DiversityNursing Blog

Written by James McIntosh

While many would rather not think about when someone might die, knowing how much longer a seriously ill person has left to live can be very useful for managing how they spend their final days. Researchers have now revealed eight signs in patients with advanced cancer associated with death within 3 days.

Diagnosis of an impending death can help clinicians, patients and their friends and family to make important decisions. Doctors can spare time and resources by stopping daily bloodwork and medication that will not make a short-term difference. Families will know if they still have time to visit their relatives.

"This study shows that simple bedside observations can potentially help us to recognize if a patient has entered the final days of life," says study author Dr. David Hui.

"Upon further confirmation of the usefulness of these 'tell-tale' signs, we will be able to help doctors, nurses, and families to better recognize the dying process, and in turn, to provide better care for the patients in the final days of life."

The study, published in Cancer, follows on from the Investigating the Process of Dying Study - a longitudinal observational study that documented the clinical signs of patients admitted to an acute palliative care unit (APCU). During the study, the researchers identified five signs that were highly predictive of an impending death within 3 days.

For the new study, the researchers again observed the physical changes in cancer patients admitted to two APCUs - at the MD Anderson Cancer Center in Houston, TX, and the Barretos Cancer Hospital in Brazil.

Eight highly-specific physical signs were identified

A total of 357 cancer patients participated in the study. The researchers observed them and documented 52 physical signs every 12 hours following their admission to the APCUs. The patients were observed until they died or were discharged from the hospitals, with 57% dying during the study.

The researchers found eight highly-specific physical signs identifiable at the bedside that strongly suggested that a patient would die within the following 3 days if they were present. The signs identified were:

• Decreased response to verbal stimuli
• Decreased response to visual stimuli
• Drooping of "smile lines"
• Grunting of vocal cords
• Hyperextension of neck
• Inability to close eyelids
• Non-reactive pupils
• Upper gastrointestinal bleeding.

With the exception of upper gastrointestinal bleeding, all of these signs are related to deterioration in neurocognitive and neuromuscular function.

Neurological decline strongly associated with death

"The high specificity suggests that few patients who did not die within 3 days were observed to have these signs," the authors write. "These signs were commonly observed in the last 3 days of life with a frequency in patients between 38% and 78%. Our findings highlight that the progressive decline in neurological function is associated with the dying process."

As the study is limited by only examining cancer patients admitted to APCUs, it is not known whether these findings will apply to patients with different types of illness. The findings are currently being evaluated in other clinical settings such as inpatient hospices.

On account of the relatively small number of patients observed for this study, the authors also suggest that their findings should be regarded as preliminary until validated by further research.

In the meantime, the authors of the study are working to develop a diagnostic tool to assist clinical decision-making and educational materials for both health care professionals and patients' families.

"Upon further validation, the presence of these telltale signs would suggest that patients [...] are actively dying," they conclude. "Taken together with the five physical signs identified earlier, these objective bedside signs may assist clinicians, family members, and researchers in recognizing when the patient has entered the final days of life."

Source: www.medicalnewstoday.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

6. …but people still expect them to show up the second they ring the call bell.

7. Sometimes they’re working so hard, they can go entire shifts without eating, drinking water, or sitting.

instagram.com

Lunch break? What’s that?

8. Ditto going to the bathroom.

instagram.com

9. Some patients will incessantly hit on them.

Fox / Via nurseeyeroll.tumblr.com

10. Others will expose themselves for no clear medical reason.

Flickr: eflon / Creative Commons / Via Flickr: eflon

“Your arm is broken… so why is your dick out?”

Source: www.buzzfeed.com

By LIZ NEPORENT

Cathy Nichols and son Jason were front and center at the National Football League playoff game last Sunday to witness her beloved New England Patriots clinch a spot in this year’s Super Bowl.

The Fayette, Maine, resident, 59, had been diagnosed with terminal cancer just two days before the big game. She said it was the support of a close-knit community, and the generosity of the Patriots, that brought her to what she believed will be the last football game she will attend.

