn, one of nearly 100 babies cared for in the NICU at Children’s Healthcare of Atlanta every day. "We always talk about how feisty this one is or how sweet this one is,” Zimmerman says.

That bedside chatting took on a whole new life with a photo series called "From the NICU to the Moon" that imagines what the babies dream about as they wiggle and smile in their sleep, and what they might become someday. It also aims to educate parents about safe sleep for newborns.

The nurses and hospital communications team imagined Madilyn as a physician, surrounded by stethoscopes and Band-Aids. The photo series also features Brentley, the future astronaut, Arianna, the future chef, Sofia the ballerina, and Carolina as an Olympian.

Madilyn was born two months early and has what is called vacterl association (a collection of birth defects), resulting in multiple surgeries and months in the NICU. Zimmerman remembers Madilyn's arrival in the NICU like it was her own child.

"I think she's strong and she's definitely got the will to see whatever it is through to the end, so, if that happens to be med school in a few years, I would not be surprised," says Zimmerman. "It's funny how much personality these babies have."

And Mom is happy with the depiction. "Even though Miss Madilyn does have a whole bunch of obstacles ahead of her right now," she says, "she can do amazing things and she can aspire to be anything that she wants to be."

Carolina, the tiny Olympian, is “a strong-willed patient who has a lot of heart and she is letting nothing hold her back," says Jessica Wright, a NICU Nurse with 10 years of experience. "Just because they were born early doesn't mean they cannot do whatever they want when they grow up in life."

True to her athletic depiction, Carolina is hardly ever still in her crib. Gazing up at the green alligator and orange lion of her soother, Carolina playfully kicks her feet back and forth, her bright eyes fixed on Nurse Wright. "What are you thinking about?" Wright asks, her hand on Carolina's blue and pink ensemble, "You tell 'em about it, wiggle worm."

Sofia, the ballerina in the photo series, is also on the move. Since she was photographed, Sofia was able to leave the NICU and go home with her parents, Fred and Dawnyale "Dawny" Hill.

In the pale orange light of an Atlanta sunset, Fred and Dawny cradle their daughter in their arms on the family's front porch. It's Sofia's first time outside on the porch and her longest stint outside in the evening since she went home. "What do you think? What do you think? Hill asks his daughter, holding her hand. "Interesting, huh?"

Sofia spent 157 days, 20 hours, and 6 total minutes in NICUs. Respiratory and reflux issues keep this 5 1/2-month-old on an oxygen tank and feeding tube.

"She has some accessories, as we like to refer to them as," says Mr. Hill, about the oxygen tank and tubes. "They kind of travel with her."

But in the "NICU to the Moon" photos, Sofia left all the tubes behind for the stage and curtains. "It made her seem normal. The way the pictures kind of erased all of the cords. All of the tubes," says Hill of his daughter. "I saw the innocence of Sofia as opposed to my child in the NICU."

"She's got a family full of dancers on both sides so we definitely are excited to see Miss Sofia the ballerina come about," Dawny says with a laugh. "She'll be dancing around."

But for now, the Hills cherish moments with Sofia at home, like their evening bedtime routine. Mr. Hill carries Sofia on his chest while Dawny wheels the oxygen tank and other cords towards the bedroom. "Good holding your head, Sofia. Look at you," applauds Mrs. Hill.

As they gently place her on her back in her crib, Sofia rubs her eyes.

"Hey, you had a good day. You had a good day, right? Are you sleepy?" asks her father, the machine beeping and sighing next to the crib.

"Ready? Time to pray," Mr. Hill says, kneeling over the crib next to his wife. They pray for every organ in their daughter's body and give thanks to the doctors who helped bring her home.

"We will be keeping up our bedtime routine," Mrs. Hill says, looking at her husband. "Until she can start saying her prayers," he answers.

"Any child that has to go through that much opposition from day one, there's got to be something great for them to accomplish out of life, so my hope is that she accomplishes exactly what she was sent here to do," Mr. Hill says.

And with that, the bedroom light switches off and one more former NICU baby gets to dream of her future in her own crib.

Source: www.nbcnews.com

By Linda Carroll

As Jill Koziol turned away from her 8-month-old daughter to check on her toddler, the unthinkable happened. In a fraction of a second little Cate pulled herself up against the laundry hamper, grabbed a detergent pod and popped it into her mouth. 

