DiversityNursing Blog

Shelly Lopez Gray

Recently, a nurse made headlines for dropping a newborn, fracturing the baby's skull. The parents, understandably upset, claim the nurse should have known better than to hold the baby if she was sleepy. As a labor and delivery nurse, here is what I wish I could say to every mother out there, what I'm sure many of us would want to say to the families we care for:

Accidentally hurting your baby is one of our biggest fears. No nurse goes to work thinking they want to hurt someone. None of us leave our house thinking, "I really want to make someone suffer." There are a million and one ways a nurse can accidentally do something wrong. And every day, all day, we are very conscious of this fact and we work hard to provide the best care we possibly can... even if we're short-staffed, even if our assignments are difficult, even if every room on our unit is full. Even though we literally have 20 things to do at any given moment with a handful of different, complicated patients, we strive to provide compassionate care in a timely manner while struggling to chart every single action we take. We know we're going to make mistakes... our only hope is that the mistakes we make do not cause harm.

That nurse made a lot of right decisions. I'm just keeping it real -- but seriously, that nurse could have made a lot of other really bad decisions. She could have dropped the baby and not told anyone. Even though she was probably frightened and distraught that her action caused a baby harm, she chose to do the right thing and immediately get the baby evaluated.

A nurse's mistake can have many consequences. No one is asking why the nurse had the baby in the first place. I would bet any amount of money that she was trying to allow an exhausted mother to get a few minutes of uninterrupted sleep. And although I do not agree with this practice, I'm sure her intentions were pure. What people who are not nurses do not understand is that our mistakes can have many consequences. If we make a mistake, we can be peer-reviewed, which means our actions are brought before a committee to determine our nursing fate. We could lose our nursing license, leaving us unable to work or financially support ourselves or our family. If it's deemed we were neglectful, criminal charges could be filed against us, and we could face hefty fines or even jail time. And our actions at work and at home are all up for examination and scrutiny.

That nurse is suffering right now. I don't say this to diminish any anguish the family must feel that their baby was hurt while in the care of a healthcare provider. But wherever that nurse is right now, I promise you that she has been suffering. As I said before, no nurse goes to work wanting to hurt someone. She has had to endure being judged by her peers, questioning whether or not her facility would support her, and knowing that she caused a family distress. This is an incident that she will never forget, an incident that will probably taint her 30-year memory of nursing.

If you would have dropped your baby while in the hospital, the nurse would also be blamed. I don't believe healthy mothers and healthy babies should be separated while in the hospital. I don't believe a nurse should take a baby from a mother, even at her request, so that the mother can get uninterrupted sleep. This may not be a popular opinion, but as nurses, we need to see how these mothers interact with their babies even when they're exhausted and sleep-deprived. But this leads to another issue... even if this mother would have dropped her own baby, the nurse and hospital would still be blamed. It would have been all about rounding and if it was documented that the nurse educated the patient not to sleep with the baby in the bed or if the room was free of clutter. As nurses, we have to be everything to everyone.

We are all human. As I drive to work tomorrow, I will think of the patients I will meet and care for. And as I walk through the doors of my hospital, I will think the same thing I have thought every single day since I graduated from nursing school: Just don't hurt anyone. I know I will make mistakes. I'm human. But I hope I never make a mistake that hurts or kills someone. And that is a fear that lives inside of every nurse everywhere. My thoughts are with this family, and my thoughts are also with this nurse. To every nurse out there -- May the mistakes we make tomorrow bring no harm to the patients we try to give so much to.

Until my next delivery ♥

www.huffingtonpost.com

By Pat Magrath – DiversityNursing.com

If you’re considering a career in nursing and are bilingual, this can be a tremendous advantage for you, your patients and their families. With increased diversity in the U.S., patients with limited English-language skills often arrive at the emergency room and there is no one available who speaks their language. This makes it very difficult for everyone involved to try to understand why the patient is there. Sometimes a family member who speaks limited English accompanies the patient and attempts to describe the family member’s symptoms. This is not an ideal situation and can lead to misunderstanding, frustration and an incorrect diagnosis. To drive this scenario home, imagine you’re on vacation in another country and become ill. You need medical attention, and when you arrive at the hospital no one understands you. This is a scary situation!

