DiversityNursing Blog

When You Have The 'Right To Die,' But Don't Want To`

Posted by Erica Bettencourt

Tue, May 26, 2015 @ 02:26 PM

By Stephanie O'Neill

www.cnn.com 

150525102957 packer family 2 exlarge 169 resized 600Stephanie Packer was 29 when she found out she has a terminal lung disease.

It's the same age as Brittany Maynard, who last year was diagnosed with terminal brain cancer. Maynard, of northern California, opted to end her life via physician-assisted suicide in Oregon last fall. Maynard's quest for control over the end of her life continues to galvanize the "aid-in-dying" movement nationwide, with legislation pending in California and a dozen other states.

But unlike Maynard, Packer says physician-assisted suicide will never be an option for her.

"Wanting the pain to stop, wanting the humiliating side effects to go away -- that's absolutely natural," Packer says. "I absolutely have been there, and I still get there some days. But I don't get to that point of wanting to end it all, because I have been given the tools to understand that today is a horrible day, but tomorrow doesn't have to be."

A recent spring afternoon in Packer's kitchen is a good day, as she prepares lunch with her four children.

"Do you want to help?" she asks the eager crowd of siblings gathered tightly around her at the stovetop.

"Yeah!" yells 5-year-old Savannah.

"I do!" says Jacob, 8.

Managing four kids as each vies for the chance to help make chicken salad sandwiches can be trying. But for Packer, these are the moments she cherishes.

Diagnosis and pain

In 2012, after suffering a series of debilitating lung infections, she went to a doctor who diagnosed her with scleroderma. The autoimmune disease causes hardening of the skin and, in about a third of cases, other organs. The doctor told Packer that it had settled in her lungs.

"And I said, 'OK, what does this mean for me?'" she recalls. "And he said, 'Well, with this condition...you have about three years left to live.'"

Initially, Packer recalls, the news was just too overwhelming to talk about with anyone --including her husband.

"So we just...carried on," she says. "And it took us about a month before my husband and I started discussing (the diagnosis). I think we both needed to process it separately and figure out what that really meant."

Packer, 32, is on oxygen full time and takes a slew of medications.

She says she has been diagnosed with a series of conditions linked to or associated with scleroderma, including the auto-immune disease, lupus, and gastroparesis, a disorder that interferes with proper digestion.

Packer's various maladies have her in constant, sometimes excruciating pain, she says, noting that she also can't digest food properly and is always "extremely fatigued."

Some days are good. Others are consumed by low energy and pain that only sleep can relieve.

"For my kids, I need to be able to control the pain because that's what concerns them the most," she adds.

Faith and fear

Packer and her husband Brian, 36, are devout Catholics. They agree with their church that doctors should never hasten death.

"We're a faith-based family," he says. "God put us here on earth and only God can take us away. And he has a master plan for us, and if suffering is part of that plan, which it seems to be, then so be it."

They also believe if the California bill on physician-assisted suicide, SB 128, passes, it would create the potential for abuse. Pressure to end one's life, they fear, could become a dangerous norm, especially in a world defined by high-cost medical care.

"Death can be beautiful"

Instead of fatal medication, Stephanie says she hopes other terminally ill people consider existing palliative medicine and hospice care.

"Death can be beautiful and peaceful," she says. "It's a natural process that should be allowed to happen on its own."

Stephanie's illness has also forced the Packers to make significant changes. Brian has traded his full-time job at a lumber company for that of weekend handyman work at the family church. The schedule shift allows him to act as primary caregiver to Stephanie and the children. But the reduction in income forced the family of six to downsize to a two-bedroom apartment it shares with a dog and two pet geckos.

Even so, Brian says, life is good.

"I have four beautiful children. I get to spend so much more time with them than most head of households," he says. "I get to spend more time with my wife than most husbands do."

And it's that kind of support from family, friends and those in her community that Stephanie says keeps her living in gratitude, even as she struggles with the realization that she will not be there to see her children grow up.

"I know eventually that my lungs are going to give out, which will make my heart give out, and I know that's going to happen sooner than I would like — sooner than my family would like," she says. "But I'm not making that my focus. My focus is today."

Stephanie says she is hoping for a double-lung transplant, which could give her a few more years. In the meantime, next month marks three years since her doctor gave her three years to live.

So every day, she says, is a blessing.

