DiversityNursing Blog

By CHRISTINA FARR

SAN FRANCISCO, USA - For decades, medical technology firms have searched for ways to let diabetics check blood sugar easily, with scant success. Now, the world's largest mobile technology firms are getting in on the act.

POACHING

Silicon Valley is already opening its vast wallet.

Medtronic Inc Senior Vice President of Medicine and Technology Stephen Oesterle recently said he now considers Google to be the medical device firm's next great rival, thanks to its funding for research and development, or R&D.

"We spend $1.5 billion a year on R&D at Medtronic - and it's mostly D," he told the audience at a recent conference. "Google is spending $8 billion a year on R&D and, as far as I can tell, it's mostly R."

Google has been public about some of its plans: it has developed a "smart" contact lens that measures glucose. In a blog post detailing plans for its smart contact lens, Google described an LED system that could warn of high or low blood sugar by flashing tiny lights. It has recently said it is looking for partners to bring the lens to market.

The device, which uses tiny chips and sensors that resemble bits of glitter to measure glucose levels in tears, is expected to be years away from commercial development, and skeptics wonder if it will ever be ready.

Previous attempts at accurate non-invasive measurement have been foiled by body movement, and fluctuations in hydration and temperature. Tears also have lower concentrations of glucose, which are harder to track.

But the Life Sciences team in charge of the lens and other related research is housed at the Google X facility, where it works on major breakthroughs such as the self-driving car, a former employee who requested anonymity said.

Apple's efforts center on its iWatch, which is on track to ship in October, three sources at leading supply chain firms told Reuters. It is not clear whether the initial release will incorporate glucose-tracking sensors.

Still, Apple has poached executives and bio-sensor engineers from such medical technology firms as Masimo Corp, Vital Connect, and the now-defunct glucose monitoring startup C8 Medisensors.

"It has scooped up many of the most talented people with glucose-sensing expertise," said George Palikaras, CEO of Mediwise, a startup that hopes to measure blood sugar levels beneath the skin's surface by transmitting radio waves through a section of the human body.

The tech companies are also drawing mainstream interest to the field, he said. "When Google announced its smart contact lens, that was one of the best days of my career. We started getting a ton of emails," Palikaras said.

Samsung was among the first tech companies to produce a smartwatch, which failed to catch on widely. It since has introduced a platform for mobile health, called Simband, which could be used on smart wrist bands and other mobile devices.

Samsung is looking for partners and will allow developers to try out different sensors and software. One Samsung employee, who declined to be named, said the company expects to foster noninvasive glucose monitoring.

Sources said Samsung is working with startups to implement a "traffic light" system in future Galaxy Gear smartwatches that flashes blood-sugar warnings.

Samsung Ventures has made a number of investments in the field, including in Glooko, a startup that helps physicians access their patients' glucose readings, and in an Israeli glucose monitoring startup through its $50 million Digital Health Fund.

Ted Driscoll, a health investor with Claremont Creek Ventures, told Reuters he's heard pitches from potentially promising glucose monitoring startups, over a dozen in recent memory.

Software developers say they hope to incorporate blood glucose data into health apps, which is of particular interest to athletes and health-conscious users.

"We're paying close attention to research around how sugar impacts weight loss," said Mike Lee, cofounder of MyFitnessPal.

After decades of false starts, many medical scientists are confident about a breakthrough on glucose monitoring. Processing power allows quick testing of complex ideas, and the miniaturization of sensors, the low cost of electronics, and the rapid proliferation of mobile devices have given rise to new opportunities.

One optimist is Jay Subhash, a recently-departed senior product manager for Samsung Electronics. "I wouldn't be at all surprised to see it one of these days," he said. — Reuters

Source: gmanetwork.com

By BENJAMIN MUELLER

In a case weighing the government’s ability to require vaccination against the individual right to refuse it, a federal judge has upheld a New York City policy that bars unimmunized children from public school when another student has a vaccine-preventable disease.

Citing a 109-year-old Supreme Court ruling that gives states broad power in public health matters, Judge William F. Kuntz II of Federal District Court in Brooklyn ruled against three families who claimed that their right to free exercise of religion was violated when their children were kept from school, sometimes for a month at a time, because of the city’s immunization policies.