While most healthcare institutions offer translation services, sometimes the service is provided over the phone. This method is efficient in communicating information such as what the patient’s symptoms are, describing the appropriate course of treatment, or explaining the specific care of a condition at home. However, we all know there’s nothing like the ability to communicate with someone on a more personal, face-to-face basis. The patient may have more questions after the phone conversation is over. They or their family might ask questions such as, how often should I take this medication? Should I take it with or without food? Who do I call if I have questions when I get home?

As a nurse who is bilingual, you can be a tremendous help and source of comfort in answering these questions. Let’s take the example of a Hispanic nurse who not only speaks and understands both English and Spanish, but who also understands Hispanic culture, values and family traditions because of growing up in that community. My friend Esteban, who happens to be a bilingual Hispanic nurse, also knows the prevalence of certain diseases in the Hispanic community. These include diabetes, hypertension and cardiovascular issues. He’s seen these diseases in his family and community. He mentioned that diet and genetics contribute to these problems as the Hispanic diet often contains a lot of pork and fatty foods, which can lead to these conditions.

This is important information he already has because he is a member of the Hispanic community. He also speaks the language and can translate information to the medical team. His ability to communicate between the patient and medical team as well as his knowledge of Hispanic culture is extremely valuable in the care he can give his Hispanic patients. The ability of a patient to communicate directly and effectively with their healthcare provider increases feelings of trust and understanding, which can lead to a higher level of care and well-being. Again, I’ll take you back to becoming ill while traveling in another country and you don’t have the tools to effectively communicate your symptoms. Finding someone on the medical team who speaks English would be a tremendous relief!

The bottom line is clear: open communication, in terms of both verbal and listening skills, is essential to assessing a patient’s problem and determining the appropriate care and treatment. If you’re considering the field of nursing and are bilingual, you know so much already about your community’s language, customs, food and family values. You also have an awareness of healthcare issues prevalent in your community. As a bilingual nurse, you can be incredibly effective in delivering a high standard of care while putting your patient at ease.

As the Hispanic population and the need for nurses continues to grow, consider becoming a nurse. Courses are available online so you can fit classes in that accommodate your schedule and needs. The biggest benefit of online courses is that they offer flexibility. You’ll also save on time and commuting expenses. You can work, take classes online and reach your goal of becoming a nurse on your timeline!

I’m compensated by University of Phoenix for this blog. As always, all thoughts and opinions are my own.

For more information about on-time completion rates, the median debt incurred by students who completed this program and other important information, please visit phoenix.edu.

Here’s an interesting option for people with Parkinson’s Disease to cope with the motor skills challenges they face every day. It’s another example of technology improving people’s lives.

Parkinson's Disease is a nervous system disorder that affects a person's movement. The most common sign of this disease is hand tremors. Other signs like stiffness or slow movement can also be common. Parkinson's Disease has symptoms that will worsen with progression of the condition over time. This disease has no cure but, medications or physical therapy programs can help improve symptoms. 

Google Glass was a failure. At least, according to most people. But not for one specific group: people with Parkinson's. They've been experimenting with new software for Glass and say that it improves the quality of their lives.

People suffering from Parkinson's have challenges with their motor skills. Joy Esterberg, who was diagnosed with Parkinson's in 2003, compares the feeling to moving through mud. She was an early adopter of the Glass software, which has been in development for the last year. 

"It is very sci-fi," Esterberg said of Glass. "What I like about it is that I can wear it at home. You have the little screen, you see David dancing, and you can follow the moves." 