Topics: assisted suicide, Right-to-die, health, healthcare, nurses, doctors, hospitals, medica, medical laws, physician assisted suicide

Innovations: Testing A Digital Pillbox To Improve Medication Compliance

Posted by Erica Bettencourt

Wed, May 20, 2015 @ 03:10 PM

By Darius Tahir

www.modernhealthcare.com 

Digital pillbox.jpg&q=40&maxw=600&maxh=600 resized 600In the fall of 2012, Nick Valilis was diagnosed with leukemia just as he was starting medical school. In treatment he found it difficult to remember to take his medications at the proper time and in the right order.

“He struggled handling the sheer complexity,” said Rahul Jain, Valilis' classmate at Duke University. “He went from no meds to 10 meds a day. How is an 85-year-old cancer patient supposed to handle that same regimen?” 

Since then, Jain, Valilis and a few other Duke classmates have formed a startup company called TowerView Health with the goal of making it easier for patients to manage their medication regimens. Jain is CEO of the company, which was incorporated last year; Valilis is chief medical officer. They are about to launch a clinical trial, in partnership with Independence Blue Cross and Penn Medicine in Philadelphia, to test whether their technological solution helps patients understand and comply with their drug regimens.

That could be an important innovation. Poor medication adherence is estimated to cause as much as $290 billion a year in higher U.S. medical costs, as well as a big chunk of medication-related hospital admissions.

TowerView has developed software and hardware that reminds patients and their clinicians about medication schedules, and warns them when a patient is falling off track.

Dr. Ron Brooks, senior medical director for clinical services at Independence Blue Cross, said he thinks TowerView's solution is a notable improvement over previous medication-adherence technology. “Most of the apps I've seen are reminder apps,” he said. “It might remind you to take a medication, but you have to input that you actually take it. There's no closing of the loop.” By contrast, TowerView automatically provides reminders and tracking, with the opportunity for clinician follow-up.  

Here's how TowerView's system works. When clinicians prescribe drugs and develop a medications schedule for a patient, the scrips and schedule are sent to a mail-order pharmacy that has partnered with TowerView. The pharmacy splits the medications into the scheduled dosages on a prescription-drug tray. The tray is labeled with the schedule and sent to the patient, who places the tray into an electronic pillbox, which senses when pills are taken out of each tray compartment. 

The pillbox sensors communicate with connected software through a cellular radio when patients have taken their pills and when it's time to remind them—either through a text message, phone call or the pillbox lighting up—that they've missed a dose. The system also compiles information for providers about the patient's history of missed doses, enabling the provider to personally follow up with the patient.

But some question whether tech solutions are the most effective way to improve medication adherence. A 2013 literature review in the Journal of the American Pharmacists Association identified nearly 160 medication-adherence apps and found poor-quality research evidence supporting their use.

Experts say it's not clear whether apps and devices can address the underlying reasons why patients don't comply with their drug regimens. For instance, patients simply might not like taking their drugs because of side effects or other issues. “I'd wager that improved adherence—and a range of other health benefits—are ultimately more likely to be achieved not by clever apps and wireless gadgets, but rather by an empathetic physician who understands, listens and is trusted by her patients,” Dr. David Shaywitz, chief medical officer at DNAnexus, a network for sharing genomic data, recently wrote.

Jain doesn't disagree. He notes that his firm's system empowers empathetic clinicians to provide better care. “This solution allows more of a communication element,” he said. “We'll be able to understand why patients don't take their meds.” 

That system soon will be put to the test in a randomized clinical trial. TowerView and Independence Blue Cross are enrolling 150 diabetic patients who are noncompliant with their medication regimens; half of those participants will receive usual care. The goal is to improve compliance by at least 10% over six months.

If it works, Jain and his company hope to sell the product to insurers and integrated healthcare providers working under risk-based contracts. The idea is that patients' improved adherence will reduce providers' hospitalization and other costs and boost their financial performance.

Topics: pills, software, technology, health, healthcare, medication, medical, patients, medicine, patient, treatment, digital pillbox

Study: ICU Nurses Benefit From Workplace Intervention To Reduce Stress

Posted by Erica Bettencourt

Wed, May 20, 2015 @ 02:25 PM

http://news.nurse.com 

stress resized 600A small study by researchers at The Ohio State University Wexner Medical Center found that a workplace mindfulness-based intervention reduced stress levels of employees exposed to a highly stressful occupational environment, according to a news release.

Members of a surgical ICU at the academic medical center were randomized to a stress-reduction intervention or a control group. The eight-week group intervention included mindfulness, gentle stretching, yoga, meditation and music therapy in the workplace. Psychological and biological markers of stress were measured one week before and one week after the intervention to see if these coping strategies would help reduce stress and burnout among participants.