The Supreme Court, Judge Kuntz wrote in his ruling, has “strongly suggested that religious objectors are not constitutionally exempt from vaccinations.”

The lawyer for the plaintiffs, Patricia Finn, said she plans to appeal the decision, announced this month. On Thursday, Ms. Finn asked the district court to rehear the case.

Amid concerns by public health officials that some diseases are experiencing a resurgence in areas with low vaccination rates, the decision reinforces efforts by the city to balance a strict vaccine mandate with limited exemptions for objectors. Pockets of vaccination refusal persist in the city, despite high levels of vaccination overall.

State law requires children to receive vaccinations before attending school, unless a parent can show religious reservations or a doctor can attest that vaccines will harm the child. Under state law, parents claiming religious exemptions do not have to prove their faith opposes vaccines, but they must provide a written explanation of a “genuine and sincere” religious objection, which school officials can accept or reject.

Some states also let parents claim a philosophical exemption, though New York does not. Some parents refuse to have their children vaccinated because of a belief that vaccines can cause autism, though no link has ever been proved.

Two of the families in the lawsuit who had received religious exemptions challenged the city’s policy on barring their children, saying it amounted to a violation of their First Amendment right to religious freedom and their 14th Amendment right to equal protection under the law, among other claims. Their children had been kept from school when other students had chickenpox, their suit said.

The third plaintiff, Dina Check, sued on somewhat different grounds, saying that the city had improperly denied her 7-year-old daughter a religious exemption. She said the city rejected her religious exemption after it had denied her a medical exemption, sowing doubts among administrators about the authenticity of her religious opposition. But Ms. Check said the request for a medical exemption had been mistakenly submitted by a school nurse without her consent.

After the school barred her daughter, Ms. Check home-schooled her and then moved her to a private school that accepted her daughter without the vaccinations. State vaccination requirements cover public and private schools, but in New York City, private schools have more autonomy in handling exemptions.

“Disease is pestilence,” Ms. Check said, “and pestilence is from the devil. The devil is germs and disease, which is cancer and any of those things that can take you down. But if you trust in the Lord, these things cannot come near you.”

In turning down all three families, Judge Kuntz cited a 1905 Supreme Court ruling that upheld a $5 fine for a Massachusetts man who disobeyed an order to be vaccinated during a smallpox outbreak, a case that helped establish the government’s right to require immunizations as a matter of public health.

Ms. Finn, the families’ lawyer, said that case should not be relevant. “There’s no way that court anticipated that children would be subjected” to the vaccines they must get today, she said.

In New York, the statewide mean religious exemption rate rose over the last decade, from .23 percent in 2000 to .45 percent in 2011, a 2013 study in the medical journal Pediatrics said.

New York City schools granted 3,535 religious exemptions in 2012-13, according to data from the state’s Health Department. Though city schools, public and private, have an overall immunization rate around 97 percent, according to the department, 37 private schools were below 70 percent. Health experts believe that above a certain immunization rate, outbreaks are limited because a disease cannot spread to enough people during its incubation period to sustain itself, a phenomenon known as “herd immunity.” For measles, which is highly contagious, that rate is believed to be 95 percent, according to Daniel Salmon, deputy director at the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health.

Though widespread vaccinations have practically eliminated diseases like measles and mumps from the United States, flare-ups have occurred. The 477 measles cases reported this year represent the worst year-to-date count since 1994, according to the Centers for Disease Control and Prevention.

Among the 25 people who contracted measles in New York City between February and April this year, two were school-age children unvaccinated because of parental refusal. When one of the children, who was being home-schooled, contracted the measles, city health officials barred that child’s sibling, who had a religious exemption, from attending school. The sibling eventually contracted measles as well. Health officials credited the decision to keep the second child out of school with stopping the spread of disease in that community.

Ohio, which granted more than three times as many religious and philosophical exemptions to kindergarten students last year as it did in 2000, is struggling to contain a measles outbreak that has recently spread to 339 Amish people who were largely unvaccinated, the state health department said.

Mr. Salmon said it can be difficult for states to balance an obligation to mandate vaccination with some leniency for families who have strong objections. Rules that force parents to articulate their beliefs and require public officials to educate them about the risks of exemption are states’ best defense against the spread of disease, he said.

