DiversityNursing Blog

By Federico Guerrini

I just had a Skype chat with entrepreneur Olivier Jeannel about his new product. It was a text chat, as Olivier – just like roughly 70 million people in the world (of which approximately 26 million of Americans) – suffers from profound hearing loss. If he has his way, soon this is no longer going to be a problem. Together with his associate Sidney Burks and product manager Pablo Seuc-Rocher, he’s working on the launch of RogerVoice, an Android app that has been designed from the ground up for those who cannot hear on the phone.

With RogerVoice, the deaf or hard-of-hearing person starts a call and receives on his smartphone instant live transcriptions of what the other speaker is saying, regardless if he is speaking in English or another of the many other languages recognized by the system (Spanish, Portuguese, French, Italian, German, Greek and Japanese top the list).

While the idea, generally speaking, is brilliant, there are still some hurdles to overcome. Automatic speech recognition (ASR) technology is still far from flawless; also, unlike other softwares (Dragon and friends) that can be trained to recognize a single voice, improving this way the recognition rate, RogerVoice has to work with any kind of voice, so don’t imagine you can have a long, complex conversation without any trouble.

“You might use it to confirm an appointment with a doctor – Olivier says – or tell a plumber to come”. Basic stuff, but enough to significantly improve the quality of life of a deaf person, allowing he or she to rely less on other people’s intervention. It’s also up to the hearing person to make a better effort to enunciate, to help the voice recognition software’s performance. So you could in fact have a long and articulate conversation, provided that the counterpart is a relative, a friend, or someone that’s kind enough not to speak in a rush.

I asked Jeannel if – when the problem is not too severe – an hearing aid wouldn’t work as well, and the answer was quite interesting, because it pointed to the social implications of suffering from hearing loss.

“The interesting fact is – he says – that most deaf people don’t wear hearing aids, only 1 in 5 apparently bother to get equipped. This is because wearing hearing aids is often associated to a kind of social stigma. Also, of the profoundly deaf population, most manage to speak, but understanding a conversation without visual cues is difficult, if not impossible. In my case, impossible without lip-reading. More and more profoundly deaf use cochlear implants, which is a revolution: it helps a lot to understand speech, but it’s still quite difficult over a phone”.

The app is designed to be Bluetooth compatible, meaning that the RogerVoice app could connect directly to a Bluetooth-equipped hearing aid for a better listening experience and, after the launch of the Android version, the team will start working on the iOS and Windows ones.

The business model will be based on subscriptions, with one year of unlimited calls priced at $59 for those that will contribute to the Kickstarter campaign that’s currently running to support the product’s development. As for the time to market, if the $20,000 is reached on Kickstarter, founder hope to release the product by the end of the year. “Hopefully for Christmas – Jeannel says”.

Source: http://www.forbes.com

By Dr. Sanjay Gupta

Annette Tersigni decided at the age of 48 that she wanted to make a difference. She attended nursing school and became a registered nurse three years later. “Having that precious pair of letters – RN – at the end of my name gave me everything I wanted,” she writes on her website. Before long, Tersigni discovered the rewards – as well as the physical and emotional challenges – that come with nursing.

“I was always stressed when I worked, afraid to get sued for making a mistake or medical error,” says Tersigni, who was working in the heart transplant unit of a North Carolina hospital. “Plus, working the night shift caused me to gain weight and stop working out.” Tersigni moved to another hospital, but the long shifts continued. Three years later, she left her job.

Tersigni’s experience isn’t unusual. Three out of four nurses cited the effects of stress and overwork as a top health concern in a 2011 survey by the American Nurses Association. The ANA attributed problems of fatigue and burnout to “a chronic nursing shortage.” A 2012 report in the American Journal of Medical Quality projected a shortage of registered nurses to spread across the country by 2030.

Work schedules and insufficient staffing are among the factors driving many nurses to leave the profession. American nurses often put in 12-hour shifts over the course of a three-day week. Research found nurses who worked shifts longer than eight to nine hours were two-and-a-half times more likely to experience burnout.

“Our results show that nurses are underestimating their own recovery time from long, intense clinical engagement, and that consolidating challenging work into three days may not be a sustainable strategy to attain the work-life balance they seek,” says study author Linda Aiken, PhD, director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

Deborah Burger, RN, co-president of the union and professional association National Nurses United, doesn’t believe that long work shifts tell the whole story. “Most people can work a 10- or 12-hour shift if they’ve got the right support and right level of staffing,” Burger says.

“In order for nurses to feel satisfied and fulfilled with their work, the staffing issues must be seriously addressed from a very high level,” says Eva Francis, MSN, RN, CCRN, a former nursing administrator. “Nurses also need to be able to express themselves professionally about the workload, and be heard without the fear of threat to their jobs or the fear of being singled out.”