“My son and I are super fans and when I got the diagnosis, I told him we probably weren’t going to get to go to many more games,” Nichols told ABC News today. “Now, not only did I get to see them play, but I was at a playoff game; it was just unbelievable.”

Nichols’ worship of Tom Brady and all things Patriots is well known at Spruce Mountain High School in Jay, Maine, where she works as a special education teacher. So when she confided in several work friends about her illness, they immediately contacted a local sportscaster, who, in turn, reached out to the Patriots.

By Friday night, a team representative had called Nichols to offer her two tickets in the owner’s box to the playoff game.

Despite her rollercoaster of a week, Nichols said she was touched by the outpouring from friends and strangers alike.

“It isn't just the tickets, they’re doing fund-raisers and I’m getting calls from students and athletes I coached more than 25 years ago,” the former cheerleader coach said.

At Sunday’s game she not only had the best seats in the house, she was given field passes so she could watch the pregame warm-ups. Team owner Robert Kraft even called down to the field to make sure she was having a good time, before she returned to the box.

Nichols said she knows an invite to the Super Bowl was in the works but she put a stop to it. Doctors believe the disease may have already spread from her pancreases to her liver, she said, and she may only have six months to live. She doesn't feel strong enough to make the trip to Arizona for the February game.

But Nichols said she isn't bitter. Far from it.

“I am a very fortunate woman to have all this support and it makes me determined to be here as long as I can,” she said. “But I've lived a good life and I want to focus on quality of life over quantity.”

Source: http://abcnews.go.com

Moments after Jacob "Jake" Boddie woke from surgery to remove a tumor in his pelvis, his father, Kyle Boddie, said to his 2-year old son, "Hey, Jake, bust a move!" Although he was still groggy, the toddler smiled. One tiny shoulder, then the other, wiggled in time to a beat. 

Kyle and Jake's mother, Ashley McIntyre, say Jake started dancing long before he could walk. "And now that's all he does," Kyle said. "He loves it. You can't stop him."

During his yearlong treatment for a rare cancer, Jake danced with his nurses, child life specialists and doctors at the University of Chicago Medicine Comer Children's Hospital. He boogied in his hospital room, in the hallways, and even on the way to the operating room. His parents say dance helped Jake recover from his treatments and surgery. It helped them cope with their son's illness. 

"Even though Jake went through so much, he uplifted us," Ashley said. "We thought, if he can have fun through all of this, why can't we?"

Kyle and Ashley knew something was wrong when Jake wasn't acting like himself at a Fourth of July picnic in 2013. Agitated and restless, the toddler wasn't his "silly self" and refused to dance or play with the other children. A few days later he began limping. An ultrasound performed in the emergency room at Comer Children's Hospital showed a large mass resting in the lower part of his abdomen and reaching into his pelvis.

A biopsy revealed the mass to be a sarcoma, a fast-growing cancer. "The tumor was 4 inches in diameter, about the size of a small grapefruit," said pediatric oncologist Navin Pinto, MD, an expert on sarcoma treatment. In addition to his clinical work, Pinto leads a personalized medicine initiative at Comer Children's Hospital that is sequencing the genetic makeup of pediatric tumors from every patient to help guide treatment.

For Jake, several rounds of chemotherapy were needed to shrink the tumor to half its original size. It was then small enough to be removed, but Jake's surgery would be complicated. The tumor was wrapped around critical blood vessels as well as the right ureter, a tube that brings urine from the kidney to the bladder. 

On the morning of the surgery in January 2014, Ashley and Kyle danced with Jake to the song "Happy" as they headed toward the operating room doors; there they turned him over to the surgical team. "Jake knew something was going on," Ashley recalled, "but I think it made him feel better to see us laughing and dancing."

Pediatric urologist Mohan Gundeti, MD, and pediatric surgeon Grace Mak, MD, worked together in the surgical suite. First, Gundeti used an endoscopic approach, placing a stent in the ureter to mark its location and keep the fragile tube open. Mak then surgically removed as much of the tumor as possible, meticulously separating it from the vessels and ureter while avoiding nearby nerves. 