Results of this study, published in the April 2015 issue of Journal of Occupational and Environmental Medicine, showed levels of the chemical salivary alpha amylase, were significantly decreased from the first to second assessments in the intervention group. The control group showed no changes. Chronic stress and stress reactivity have been found associated with increased levels of salivary alpha amylase, according to the release. Psychological components of stress and burnout were measured using well-established self-report questionnaires. “Our study shows that this type of mindfulness-based intervention in the workplace could decrease stress levels and the risk of burnout,” one of the study’s authors, Maryanna Klatt, PhD, associate clinical professor in the department of family medicine at Ohio State’s Wexner Medical Center, said in the release. “What’s stressful about the work environment is never going to change. But what we were interested in changing was the nursing personnel’s reaction to those stresses.”

Klatt said salivary alpha amylase, which is a biomarker of the sympathetic nervous system activation, was reduced by 40% in the intervention group.

Klatt, who is a trained mindfulness and certified yoga instructor, developed and led the mindfulness-based intervention for 32 participants in the workplace setting. At baseline, participants scored the level of stress of their work at 7.15 on a scale of 1 to 10, with 10 being the most stressful. The levels of work stress did not change between the first and second set of assessments, but their reaction to the work stress did change, according to the release. 

When stress is part of the work environment, it is often difficult to control and can negatively affect employees’ health and ability to function, lead author Anne-Marie Duchemin, PhD, research scientist and associate professor adjunct in the department of psychiatry and behavioral health at Ohio State’s Wexner Medical Center, said in the release. “People who are subjected to chronic stress often will exhibit symptoms of irritability, nervousness, feeling overwhelmed; have difficulty concentrating or remembering; or having changes in appetite, sleep, heart rate and blood pressure,” Duchemin said ih the release. “Although work-related stress often cannot be eliminated, effective coping strategies may help decrease its harmful effects.” 

The study was funded in part by the OSU Harding Behavioral Health Stress, Trauma and Resilience Program, part of Ohio State’s Neurological Institute.

Topics: employees, ICU, studies, Medical Center, health, healthcare, research, nurses, doctors, medical, burnout, stress, medical staff, surgical, stress levels, mindfulness

Kayla Montgomery: Young Runner's Brave Battle With MS

Posted by Erica Bettencourt

Wed, May 20, 2015 @ 02:18 PM

 Gary Morley and Lisa Cohen

www.cnn.com 

150514175906 h2h kayla4 exlarge 169 resized 600Kayla Montgomery is a runner unlike any other.

Every time she competes in a race, she knows she'll collapse in a sobbing heap at the finish line.

Unable to feel her legs, she'll crumple into the arms of her athletics coaches. Ice-cold water will be applied to calm the misfiring nerve fibers blazing beneath her numb skin.

The teenager has gone through this post-race trauma for the past five years since being diagnosed with multiple sclerosis.

"Every day that I run, it might be my last day -- I could easily wake up tomorrow and not be able to move," the 19-year-old American tells CNN's Human to Hero series. 

"My initial MS attack caused lesions and scarring on my brain and my spine that affects the areas that are in control of how I feel my legs. So when I am overheated the symptoms reappear because my neurones start misfiring more.

"You can never really get used to the lack of feeling and the change of sensation, no matter how long you go through it. Every time it is still a bit of a shock and it's scary -- it freaks me out a little bit."

After five to 10 minutes she's able to get back on her feet again and start walking around, albeit a little stiffly as feeling slowly returns to her lower body.

It sounds like a nightmare ordeal that would put anyone off an athletics career, but Montgomery is determined to pursue her running dream.

She's actually faster now than before her diagnosis -- which, she says, was a painfully long and uncertain process following an accident playing soccer, falling hard on her neck and tailbone.

"It was really scary. I was so young. Most people with MS aren't diagnosed until their mid to late 20s, 30s. There wasn't anybody my age to relate to and understand what I was going through," she recalls. 

"It took so long to get back results and we were ruling things out and leaving MS as the last option. For a while they thought maybe it was cancer."

When the diagnosis finally came, it sent Montgomery into a spiral of anger, depression and denial.

She avoided confronting the issue with her parents -- Keith, a salesman, and mom Alysia, recently qualified as a nurse -- and younger sister Courtney.

"I tried to pretend I wasn't sick or anything -- I wanted to go on with life as normal as possible," Kayla says.