A new study suggests that nurses’ burnout risk may be related to what drew them to the profession in the first place. Researchers at the University of Akron in Ohio surveyed more than 700 RNs and found that nurses who are motivated primarily by the desire to help others, rather than by enjoyment of the work, were more likely to burn out.

“We assume that people that go into nursing because they are highly motived by helping others are the best nurses,” says study author Janette Dill, assistant professor of sociology at the University of Akron. “But our findings suggest these nurses may be prone to burnout and other negative physical symptoms.”

RELATED: Managing Job Stress

That finding doesn’t surprise Jill O’Hara, a former nurse from Hamburg, NY, who left nursing more than a decade ago.

“When a person goes into nursing as a profession, it’s either because it’s a career path or a calling,” says O’Hara, 56, who now operates her own holistic health consulting practice. “The career nurse can leave work at the end of the day and let it go, but the nurse who enters the field because she is called to it takes those emotionally charged encounters home with her. They are empathetic, literally connecting emotionally with their patients, and it becomes a part of them energetically.”

Besides driving many nurses out of the profession, burnout can compromise the quality of patient care. A study of Pennsylvania hospitals found a “significant association” between high patient-to-nurse ratios and nurse burnout with increased infections among patients. The authors’ conclusion: A reduction in burnout is good for nurses and patients.

So what can be done? O’Hara thinks the burnout issue should be addressed early on, when future nurses are still in school. “I honestly believe the way to truly help nurses avoid burnout is to begin with a foundation of teaching while in school that stresses the importance of knowing yourself,” she says. “By that I mean your strengths and weaknesses. It should be taught that self-care must come first.”

Burger stresses the importance of taking regular breaks on the job. “If you’re not getting those breaks or they’re interrupted, then you don’t have the ability to refresh your spirit,” she says. “It sounds hokey, but it is true that you do need some brain downtime so that you could actually process the information you’ve been given.”

Tersigni, 63, now works part-time at a local hospital, specializing in the health and well-being of other nurses. She founded Yoga Nursing, a stress-management program combining deep breathing, quick stretches, affirmations, and relaxation and meditation techniques. “All of these can be done anytime throughout the day,” Tersigni says. “I even teach nurses to teach these to their patients. So the nurse breathes, stretches, and relaxes, while also teaching it to the patient.”

Source: http://www.everydayhealth.com

By Ian Lee

 Far from the sea, a man-made coral reef is taking shape -- and it could change medical operations forever.

Step inside the OkCoral lab in Israel's Negev Desert and you'll find row after row of quietly bubbling fish tanks, each containing a precious substance.

It is hoped the coral grown in this surreal "farm," could one day be used in bone operations -- encompassing everything from dental implants to spinal procedures.

Unlike animal and human bones, coral can't be rejected by the body, say medical experts at the company CoreBone, which manufactures bone replacements from coral.

Grown in the lab, this coral is also free from the diseases you might find in the oceanic variety.

Start-up science

Assaf Shaham founded the unusual laboratory six years ago at a cost of $2.5 million, with an ambitious vision of tapping into the billion dollar worldwide bone grafting industry.

But first he'll need the approval of authorities in the European Union and U.S., with a decision expected next year.

The father-of-two's dedication to the business is astounding -- if not a little disconcerting.

"In six years of growing corals, I haven't left these four walls for more than 12 hours -- not even once," he said.

"For me, it's 100% learning as I go. I take the mother colony, and I cut off a branch of the coral with a diamond saw. Then I glue it to another base made out of cement."

The delicate ecosystem needs constant care to ensure the water's salinity, temperature, and chemical make-up is perfect -- any variations and the coral could die.

The fish swimming around each tank are essentially the "worker bees" of the artificial reef. They eat the algae growing on the coral, their feces helps feed the coral, and finally, their movements in the water keep the coral strong.

And much like the traditional canary in the coalmine, if the fish die, you know something's not quite right in the water.

Clever company?

Happily for Shaham, his ambitious experiment appears to be thriving, with coral in the lab growing at ten times the normal rate.

Just a small container of the coral costs roughly $5 to $10 to produce, and sells for around $250.

One of the biggest benefits of the business is its environmental sustainability.

"We have a constant supply," says Ohad Schwartz of company CoreBone.

"We don't have to worry that in several years, harvesting from the sea could be forbidden."

It's a concern they'll never have to think about, when harvesting these remarkable fruits of the desert.

Source: http://www.cnn.com

For three young siblings, eating is a life or death proposition, thanks to a rare white blood cell disease, reported KSL.