She's talking about David Leventhal, the director of the Mark Morris Dance Group's Dance for PD program, which has been offering free dance classes for people with Parkinson's since 2001.

When a user activates Glass, they can choose from a variety of different exercises, like "warm me up" or "balance me." Once selected, they see Leventhal or one of his co-teachers projected in front of them. 

This technology is especially important because when people with Parkinson's walk down the street, they sometimes freeze up. In order to get going again, they often need to watch someone else's movements or footsteps. This can be problematic, especially if there's no one around.

The software, called Moving Through Glass, is based off exercises done in Leventhal's weekly class. The movements have roots in ballet and modern dance, and include a lot of extension exercises, which are particularly helpful for people with Parkinson's. Some students are very mobile, while others are confined to wheelchairs and exercise with assistance. 

To get the Glass project going, Leventhal applied for a $25,000 Google (GOOG) grant. He got it, and then partnered with SS+K, a New-York based advertising agency with a strong focus on social responsibility. It developed the software for free through its innovation lab.

Though still in the pilot stage, it's hoped that the software will make people with Parkinson's more independent and confident when they go outside. 

"It's surprisingly un-weird," Esterberg said. "In New York, nobody is going to look at you if you have something on your face. You'd have to have orange feathers sticking out of it for people to notice." 

More and more of the students in her dance class will be using Glass as part of the program. There are about 50 people who attend each week in Brooklyn, and it's known as a place for camaraderie and acceptance. 

"Everyone comes to dance class for a reason," Leventhal said. "Some people come to escape Parkinson's. Some people come because they want to work on specific skills related to balance or coordination or musicality."

There isn't data on how successful the class has been, but Levanthal said he sees it in students' stories. One student, he said, had been able to dance at a family member's wedding thanks to the class. Esterberg said she dances better now than she did before Parkinson's because she practices every day. 

For now, the Glass software is still in the early stages, and the dance studio has 25 pairs available for students to borrow. However, the future is uncertain because Google stopped selling Glass earlier this year, saying it will focus on future incarnations. 

Whatever Glass 2.0 looks like, Leventhal said his students will have a lot of feedback and, no matter what, they'll still be dancing. Esterberg certainly will be, and said she hopes more people will see that a diagnosis doesn't have to mean giving up. 

"You can do new things," she said. "You don't have to just accept [that Parkinson's is] the end of everything. Because it really isn't."

Contributor: Jillian Eugenios and Erica Bettencourt

Story Source: CNN

Erica Bettencourt

There is a need for diversity in the health industry, especially Nurses. Having more diverse nurses will improve access to healthcare for racial and ethnic minority patients. Also those patients will be more comfortable and have higher satisfaction. Diversity must be increased at all levels especially educational institutions. More cultural healthcare programs and initiatives should be offered for students.

By ALEXANDRA ROBBINS

www.nytimes.com 

SEVERAL emergency-room nurses were crying in frustration after their shift ended at a large metropolitan hospital when Molly, who was new to the hospital, walked in. The nurses were scared because their department was so understaffed that they believed their patients — and their nursing licenses — were in danger, and because they knew that when tensions ran high and nurses were spread thin, patients could snap and turn violent.

The nurses were regularly assigned seven to nine patients at a time, when the safe maximum is generally considered four (and just two for patients bound for the intensive-care unit). Molly — whom I followed for a year for a book about nursing, on the condition that I use a pseudonym for her — was assigned 20 patients with non-life-threatening conditions.

“The nurse-patient ratio is insane, the hallways are full of patients, most patients aren’t seen by the attending until they’re ready to leave, and the policies are really unsafe,” Molly told the group.

That’s just how the hospital does things, one nurse said, resigned.

Unfortunately, that’s how many hospitals operate. Inadequate staffing is a nationwide problem, and with the exception of California, not a single state sets a minimum standard for hospital-wide nurse-to-patient ratios.