"Nobody at school knew, and we were not allowed to talk about it at home. I just avoided it at all costs, and that actually made it a lot harder. 

"The first couple of years after my diagnosis were impossibly hard -- I was so alone and still really scared. It was definitely a darker time in my life."

Running has proved to be her salvation. After a short break, in which she received treatment that made the numbness temporary, Montgomery decided she was going to make use of her legs while she still could -- despite knowing that exertion would bring back the symptoms.

"I wasn't amazing by any means but I was eighth on the team, so if somebody got hurt then I was there! And I wanted to be there if they needed me, so I trained so hard all the time and that definitely helped to deal with the things I wouldn't talk about," she says.

Montgomery's determination to succeed won her the North Carolina high school state title in the 3,200 meters last year, as she ran the 21st fastest time in the U.S.

She was team captain at Mount Tabor High School, setting several age-group records, and also excelled off the track in cross-country.

Now a freshman on an athletics scholarship at Nashville's Lipscomb University, she is studying molecular biology and has dreams of becoming a forensic scientist.

But before a career in CSI beckons, Montgomery is making the most of her chance to run for the college team.

"Racing is one of the greatest feelings in the world. I love it," she says. 

"Long-distance running is my favorite ... you have to have so much stamina, strength and determination. I like to push myself to my limits for as long as I can."

One of the big challenges is staying on her feet during a race. If she gets knocked over or falls, which sometimes happens, then it's difficult to get up again -- especially in the later stages.

"If it is a track meet you can't grab on to something, whereas cross country there might be a tree close by that you can pull yourself up on," Montgomery explains.

"It all depends on when I fall as to how it will affect the outcome of my race."

Montgomery trains three hours a day, six days a week, covering 60-75 miles.

Without being able to judge pace through her legs, she has learned a new way to run, by focusing on the movement of her arms.

The hard work is paying off. Lipscomb is a Division One university in NCAA competitions, giving her an elite platform on which to impress.

It's a long way from those early high-school days when she asked her coach, mentor and "second father" Patrick Cromwell about her chances of running at college level.

"He said, 'I don't know, you might be lucky if you can be a walk-on.' I was like, 'Well I'll show you, I'm going to run in college and not only that I'm going to run for a D1 school.' And I am! 

"Lipscomb is one of the best, it's really awesome to achieve that once really far-fetched dream."

Montgomery was actively recruited by Lipscomb, the first school to contact her -- others also rang "but a lot of them never called back" after she explained her condition.

"They made me feel so welcome," she says of her first visit to Lipscomb's campus. "They all knew my situation and it didn't bother them, and they didn't acknowledge it or ignore it either. It was exactly what I was looking for."

Her debut collegiate cross-country season was a steep learning curve, but Montgomery helped Lipscomb win a fourth successive conference championship in November, placing 13th overall and seventh in her team in the 5 km race.

On the track, she was sixth in the 10,000 meters last weekend as Lipscomb's women's team finished third at the Atlantic Sun championships in Florida, its best result at the event -- and a continuation of its rapid improvement since Bill Taylor, who recruited Montgomery, took over the athletics program in 2007.

She says the coach has given her the confidence to keep pushing herself, having taken a chance on her even though he realizes she may not be able to fulfill the four years of her scholarship if her condition gets worse.

"I keep running because it makes me happy," Montgomery says. "It makes me feel whole and safe, just because I know as long as I am running and still moving, I am still OK."

Topics: diagnosis, health, healthcare, nurse, nurses, doctors, medical, hospital, patient, treatment, college, MS, runner, multiple sclerosis

CDC Publish Map Of 'Distinctive' Deaths By State

Posted by Erica Bettencourt

Mon, May 18, 2015 @ 11:31 AM

Written by David McNamee

www.medicalnewstoday.com 

distinctive death map resized 600A new, first-of-its-kind infographic published in the Centers for Disease Control and Prevention's Preventing Chronic Disease journal maps the most 'distinctive' causes of deaths across all states in the US.

The map presents 2001-10 data on causes of death within individual states that were statistically more significant than the national averages, drawn from the Centers for Disease Control and Prevention's (CDC) own "Underlying Cause of Death" file, which is accessible through the WONDER (Wide-ranging Online Data for Epidemiologic Research) website.

The largest number of deaths in the map from a single condition were the 37,292 deaths from atherosclerotic cardiovascular disease in Michigan. The fewest were 11 deaths from "acute and rapidly progressive nephritic and nephrotic syndrome" in Montana.