The Frisk children— Jaxen, age 9; Tieler, age 7; Boston, age 4— have spent weeks in the hospital and are allergic to pets, pollens and multiple foods. The siblings all have eosinophilic gastrointestinal disorder (EGID), an abnormal build-up of eosinophil white blood cells in their GI tracts that can cause inflammation and tissue damage in response to foods and allergens. While the disease is relatively rare, it has increased in prevalence over the past decade affecting one in 2,000 people, according to the American Partnership for Eosinophilic Disorders.

"You need food to survive. But it is also what can kill you in our house," their mother, Jenny Frisk, told KSL.

When they’re exposed to their triggers, the children could have an anaphylactic reaction— potentially fatal allergic symptoms throughout the body.

"Tieler had one sip of milk when she was 1-year-old, and instantly started projectile vomiting and got hives all over her body," her father, Gary, told KSL. "It's a life and death situation at birthday parties, or religious events, or anywhere we go, because food is such a big part of our culture."

Between the three children, they’ve endured 11 surgeries and eight extended hospital stays, with more expected in the future.

On top of the children’s health issues, Gary battled cancer two years ago and Jenny had to have several surgeries due to serious adrenal insufficiencies that were unrelated to EGID.

The family has been bankrupted twice by medical bills. While they make too much income to qualify for help, they don’t make enough to pay for their children’s medical needs. Friends and family have started a GoFundMe account to raise money to pay for genetic testing and treatment.

"When we're looking at an illness that is not curable, and the treatment isn't covered (by insurance), the light at the end of the tunnel is really far away," Jenny said.

Source: http://www.foxnews.com

By David McNamee

Recently, Medical News Today reported on a breakthrough in xenotransplantation - the science of transplanting functional organs from one species to another. Scientists from the Cardiothoracic Surgery Research Program of the National Heart, Lung and Blood Institute (NHLBI) demonstrated success in keeping genetically engineered piglet hearts alive in the abdomens of baboons for more than a year.

While that is a sentence that might sound absurd, or even nightmarish to some, xenotransplantation is a credible science involving the work of leading scientists and respected organizations like the NHLBI and the Mayo Clinic, as well as large private pharmaceutical firms such as United Therapeutics and Novartis.

What is more, xenotransplantation is not a new science, with experiments in cross-species blood transfusion dating as far back as the 17th century.

Why transplant the organs of animals into living humans?

The reason why xenotransplantation is a burning issue is very simple: because of a crippling shortage of available organs for patients who require transplants, many people are left to die.

US Government information on transplantation reports that an average of 79 people receive organ transplants every day, but that 18 people die each day because of a shortage of organs.

The number of people requiring an organ donation in the US has witnessed a more than five-fold increase in the past 2 decades - from 23,198 in 1991 to 121,272 in 2013. Over the same period, the number of people willing to donate has only doubled - 6,953 donors in 1991, compared with 14,257 donors in 2013.

Although some researchers are attempting to solve this shortage by developing mechanical components that could assist failing organs, these devices are considered to increase the risk of infection, blood clots and bleeding in the patient.

Stem cell research is also actively pursuing the goal of growing replacement organs, but despite regular news of breakthroughs, the reality of a functional lab-grown human organ fit for transplant is a long way off.

As the NHLBI's Dr. Muhammad M. Mohiuddin, who led the team responsible for the baboon trial, explained:

"Until we learn to grow organs via tissue engineering, which is unlikely in the near future, xenotransplantation seems to be a valid approach to supplement human organ availability. Despite many setbacks over the years, recent genetic and immunologic advancements have helped revitalized progress in the xenotransplantation field.

Xenotransplantation could help to compensate for the shortage of human organs available for transplant."

Xenotransplantation's eccentric history

The earliest known example of using animal body parts to replace diseased or faulty components of human bodies dates back to the 17th century, when Jean Baptiste Denis initiated the clinical practice of animal-to-human blood transfusion.

Perhaps predictably, the results were not successful and xenotransfusion was banned in Denis' native France.

Fast forward to the 19th century and a fairly unusual trend for skin xenotransplantation had emerged. Animals as varied as sheep, rabbits, dogs, cats, rats, chickens and pigeons were called upon to donate their skin, but the grafting process was not for the squeamish.

Medical records show that, in order for the xenosurgeons of the time to be satisfied that the donor skin had vascularized (developed capillaries), the living donor animal would usually have to be strapped to the patient for several days. However, the most popular skin donor - the frog - was typically skinned alive and then immediately grafted onto the patient.

Despite several reputed successes, modern physicians are skeptical that these skin grafts could have been in any way beneficial to the patient.

The first corneal xenotransplantation - where the cornea from a pig was implanted in a human patient - took place as early as 1838. However, scientists would not look seriously again at the potential for xenotransplantation until the 20th century and the first successes in human-to-human organ transplantation.