Koziol heard a gagging sound, whipped around and was horrified to see the remains of the pod on the floor and Cate in obvious distress. 

"The next few moments were very chaotic with a screaming child, me crying and screaming to poison control to be heard over Cate's cries," the 34-year-old New Yorker said.

Within minutes Cate was vomiting and the Koziols were in an ambulance racing to the hospital.

Cate Koziol is hardly alone in her run-in with a detergent pod. A study published on Monday in Pediatrics finds that in 2012 and 2013 17,230 children under age 6 got into trouble with detergent pods. Most — nearly 80 percent — of the children were reported to have ingested a pod. Nearly two-thirds of the children were between 1 and 2 years old.

“The severity of these exposures varies,” said study coauthor Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Columbus, Ohio. “Sometimes the chemicals get into the eyes, sometimes they are swallowed. And if they are swallowed, they can cause severe burns to the esophagus and the stomach.”

It shouldn’t be surprising that most of the problems involved 1- and 2-year-old kids putting pods into their mouths, Smith said.

“This is the age group where they explore the environment with their mouths,” he explained.

A big part of the problem is that the chemicals in the pods are more dangerous than those in traditional laundry detergents.

“I’ve been treating children for over 30 years in emergency departments,” Smith said. “And for decades if a child came in with a laundry detergent exposure it was usually no big deal. But these are different. They have strong concentrated chemicals in them. And that’s why it’s so important for parents to understand the dangers associated with their use.”

Smith and his colleagues found that among children exposed to the packets, about half were managed at home and 35 percent were treated and released from a health care facility. One child died.

“The concern we have is that in about 700 of these children — that’s a child every day in this country — they had to be admitted to the hospital,” Smith said, adding that some ended up in pediatric intensive care units either in a coma or unable to breathe without the help of mechanical ventilation.

Andrea Gielen, director of the Johns Hopkins Center for Injury Research and Policy, hopes the new findings will be a wake up call for parents.  

“I think it is definitely intended to alert parents to a hazardous household product that they need to make sure is tucked away from where young children can access — much like other dangerous household products, said Gielen, a professor at the Johns Hopkins Bloomberg School of Public Health.

In a statement the American Cleaning Institute said, “ACI and its member companies have directly engaged parents and caregivers, as well as poison control centers, pediatricians and other medical professionals, educators and social service providers in alerting them to the potential for childhood accidents involving these products.”

A recent survey by the institute suggests that many parents are unaware of the dangers. While 70% of those surveyed said they store household cleaners — such as dishwashing detergent and glass and toilet cleaners — safely and securely, just 34 percent reported properly storing their laundry pods in a cabinet or a cabinet with a lock, the ACI found. More worrisome, one out of six people admitted to taking no safety precautions at all when it came to storing laundry pods.

That wasn’t the case in the Koziol home. In the minutes before Cate got into trouble with one, Jill Koziol had taken a single pod down and set it on the family’s hamper to get everything ready for her husband to take to their apartment’s laundry room.

The Koziols’ experience is “a perfect example of how these things can happen in the blink of an eye,” Gielen said.

But Gielen said the onus isn’t just on parents. The new study should sound the alarm for product designers, too. “When you are designing a new product you need to be thinking about the most vulnerable part of the population and how it will interact with the product. In this case, it is kids,” she said

When the Koziols arrived at the emergency room, doctors decided to keep Cate there for observation. And it was a good thing they did. Within a couple of hours the little girl was wheezing and struggling to breathe. Her doctors decided to intubate her and Cate spent the next two days in the pediatric intensive care unit.

The whole experience was frightening, but Cate pulled through unscathed.

“Cate is back to normal, though mommy may never quite recover from the ordeal,” Koziol said.

Have you or someone you know dealt with a child who ate a laundry pod? If so, please share your experience.

Source: www.today.com

Many people have been told, incorrectly, that they're allergic to penicillin, but have not had allergy testing. These people are often given alternative antibiotics prior to surgery to ward off infection. But when antibiotic choices are limited due to resistance, treatment alternatives may be more toxic, more expensive and less effective.