The numbers of death from discrete illnesses varied across states. For example, 15,000 HIV-related deaths were recorded in Florida during the study period, 679 deaths from tuberculosis in Texas, and 22 people died from syphilis in Louisiana.

The most distinctive causes of death in New York were from gonorrhea and chlamydia, and the state also had the highest number of deaths from infection of female reproductive organs - mostly as a result of untreated sexually transmitted diseases.

According to the researchers behind the map, some of the findings make "intuitive sense," such as the high numbers of death from influenza in northern states, or pneumoconiosis (black lung disease) in states where coal is mined. However, some of the other findings are less easily explained, such as the deaths from septicemia in New Jersey.

What are the strengths and limitations of the map?

The map only presents one distinctive cause of death for each state, all of which were significantly higher than the national rate. However, many other causes of death that were also significantly higher than national rates were not mapped.

Another limitation of the map is that it has a predisposition toward exhibiting rare causes of death. For instance, in 22 of the states, the total number of deaths mapped was under 100. 

"These limitations are characteristic of maps generally and are why these maps are best regarded as snapshots and not comprehensive statistical summaries," explain the researchers, Francis P. Boscoe, of the New York State Cancer Registry, and Eva Pradhan, of the New York State Department of Health.

Boscoe and Pradhan say that the map has been "a robust conversation starter" - generating hypotheses that they consider would not have occurred had the data been formatted in "an equivalent tabular representation." They add:

"Although chronic disease prevention efforts should continue to emphasize the most common conditions, an outlier map such as this one should also be of interest to public health professionals, particularly insofar as it highlights nonstandard cause-of-death certification practices within and between states that can potentially be addressed through education and training."

Topics: illness, health, healthcare, CDC, population, medical, patients, death, infographic, map, causes of death, states

Pre-babbling Babies Prefer Baby Sounds To Adult Sounds

Posted by Erica Bettencourt

Fri, May 15, 2015 @ 12:02 PM

Written by Catharine Paddock PhD

www.medicalnewstoday.com 

four infants on a rug resized 600A new study that offers insights into early language development suggests babies prefer listening to other babies rather than adults as they get ready to produce their own speech sounds.

The study, led by McGill University in Canada and published in the journal Developmental Science, observed the reactions of infants aged from 4-6 months who were not yet attempting speech, as they listened to baby-like and adult-like sounds produced by a voice synthesizer.

They found when the vowel sounds the babies listened to sounded more baby-like (for instance, higher pitch), the infants paid attention longer than when the sounds had more adult-like vocal properties.

Previous studies have shown that children at this age are more attracted to vocal sounds with a higher voice pitch, the authors note in their paper.

The team says the finding is important because being attracted to infant speech sounds may be a key step in babies being able to find their own voice - it may help to kick-start the process of learning how to talk.

They say the discovery increases our understanding of the complex link between speech perception and speech production in young infants.

It may also lead to new ways to help hearing-impaired children who may be struggling to develop language skills, they note.

Baby-like sounds held infants' attention nearly 42% longer

For the study, the team used a voice synthesizer to create a set of vowel sounds that mimicked either the voice of a baby or the voice of a woman.

They then ran a series of experiments where they played the vowel sounds one at a time to the babies as they sat on their mother's lap and listened. They measured the length of time each vowel sound held the infants' attention.

The results showed that, on average, baby-like sounds held the infants' attention nearly 42% longer than the adult-like sounds.

The researchers note that this finding is unlikely to be a result of the babies having a particular preference for a familiar sound because they were not yet producing those sounds themselves - they were not yet part of their everyday experience.

Some of the infants showed their interest in other ways. For example, when they listened to the adult sounds, their faces remained fairly passive and neutral. In contrast, when they heard the baby-like sounds, they became more animated, moved their mouths and smiled.

The following video shows how one of the infants - baby Camille, who is not yet babbling herself - reacts to the various sounds. Every time she looks away, the sound is replaced by another. Her reactions show which sounds she seems to like the most.

Babies need to 'find their own voice'

The researchers say maybe the babies recognized that the baby-like sounds were more like sounds they could make themselves - despite not having heard them before.

The findings may also explain the instinct some people have when they automatically speak to infants in baby-like, high-pitched tones, says senior author Linda Polka, a professor in McGill's School of Communication Disorders, who adds:

"As adults, we use language to communicate. But when a young infant starts to make speech sounds, it often has more to do with exploring than with communicating."