In 1907, the Nobel prize-winning surgeon Alexis Carrel - whose work on blood vessels made organ transplantation viable for the first time - wrote:

"The ideal method would be to transplant in man organs of animals easy to secure and operate on, such as hogs, for instance. But it would in all probability be necessary to immunize organs of the hog against the human serum. The future of transplantation of organs for therapeutic purposes depends on the feasibility of hetero [xeno] transplantation."

These words have been described as "prophetic" because Carrel is describing the exact line of research adopted by xenotransplantation scientists a century later.

A few years later, another leading scientist, Serge Voronoff, would also predict modern science's interest in using the pancreatic islets of pigs to treat severe type 1 diabetes in human patients. However, other xeno experiments by Voronoff have not endured critical reappraisal quite so well.

Voronoff's main scientific interest was in restoring the "zest for life" of elderly men. His attempt to reverse this element of the aging process was to transplant slices of chimpanzee or baboon testicle into the testicles of his elderly patients.

Incredibly, this surgery proved quite popular, with several hundred operations taking place during the 1920s in both the US and Europe.

By the 1960s, despite limited availability, the transplantation of kidneys from deceased to living humans had been established by French and American surgeons.

Dialysis was not yet in practice and given that, in the absence of an available donor kidney, his renal failure patients were facing certain death, the Louisiana surgeon Keith Reemtsma took the unprecedented step of transplanting animal kidneys. He chose chimpanzees as the donor animals, due to their close evolutionary relationship with humans.

Although 12 of his 13 chimpanzee-to-human transplants resulted in either organ rejection or infectious complications within 2 months, one patient of Reemtsma continued to live and work in good health for 9 months, before dying suddenly from acute electrolyte disturbance. Autopsy showed that the chimpanzee kidneys had not been rejected and were working normally.

Experiments in the xenotransplantation of essential organs continued in living patients until the 1980s - without lasting success. However, the procedures attracted widespread publicity, with some attributing a subsequent rise in organ donation to the failed attempt to transplant a baboon heart into a baby girl in 1983.

Where does research currently stand?

Despite the more obvious similarities between humans and other primates, pigs are now considered to be the most viable donor animal for xenotransplantation.

Despite diverging from humans on the evolutionary scale about 80 million years ago, whole genome sequencing of the pig has shown that humans and pigs share similar DNA, while the pig's organs - in size and function - are anatomically comparable to humans.

However, perhaps the main advantage of the pig as donor is in its availability - potentially providing an "unlimited supply" of donor organs. If transplantation is viable, pig donors would provide an immediate solution for the organ shortage problem.

Xenotransplantation optimists also believe that the process can improve on the existing success rate of transplantation of human organs. By keeping the pigs healthy, regularly monitored for infection, and alive right until the point when the required organs are excised under anesthesia, the adverse effects associated with transplantation from deceased donors - such as non-function of organs or transmission of pathogens - would be much less likely, this group argues.

However, there are still significant scientific barriers to the successful implementation of xenotransplantation.

The company United Therapeutics - who moved into xenotransplantation research after the daughter of CEO Martine Rothblatt was diagnosed with pulmonary hypertension, a condition with a 90% shortage rate of available lung donors - claim to be making progress with eliminating these barriers.

MedIcal News Today spoke to Rothblatt, who once claimed that the company will have successfully transplanted a pig lung into a human patient "before the end of the decade."

"For a first clinical trial, which was my goal, I think we are on track," she told us. "I said our goal by end of decade is to transplant a xeno lung into a patient with end-stage lung disease and bring them safely back to health."

As well as pioneering lung xenotransplants, the company has ambitions of making pig kidneys, livers, hearts and corneas available for human transplant.

"All are years away, but lung may well be most difficult," admits Rothblatt. "We call it the canary in the coal mine."

In order to make pig lungs compatible with humans, Rothblatt has estimated that 12 modifications need to be made to the pig genome that will prevent rejection. She claims United Therapeutics have now succeeded in making six of these genome modifications.

Also, it was United Therapeutics' genetically modified piglets that provided the world record-beating pig hearts for the NHLBI study in baboons.

Opposition to xenotransplantation

However, science is not the only obstacle to xenotransplantation. Despite clearing all steps of the research with ethics committees at every step, Rothblatt - who has a doctorate in medical ethics - admits there will be unforeseeable regulatory dilemmas and ethics conversations before xenotransplantation can be accepted into clinical practice.

In 2004, the UK's Policy Studies Institute conducted the first major survey of public attitudes towards potential solutions for the organ shortage crisis. The public perception of xenotransplantation was shown to be overwhelmingly negative.

Indeed, response to animal-to-human transplantation was so hostile that some respondents demanded that it be removed as an option on the survey. Although many respondents considered xenotransplantation unethical, the major concern was that animal viruses could infect humans and spread into the population.