According to two studies presented at the American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting, people who believe they have a penicillin allergy would benefit from consultation from an allergist and penicillin allergy skin testing. Once they know if they are allergic, they can be given appropriate -- and not more resistant -- treatment prior to surgery. Of the 384 people in the first study who believed they were allergic to penicillin, 94 percent tested negative for penicillin allergy.

"A large number of people in our study who had a history of penicillin allergy were actually not allergic," said allergist and ACAAI member Thanai Pongdee, MD, lead study author. "They may have had an unfavorable response to penicillin at some point in the past, such as hives or swelling, but they did not demonstrate any evidence of penicillin allergy at the current time. With that in mind, their doctors prescribed different medications prior to surgery."

In the second study, 38 people who believed they were allergic to penicillin were given penicillin skin testing to see if it was possible to help reduce the use of high-cost antibiotics. Of the 38 people tested, all of them tested negative to an allergy for penicillin. Once it was known they weren't allergic to penicillin, the medical center was able to change the medications of 29 of the patients, thereby significantly lowering prescription costs.

"When you are told you have an allergy to something, it's important to be seen and tested by an allergist, who has the specialized training needed for accurate diagnosis and treatment," said allergist James Sublett, ACAAI president-elect. "If you're truly allergic to a medication, your allergist will counsel you on an appropriate substitute."

Source: www.sciencedaily.com

By Marie Ellis

It is well known that exercise is good for the mind and body, but to what extent does the neighborhood or community in which we live affect our physical and mental health? New research from the University of Kansas suggests the walkability of a community has a great impact on cognition in older adults.

Previous studies have detailed the importance physical exercise has for executive function in older adults.

But how can the layout of a neighborhood encourage its residents to get out and walk? This is precisely what Amber Watts, assistant professor of clinical psychology at the University of Kansas, wanted to find out.

"Depending on which type of walking [leisure vs. walking to get somewhere] you're interested in, a neighborhood might have different characteristics," she says. "Features of a neighborhood that encourage walking for transportation require having someplace worth walking to, like neighbors' houses, stores and parks."

She adds that neighborhoods that encourage leisure walking have "pleasant things to look at," including walking trails and trees, and they should feel safe.

Her research, which she presented yesterday at the Gerontological Society of America's annual meeting in Washington, DC, suggests that neighborhoods that encourage walking can protect against cognitive decline in older adults.

To conduct her research, Watts used geographic information systems (GIS) to judge walkability. This involved maps that measure and analyze spatial data.

Better physical and mental health

Detailing how she collected her data, Watts explains:

"GIS data can tell us about roads, sidewalks, elevation, terrain, distances between locations and a variety of other pieces of information. We then use a process called space syntax to measure these features, including the number of intersections, distances between places or connections between a person's home and other possible destinations they might walk to."

She also looked at how complicated a route is from one location to another: "For example, is it a straight line from point A to point B, or does it require a lot of turns to get there?"

To conduct the study, Watts and colleagues tracked 25 people with mild Alzheimer's disease and 39 older adults without any cognitive impairment. Using the space syntax data, they created a "walkability score" for the participants' home addresses.

Then, they estimated the relationship between a person's neighborhood scores and how well they performed on cognitive tests over 2 years. The cognitive tests included three categories: attention, verbal memory and mental status. The team also factored in issues that might influence cognitive scores, including age, gender, education and wealth.

Results from the study suggest that communities that are easier to walk in are linked to better physical health outcomes - such as lower body mass and blood pressure - and cognition - including better memory.

Watts and her colleagues believe their findings could benefit older adults, health care professionals, caregivers and even architects and urban planners.

Do mentally complex neighborhoods act like a brain-training game?

Though elaborate community layouts may be expected to confuse older residents, Watts and her team found that they actually serve to keep cognition sharp.

"There seems to be a component of a person's mental representation of the spatial environment, for example, the ability to picture the streets like a mental map," Watts says.

She adds that complicated environments may demand more intricate mental processes in order to navigate them, which could keep the mind sharp. This is in line with previous studies, which have demonstrated how staying mentally active helps to preserve memory.

"Our findings suggest that people with neighborhoods that require more mental complexity actually experience less decline in their mental functioning over time," Watts adds.

