DiversityNursing Blog

By Jen Christensen

Cancer is plaguing a growing number of first responders and rescuers who worked at ground zero after the terrorist attack on the World Trade Center on September 11, 2001. These are cancers the federal government says are thought to be directly related to that effort -- cancers like leukemia, myeloma, thyroid and prostate cancers.

There are at least 1,646 certified cancer cases that have been documented by Mount Sinai Selikoff Centers for Occupational Health. There are some additional 863 cancer cases among both fire and EMS personnel, according to FDNY, which keeps a separate database for its members.

That's a total of 2,509 cases. The center has screened more than 37,000 World Trade Center rescue and recovery workers since 2002. It will continue to monitor those workers and volunteers for any new cases.

Some reports suggest the number of cancer cases in this group has doubled since last year. While that may be mathematically true, cancer experts caution that we can't draw any significant conclusions from the increase.

"For every decade of life, if you look at a population ... cancer rates go up the older you are," said Dr. Otis Brawley, the chief medical and scientific officer and executive vice president of the American Cancer Society. "Looking at an increase from one year to the next is a nonscientific way of making an assessment that is incredibly biased to find a link between the activity and the cancer."

To be scientifically accurate, Brawley said someone would have to look at all the cancer records for the people in the 9/11 group and compare them to a group that had the same age makeup, same gender, and other demographic data. There would also have to be a significant portion of firefighters in that sample, because as a profession they tend to have higher cancer rates than the general population, Brawley said.

A deep scientific analysis of available medical data through 2010 showed a 20% increase in the rate of cancer cases for 9/11 rescue and recovery workers when compared to the general population, according to Mount Sinai.

Government reports suggest workers at the World Trade Center were exposed to a number of chemicals that were known to be carcinogens, or agents that may cause cancer.

Many people who worked at the site are struggling with devastating cancers they may not otherwise have had, had they not responded to the tragedy. That much is clear, according to the U.S. government, which set up a special World Trade Center Health Program.

The program provides medical monitoring and treatment services for 9/11 responders and survivors. Nearly 65,000 people are enrolled. Enrollees are qualified to get health care treatment through several reputable medical centers that keep experts on staff who are qualified to treat and identify illnesses related to the terrorist attacks. The program plans to continue to monitor those workers.

"I think all of us are open to the possibility that these brave folks were exposed to things that caused further illness," Brawley said. "What's most important is that someone has cancer and needs help and we should continue to provide them with the good care they truly deserve."

Source: www.cnn.com

By Caitlin Schmidt

When you're sick, sometimes it feels impossible to get out of bed, let alone get to the doctor. And the last thing anyone wants to do is spend hours at the emergency room.

So Silicon Valley is retooling a service that was common almost a century ago: the house call. Several companies have developed smartphone apps that bring doctors to patients, often in less time than it would take to seek treatment elsewhere. With apps like Pager and Medicast, a patient can request a doctor with the push of a button.

In the 1930s, physician house calls accounted for 40% of medical visits, according to a 2011 article in the journal American Academy of Family Physicians. By the 1980s, that number had dropped to 1%, due in part to a lack of funding by insurance carriers.

Elizabeth Krusic, a mother of two young children from Seal Beach, California, knows how difficult it can be to take a sick child to see a doctor. When her daughter developed an eye infection, she took a friend's advice and tried Medicast, calling a doctor into her home and saving the stress of getting her small children ready and out of the house.

The doctor arrived in 30 minutes and had the necessary prescription medication on hand.

"My son was able to sleep during the entire visit, because the doctor came to the house," Krusic said. "The doctor came into my daughter's room and conducted the visit there, where she was comfortable."

The house call also removed the risk that her children would be exposed to illnesses in a waiting room.

Inspired by Uber

In early 2014, Uber co-founder Oscar Salazar saw room for improvement in the health care system and seized the opportunity.

The app he developed, Pager, offers house call services for customers in Manhattan and, starting next week, Brooklyn. Pager's doctors are available from 8 a.m. to 10 p.m., 365 days a year, with an additional after-hour fee for nights and weekends.

Toby Hervey, Pager's head of marketing and business development, said that several aspects of Uber informed Pager's approach. Like Uber, the app is structured as a mobile, location-based service.