Still, especially because parents who refuse vaccination tend to cluster geographically, it takes only a few unvaccinated children to start an outbreak, he said. At that point, even vaccinated children are at risk.

“Diseases have a way of finding our vulnerabilities,” Mr. Salmon said, “the kinks in our armor.”

We want to know what you think. Agree or disagree?

Source: nytimes.com

By Hannah Poturalski

A research effort underway at an area nursing home is testing out telehealth robots and other technology to enhance a patient’s ability to remain independent longer.

Students and faculty from the University of Cincinnati’s College of Nursing, as well as students from the colleges of medicine, engineering and allied health sciences, have partnered with Maple Knoll Village to develop innovative models using technology to help older adults stay independent and in their homes longer, said Tim McGowan, vice president of operations at Maple Knoll.

“The quicker we can develop the technology necessary to safely monitor them at home, the lower the cost of care will be and the quality of life for the patient returning home will improve,” McGowan said.

Every month more than a quarter-million Americans turn age 65. By 2015, for the first time in U.S. history, people age 65 and older will outnumber children under age five, according to the Council on Aging of Southwestern Ohio.

The partnership has opened a “smart house” on the Maple Knoll campus, formally called the Innovation Collaboratory House, inside an independent living unit for the UC students to conduct research and pilot new technologies.

Debi Sampsel, chief officer of innovation and entrepreneurship at UC, said the partnership developed in October 2012, and the smart house opened last spring for senior capstone classes in nursing and engineering.

Now hundreds of students are using the facility for education, research and translational practice.

“The house is about preparing them to come out into the community and hone in on their skills and techniques they’ll need in real positions,” Sampsel said. “We can start mirroring real life because they have to start thinking on their feet.”

A number of student-led projects are underway at the house, including the ability to control the temperature and lighting from a remote location, and motion detectors used to track patterns of activity in daily living to detect when an unexpected change in habit has occurred, said Megan Gresham, spokeswoman for Maple Knoll.

“Staff or family can be alerted if say they’re not getting out of bed at a certain time,” Gresham said.

Sampsel said students are also training on human simulators — with speech and movements controlled by a teacher in the next room — to learn the proper ways to take an IV, bathe a patient, take blood pressure and listen to the heart and lungs.

“This fits into our strategic plan to creatively leverage technology to change health care,” said Greer Glazer, dean of UC’s College of nursing.

After a public open house June 26, the UC students will start working with physicians on geriatric rounds at Maple Knoll. A large telehealth robot, called “Flo Bot,” will go along on the rounds and nurse practitioner students and college of medicine fellows will access the data remotely from UC.

A smaller telehealth system coined “Little Bot” will be used by students making rounds inside the independent living units of resident who have volunteered.

“I’m most appreciative for the resident support at Maple Knoll,” Sampsel said. “It really brings home what their (the students’) health care profession is going to be all about.”

Sampsel said the two entities are developing a formal agreement to be reached this summer.

Source: journal-news.com 

BY ROSE RUSSELL

Kevin Cischke left a music career after 25 years to pursue a new one in nursing, and it won’t bother him that he’ll be a man in a profession largely dominated by women.

As the face of the nursing profession slowly changes, Mr. Cischke, 45, is among the growing number of men signing up for the job. According to the U.S. Census Bureau, slightly less than 10 percent of the 3.5 million nurses in 2011 were men. That’s up from 1970, when only 2.7 percent of nurses were males.

For Mr. Cischke – who will receive a bachelor’s in nursing next year from Mercy College — nursing is in line with his interests. When introduced to nursing, the former organist and choir master for the Archdiocese of Detroit fell in love with it.

“A couple of my close friends who are nurses said I should look into this profession to see if it would interest me,” he said, during a break from his externship in the emergency room at Mercy St. Vincent Medical Center. “It was a whirlwind love affair that has not ended, and I don’t suspect that it will.”

Craig Albers, chief nursing officer and vice president of patient care services at Mercy St. Charles Hospital, said men in nursing offer an important component in the delivery of public health care.

“In the past, nursing was more of a pink collar profession and more of a career for women. A lot of times it’s seen as a profession for Caucasian women. Now, with large numbers of baby boomers retiring and seeking health care, we need a diverse workforce able to work with a diverse population,” said Mr. Albers.