Prof. Polka says babies often try speaking when they are on their own, without eye contact or interaction with others. She explains:

"That's because to learn how to speak babies need to spend lots of time moving their mouths and vocal cords to understand the kind of sounds they can make themselves. They need, quite literally, to 'find their own voice.'"

Funds for the study came from the Natural Sciences Engineering and Research Council.

Meanwhile, parents and schools looking for ways to encourage children to eat more healthily may be interested in a study carried out among kindergarten through sixth-grade students at an inner-city school in Cincinnati, OH. There, researchers discovered that children found healthy food more appealing when linked to smiley faces and other small incentives. The low-cost intervention led to a 62% rise in vegetable purchases and a 20% rise in fruit purchases.

Topics: learning, studies, infants, health, healthcare, research, medical, communication, newborns, babies, sounds, speech

Frequent Tanner Shares Grisly Skin-Cancer Selfie

Posted by Erica Bettencourt

Fri, May 15, 2015 @ 11:46 AM

By AnneClaire Stapleton

www.cnn.com 

Tawny Willoughby grew up in small-town Kentucky, where, she said, it was normal to use a tanning bed four or five times a week. 

"I had my own personal tanning bed in my home, and so did a lot of my friends growing up. ... Everyone tanned," Willoughby said. "I didn't really even think about the future or skin cancer at the time." 

150512155326 09 tawny willoughby exlarge 169 resized 600After one of her classmates in nursing school was diagnosed with melanoma, Willoughby made her first dermatology appointment at age 21. Sure enough, she had skin cancer.

Now 27, Willoughby says she has had basal cell carcinoma five times and squamous cell carcinoma once. She goes to the dermatologist every six to 12 months and usually has a cancerous piece of skin removed at each checkup.

She's become a cautionary tale about the hazards of tanning beds, thanks to a selfie she posted last month on Facebook. The grisly image, taken after one of her cancer treatments, shows her face covered with bloody scabs and blisters. It's since been shared almost 50,000 times.

"If anyone needs a little motivation to not lay in the tanning bed and sun here ya go! This is what skin cancer treatment can look like," she wrote in a post along with the photo. "Wear sunscreen and get a spray tan. You only get one skin and you should take care of it."

150512132628 01 tawny willoughby exlarge 169 resized 600

One in five Americans will develop skin cancer in their lifetime, according to the American Academy of Dermatology. Exposure to tanning beds increases the risk of melanoma, the deadliest form of skin cancer, said the academy, which reports that more than 419,000 cases of skin cancer in the U.S. each year are linked to indoor tanning.

Melanoma is the most common form of cancer for adults 25-29 years old and the second-most common form of cancer for adolescents and young adults 15-29 years old, according to the academy. Warning signs include changes in size, shape or color of a mole or other lesion, the appearance of a new growth on the skin or a sore that doesn't heal. 

Risk factors for all types of skin cancer include skin that burns easily, blond or red hair and a history of excessive sun exposure, including sunburns and tanning-bed use -- dangers that the blonde, blue-eyed Willoughby now knows all too well. 

Willoughby, a registered nurse who now lives in northern Alabama, said she never expected the Facebook picture of her damaged face to go viral. 

But she's excited to think her story might save someone's life.

"I've lost count of how many people shared it now and told me I've helped them," she said. "It's really cool to hear people say they won't tan anymore. I've had mothers thank me after sharing my pictures with their daughters. People in my hometown said they are selling their tanning beds.

"I never thought about the future when I was in high school; I just tanned because it was normal to me." 

Willoughby knows she'll deal with the consequences of tanning for the rest of her life. She's at high risk for developing melanoma but is now doing everything she can to ensure that she's around for her husband, Cody, and their young son, Kayden, for years to come. 

"Learn from other people's mistakes," she wrote on Facebook. "Don't let tanning prevent you from seeing your children grow up. That's my biggest fear now that I have a two-year-old little boy of my own."

Topics: health, healthcare, nurses, doctors, medical, cancer, treatment, skin, tanning beds, basal cell carcinoma, tanning, skin cancer, melanoma, dermatology

8-Year-Old Meets With Bone Marrow Donor Who Saved His Life

Posted by Erica Bettencourt

Tue, May 05, 2015 @ 12:26 PM

By SYDNEY LUPKIN

http://abcnews.go.com 

kabc bone marrow donor 02 jc 150504 4x3 992 resized 600If not for a stranger halfway around the world, 8-year-old Grant Berg wouldn't be alive today, his mother said.