Dozens of studies have found that the more patients assigned to a nurse, the higher the patients’ risk of death, infections, complications, falls, failure-to-rescue rates and readmission to the hospital — and the longer their hospital stay. According to one study, for every 100 surgical patients who die in hospitals where nurses are assigned four patients, 131 would die if they were assigned eight.

In pediatrics, adding even one extra surgical patient to a nurse’s ratio increases a child’s likelihood of readmission to the hospital by nearly 50 percent. The Center for Health Outcomes and Policy Research found that if every hospital improved its nurses’ working conditions to the levels of the top quarter of hospitals, more than 40,000 lives would be saved nationwide every year.

Nurses are well aware of the problem. In a survey of nurses in Massachusetts released this month, 25 percent said that understaffing was directly responsible for patient deaths, 50 percent blamed understaffing for harm or injury to patients and 85 percent said that patient care is suffering because of the high numbers of patients assigned to each nurse. (The Massachusetts Nurses Association, a labor union, sponsored the study; it was conducted by an independent research firm and the majority of respondents were not members of the association.)

And yet too often, nurses are punished for speaking out. According to the New York State Nurses Association, this month Jack D. Weiler Hospital of the Albert Einstein College of Medicine in New York threatened nurses with arrest, and even escorted seven nurses out of the building, because, during a breakfast to celebrate National Nurses Week, the nurses discussed staffing shortages. (A spokesman for the hospital disputed this characterization of the events.)

It’s not unusual for hospitals to intimidate nurses who speak up about understaffing, said Deborah Burger, co-president of National Nurses United, a union. “It happens all the time, and nurses are harassed into taking what they know are not safe assignments,” she said. “The pressure has gotten even greater to keep your mouth shut. Nurses have gotten blackballed for speaking up.”

The landscape hasn’t always been so alarming. But as the push for hospital profits has increased, important matters like personnel count, most notably nurses, have suffered. “The biggest change in the last five to 10 years is the unrelenting emphasis on boosting their profit margins at the expense of patient safety,” said David Schildmeier, a spokesman for the Massachusetts Nurses Association. “Absolutely every decision is made on the basis of cost savings.”

Experts said that many hospital administrators assume the studies don’t apply to them and fault individuals, not the system, for negative outcomes. “They mistakenly believe their staffing is adequate,” said Judy Smetzer, the vice president of the Institute for Safe Medication Practices, a consumer group. “It’s a vicious cycle. When they’re understaffed, nurses are required to cut corners to get the work done the best they can. Then when there’s a bad outcome, hospitals fire the nurse for cutting corners.”

Nursing advocates continue to push for change. In April, National Nurses United filed a grievance against the James A. Haley Veterans’ Hospital in Tampa, which it said is 100 registered nurses short of the minimum staffing levels mandated by the Department of Veterans Affairs (the hospital said it intends to hire more nurses, but disputes the union’s reading of the mandate).

Nurses are the key to improving American health care; research has proved repeatedly that nurse staffing is directly tied to patient outcomes. Nurses are unsung and underestimated heroes who are needlessly overstretched and overdue for the kind of recognition befitting champions. For their sake and ours, we must insist that hospitals treat them right.

ANGUS CHEN

www.npr.org 

If you're in the hospital or a nursing home, the last thing you want to be dealing with is bedbugs. But exterminators saying they're getting more and more calls for bedbug infestations in nursing homes, hospitals and doctor's offices.

Nearly 60 percent of pest control professionals have found bedbugs in nursing homes in the past year, according to an industry survey, up from 46 percent in 2013. Bedbug reports in other medical facilities have gone up slightly. Thirty-six percent of exterminators reported seeing them in hospitals, up from 33 percent. Infestations seen in doctors' offices rose from 26 percent to 33 percent in the past two years.

"Nursing homes would be difficult to treat for the simple reason you don't use any pesticides there," says Billy Swan, an exterminator who runs a pest-control company in New York City. That and the fact that there's a lot more stuff. "Somebody's gotta wash and dry all the linens, you know, and all their personal artifacts and picture frames."