"Convenient access to quality health care when you need it is a real problem," he said. "We're using technology to make the house call -- one of the best ways to get personal care -- viable again."

Hervey said customers range from parents not wanting to take a sick child to an emergency room to businesspeople with no time to see a doctor during the day.

A similar company, Medicast, started in South Florida in late 2013, with services now also available in San Diego, Orange County and Los Angeles.

"Long wait times are frustrating for everyone," Sam Zebarjadi, co-founder and CEO of Medicast, said. "With the proliferation of technology and increasing levels of education, we knew there were alternate ways to get amazing health care."

Dr. Kimberly Henderson is a Pager physician and works in the emergency room at New York's Beth Israel Medical Center. For her, the idea of being a part of a new practice of medicine was appealing.

"I believe we will see a shift away from medical practice exclusively in the brick and mortar model," Henderson said. "Medicine will become, or return to being, more mobile."

As the doctor shortage grows and patients struggle to balance their busy lives, telemedicine has become a fast-growing field. Health care professionals offer their services using two-way video, e-mail, smartphones and other forms of technology. Apps, such as Doctor on Demand and Ringadoc, allow patients to speak to a physician via phone or video chat.

Doctors enrolled with the service PINGMD can receive text, photo or video messages from their patients that can be forwarded to colleagues for referrals and are automatically saved to the patient's medical file. Another app, HealthTap, connects patients to 50,000 doctors across the country for verified answers to medical questions. Patients can search the database or ask their own questions and receive responses from multiple doctors, providing them with several opinions.

The American Medical Association says that telemedicine, including house call services, is useful for both patients and the health care industry as a whole, according to its June Report on the Council of Medical Service.

"Telemedicine, a key innovation in support of health care delivery reform, is being used in initiatives to improve access to care, care coordination and quality, as well as reduce the rate of growth in health care spending."

How house call apps work

After a brief video conference, a doctor will assess the patient's need for a home visit. If no visit is necessary or the physician recommends a trip to the emergency room, there's no charge.

"With this system, we're able to provide high quality care that goes beyond the issue at hand," Zebarjadi said. "With the doctor visiting patients in their own homes, it's easy to make observations and discuss other health concerns and lifestyle choices."

"I love the concept of bringing our services to people's homes," said Medicast's Dr. Elisa Malin. "It's a convenience factor, both for the patients and for us as physicians, in the sense that I can choose to be on call whenever I'm available."

Malin also works as a pediatric hospitalist for Kaiser Permanente. She said that a typical house call visit lasts about 45 minutes, as opposed to the average 10-minute visit at a clinic.

"The fact that I get the luxury of time with Medicast patients improves the quality of care they receive."

With both apps, physicians follow up with the patient via phone and are available to answer any questions that may have come up since the visit.

Although the apps are only currently available for iPhone, Pager and Medicast are actively working on an Android app. For non-iPhone users, their services are also available by phone and on their websites. They also have plans to move into other markets in the near future.

The house calls are comparable to an urgent care visit, and cost much less than the emergency room, where many people still go to seek treatment for minor ailments. Both companies offer flat rates, starting at $199 for a house call. Customers can also sign up for a monthly plan that allows them two or four visits a year.

The companies aren't able to accept insurance, but are in talks with various providers to make that option available in the future.

House calls have their advantages, such as privacy and convenience, according to Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons. They also can save on office overhead for physicians. But they do have limitations, she said.

"The doctor's black bag won't have all the equipment available in the office," she said.

Both companies' websites have long lists of conditions they treat, such as cold and flu, sprains, eye infections, pneumonia, abdominal pain and cuts that require stitches. But there are also conditions their doctors cannot handle. You should call 911 or go to the emergency room if you are experiencing chest pain, shortness of breath, or have had a head injury and lost consciousness.

Source: www.cnn.com

Source: www.rntobsnonlineprogram.com

By Michelle Healy

Nearly one-third of U.S. children and adolescents are obese or overweight, but many don't realize that they fall into that category.

According to new government statistics, approximately 30% of children and adolescents ages 8-15 years (32% of boys and 28% of girls) — an estimated 9.1 million young people — don't have an accurate read on their own weight.