Grant needed a bone marrow transplant, but after an international search, it was an 18-year-old German college student who came to his rescue in 2011, Grant's mother, Kristi Berg told ABC News. And on Sunday night, Grant and his hero met for the first time at the Los Angeles International Airport.

"I've imagined it so often in my mind and now it is reality," Grant's bone marrow donor, Marvin Zumkley, 22, told KABC-TV, ABC's Los Angeles station. "It was crazy. It was overwhelming, and it was just a good feeling."

A year and a half before the transplant, Grant was diagnosed with aplastic anemia, a rare but serious condition in which the bone marrow stops producing new blood cells, Berg said. This includes red blood cells, which carry oxygen; white blood cells, which fight off infection; and platelets, which mend blood vessels and stop bleeding, according to Dr. Hillard Lazarus, who directs UH Case Medical Center's novel cell therapy program in Cleveland but has not met or treated Grant.

"You need to treat this thing," Lazarus said, adding that it's often unclear what causes aplastic anemia. But only about 600 to 900 people are diagnosed with it every year.

Berg said Grant was getting different kinds of transfusions every week for a year and a half before the transplant.

"For a year and a half, he lived off other people's blood," Berg said. "I can't even count the amount of transfusions he had."

And then Zumkley's bone marrow changed Grant's life, she said. “It means everything to me," she added.

Grant was also born with only part of his cerebellum, so he'll be tested later this year for genetic conditions, she said.

After staying up well past his bedtime to meet Zumkley, Grant fell asleep in the car on the ride home to Temecula, California, Berg said. The plan is for Zumkley to relax for a few days, visit Disneyland and find other ways to enjoy southern California and get to know Grant, she said.

Topics: health, healthcare, medical, hospital, patient, treatment, bone marrow donor, bone marrow

Preterm Birth Alters Brain Connections Linked To Cognitive Functioning, Study finds

Posted by Erica Bettencourt

Tue, May 05, 2015 @ 12:00 PM

Written by Honor Whiteman

www.medicalnewstoday.com 

preterm baby resized 600Infants born preterm are known to be at greater risk for neurodevelopmental disorders. Now, a new study by researchers from King's College London in the UK brings us closer to understanding why - premature birth reduces connectivity in brain regions linked to cognitive functioning.

First author Dr. Hilary Toulmin, of the Centre for the Developing Brain at King's College, and colleagues publish their findings in the Proceedings of the National Academy of Sciences.

Preterm birth - defined as the birth of an infant before 37 weeks gestation - affected more than 450,000 babies in the US in 2012.

It is a leading cause of neurological disability among children in the US. Babies born preterm are at higher risk of cerebral palsy, autism and attention-deficit hyperactivity disorder (ADHD), among other intellectual and developmental conditions.

For their study, Dr. Toulmin and colleagues set out to gain a better understanding of the brain connectivity among babies born preterm in an attempt to uncover clues as to why preterm babies are more likely to develop neurodevelopmental problems.

The researchers used functional magnetic resonance imaging (fMRI) to analyze the connectivity between two specific brain regions - the thalamus and the cortex - among 66 infants. Of these, 47 were born prior to 33 weeks gestation and 19 were born at full term - between 37 and 42 weeks gestation.

The team says they focused on the connectivity between the thalamus and the cortex because these are the brain connections that develop quickly during preterm infants' care in neonatal units.

Preemies showed reduced connectivity in brain area linked to higher cognitive functioning

Among the babies born at full term, the researchers found the connectivity between the thalamus and the cortex was very similar to that of adults, which the researchers say supports previous findings that infants are born with mature brain connections.

Among the preterm infants, however, the team identified reduced connectivity between areas of the thalamus and areas of the cortex associated with higher cognitive function. This may explain why preterm babies are at greater risk of neurodevelopmental problems later in childhood, say the researchers.

What is more, brain scans of the preterm infants revealed increased connectivity between the thalamus and an area of the primary sensory cortex that plays a role in processing signals from the face, lips, jaw, tongue and throat.

Preterm infants' earlier exposure to breastfeeding and bottle feeding may explain this finding, according to the team.

The team says the earlier a preterm baby was born, the more pronounced the differences were in brain connectivity.

Overall, the team believes their findings bring us a step closer to understanding why infants born preterm are at higher risk of neurodevelopmental problems.

Senior author Prof. David Edwards, also of the Centre for the Developing Brain at King's College, says modern science has allowed the team to assess brain connectivity among preterm infants - something he says would have been "inconceivable" only a few years ago.