A nurse himself since 1998, he began his college studies pharmacy. When he decided he needed more patient interaction, a professor suggested he look into nursing.

“I job shadowed an ICU nurse and the role really appealed to me. That’s what led me to the profession,” he said.

It was the patients who also attracted Mr. Cischke.

"I enjoy the patient-care side of things. I wanted hands-on patient care. That's what drives me, and the fact that I can continue to learn and grow fits my personality perfectly," he said.

He also liked contributing to the profession and addressing concerns of his male peers. In fact, when they discovered something missing in their nursing school experience, he led the way to establishing a local chapter of the American Assembly of Men in Nursing. The organization addresses issues that affect men in nursing. About 20 men and five women are members of the group.

"I continued to explore what the assembly had to offer, promote, and to accomplish and I realized that their goals aligned with what we needed to have at Mercy to support our male students," said Mr. Cishke, one of 116 male students in the nursing program.

The organization will also help groom male nurses for retiring baby boomers who increasingly use health care. Health professionals who deliver care to boomers must be on their toes.

"Our baby boomer population will be very informed and knowledgeable and Internet and computer savvy, and people going into the nursing profession will have to be extremely knowledgeable and confident and able to communicate with their patients because the patients are very knowledgeable," said Mr. Albers.

While male nurses' physical strength is also a plus for patient care, Mr. Albers said more men joining the field may pursue advanced fields in nursing, such as management, administration, business, and anesthetics. Those advanced career possibilities attracted Daniel Koehler to the profession.

He received a bachelor's in nursing from Lourdes University in December. Eight years ago, he obtained a bachelor's in human biology from Michigan State University. He then worked in the restaurant and fitness businesses before going to nursing school.

He wasn't intimidated by the predominantly female profession, and in fact received positive responses from others.

"Most guys don't grow up thinking they want to be nurses," as many girls do, said Mr. Koehler, whose mother was a nurse in Germany. "With the guys I've met in the profession, I think less of that stigma now days."

Though slightly less than 10 percent of ProMedica's nurses are men and slightly more than 8 percent of the nurses in the Mercy health system are men, the idea that nursing is a woman's job stopped Roberta Pratte's father and grandfather, both medics in the military, from continuing in the profession. As a teenager, Ms. Pratte — a Mercy nursing professor — recalls hearing her grandfather speak fondly about nursing.

"Back then it wasn't something that men talked about or thought about. I sensed that they regretted that they were not allowed to follow their dream," said Ms. Pratte, an instructor at Mercy College. She has been a nurse for 33 years, and her mother was also a nurse.

Large numbers of nurses are expected to retire soon, adding to the already critical nursing shortage. That's why the profession is pushing to attract men and women into nursing. As a matter of fact, the American Assembly for Men in Nursing is campaigning to increase the number of male nurses by 20 percent by the year 2020, said Ms. Pratte. She also said the Institute of Medicine and the Centers for Disease Control and Prevention are reviewing how to fill nursing positions to ensure that the public gets proper care.

Source: toledoblade.com

By Stacey Burling

The nurses' emotional response to George's impending loss was a sign of the emotional power of narrative, which the National League for Nursing is harnessing to improve education about late-life medical problems. The group also is embracing a multimedia approach that includes the written word, audio recordings of the "patients" voiced by actors, simulations that include mannequins and live actors, and the latest addition: virtual animations of the patients and nurse avatars who make treatment decisions.

"Traditional-based teaching is really over for most of us," Elaine Tagliareni, the league's chief program officer, told the crowd of about 175 who had gathered for her group's Advancing Care Excellence for Seniors conference. The Independence Blue Cross Foundation is a sponsor. Using technology to improve care was a theme this year.

The nursing group wants to reach a new generation of students who are already accustomed to multimedia learning, may be taking classes online, and will work in a world where technology increasingly connects patients, doctors, and nurses who are not in the same room.

Medical and nursing schools have long used standardized patients: actors who portray certain medical conditions. Increasingly sophisticated mannequins have been playing a bigger role in medical education in recent years.

Drexel University's College of Nursing and Health Professions began using a virtual-patient program produced by Shadow Health last year. It is meant to reinforce classroom training. The University of Pennsylvania School of Nursing also is using a Shadow Health program to teach nurses how to take a health history and perform a physical exam.