Following the survey, an intriguing debate over the ethics of xenotransplantation took place in the pages of Philosophy Now. Making the case against xenotransplantation, Laura Purdy - professor emerita of philosophy at Wells College in Aurora, NY - commented that "the xeno debate proceeds as if saving lives is our top moral priority." She argues that, from this perspective, it suggests that the lives lost down the line as a result of perfecting xenotransplantation do not count.

"What about the 11 million babies and children who die every year from diarrhea, malaria, measles, pneumonia, AIDS and malnutrition?" she questioned. "What about the half-million women who die every year during pregnancy and childbirth when simple measures could save most of them?"

We asked Prof. Purdy why the fact that people die from matters unrelated to transplantation issues would morally preclude science from attempting to also solve the issue of organ donor shortages.

"I agree that, other things being equal, saying that people are dying from other causes doesn't show why we should not also tackle this cause," she replied.

"But once one has taken on board the larger risks to society, both from the research as well as the deployment of the technology, as well as the probability that this is merely a bridge technology that, hopefully will be made obsolete by future developments (such as partial or whole artificial hearts) or advances in public health (making headway against diabetes) and the probability that both research and implementation will be very expensive, that seriously erodes the case for proceeding.

Resources for health are far from infinite. There is a great deal that we could be doing now to advance human health that does not have these downsides - why not focus more there?"

Whether public attitudes toward xenotransplantation have mellowed in the decade since the Policy Studies Institute's survey is not currently known.

However, as the technology advances and the likelihood of implementation draws closer, so too must the public conversation over the perceived rights and wrongs of animal organ transplantation advance in order to hold the science accountable.

Do you have a view on this issue? If so, use our comments box to join the debate.

Source: http://www.medicalnewstoday.com

A study in the current issue of Policy, Politics & Nursing Practice estimates 17.5% of newly licensed RNs leave their first nursing job within the first year and 33.5% leave within two years, according to a news release. The researchers found that turnover for this group is lower at hospitals than at other healthcare settings.

The study, which synthesized existing turnover data and reported turnover data from a nationally representative sample of RNs, was conducted by the RN Work Project, funded by the Robert Wood Johnson Foundation. The RN Work Project is a 10-year study of newly-licensed RNs that began in 2006. The study draws on data from nurses in 34 states, covering 51 metropolitan areas and nine rural areas. The RN Work Project is directed by Christine T. Kovner, PhD, RN, FAAN, professor at the College of Nursing, New York University, and Carol Brewer, PhD, RN, FAAN, professor at the School of Nursing, University at Buffalo. 

“One of the biggest problems we face in trying to assess the impact of nurse turnover on our healthcare system as a whole is that there’s not a single, agreed-upon definition of turnover,” Kovner said. “In order to make comparisons across organizations and geographical areas, researchers, policy makers and others need valid and reliable data based on consistent definitions of turnover. It makes sense to look at RNs across multiple organizations, as we did, rather than in a single organization or type of organization to get an accurate picture of RN turnover.”

According to the release, the research team noted that, in some cases, RN turnover can be helpful — as in the case of functional turnover, when a poorly functioning employee leaves, as opposed to dysfunctional turnover, when well-performing employees leave. The team recommends organizations pay attention to the kind of turnover occurring and point out their data indicate that when most RNs leave their jobs, they go to another healthcare job.

“Developing a standard definition of turnover would go a long way in helping identify the reasons for RN turnover and whether managers should be concerned about their institutions’ turnover rates,” Brewer said in the release. “A high rate of turnover at a hospital, if it’s voluntary, could be problematic, but if it’s involuntary or if nurses are moving within the hospital to another unit or position, that tells a very different story.” 

The RN Work Project’s data include all organizational turnover (voluntary and involuntary), but do not include position turnover if the RN stayed at the same healthcare organization, according to the release.

Source: http://news.nurse.com

By JOSHUA A. KRISCH

McBaine, a bouncy black and white springer spaniel, perks up and begins his hunt at the Penn Vet Working Dog Center. His nose skims 12 tiny arms that protrude from the edges of a table-size wheel, each holding samples of blood plasma, only one of which is spiked with a drop of cancerous tissue.

The dog makes one focused revolution around the wheel before halting, steely-eyed and confident, in front of sample No. 11. A trainer tosses him his reward, a tennis ball, which he giddily chases around the room, sliding across the floor and bumping into walls like a clumsy puppy.

McBaine is one of four highly trained cancer detection dogs at the center, which trains purebreds to put their superior sense of smell to work in search of the early signs of ovarian cancer. Now, Penn Vet, part of the University of Pennsylvania’s School of Veterinary Medicine, is teaming with chemists and physicists to isolate cancer chemicals that only dogs can smell. They hope this will lead to the manufacture of nanotechnology sensors that are capable of detecting bits of cancerous tissue 1/100,000th the thickness of a sheet of paper.