"Jacob recovered beautifully and bounced back quickly after the operation," Mak said, adding, "he was eating -- and doing his moves -- a few days later."

Completing Jake's treatment required both chemotherapy and radiation to eliminate any lingering cancer cells. In addition, the lower section of the right ureter had narrowed, leading to pressure on the right kidney, and needed attention before it became completely obstructed. 

Gundeti performed reconstructive surgery, moving the right kidney down a few centimeters and making a new tube for the ureter using a flap from the bladder. Again, Jake recovered quickly from an extensive surgery.

Today, the 3-year-old visits Comer Children's Hospital regularly for follow-up care with the nurses and doctors who cared for him. 

"He feels comfortable at the hospital; he's always laughing and having a good time," Kyle said. "Everyone knows him now. And everyone dances with him."

Source: www.uchicagokidshospital.org

By Dan Kedmey

General Electric released images on Wednesday from its first clinical trial of a next generation body scanner that captures bones, blood vessels and organs in high-definition.

The patients ride into the chamber of the scanner, dubbed “Revolution CT,” where a fan-shaped beam of x rays passes down their bodies and a computer reconstructs a digital model of the body, slice-by-slice. The scanner can build an image of a heart in the time it takes for a single heartbeat, according to GE.

The snapshots below, provided by GE, may look like an artist’s rendering from an anatomy textbook. In fact, they were taken from living patients at West Kendall Baptist Hospital in south Florida, the first hospital to test the new scanner in the field.

Source: http://time.com

By Marie Ellis

Amyotrophic lateral sclerosis - also known as Lou Gehrig's disease - is a condition that gradually attacks nerve cells that control our voluntary movement, leading to paralysis and death. In the US, a reported 30,000 individuals are living with the disease, but now, scientists have identified a fault in protein formation, which could be the origin of this condition.

The researchers, from the University of Wisconsin-Madison, have published their study on amyotrophic lateral sclerosis (ALS) in the journal Cell Stem Cell.

According to the Centers for Disease Control and Prevention (CDC), nobody knows for sure why ALS occurs, and there is currently no cure.

The researchers of this latest study, led by Su-Chun Zhang, senior author and neuroscientist at UW-Madison, say previously, a genetic mutation was discovered in a small group of patients with ALS, prompting scientists to transfer that gene to animals for drug treatment testing. 

However, this approach has not yet worked. As such, Zhang and his team decided to study diseased human cells - called motor neurons - in lab dishes. These motor neurons are what direct muscles to contract, and Zhang explains this is where failures occur in ALS.

Discovery centers on faulty proteins inside motor neurons

Zhang was the first scientist to ever grow motor neurons from human embryonic stem cells around 10 years ago, and he has recently been transforming skin cells into induced pluripotent stem (iPS) cells, which are then transformed into motor neurons.

He explains that the iPS cells can be used as models for disease since they have many of the same characteristics as their donor cells.

"With iPS, you can take a cell from any patient, and grow up motor neurons that have ALS," Zhang explains. "That offers a new way to look at the basic disease pathology."

For their latest study, the researchers have focused on proteins that erect a transport structure - called a neurofilament - inside the motor neurons.

They say the neurofilament moves chemicals and cellular parts - including neurotransmitters - to far sides of the nerve cell. 

Zhang explains that the motor neurons, for example, that control foot muscles are around 3 ft long, so they need to be moved a whole yard from the cell body to the spot where they can signal the muscles.

As such, one of the first signs of ALS in a patient who lacks this connection is paralysis of the feet and legs.

'Findings have implications for other neurodegenerative disorders'

Before now, scientists have understood that with ALS, so-called tangles - misshapen protein - along the nerve's paths block the route along the nerve fibers, which eventually results in the nerve fiber malfunctioning and dying.

The team's recent discovery, however, has to do with the source of these tangles, which lies in a shortage of one of three proteins in the neurofilament.