Gregg Lipschik, director of life-support training and undergraduate curriculum at the Penn Medicine Clinical Simulation Center, said Penn sometimes uses a virtual program to review resuscitation techniques. It pairs computer simulation and mannequins to teach procedures such as bronchoscopies.

Lipschik said use of simulation had been growing since 1999, when an Institute of Medicine report recommended it to reduce medical errors and improve teamwork. "It's really boomed in the last few years," he said.

The nursing league began its Advancing Care program in 2009, Tagliareni said, because "care of older adults is not well integrated into nursing programs" even though 75 percent of the care nurses give is to people over 65. It's adding the new dementia cases to expand education on another neglected topic.

The patient profiles are purposely complicated - like real people - and they unfold over time in unpredictable ways. The death of George Palo's golden retriever is a calamity not only because George's grief adds to his thinking problems but because walking Max was a key way the man exercised and interacted with the outside world. The profiles are accompanied by teacher information.

Tagliareni said that the dementia patients may not end up in the virtual world but that other fictitious elderly characters like Millie Larsen and Red Yoder may be available this fall in the gamelike "vSim for Nursing" program developed by Wolters Kluwer Health of Philadelphia and Laerdal Medical.

An audience member said her students easily identified with the league's patients. "That's my Pop-Pop," one of them told her.

The group at the meeting saw a younger virtual patient named Stan and his virtual nurse, Dan. Stan had gone to the emergency room with stomach pain from a bowel obstruction. The student, who had access to test information and doctor's orders, had to use a menu of options to decide what Dan should say and do. The animation was primitive, but the decisions were complex. At the end of their 30-minute encounter, the student received a number score and a report on what had been done and should have been done.

Barbara McLaughlin, head of nursing at Community College of Philadelphia, did a pilot test of vSim, which costs $100 per student for two years of access, with her students last year. "They liked them [the scenarios] a lot because it gave them the opportunity to do the same experience over and over and correct their mistakes," she said.

Source: philly.com

Wolters Kluwer Health

Concerted effort is needed to reverse the ongoing rise in pertussis cases and deaths, especially among children and young people, according to the article in the Journal of Christian Nursing by Emily Peake, APRN, MSN, FNP-C, CLC, and Lisa K. McGuire, MSN, MBA-HCM, RN. "This effort begins with nurses and nurse practitioners and other primary care providers who educate patients and the public," they write. "The battle of pertussis is winnable through education, awareness, and vaccination."

Caused by infection with Bordetella pertussis  bacteria, pertussis has been increasing in recent years. In the United States, average annual pertussis cases increased from less than 3,000 cases per year during the 1980s to 48,000 in 2012, including 20 deaths. Worldwide, there are an estimated 50 million cases of pertussis and 300,000 deaths. Pertussis is a major cause of death in infants worldwide.

Why is pertussis on the rise? "Ambivalence toward precautionary childhood vaccinations" is a key reason, along with the lack of well-child visits and appropriate boosters. The arrival of non-vaccinated immigrants may also be linked to new clusters of pertussis outbreaks, according to Peake and McGuire. They write, "Nurses should educate patients and the public that follow-up booster vaccinations at all ages are critical to maintain immunity to pertussis and other vaccine-preventable diseases."

Issues including vaccine availability and cost, literacy and language barriers, and lack of information all contribute to the lack of recommended vaccinations. Fear of vaccination and religious objections also play a role. Most states allow exemptions from vaccination based on religious reasons, and there's evidence that even non-religious parents are using these exemptions to avoid vaccinating their children.

Nurses should reassure parents that that recommended vaccines are safe. Current diphtheria-tetanus-pertussis vaccines do not contain the mercury-containing preservative thimerosal. Adverse events occur in only a small fraction of vaccinated children, and most of these are mild local reactions.

"Practitioners must build a trusting relationship with patients and reinforce the need for vaccinations through face-to-face contact, engaging parents to discuss concerns, and provide evidence-based research to guide recommendations and reassure patients of the safety of vaccines," Peake and McGuire write. Waiting rooms provide a good opportunity to present videos and other educational materials.