“We don’t ever anticipate our dogs walking through a clinic,” said the veterinarian Dr. Cindy Otto, the founder and executive director of the Working Dog Center. “But we do hope that they will help refine chemical and nanosensing techniques for cancer detection.”

Since 2004, research has begun to accumulate suggesting that dogs may be able to smell the subtle chemical differences between healthy and cancerous tissue, including bladder cancer, melanomaand cancers of the lung, breast and prostate. But scientists debate whether the research will result in useful medical applications.

Dogs have already been trained to respond to diabetic emergencies, or alert passers-by if an owner is about to have a seizure. And on the cancer front, nonprofit organizations like the In Situ Foundation, based in California, and the Medical Detection Dogs charity in Britain are among a growing number of independent groups sponsoring research into the area.

A study presented at the American Urological Association’s annual meeting in May reported that two German shepherds trained at the Italian Ministry of Defense’s Military Veterinary Center in Grosseto were able to detect prostate cancer in urine with about 98 percent accuracy, far better than the prostate-specific antigen (PSA) test. But in another recent study of prostate-cancer-sniffing dogs, British researchers reported that promising initial results did not hold up in rigorous double-blind follow-up trials.

Dr. Otto first conceived of a center to train and study working dogs when, as a member of the Federal Emergency Management Agency’s Urban Search and Rescue Team, she was deployed to ground zero in the hours after the Sept. 11 attacks.

“I remember walking past three firemen sitting on an I-beam, stone-faced, dejected,” she says. “But when a handler walked by with one of the rescue dogs, they lit up. There was hope.”

Today, the Working Dog Center trains dogs for police work, search and rescue and bomb detection. Their newest canine curriculum, started last summer after the center received a grant from the Kaleidoscope of Hope Foundation, focuses on sniffing out a different kind of threat: ovarian cancer.

“Ovarian cancer is a silent killer,” Dr. Otto said. “But if we can help detect it early, that would save lives like nothing else.”

Dr. Otto’s dogs are descended from illustrious lines of hunting hounds and police dogs, with noses and instincts that have been refined by generations of selective breeding. Labradors and German shepherds dominate the center, but the occasional golden retriever or springer spaniel — like McBaine — manages to make the cut.

The dogs, raised in the homes of volunteer foster families, start with basic obedience classes when they are eight weeks old. They then begin their training in earnest, with the goal of teaching them that sniffing everything — from ticking bombs to malignant tumors — is rewarding.

“Everything we do is about positive reinforcement,” Dr. Otto said. “Sniff the right odor, earn a toy or treat. It’s all one big game.”

Trainers from the center typically notice early on that certain dogs have natural talents that make them better suited for specific kinds of work. Search and rescue dogs must be tireless hunters, unperturbed by distracting environments and unwilling to give up on a scent – the equivalent of high-energy athletes. The best cancer-detection dogs, on the other hand, tend to be precise, methodical, quiet and even a bit aloof — more the introverted scientists.

“Some dogs declare early, but our late bloomers frequently switch majors,” Dr. Otto said.

Handlers begin training dogs selected for cancer detection by holding two vials of fluid in front of each dog, one cancerous and one benign. The dogs initially sniff both but are rewarded only when they sniff the one containing cancer tissue. In time, the dogs learn to recognize a unique “cancer smell” before moving on to more complex tests.

What exactly are the dogs sensing? George Preti, a chemist at the Monell Chemical Senses Center in Philadelphia, has spent much of his career trying to isolate the volatile chemicals behind cancer’s unique odor. “We have known for a long time that dogs are very sensitive detectors,” Dr. Preti says. “When the opportunity arose to collaborate with Dr. Otto at the Working Dog Center, I jumped on it.”

Dr. Preti is working to isolate unique chemical biomarkers responsible for ovarian cancer’s subtle smell using high-tech spectrometers and chromatographs. Once he identifies a promising compound, he tests whether the dogs respond to that chemical in the same way that they respond to actual ovarian cancer tissue.

“I’m not embarrassed to say that a dog is better than my instruments,” Dr. Preti says.

The next step will be to build a mechanical, hand-held sensor that can detect that cancer chemical in the clinic. That’s where Charlie Johnson a professor at Penn who specializes in experimental nanophysics, the study of molecular interactions between microscopic materials, comes in.

He is developing what he calls Cyborg sensors, which include biological and mechanical components – a combination of carbon nanotubes and single-stranded DNA that preferentially bond with one specific chemical compound. These precise sensors, in theory, could be programmed to bind to, and detect, the isolated compounds that Dr. Otto’s dogs are singling out.

“We are effectively building an electronic nose,” said Dr. Johnson, who added that a prototype for his ovarian cancer sensor will probably be ready in the next five years.

Some experts remain skeptical.