About 33% of kids (ages 8–11) and 27% of teens (ages 12–15) misperceive their weight status, says the report from the National Center for Health Statistics.

Based on data collected between 2005 and 2012 from more than 6,100 kids and teens for the National Health and Nutrition Examination Survey (NHANES), the report also finds:

• 42% of those classified as obese (48% of boys; 36% of girls) considered themselves to be about the right weight.

• 76% of those classified as overweight (81% of boys; 71% of girls) believed they were about the right weight.

• 13% of those classified as being at a healthy weight considered themselves too thin (9%) or too fat (4%).

Studies have shown that recognizing obesity can be an important step in reversing what is a major health problem for U.S. children and adolescents, and it can be an important predictor of later weight-control behaviors, says Neda Sarafrazi, a nutritional epidemiologist at NCHS and lead author of the report.

"When overweight kids underestimate their weight, they are less likely to take steps to reduce their weight or do additional things to control their weight, like adopt healthier eating habits or exercise regularly," Sarafrazi says.

"On the other hand, when normal weight or underweight kids overestimate their weight, they might have unhealthy weight-control behaviors," she says.

Weight misperception varied by race and Hispanic origin, according to the report. Black and Mexican-American youths were more likely to misperceive their weight than white children. It also varied by income level and was significantly less common among higher-income families compared with lower-income families.

The report's findings are not a surprise, says Timothy Nelson, an assistant professor of psychology at the University of Nebraska-Lincoln. He was not involved in the study.

"In general, children and adolescents have a tendency to underestimate their health risks, and this certainly appears to be the case with obesity," says Nelson, who studies pediatric health behaviors. "We see a similar pattern of misperception when parents are asked about their children's weight. Parents are often unaware of the problem."

With obesity so prevalent today, it's understandable that many kids might have a skewed take on their weight, he says. "If they are surrounded by people who are overweight, they may be less likely to label their own weight as a problem."

The findings highlight the need for health professionals "to communicate with families about the child's weight," Nelson says. "This can be a tough conversation when the child is overweight, but it is critical that pediatricians help parents understand where their child stands and what steps need to be taken to get the child on a healthier track."

Source: http://www.usatoday.com

By: Healthday

Odds are small, but family, doctors should keep possibility in mind, researchers say.

Babies born prematurely appear to have a slightly increased risk of potentially fatal blood clots that they will carry into adulthood, Swedish researchers report.

Doctors have previously suspected that babies born earlier than 37 weeks' gestation have a raised risk of deep vein thrombosis and pulmonary embolism, two serious conditions caused by blood clotting in the veins, the researchers noted in background information.

This new study confirms that link, and takes it even further. Premature birth appears to be linked to an increased chance of blood clots in the veins in childhood and early adulthood, according to findings published online July 28 in the journal Pediatrics.

The researchers also reported that a baby's chances of blood clot-related illnesses are directly related to the degree of prematurity. "The more premature, the higher the risk," said Dr. Edward McCabe, chief medical officer of the March of Dimes. A full-term pregnancy lasts from 39 to 40 weeks.

While parents and doctors should keep this risk in mind, they should also be aware that the risk is not huge, said Dr. Kristi Watterberg, chair of the American Academy of Pediatrics' committee on the fetus and newborn. Watterberg and McCabe were not involved with the study.

The association between premature birth and clot risk seen in the study does not prove a cause-and-effect relationship.

The study involved 3.5 million babies born in Sweden between 1973 and 2008, including almost 207,000 born preterm. Out of all the births, only about 7,500 children -- 0.2 percent -- suffered either deep vein thrombosis or pulmonary embolism later in life.

"I think it's important scientifically to know, but it's such a low incidence phenomenon that there are a lot of things to think about before that," said Watterberg, a professor of pediatrics and neonatology at the University of New Mexico School of Medicine.

Deep vein thrombosis involves blood clots that form in a vein deep in the body. If these clots aren't treated and dissolved, they can break off and travel through the bloodstream to the lungs, causing a blockage called a pulmonary embolism. Such a blockage can be deadly.