The World Health Organization is working to increase the percentage of infants who receive at least three doses of pertussis vaccine to 90 percent or higher, especially in developing countries. Closer to home, partnerships should be formed with service organizations, food banks, churches, hospitals and schools. "These groups can help identify those most likely not to be vaccinated and help them find free or low cost immunizations," the authors write. "Faith community nurses are in an ideal role to create and lead these partnerships."

Nurses can also advocate for policies aimed at making universal vaccinations available for adolescents and adults. Peake and McGuire conclude, "By using our resources and uniting, a global battle will be waged and won against pertussis and the children of tomorrow can breathe easier for a lifetime."

Source: infectioncontroltoday.com

By Jeffrey S. Solochek

TRINITY, Fla. (AP) — Evan Wolin sat patiently in his slightly oversized cap and knee-length black gown, waiting his turn.

One by one, the teacher called his classmates to the stage. Then, finally, she read his name.

Evan burst from his seat, sped to the front and grabbed his diploma, a huge smile eclipsing his face. He thrust the paper into the air with an extra arm pump, as his mom, Jessica, tried not to cry while she captured it all on her phone.

He was so ready for kindergarten.

____

Nearly three years ago, when Evan first entered Longleaf Elementary's preschool program for children with developmental delays, few predicted that this day would come.

At 2 1/2 years old, he had barely begun walking, hadn't started talking and coped daily with many medical problems stemming from being born a micropreemie.

"On paper, his medical diagnosis had us thinking, 'Oh, my,' " recalled school speech pathologist Janice Whittaker.

Since he still sometimes used a feeding tube, some of the staff at Longleaf thought Evan might be better suited for a program at Cotee River Elementary, which had dedicated nurses on staff. But his mom, a special-education teacher, and dad, a school administrator, did not want their son in a medical unit.

"I knew developmentally I wanted him in the area school. I knew that he had more in him," Jessica Wolin said. "Although he wasn't speaking, although he wasn't eating, I knew he was very bright. . I always wanted him to be challenged."

Teacher Heather Goldstein, also a neighbor of the Wolins who remembered seeing Evan come home as an infant "with every tube connected to him," committed to making her classroom work for his needs.

"As soon as they told me, I went right online to research everything," she said. "I thought, if he is coming I want to make sure I have everything in place."

Before he arrived, Goldstein reorganized the furniture in her book- and toy-filled classroom to make it easier for Evan to navigate. She continued to learn about his medical demands and prepare for his academic requirements, communicating with his family to keep them informed on daily activities.

Jessica Wolin praised Goldstein's dedication, saying the teacher went above and beyond to make Evan feel at home in school and to help ensure his success. District special-education prekindergarten coordinator Kelli Boles never doubted it.

Goldstein, Boles said, exemplifies what the school district wants from its teachers in the program, which is federally funded and guaranteed to all eligible children with special needs ages 3 to 5. When other educators need training or classroom ideas, Boles sends them to Goldstein.

"She knows where the kids are, what they need to work on," Boles said. "She's the model of what I would like to see for all classrooms."

Goldstein's overriding philosophy is simple: Treat all kids like typical kids, set high expectations and then help them get there. She's taught her special-needs preschoolers to read and write that way, not to mention how to speak and socialize.

____

During a recent class day, Goldstein had Evan working with pattern blocks, where he would match colored plastic shapes to a design on a paper. She had him count yellow hexagons to figure out how many he needed to complete the pattern. Then she turned to another set of pieces.

"What do we call the blue?" she asked. "We used to call them diamonds, but now that you're going to kindergarten we have to call them ..."

"Rom," Evan said, looking up at Goldstein for affirmation.

"Rhombus," she said, completing the word.

"I love rhombus," Evan said cheerfully, placing them on the pattern and then sweeping them all away to start again. "I did it!"

"What do you get to do now?" Goldstein asked.

"Build a tower!" Evan shouted. He started to stack pieces, knock them down and repeat.

____

Goldstein refuses to take full credit for Evan's progress. Parents must participate actively, she said, and the child must be determined, too, in order for them all to find success.

That collaboration shone through for Evan, she said. "He amazes me every year."

His mom feels much the same.

When he was born at 24 weeks weighing 1.5 pounds, some people wondered whether he would even survive. She kept the faith through illnesses and surgeries for short-bowel syndrome, months in the hospital, feeding tubes, therapists.