She explains that a challenging environment keeps an individual's body and mind healthy:


"With regard to the complexity of neighborhood street layouts - for example, the number of turns required getting from point A to point B - our results demonstrate that more complex neighborhoods are associated with preserved cognitive performance over time.


We think this may be because mental challenges are good for us. They keep us active and working at that optimal level instead of choosing the path of least resistance."

A National Institute on Aging grant, KU Strategic Initiative Grant and Frontiers Clinical Translational Science award helped fund the study.

Source: www.medicalnewstoday.com

By Jamie Bond

Beginning in 1999, blogging became a route for individuals with a devotion to writing to share their talent. Blogging gives the author the ability to channel their thoughts in a manner that can be useful and enjoyable to readers.  Nurses encounter many learning situations which may be helpful to fellow nurses.  Blogs give the writer a means to share these experiences and readers a chance to learn and relate to others in a virtual setting.  In nursing, blogs serve multiple purposes including engaging fellow nurses in educational opportunities, networking, providing insight into unique avenues in nursing, and burnout prevention.

This list of top nursing blogs was compiled based on Facebook likes, frequency of postings, and number of followers. Many of the following blogs are top hits when conducting online searches and can also be followed on Twitter, Pinterest, and Google+. This list has been divided into sections for the reader’s convenience: general nursing, registered nurse, nurse practitioner, nursing student, nursing career, and women’s health.

GENERAL NURSING

1. Confident Voices – Beth Boynton is a national speaker, professional coach, facilitator, and medical improv trainer. She writes this blog founded on respectful communication for nurses, physicians, patient advocates, and support staff to encourage safe, respectful work cultures.
   
   
2. Disruptive Women in Healthcare – This blog targets challenging and inspirational concepts in the current healthcare field. There are over 100 individuals that actively contribute to this blog including elected officials, healthcare workers, patient advocates, researchers, and economists.
   
   
3. Diversity Nursing – Diversity Nursing offers a variety of articles on all topics pertinent to nursing including health and wellness and career tips. This blog also includes a job board and a forum for open discussion amongst nurses and student nurses.
   Highlight: Nurses Among Most Influential People in Healthcare
4. ER Nurses Care – Written by emergency room nurse Leslie Block, this blog uses her passion for nursing to demonstrate caring and compassion through her posts focusing on healthy living, injury prevention, and various current trending topics in healthcare.
   
   
5. Living Sublime Wellness – Elizabeth Scala MSN/MBA, RN is a motivational speaker who focuses her writing on encouraging nurses to make the necessary changes in healthcare by facilitating out-of-the box critical thinking.
   
   
6. Not Nurse Ratched – A nurse and freelance writer, Megen Duffy blogs about all things nursing while using her humor to lighten the mood as necessary. Duffy’s blog is highly followed online and on Facebook likely due to her down to earth writing style.
   
   
7. Nurse Barb’s Daily Dose – Barb Dehn, RN, MS, NP is committed to deciphering convoluted health information in order to assist individuals in achieving optimal health and wellness. Nurse Barb’s Daily Dose contains articles pertaining to women’s health, parenting, caregiving, healthy living, and medical conditions.
   
   
8. Nursetopia – Nursetopia features timely articles on all pertinent topics in healthcare. This blog inspires nurses by highlighting and displaying the positive influence nurses have on the healthcare culture.
   
   
9. rtConnections – Renee Thompson is a motivational speaker and the author of “Do No Harm” Applies to nurses too! Strategies to protect and bully-proof yourself at work. Thompson gears her presentations toward clinical competence and bullying within the workplace and works to enhance effective communication within a healthy organization.
   
   
10. The Nursing Show -The Nursing Show is not your typical blog.  It is filled with hundreds of short podcasts and easy to read articles pertaining various nursing topics geared toward nurses of all skill levels. All nurses are sure to find topics of interest in this diverse, educational blog.
    
    

REGISTERED NURSES

11. According to Nurse Kateri – Kateri, RN, BSN, started this blog while on a personal journey to discover herself and now uses it to detail her personal experiences as they pertain to health and happiness. This blog features narratives relating to her career in pediatrics and pediatric intensive care.
    
    
12. JParadisi RN’s Blog – Julianna Paradisi, RN is an accomplished artist and an oncology nurse who incorporates art into patient care. This blog focuses on the same while featuring some of her personal pieces of art as they relate to her writing.
    