For the study, Dr. Bengt Zoller, of the Center for Primary Health Care Research at Lund University in Malmo, Sweden, and colleagues used records from the Swedish Birth Registry to track the babies' health. The researchers found that premature babies had an increased risk of blood clots in their veins in infancy, but also from ages 1 to 5 and from 18 to 38.

Very preterm births -- before 34 weeks of gestation -- also had a risk of blood clot-related illness in adolescence, from age 13 to 17.

Boys had an increased risk of blood clots in infancy, while girls were more likely to carry the risk into adolescence and adulthood, the study authors reported.

No one knows why this increased risk exists, but it could be due to genetic factors that caused the mother to deliver prematurely in the first place, Watterberg and McCabe said.

Diseases such as diabetes, thyroid problems and obesity are genetic in nature and can cause preterm delivery, McCabe said.

Also, some mothers who suffer a genetic deficiency in a key protein that controls blood clotting may be predisposed to give birth prematurely, Watterberg said.

"It may be that maternal genetics are a setup for preterm delivery, and those problems are passed along to the infant," she said.

The mother's wellness and lifestyle also play a role in a baby's lifelong health, and could influence their risk of blood clots, McCabe said.

Finally, this link might arise because the babies are born prematurely, and are robbed of maternal hormones and nutrition in the womb that could have decreased their future risk of blood clots.

"We are not as good at getting nutrition into those babies as the mother and placenta are, and we do know that hormones have something to do with the predisposition to clotting," Watterberg said. "It makes sense to me you'd have changes in those long-term outcomes as well."

In any case, it is something for the family and doctor of a person born prematurely to keep in mind, McCabe said.

"If a patient has a history of preterm birth, and the more preterm, the more attention it needs to have," he said. "It helps us be better prepared. If a patient comes in with unusual findings, this provides us some clue."

Source: http://healthfinder.gov

By SYDNEY LUPKIN

Wyatt Scott turned a year old earlier this summer, but he ate his birthday dinner through a tube in his tummy.

It’s been more than four months since the Scott family launched WhatsWrongWithWyatt.com to find out why their baby boy can’t open his mouth, and though they’ve been flooded with emails, their little boy’s condition remains a mystery.

Wyatt’s lockjaw has baffled doctors since he was born in June 2013 in Ottawa, Canada, and though the Scott family has taken him to every specialist imaginable, they can’t figure out the root of the problem, Andrew Scott said. Wyatt spent the first three months of his life in the hospital, and his parents have had to call 911 several times because he's been choking and unable to open his mouth.

So Wyatt's mother, Amy, decided to create a website, WhatsWrongWithWyatt.com last spring in the hopes that someone would recognize the condition and offer a solution.

Wyatt's doctor, Dr. J. P. Vaccani, told ABC News in April that the condition, congenital trismus, is rare and usually the result of a fused joint or extra band of tissue. But Wyatt’s CT and MRI scans appear to be normal.

"It's an unusual situation where he can’t open his mouth, and there’s no kind of obvious reason for it,” Vaccani, a pediatric otolaryngologist at Children’s Hospital of Eastern Ontario told ABC News. “Otherwise, he’s a healthy boy."

Andrew Scott said he’s sifted through 500 emails submitted to WhatsWrongWithWyatt.com over the last several months, and compiled a list of the most important ideas to give to Wyatt’s doctors. One letter-writer from Virginia told the Scotts that Wyatt’s story made her cry because her now-14-year-old had similar mysterious symptoms.

“She could have written it herself,” Andrew Scott recalled her saying.

Though the Virginia 14-year-old underwent surgery and therapy, Andrew Scott said Wyatt seems to have something different.

“It’s not just that his mouth doesn’t open,” he said.

Wyatt underwent a study in which doctors X-rayed him while he was feeding to see how the muscles in his mouth and throat worked. They found that he has problems with motor function and swallowing in addition to the lockjaw.

“His blinking is erratic,” Andrew Scott added. “He’ll wink on one side a bunch, then the other side and back and forth.”

Their quest for answers has been slow. A recent muscle biopsy came back negative, and Wyatt is awaiting results of his third genetic test.

Since the website launched, Wyatt had a major health scare: he stole a piece of chicken off his mother’s plate and put it in his mouth, Andrew Scott said. His lips were parted just enough to get it in, but neither of his parents could get it out, so they pulled it out in pieces. They thought it was all gone when Wyatt fell asleep.