Zhang explains that the neurofilament plays both a structural and a functional role:

"Like the studs, joists and rafters of a house, the neurofilament is the backbone of the cell, but it's constantly changing. These proteins need to be shipped from the cell body, where they are produced, to the most distant part, and then be shipped back for recycling.

If the proteins cannot form correctly and be transported easily, they form tangles that cause a cascade of problems."

He says their discovery is that the origin of ALS is "misregulation of one step in the production of the neurofilament."

Additionally, he notes that similar tangles crop up with Alzheimer's and Parkinson's diseases: "We got really excited at the idea that when you study ALS, you may be looking at the root of many neurodegenerative disorders."

Zhang and his team also observed that this misregulation happens very early, which is why it is highly likely that what they found is the origin ALS.

"Nobody knew this before, but we think if you can target this early step in pathology, you can potentially rescue the nerve cell," he says.

And as if this discovery is not exciting enough, the team also found a way to rescue the neural cells in the lab dishes, and when they "edited" the gene that orchestrates formation of the blundered protein, they found that the cells suddenly looked normal.

They report that they are currently testing a wide range of potential drugs, which brings hope to the domain of ALS research.

The CDC have a National ALS Registry, where patients with the condition can complete brief risk-factor surveys to help scientists defeat ALS.

Source: www.medicalnewstoday.com

By Steven Reinberg

A brain abnormality may be responsible for more than 40 percent of deaths from sudden infant death syndrome (SIDS), a new study suggests.

The abnormality is in the hippocampus, a part of the brain that influences breathing, heart rate and body temperature. This abnormality may disrupt the brain's control of breathing and heart rate during sleep or during brief waking that happens during the night, the researchers report.

"This abnormality could put infants at risk for SIDS," said lead researcher Dr. Hannah Kinney, a professor of pathology at Harvard Medical School in Boston.

Kinney can't say for sure that this abnormality is a cause of SIDS. "We don't know at this stage. This is the first observation of this abnormality," she said. "It's just an observation at this point."

Before this brain abnormality can be called a cause of SIDS, Kinney said, they have to find out what causes this abnormality and determine if it alone can cause SIDS.

For the study, Kinney's team examined sections of the hippocampus from 153 infants who died suddenly and unexpectedly between 1991 and 2012. The deaths were classified as unexplained -- which includes SIDS -- or from a known cause, such as infection, accident, murder or lack of oxygen.

Kinney's group found that 41.2 percent of infants who died for an unexplained reason compared with 7.7 percent of those whose death was explainable had an abnormality in the part of the hippocampus known as the dentate gyrus. 

Among the 86 infants whose death was classified as SIDS, 43 percent had this abnormality, the researchers added.

This change in the dentate gyrus suggests there was a problem in development at some point late in the life of the fetus or in the months after birth, Kinney said.

Kinney added that this abnormality has only been seen under the microscope after death, so a child cannot be tested for the abnormality.

"There are no signs or symptoms that predict SIDS or warn families that this problem is there or that SIDS is going to occur," she said.

The report was published online Nov. 24 in the journal Acta Neuropathologica.

"Until we understand more about this abnormality, parents should follow the safe sleep recommendations of the American Academy of Pediatrics," Kinney said.

The recommendation is to place an infant alone in a crib on the back without toys or pillows as bolsters. "The same messages we have always had are still applicable," she said.

SIDS is the leading cause of death of infants younger than 1 year of age in the United States, the researchers said.

Dr. Sayed Naqvi, a pediatric neurologist at Miami Children's Hospital, noted that this brain abnormality has been found in epilepsy, but this is the first time it has been linked to SIDS.

"This needs to be confirmed and more research done to say this is a cause of SIDS," he said. 

Marian Willinger, a special assistant for SIDS at U.S. National Institute of Health's Eunice Kennedy Shriver National Institute of Child Health and Human Development, said in a statement, "The new finding adds to a growing body of evidence that brain abnormalities may underlie many cases of SIDS." 

"The hope is that research efforts in this area eventually will provide the means to identify vulnerable infants so that we'll be able to reduce their risk for SIDS," she added.

Source: www.medicinenet.com