    
13. Nurse Eye Roll – Nurse Eye Roll was established by a newly seasoned nurse wishing to provide encouragement, inspiration, support, and laughter to student nurses. Nursing school is tough and Nurse Eye Roll is there to offer tips and suggestions about navigating the path toward graduation and successful board examination.
    
    
14. The Nerdy Nurse – Brittany Wilson, RN, BSN is a nursing informatics nurse who prides herself by incorporating technology into healthcare in order to improve and streamline patient care. This blog is found on various lists of top nursing blogs and is highly followed on social media.  For more information, see what is nursing informatics?
    
    

NURSE PRACTITIONER

15. Barefoot Nurse – Barefoot Nurse reviews real life experiences as they occur through the eyes of an advance practice nurse. Kelly Arashin, the author behind this blog, is unique in her profession because she is a dually board certified nurse practitioner in acute and critical care and a clinical nurse specialist.
    
    
16. My Strong Medicine – Sean Dent is an acute care nurse practitioner by day and weightlifter and coach by night. This blog was originally designed to share his experiences as a nurse but now it contains more commentaries on his personal life, his love for CrossFit and weightlifting.
    
    
17. NP Business Blog – Nurse practitioners whom are in private, independent practice are breaking the mold of traditional NP employment status and are often found without the available resources to answer common questions. Barbara C. Phillips developed this blog as a means for NPs to offer support to others in all avenues of business NPs may be involved in.
    
    
18. NP Odyssey – In existence since 2009, this blog contains a wealth of valuable information and insight including what it takes to become a nurse practitioner and the challenges NPs frequently encounter. This blog also incorporates articles pertaining to recent headlines in healthcare and how they pertain to NP practice.
    
    
19. The NP Mom -Brett Badgley Snodgross is a family nurse practitioner with a passion for pain management and palliative care. She writes informative, easy to read articles related to common concerns she sees in her practice ranging from dieting to hypertension to allergies and beyond.
    
    

NURSING STUDENT

20. A Journey Through Nursing School and Beyond – This blog takes the reader through the entire process of climbing the ladder through nursing education. The author began this blog as a certified nurse assistant, became a LPN, then an RN, and is currently seeking a master’s degree in nursing education. Most entries are brief and include an update on coursework although others offer valuable tips and tricks of the nursing trade.
    
    
21. Adrienne, Student Nurse – Adrienne, RN is passionate about the way nurses and nursing students use social media in their professional lives. Adrienne, Student Nurse is written with the goal of telling the story of being a student nurse in an effort to motivate others to accept the challenge of becoming a nurse.
    
    
22. Becoming a RN – Follow Amy on her journey through nursing school through her blog where she recounts her trials, tribulations, and triumphs. This blog includes insight on navigating through the various challenges presented by nursing school and inspires nursing students to prevail.
    
    

NURSING CAREER

23. Digital Doorway – Keith Carlson, RN utilizes his blog, Digital Doorway, to coach nurses so they may feel fulfilled in their nursing careers. One of the most well known bloggers in healthcare, Carlson blogs about career opportunities, social media in healthcare, and burnout prevention.
    
    
24. Innovative Nurse – Kevin Ross, RN is the ‘Innovative Nurse’ behind this blog. Ross writes about numerous areas of career nursing such as time management, salary, mobile apps, networking, and workplace happiness in the healthcare arena.
    
    
25. International Nurse Support – International Nurse Support provides nurses with the necessary strategies to be confident in their positions while empowering them to climb the profession’s ladder as they progress in their career. This blog is owned by Joyce Fiodembo, however guest bloggers are featured frequently.
    
    
26. Off the Charts – Off the Charts is the online publication of the well renowned American Journal of Nursing. While this blog lacks the personal touch many other blogs convey, Off the Charts presents up to date research data provided in an easy to read format. Various bloggers are often featured on this blog including many other bloggers in this list.
    
    
27. The Nursing Site Blog – Kathy Quan, RN, BNS, PHN, has been a nurse for greater than 30 years and utilizes this blog as a means to share her extensive knowledge with fellow nurses. Quan is the author of five books including The Everything New Nurse Book which helps new nurses transition from nursing school to bedside nursing.
    