“While I applaud any effort to detect ovarian cancer, I’m uncertain that this research will have any value,” said Dr. David Fishman, a gynecologic oncologist at Mount Sinai Hospital in New York City. One challenge, he notes, is that any cancer sensor would need to be able to detect volatile chemicals that are specific to one particular type of cancer.

“Nonspecificity is where a lot of these sort of tests fail,” Dr. Fishman said. “If there is an overlap in volatile chemicals — between colon, breast, pancreatic, ovarian cancer — we’ll have to ask, ‘What does this mean?’ ”

And even if sensors could be developed that detect ovarian cancer in the clinic, Dr. Fishman says, he doubts that they would be able to catch ovarian cancer in its earliest, potentially more treatable, stages.

“The lesions that we are discussing are only millimeters in size, and almost imperceptible on imaging studies,” Dr. Fishman says. “I don’t believe that the resolution of the canine ability will translate into value for these lesions.”

McBaine remains unaware of the debate. After correctly identifying yet another cancerous plasma sample, he pranced around the Working Dog Center with regal flair, showing off his tennis ball to anyone who would pay attention. In an industry saturated with hundreds of corporations and thousands of scientists all hunting for the earliest clues to cancer, working dogs are just another set of (slightly furrier) researchers.

Source: http://well.blogs.nytimes.com

By Jeroen Tas

Imagine a time when a device alerts you to the onset of a disease in your body long before it’s a problem. Or when your disease is diagnosed in Shanghai, based on the medical scan you did in Kenya. This future is far closer that you might think due to rapid advances in connected devices and sensors, big data and the integration of health services. Combined, these innovations are introducing a new era in healthcare and personal well-being.

In only a few years, mobile technologies have spawned tremendous innovation of consumer-level health tools. The emerging solutions are focusing on health conditions over a person’s lifetime and on holistic care. They generate constant insights through analytics and algorithms that identify patterns and behaviours. Social technologies enable better collaboration and interconnected digital propositions that reach out to communities of people with similar conditions, engaging them in ways which were never before possible.

We are starting to get a taste of what the consumerization of healthcare will mean in the future. In two to three years, analysing your personal health data will become commonplace for large parts of the population in many countries. Also, it is very likely that for the first time it will not be the chronically ill but the healthy people who will invest the most in managing their health.

Digitization and consumerization will rattle the healthcare industry. It is already tearing at the very fabric of the traditional healthcare companies and providers. Innovation is not only about just adding a new channel or connecting a product. It is also a complete redesign of business models, adjustment of systems and processes and, most importantly, it calls for changing the culture in companies to reflect the new opportunities – and challenges – presented by the digital world.

To drive true industry transformation, companies need to collaborate and continue to learn from each other. Great strides will be made in alliances, which, for example, will deliver open, cloud-based healthcare platforms that combine customer engagement with leading medical technology, and clinical applications and informatics.

The game will not only be played by the traditional healthcare providers. With consumerization, even companies without healthcare expertise, but with strong consumer engagement and trust, could potentially become healthcare companies. Big multinationals invest incremental budgets in developing new propositions and count on their global user bases or professional networks to gain a foothold in the market.

And in parallel, a raft of start-ups are attempting to transform the worlds of preventive or curative healthcare – in many cases, limited only by their imaginations. For example, we may see virtual reality technology moving from gaming industry to healthcare for improving patients’ rehabilitation after a stroke. Or we may see facial recognition software become common in monitoring and guiding patients’ daily medical routines.

While these new propositions tackle a number of healthcare industry’s core concerns and provide solutions to completely new areas, these propositions still need to mature. They need to become scalable, reliable, open, and the user experience needs to be harmonized.

But perhaps one of the most important challenges is related to people’s behaviour and preferences. Regardless of whether these new and existing companies are analysing health data, using virtual reality or reading people’s vital signs, they all need ample time to become trusted and accepted in the emerging digital health care space. Especially for the new entrants, obtaining the right level of credibility will be one of the key success factors.

Consumers, patients and professionals alike, will need the right motivation, reassurance and mindsets to adopt these new solutions. The companies that know how to offer us tailored, cutting-edge solutions, combined with meaningful advice and trustworthiness, will be the winners and become our trusted advisers in health.

Source: World Economic Forum

Fastaff

Making the transition to working nights may feel a bit intimidating, but many night nurses, myself included, have grown to love the position! It tends to be quieter and less chaotic because the patients are generally asleep, and there's a special camaraderie that develops between a team of night nurses. Put these tips into practice to survive, and even thrive, in your night shifts.

Stack several night shifts in a row: Rather than spacing out your night shifts during the week and having to switch between being up during the day and up during the night, try to put all your night shifts for the week in a row. That way, you can really get yourself onto a schedule of being awake during the nights you work and sleeping during the days in between.