Would he walk? Would he talk? Would he eat?

Now he races around at breakneck speed, bouncing from his pet hamster to his stash of toy cars, climbing on furniture and jabbering nonstop. He loves bacon and pancakes (and syrup and eggs), and though he's still small for his age, he loves to play with as much abandon as any 5-year-old.

In April, he was named Longleaf's pre-K student of the month.

Program coordinator Boles had nothing but good to say about Evan's progress, which includes his move to a traditional kindergarten class in the fall.

"He is like the poster child of why we do this, because early intervention works," she said, expressing hope that more families would enroll their eligible children in the classes.

Jessica Wolin, meanwhile, looks forward to Evan's next adventure. Sure, she's nervous about kindergarten, just like she was about so many other steps in her son's life.

But "he's done all those things. I want to be surprised by him. I want to see the next surprise."

Source: ksl.com

By LAUREN SILVERMAN

In the emergency department at Children's Medical Center in Dallas, pharmacists who specialize in emergency medicine review each medication to make sure it's the right one in the right dose.

It's part of the hospital's efforts to cut down on medication errors and dangerous drug interactions, which contribute to more than 7,000 deaths across the country each year.

At Children's in Dallas, there are 10 full-time emergency pharmacists, more than anywhere else in the country, and they are on call 24 hours a day. The pharmacists provide a vital safety net, according to Dr. Rustin Morse, chief quality officer and a pediatric ER physician.

"Every single order I put in," Morse says, "is reviewed in real time by a pharmacist in the emergency department prior to dispensing and administering the medication."

That may sound obvious, but Morse says doctors like him, are used to jotting down a type and quantity of drugs and moving on. If there's a problem, a pharmacist will hopefully catch it and get in touch later. But later won't work in the emergency room.

The extra review is particularly important at Children's because medication errors are three times more likely to occur with children than with adults. That's because kids are not "just little adults," says Dr. Brenda Darling, the clinical pharmacy manager for Children's Medical Center.

"They have completely different metabolic rates that you have to look at," Darling says, "so you have to know your patients."

On any given week, pharmacists at Children's review nearly 20,000 prescriptions and medication orders, looking at things like the child's weight, allergies, medications and health insurance.

There are also automatic reviews by an electronic medical record system designed to essentially "spell check" orders to prevent errors. You need both, says Dr. James Svenson, associate professor of emergency medicine at the University of Wisconsin, because the electronic medical record doesn't catch all errors.

Svenson co-authored a study in the Annals of Emergency Medicine that found that even with an electronic medical record, 25 percent of children's prescriptions had errors, as did 10 percent of adults'. Now his hospital also has a pharmacist in the emergency department 24 hours a day.

So why doesn't every hospital do this? The main reason, Svenson says, is money.

"If you're in a small ER, it's hard enough just to have adequate staffing for your patients in terms of nursing and techs, let alone to have a pharmacist sitting down. If the volume isn't there, it's hard to justify."

Hiring pharmacists is expensive, but Morse points to research showing prescription review can reduce the number of hospital readmissions, thereby saving money and lives.

"People do make mistakes," Morse says, and you need to make sure "a patient doesn't get a drug that could potentially stop them breathing because it's the wrong dose."

Source: npr.org

BY LINDA CARROLL

Want a healthy baby? You may want to roll her around in dirt.

For decades, parents have shielded infants from bacteria and other possible triggers for illness, allergies and asthma.

Interestingly, contact with bacteria and dander after age 1 was not protective — it actually increased the risk.

“It was the opposite of what we expected,” said Dr. Robert Wood, chief of the division of allergy and immunology at the Johns Hopkins Children’s Center and co-author of the study in the Journal of Allergy and Clinical Immunology. “We’re not promoting bringing rodents and cockroaches into the home, but this data does suggest that being too clean may not be good.”

 The new findings may help explain some contradictions in research on the so-called hygiene hypothesis, which suggested that kids growing up in a super clean environment were more likely to develop allergies.

“This doesn't completely resolve the controversy, but it does add a big piece of the puzzle,” said Dr. Jonathan Spergel, a professor of pediatrics and chief of allergy at the Children’s Hospital of Philadelphia.

“We’re not promoting bringing rodents and cockroaches into the home, but this data does suggest that being too clean may not be good.”