    
28. Your Career Nursing – Tina Lanciault, RN helps her readers find their niche in nursing by writing about alternative nursing careers. Your Nursing Career contains articles related to online learning, networking, lifestyles, product reviews, and entrepreneurship.
    
    

WOMEN’S HEALTH

29. At Your Cervix – At Your Cervix is written by a newly graduated nurse midwife and nicely portrays the trials and tribulations a new nurse midwife may encounter in practice. The blog contains educational articles that pertain to women’s health as well as commentaries based on the situations she came across over the course of the bloggers first year in practice.
    
    
30. Mimi Secor – Mimi Secor is an accomplished family nurse practitioner with over 30 years experience in women’s health. Outside of her private practice, Mimi Secor is a public speaker and nurse consultant who prides herself in promoting quality care in women’s health.
    
    

By Denise Whitaker

'Movember' is men's health awareness month.  It's a global initiative that's now gaining steam and raising millions to help find cures for men's cancers and other health issues. 

Originally started by two mates in Australia more than 10 years ago, it's grown from 30 growing mustaches that first year, to more than 4 million in almost two dozen countries.

The original rules still exist, right along with the concept, spelled out by the announcer in a Movember YouTube video:  "It's a reality check on your health and a responsibility to take action."

The concept is easy: Men, especially those who don't normally grow facial hair, let their mustaches grow all month long.  The more peach fuzz, the better!

"Honestly, it looks terrible for the first several weeks and for some individuals it always looks terrible," says Seattle's Dr. Peter Nelson. "But the point that we get across is that you want people to ask you 'why are you doing this?' "

It's a conversation starter, to get men talking about their health, specifically prostate and testicular cancer plus mental health.

Men who join the movement are called Mo Bros and work to raise money to combat these issues.

"In general, men don't discuss their health issues," Dr. Nelson said.

Dr. Nelson is part of a locally growing team of Mo Bros called MoDawgs, plus he's a prostate cancer researcher at the Fred Hutchinson Cancer Research Center.

Last year, the Movember foundation awarded his team a $1.4 million grant to develop strategies to treat advanced prostate cancer. 

"Advanced prostate cancer unfortunately is really a deadly disease in which we have no cure," Nelson said. "Once prostate cancer spread out of the prostate an into bones another sites, we can often temporize it for years by cutting off the fuel supply which is testosterone but eventually these cancers all resist."

And so he explained that his team developed several interesting targets and that they're now developing drugs to block to improve treatment.  

The project is moving into the second of its 3 years of funding. 

And there are many such studies being funded in the United States through the Movember movement. Each country keeps all of the money it's raised.  To date, the United States has raised $559 million, since 2003, and some 770 men's health projects have been funded. 

So back to that Movember YouTube video, it ends with words on the screen:  "Makers, Thinkers, Growers, Doers; changing the face of men's health."

Are you willing to join the fight?

Source: www.komonews.com

By Kathleen Doheny

A woman's odds of having a baby with kidney and urinary tract birth defects are higher if she's obese, new research suggests.

Such defects include being born with a single kidney, having kidney swelling or enlarged ureters, the urine-carrying tubes, said lead researcher Dr. Ian Macumber, a pediatric nephrology fellow at Seattle Children's Hospital.

"The more we find out about obesity, the more we find out what a public health problem it is," he said.

Prior research has linked maternal obesity with newborn heart defects, neural tube defects such as spina bifida and other health conditions.

The discovery of a link with kidney and urinary tract birth defects is newer. "We found a significant association between maternal obesity and risk of these anomalies," said Macumber.

While the study found a link between maternal obesity and certain birth defects, it did not establish a cause-and-effect relationship.

The kinds of defects Macumber and his colleagues evaluated are diagnosed in up to 1 percent of pregnancies, with some conditions more serious than others. The defects account for about 20 percent or 30 percent of all prenatal abnormalities, he said.

And risk of these defects increased along with the level of obesity, the study found.

More than half of pregnant women in the United States are overweight or obese, and 8 percent of reproductive-aged women are extremely obese, says the American College of Obstetricians and Gynecologists.

Macumber is to present the findings Nov. 14 at a meeting of the American Society of Nephrology in Philadelphia. Studies presented at medical meetings are typically viewed as preliminary until published in a peer-reviewed journal.