Nap before work: As you transition from being awake during the day to being awake as you work at night, take a nap in the afternoon to help you go into your first night shift as rested as possible. Alternately, if your schedule allows, stay up later than usual the night before your first night shift and sleep in as late as you can the next morning.

Fuel up with healthy foods: While sugars may seem like they provide energy, they also come with a crash. Before heading into work, eat a filling meal with a healthy balance of carbohydrates, protein, and fiber. Then bring healthy snacks for the night that include protein and fiber to keep you going strong. Some options include yogurt, mixed nuts, hard boiled eggs, cheese cubes, or carrots with hummus dip

Plan caffeine carefully: It can be tempting to drink a cup of coffee anytime you feel sleepy, but you may develop an unhealthy dependence or be unable to fall asleep when you get home after your shift. Therefore, try to limit yourself to just one or two cups of coffee per shift, and drink your last one at least six hours before you plan to go to sleep.

Create a restful sleeping environment at home: The key to surviving night shifts in the long term is getting lots of restful sleep after each shift. Set up room darkening curtains and a white noise machine to help you block out signs of the day. When you get home, don't force yourself to go to bed right away. Instead, develop a routine that includes some time to bathe, read, and relax as your body winds down after work. Try to avoid bright screens, which block your body from releasing melatonin, the hormone that makes you feel sleepy.

With some attention to detail, you will probably find yourself really enjoying working at night. Many of the night nurses I know started out stuck on the shifts, but grew to prefer them. Plus, the pay differential doesn't hurt at all!

Source: http://www.fastaff.com

By ERIC WHITNEY

When a fire department gets a call for medical help, most of them scramble both an ambulance and a fully staffed fire truck. But that's way more than most people need, according to Rick Lewis, chief of emergency medical services at South Metro Fire Rescue Authority in the Denver suburbs.

"It's not the prairie and the Old West anymore, where you have to be missing a limb to go to the hospital," Lewis says, "Now it's a sore throat or one day of cold or flu season sometimes, and that can be frustrating for people, I know it is."

South Metro receives more than 12,000 emergency medical calls a year, and takes about 7,000 patients to area hospitals. Somebody who's been running a fever for a couple of days may need help — just not necessarily a ride to the ER. That disconnect can be frustrating for both ambulance crews and patients.

Crews aren't required to transport everyone who calls, but Lewis says they fear lawsuits if they were to leave and a patient got worse. Also, ambulance companies typically don't get paid unless they take somebody to the hospital. So Lewis teamed up with Mark Prather, an emergency room doctor, to try and come up with a better way.

"We created a mobile care unit that can go to a given patient, if we think they're safe to treat on scene, and provide definitive on-scene treatment," says Prather.

The mobile care unit is, basically, a station wagon. Advance practice paramedic Eric Bleeker shows off some of the gear. "This one is a suture set, so it has everything for wound closure, from staples to regular sutures," he says.

Ambulances don't have that kind of equipment, so even someone who just needs a few stitches gets a ride to the emergency department.

Several cities across the country are using paramedics as physician extenders, sending ambulance crews to do routine things like hospital follow-up visits in places where basic health care is hard to get. South Metro's model focuses on responding to calls. The team always includes at least one nurse practitioner, who can prescribe basic medicines that they stock in the mobile unit.

"A lot of what we do is sort of that mid-level between the acute care you receive in an emergency department and what the paramedics can currently do," says Bleeker.

It's kind of like an urgent care clinic on wheels.

There's also a miniature medical lab. "We can run full blood chemistry, we can do complete blood counts, we can check for strep throat, we can check for influenza," he says. Those are capabilities that even many doctors' offices don't have on site.

South Metro Fire also relies heavily on Colorado's new electronic medical records network. The nurse or EMT can call up patient records on the scene to provide care that's more like an office visit, and dispatchers can check recent medical histories to make sure they send ambulances to people who might really need one.

That person who called 911 because they were running a fever could end up being diagnosed and treated in their living room by South Metro's station wagon for about $500, instead of spending a lot more for similar care at an emergency room.

Insurance companies don't yet pay for this, though, says Prather.

"That's maybe why nobody has done it yet," he says, laughing.

For the last nine months South Metro has been running the service basically for free, to prove that it saves money. But Prather thinks that's about to change because of Obamacare. The law aims to get insurance companies, Medicare and Medicaid to stop paying for too much medical care. And it can penalize health care providers who contribute to overuse of emergency rooms.

"It allowed us to think about payment differently, and basically switch from a volume situation to a quality situation," he says.

But it's not like the law just flips a switch and starts paying for appropriate care instead of rewarding providers who see a high number of patients and do lots of procedures. The change to reward efficient, appropriate health care is just starting to happen. Slowly. But Prather is now in talks with insurers and hopes to be getting paid soon.

Source: http://www.npr.org