Then, Wyatt started choking.

“He almost died,” Andrew Scott said. “I ended up just giving him breath.”

Wyatt “came back” just as ambulances and fire trucks arrived, Andrew Scott said. At the hospital, doctors scoped Wyatt’s lungs, but he was still coughing up chicken pieces several days later.

The emergency forced doctors to use anesthesia to put Wyatt to sleep, which they were too afraid to do before because they feared he would stop breathing. While he was out for the lung scope, the also did a muscle biopsy and put in a G-tube. Now, instead of being fed through a tube in his nose that leads to his stomach, Wyatt can “eat” through a tube in his belly.

Wyatt’s birthday party at the end of June was a pig roast that drew 50 people and included a piñata, goats and a trampoline. Though Wyatt didn’t get any mashed-up pig in his G-tube, Andrew Scott said “maybe next time.” By the end of the party, Wyatt was sound asleep in the grass.

“He is a very happy baby,” he said.

Source: http://abcnews.go.com

By Kim Painter

A nice firm handshake has long been a mark of good manners and elevated social skills.

It is also a very germy way to greet your fellow humans, much worse than a couple of more casual alternatives, a new study shows.

"A short, sweet fist bump will transmit the least bacteria," and even a high-five is better than a traditional shake, says David Whitworth, a senior lecturer in biochemistry at Aberystwyth University-Ceredigion in the United Kingdom.

Whitworth and a colleague systematically tested the three greetings for a study published Monday in the American Journal of Infection Control.

For the experiment, one of them repeatedly dipped a gloved hand into a container loaded with a not-too-dangerous strain of E. coli bacteria. The dirty-gloved scientist let the film dry, then shook, fist-bumped or high-fived the other person's clean, gloved hand. Finally, the receiving gloves were tested for bacteria.

Result: The shakes transmitted about 10 times more bacteria than the fist bumps and about two times more than the high fives. The longest, firmest shakes transmitted the most.

In a separate round in which the gloves were dipped in paint rather than bacteria, the researchers found one rather obvious explanation: Bigger areas of the hands touched during the shakes. Handshakes also tended to last longer, but the researchers found more clinging germs even when they compared shakes to fist bumps and high-fives of the same duration.

Since we don't go around dipping our hands in vats of bacteria, the experiment does not perfectly mimic real life – in which different areas of the hand carry different amounts of bacteria, for one thing. It does provide some new ammunition for those who would like to ban handshaking in hospitals and other places where germs are a particular concern.

Whitworth says it also provides an especially good alternative, the fist bump. "You can't really imagine a world where people don't greet each other physically," he says. "It seems to be a basic human need."

Whitworth's findings "are not surprising," says Mary Lou Manning, an associate professor in the school of nursing at Thomas Jefferson University in Philadelphia and president-elect of the Association for Professionals in Infection Control and Epidemiology.

She is not enthusiastic about replacing handshakes with fist bumps in hospitals. The better, more hygienic idea, she says, is to promote rigorous hand-washing and ban hand-to-hand greetings altogether. "That's already starting to happen" in a lot of places, she says.

She says she "can't even imagine" health workers and patients greeting one another with a casual fist bump. A nod or slight bow might be nicer, she says.

Whitworth concedes that the perceived informality of fist bumps and high fives might be a problem. Figures as august as President Obama and the Dalai Lama have used them, he notes – "but I couldn't imagine the British prime minister doing that."

Source: www.usatoday.com

 By Carly Ledbetter

An 11-year-old's wish to give the gift of life to others came true on the last day of his life. The photograph below shows doctors bowing to Liang Yaoyi, a gifted student from Shenzhen, China, who died from a brain tumor in June. His mother can be seen crying in the background.

Liang was diagnosed with the tumor at the age of 9, just after he moved to Shenzhen to join his brother and sister, and to attend primary school, Shanghai Daily reports. One day, Liang felt dizzy and the next day had trouble walking, so his sister took him to a hospital where he learned he had a brain tumor.

Before passing away on June 6, Liang told his mother, Li Qun, that he wanted to donate his organs.