The theory “is that as we clean up our environment, our immune system moves away from being geared toward fighting bacteria and parasites,” said Dr. Maria Garcia Lloret, an assistant clinical professor of pediatric allergy and immunology at the Mattel Children’s Hospital at the University of California, Los Angeles. “It then has nothing to do and starts to react against things that are normally not harmful, like dust mites, or cat dander or cockroaches or peanuts.”

A chink in the hygiene hypothesis seemed to be the high rates of allergy and asthma in inner-city environments. But the new study may help explain the contradictions by showing that early exposure is crucial.

“It’s all about being exposed to the right bacteria at the right time,” Spergel said.

Wood and his colleagues followed 467 newborns for three years, screening them for allergies annually and testing the dust in the houses where they lived for allergens and bacteria. To the researchers’ surprise, kids who were exposed before their first birthday to mouse and cat dander along with cockroach droppings had lower rates of allergies and wheezing by age 3, compared to those who were not exposed so early on.

 In fact, wheezing was three times as common among children who had less exposure to those allergens early in life.

The protective effect of early exposure to allergens was amplified if the home also contained a wide variety of bacteria.

The reason may be that “a lot of immune system development that may lead someone down the path to allergies and asthma may be set down early in life,” Wood said.

Researchers aren’t ready to try to translate the new findings into practical advice for parents. But, Lloret said, we now know that “strict avoidance of allergens from the beginning does not protect you, and early exposure in the right context may make the difference between disease and tolerance. You could say that this is the downside of cleanliness.”

The new findings may upend advice experts have been giving to parents on the topic of pets and newborns.

“Twenty years ago we used to tell parents to get the cats and dogs out of the house,” Wood said. “This shows that the younger the child is when you get a pet, the better.”

Source: nbcnews.com

By AGATA BLASZCZAK-BOXE

Do men and women feel pain differently? A new study finds an unexpected gender divide.

Researchers found that men tend to report feeling more pain after major surgeries than women, whereas women tend to report experiencing more pain after minor surgical procedures than men.

In the study, researchers found that men were 27 percent more likely to report higher pain ratings after a major surgery such as a knee replacement, while women were 34 percent more likely to report experiencing more pain after procedures that the researchers labeled as minor, such as biopsies. (The researchers differentiated between "major" and "minor" procedures depending on the intensity of pain that people typically expect to feel after a particular procedure.)

To conduct the study, the researchers interviewed 10,200 patients from the University Hospitals of the Ruhr University of Bochum, Germany, following an operation, over more than four years. About 42 percent of the patients were male and 58 percent were female.

Initially, the study authors didn't find significant differences between the genders in people's overall experience of postoperative pain. However, that changed when the researchers distinguished between different kinds of surgeries.

The researchers are not sure where these differences stem from; however, they speculate that a lot may depend on the kind of surgery a person is undergoing. For instance, procedures such as cancer-related biopsies or an abortion may take a particularly serious emotional toll on women, and therefore exacerbate their individual perceptions of pain.

"It could be anxiety," study author Dr. Andreas Sandner-Kiesling of Medical University of Graz, Austria, told CBS News.

"This is a very interesting study," Dr. M. Fahad Khan, an assistant professor in the Department of Anesthesiology at NYU Langone Medical Center, told CBS News. "Ten thousand patients in any type of study is a huge number, and it is really great to see studies on that number of patients because it can limit a lot of the bias that some studies have."

Khan noted he found it interesting that in women, even smaller procedures "can be fraught with the development of pain problems after the procedure," which many people may not expect when they go to the hospital for a simple biopsy, he said.

Sandner-Kiesling said he did not think the findings should change the way men and women are treated for pain. "Clinically, there is no relevance," he said.

According to certain popular cultural stereotypes, women are often considered to be tougher about dealing with pain than men, but is this really the case?

"Anecdotally, people will say that women have a higher threshold for pain and they are more tolerant to pain, just because of their life experience. And perhaps, emotionally, maybe they are stronger than men," Khan said. "However, medically, in my experience, we haven't really noticed much of a difference with regard to men and women in the development of problems with dealing with severe and chronic pain."

The new study is presented at this year's Euroanaesthesia meeting in Stockholm.

Source:cbsnews.com