For the study, the researchers looked at medical charts, including birth and hospital discharge records, from 2003 to 2012. They found more than 3,200 cases of abnormal kidney or urinary tract problems and compared them with more than 13,000 "controls" -- newborns without the abnormalities.

Looking at pre-pregnancy weight records, the researchers found that mothers who delivered children with the birth defects were almost 1.3 times more likely to be obese than those whose infants didn't have the kidney and urinary tract defects.

Obesity was based on body-mass index (BMI), a calculation based on height and weight. A BMI of 30 or greater is viewed as obese. As an example, a 5-foot-4-inch-tall woman who weighs 180 pounds has a BMI of 30.9 and is considered obese.

Because the researchers went by hospital codes, they couldn't determine which defects were most common or how severe they were.

The mechanism behind the association isn't known, Macumber said.

"There is certainly some question as to whether insulin may play a role in this," he said. Pregnant women who are overweight may have insulin resistance, a condition in which the body doesn't respond well to the hormone insulin, and blood sugar is less able to get to the cells, he said.

Another expert praised the research.

"Studies like this are really quite important," said Dr. David Mendez, an attending physician at the Miami Children's Hospital and a neonatologist. However, whether obesity actually causes these birth defects is not yet known, he added.

Mendez said that chart reading, while limited in some respects, "is a vital research tool" and a good starting point.

Ideally, future research would follow mothers during pregnancy, tracking their weight and the health of their newborns, looking at the link from the start, he said.

Meanwhile, Mendez advises a good diet, exercise if approved by the woman's doctor and other good health habits. "The things that make you feel good," he tells patients, "will make the baby feel good."

Source: www.medicinenet.com

By Steven Reinberg

Residents of the southern United States may be at risk for a parasitic infection that can lead to severe heart disease and death, three new studies suggest.

Chagas disease, which is transmitted by "kissing bugs" that feed on the faces of humans at night, was once thought limited to Mexico, Central America and South America.

That's no longer the case, the new research shows.

"We are finding new evidence that locally acquired human transmission is occurring in Texas," said Melissa Nolan Garcia, a research associate at Baylor College of Medicine in Houston and the lead author of two of the three studies.

Garcia is concerned that the number of infected people in the United States is growing and far exceeds the U.S. Centers for Disease Control and Prevention's estimate of 300,000.

In one pilot study, her team looked at 17 blood donors in Texas who tested positive for the parasite that causes Chagas disease.

"We were surprised to find that 36 percent had evidence of being a locally acquired case," she said. "Additionally, 41 percent of this presumably healthy blood donor population had heart abnormalities consistent with Chagas cardiac disease."

The CDC, however, still believes most people with the disease in the United States were infected in Mexico, Central and South America, said Dr. Susan Montgomery, of the agency's parasitic diseases branch.

"There have been a few reports of people becoming infected with these bugs here in the United States," she said. "We don't know how often that is happening because there may be cases that are undiagnosed, since many doctors would not think to test their patients for this disease. However, we believe the risk of infection is very low."

Maybe so, but kissing bugs -- blood-sucking insects called triatomine bugs -- are found across the lower half of the United States, according to the CDC. The insects feed on animals and people at night.

The feces of infected bugs contains the parasite Trypanosoma cruzi, which can enter the body through breaks in the skin. Chagas disease can also be transmitted through blood.

It's a silent killer, Garcia said. People don't feel sick, so they don't seek care, but it causes heart disease in about 30 percent of those who get infected, she said.

In another study, Garcia's team collected 40 insects in 11 Texas counties. They found that 73 percent carried the parasite and half of those had bitten humans as well as other animals, such as dogs, rabbits and raccoons.

A third study found that most people infected with Chagas aren't treated.

For that project, Dr. Jennifer Manne-Goehler, a clinical fellow at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston, collected data on nearly 2,000 people whose blood tested positive for Chagas.

Her team found that only 422 doses of medication for the infection were given by the CDC from 2007 to 2013. "This highlights an enormous treatment gap," Manne-Goehler said in a news release.

The findings of all three studies, published recently in the American Journal of Tropical Medicine and Hygiene, were to be presented Tuesday in New Orleans at the annual meeting of the American Society of Tropical Medicine and Hygiene.