"There are many people doing great things in the world," he said according to China Daily. "They are great, and I want to be a great kid too."

CCTV News reported that Liang also said it was also a chance for him to be "alive in another way."

Liang's teacher said he may have learned of organ donation by reading stories in a school textbook. Liang's mother honored his wishes and doctors were able to save his kidneys and liver for donation, according to China Daily.

The picture has created a firestorm within Chinese media outlets and on Reddit, where users commented on the beauty of the photo, the strength of Liang and the importance of organ donation.

If you would like to learn more about how you can become an organ donor, contact Donate Life.

Source: www.huffingtonpost.com

By Joe Sutton and Holly Yan

A second American aid worker in Liberia has tested positive for Ebola, according to the Christian humanitarian group she works for.

Nancy Writebol is employed by Serving in Mission, or SIM, in Liberia and was helping the joint SIM/Samaritan's Purse team that is treating Ebola patients in Monrovia, according to a Samaritan's Purse statement.

Writebol, who serves as SIM's personnel coordinator, has been living in Monrovia with her husband, David, according to SIM's website. The Charlotte, North Carolina, residents have been in Liberia since August 2013, according to the blog Writebols2Liberia. They have two adult children.

On Saturday, Samaritan's Purse announced that American doctor Kent Brantly had become infected. The 33-year-old former Indianapolis resident had been treating Ebola patients in Monrovia and started feeling ill, spokeswoman Melissa Strickland said. Once he started noticing the symptoms last week, Brantly isolated himself.

Brantly, the medical director for Samaritan Purse's Ebola Consolidated Case Management Center in Monrovia, has been in the country since October, Strickland said.

"When the Ebola outbreak hit, he took on responsibilities with our Ebola direct clinical treatment response, but he was serving in a missionary hospital in Liberia prior to his work with Ebola patients," she said.

Deadliest Ebola outbreak

Health officials say the Ebola outbreak, centered in West Africa, is the deadliest ever.

As of July 20, some 1,093 people in Guinea, Sierra Leone and Liberia are thought to have been infected by Ebola since its symptoms were first observed four months ago, according to the World Health Organization.

Testing confirmed the Ebola virus in 786 of those cases; 442 of those people died.

Of the 1,093 confirmed, probable and suspected cases, 660 people have died.

There also are fears the virus could spread to Africa's most populous country, Nigeria.

Last week, a Liberian man hospitalized with Ebola in Lagos died, Nigerian Health Minister Onyebuchi Chukwu said.

Lagos, the largest city in Nigeria, has a population of more than 20 million.

The man arrived at Lagos airport on July 20 and was isolated in a local hospital after showing symptoms associated with the virus. He told officials he had no direct contact with anyone with the virus nor had he attended the burial of anyone who died of Ebola.

Another doctor infected

Confirmation of the death in Lagos came after news that a doctor who has played a key role in fighting the Ebola outbreak in Sierra Leone is infected with the disease, according to that country's Ministry of Health.

Dr. Sheik Humarr Khan is being treated by the French aid group Medecins Sans Frontieres -- also known as Doctors Without Borders -- in Kailahun, Sierra Leone, agency spokesman Tim Shenk said.

Before falling ill, Khan had been overseeing Ebola treatment and isolation units at Kenema Government Hospital, about 185 miles east of the capital, Freetown.

Ebola typically kills 90% of those infected, but the death rate in this outbreak has dropped to roughly 60% because of early treatment.

Spread by bodily fluids

Officials believe the Ebola outbreak has taken such a strong hold in West Africa because of the proximity of the jungle -- where the virus originated -- to Conakry, Guinea, which has a population of 2 million.

Because symptoms don't immediately appear, the virus can easily spread as people travel around the region. Once infected with the virus, many people die in an average of 10 days as the blood fails to clot and hemorrhaging occurs.

The disease isn't contagious until symptoms appear. Symptoms include fever, headache and fatigue. At that point, the Ebola virus is spread via bodily fluids.

Health workers are at especially high risk, because they are in close contact with infected people and their bodily fluids. Adding to the danger, doctors may mistake the initial stages of an Ebola infection for another, milder illness.

Source: www.cnn.com