"We are now able to observe brain development in babies as they grow, and this is likely to produce remarkable benefits for medicine," he adds.

Dr. Toulmin says the next steps from this research will be to gain a better understanding of how their findings are associated with learning and developmental problems among preterm children as they get older.

Topics: birth, newborn, health, healthcare, brain, nurses, doctors, medical, hospital, treatment, NICU, health studies, preterm birth, cognitive functioning

Triage And Treatment: Untold Health Stories From Baltimore's Unrest

Posted by Erica Bettencourt

Tue, May 05, 2015 @ 11:28 AM

LEANA WEN

www.npr.org 

balto cvs e23a995f198933efd10610d8a1c39b0ac803594d s800 c85 resized 600Over the last week, Baltimore's unrest has captured the nation's attention. Images of burning cars, the sounds of angry protesters and then peace rallies have dominated the airwaves and headlines.

As the city's health commissioner, I heard other stories. I spoke with a 62-year-old woman who had a heart attack a year ago and who had stopped taking her blood pressure and blood-thinning medications. Her pharmacy was one of the dozen that burned down, and neither she nor the other people in her senior housing building could figure out where to get their prescriptions filled. Her pills ran out two days before, and she'd planned to hold out until the pharmacy reopened.

A 55-year-old man called our health department. His mother was "stringing out" her inhalers and now had a cough and difficulty breathing. He also told us he had difficult-to-control diabetes and was using insulin every other day. He now was urinating frequently and reported blurry vision — symptoms of out-of-control diabetes. We called an ambulance to transport them both to the ER.

In the wake of fires and violence, the initial priority for health officials was to make sure that our acute care hospitals were protected and that staff and patients could get to them safely. In the immediate aftermath, our focus was on ensuring that injured patients got triaged and treated.

Nobody knew what lay ahead and how much more violence was to be expected. We worked with hospitals, the Fire Department, and other city and state partners to develop a hospital security plan and to convene daily phone calls with every hospital and health clinic.

As the days went on, we heard from more Baltimoreans. These were not the ones waving signs or appearing on national TV. These were people who were just trying to get by.

There was a 74-year-old woman who had abdominal pain for two days. She stayed in her apartment and put up with the pain rather than seeking care, because she thought she'd heard that her health center was closed. A middle-aged couple worried about their 22-year old son who was suffering from a manic episode. They didn't know who was available to help.

Our health department, under the leadership of Mayor Rawlings-Blake, worked with the Maryland health department and private partners around the city and state to provide these essential services. We set up the Baltimore Healthcare Access List to provide up-to-date and accurate information about closures and hours of operation for hospitals, clinics and pharmacies. We developed and implemented a Mental Health/Recovery Plan that included an around-the-clock mental health crisis line along with teams of licensed mental health professionals who were deployed in affected neighborhoods for group counseling and debriefing.

Things that seemed straightforward often were not. Transferring prescriptions from one pharmacy to another would seem easy. But what happens if the pharmacies are in different chains, or if the one that closed was an independent pharmacy where all records were destroyed? The nearest pharmacy may be just a few blocks away, but what if the patient has limited mobility and even a few blocks are prohibitive?

And, as we saw, what happens when the best-laid plans aren't known to residents? We arranged for individuals affected by pharmacy closures to call one central number — 311. Our health department team would then take care of the rest on a case-by-case basis, arranging for prescription transfers, transportation and medication delivery.

Amid all the news, our public health information wasn't getting through to all our community members. So we mobilized student volunteers from Johns Hopkins and other local universities to go door-to-door in all senior buildings in affected neighborhoods. We visited over 30 churches and knocked on hundreds of doors.

It is now a week after the initial wave of violence and unrest. Our city is quieter, but our work is nowhere near done. As we look to rebuilding and recovery, our efforts must be focused on addressing the needs of all those affected, including the ones whose stories we don't usually hear.

Topics: prescription, health, healthcare, nurses, doctors, patients, hospital, medicine, patient, treatment, triage, health department, medical staff, Baltimore, protests

Recent Jobs

Article or Blog Submissions

If you are interested in submitting content for our Blog, please ensure it fits the criteria below:
  • Relevant information for Nurses
  • Does NOT promote a product
  • Informative about Diversity, Inclusion & Cultural Competence

Agreement to publish on our DiversityNursing.com Blog is at our sole discretion.

Thank you

Subscribe to Email our eNewsletter

Recent Posts

Posts by Topic

see all