Symptoms of Chagas can range from none to severe with fever, fatigue, body aches and serious cardiac and intestinal complications.

"Physicians should consider Chagas when patients have swelling and enlargement of the heart not caused by high blood pressure, diabetes or other causes, even if they do not have a history of travel," Garcia said.

However, the two treatments for this disease are "only available [in the United States] via an investigative drug protocol regulated by the CDC," Garcia said. They are not yet approved by the Food and Drug Administration.

Efforts are under way to develop other treatments for Chagas disease, Montgomery said.

"Several groups have made some exciting progress in drug development," she said, "but none have reached the point where they can be used to treat patients in regular clinical practice."

Source: health.usnews.com

Source: Norwich University's Master of Science in Nursing online program

By DANIELA J. LAMAS, M.D.

One recent night I was asked to declare the death of a woman I had never met.

“Ms. L. passed,” the nurse said. “Could you pronounce her?”

The online medical record told me that she was 32 years old, one year younger than me. She had been in the hospital for months with leukemia that had progressed despite every possible chemotherapy regimen and a failed bone marrow transplant. And now someone needed to perform a death exam.

Declaring death is not technically hard but it is weird and sad and requires reams of paperwork. It is usually done by an intern, but my intern was busy so I said I would do it.

The first time I declared a patient dead was nearly six years earlier. I had been a doctor for a few months when I was summoned overnight with a page that told me that my patient’s heart had stopped. When I got to his room I was out of breath and his nurse smiled at me and told me that there really wasn’t urgency; he wasn’t going anywhere.

It was only when I walked into the room and saw my patient still and utterly silent, his tired family sitting around the bed, that I realized no one had ever told me precisely how to declare death. I wished I could come back later, but it didn’t seem right to leave him there, so I thumbed through my pocket-sized intern survival guide. The manual was alphabetized, and the discussion about declaring death came somewhere before a section on diabetes management.

The instructions were clear and began with the directive to express sympathy. I turned to the family to tell them how sorry I was. Listen for heart sounds and watch to see if the patient is breathing. I placed my stethoscope on the patient’s still chest and waited, watching for him to take a breath, and wondering what I would do if I heard something. But there was nothing. Feel for a pulse. I placed my hand on his neck and there was not even a quiver. And that was that. He was dead.

I looked at the clock and spoke the time out loud and said I was sorry again. And then I left the room.

Later I would face the inevitable pile of paperwork, which one hospital I worked at labeled the “Final Discharge Packet,” and another, in bold letters on a red binder, the “Death Binder.” That was followed by calls to admitting to report the death, minutes that felt like hours on hold with the medical examiner, death certificates returned to me because I had signed on the wrong dotted line. By the end of my intern year, one of the worst parts of having a patient die was those bureaucratic forms and phone calls.

Now, years later, I paused outside the room of Ms. L. before pulling back the curtain.

Until then, most of the patients I had been called to declare looked much as they did in life, only vacant. But this woman had been destroyed by illness. She was bald and yellow and bloated. She must have suffered. I took out my stethoscope as I had learned to do, rested it on her chest and listened to the silence that had taken the place of her heartbeat. I laid my fingers on her neck and there was no pulse. I looked up at the clock and said the time out loud.

As I turned to leave, I couldn’t help but note the wall of cards and photographs next to her hospital bed. She must have run a marathon to raise money for cancer research, for one photo captured her healthy and smiling, arms lifted victoriously as she crossed the finish line. Someone who loved her must have been there, waiting to take that photo.

“She must have been cool,” I said to her nurse. “I bet I would have liked her.”

“She was awesome.”

No one spoke. Two nurses gently pulled out the intravenous lines that had once run antibiotics and fluids into her veins and, one by one, removed the stickers on her chest that had recorded her heartbeat. One of the nurses paused and caught my eye.

“It’s so humid out,” she said. “How do you keep your hair from getting frizzy in this humidity?” I had showered just before my shift, I told her, and then I had come right to work so I hadn’t been outside much. When I caught a glimpse of myself in the mirror, my hair didn’t even look that good.

And then, because I didn’t know what else to say in front of this 32-year-old woman I would never meet, I offered only: “You know, I’ve always wanted to run a marathon.”

I left the room to begin the paperwork .

Source: nytimes.com