Those personal belongings might help account for the big disparity in infestations between nursing homes and hospitals, according to Dr. Silvia Munoz-Price, an epidemiologist at the Medical College of Wisconsin who studies infection control in health care facilities. "The more things you bring with you, the more likely you're bringing bedbugs, if you have a bedbug problem... and you live in a nursing home, so all your things are there."

By contrast, "When bedbugs are located in a hospital, they're usually confined to a couple of hospital rooms," Munoz-Price says.

And it may be easier for hospital staff to spot bedbugs.

"Hospital cleaning staff, nurses, doctors are extremely vigilant," says Jim Fredericks, chief entomologist for the National Pest Management Association, which conducted the survey along with the University of Kentucky. "[Bedbugs] don't go unnoticed for long."

And hospitals are typically brightly lit, routinely cleaned places. It's just much easier to find pests in this setting than in a dark movie theater, where only 16 percent of pest professionals report seeing bedbugs, according to the survey.

Fredericks says the recent multiplication of bedbug reports in medical facilities is just a part of a larger trend. Exterminators have been finding more of the bugs everywhere the parasites are most commonly found like hotels, offices, and homes, where virtually 100 percent of pest control professionals have treated bedbugs in the past year. And they've been popping up in a few unexpected places, too, like a prosthetic leg and in an occupied casket.

"There are a lot of theories as to why they've made a comeback," Fredericks says. It could be differences in pest management practices, insecticide resistance, or just increased travel. "Bottom line is nobody knows what caused it, but bedbugs are back." He falters for a moment. "And they're most likely here to stay."

The good news is bedbugs aren't known to transmit any diseases, and a quick inspection under mattresses or in the odd nook or cranny while traveling can lower the risk of picking the hitchhiking bugs up. Swan says a simple wash or freezing will kill any bedbug. "If you came home, took off all your clothes, put 'em in a bag – you'd never bring a bedbug home," he says. "But who does that?"

At least one reporter might start.

By SABRINA TAVERNISE

www.nytimes.com 

There are just a handful of psychiatrists in all of western Nebraska, a vast expanse of farmland and cattle ranches. So when Murlene Osburn, a cattle rancher turned psychiatric nurse, finished her graduate degree, she thought starting a practice in this tiny village of tumbleweeds and farm equipment dealerships would be easy.

It wasn’t. A state law required nurses like her to get a doctor to sign off before they performed the tasks for which they were nationally certified. But the only willing psychiatrist she could find was seven hours away by car and wanted to charge her $500 a month. Discouraged, she set the idea for a practice aside and returned to work on her ranch.

“Do you see a psychiatrist around here? I don’t!” said Ms. Osburn, who has lived in Wood Lake, population 63, for 11 years. “I am willing to practice here. They aren’t. It just gets down to that.”

But in March the rules changed: Nebraska became the 20th state to adopt a law that makes it possible for nurses in a variety of medical fields with most advanced degrees to practice without a doctor’s oversight. Maryland’s governor signed a similar bill into law this month, and eight more states are considering such legislation, according to the American Association of Nurse Practitioners. Now nurses in Nebraska with a master’s degree or better, known as nurse practitioners, no longer have to get a signed agreement from a doctor to be able to do what their state license allows — order and interpret diagnostic tests, prescribe medications and administer treatments.

“I was like, ‘Oh, my gosh, this is such a wonderful victory,’” said Ms. Osburn, who was delivering a calf when she got the news in a text message.

The laws giving nurse practitioners greater autonomy have been particularly important in rural states like Nebraska, which struggle to recruit doctors to remote areas. About a third of Nebraska’s 1.8 million people live in rural areas, and many go largely unserved as the nearest mental health professional is often hours away.

“The situation could be viewed as an emergency, especially in rural counties,” said Jim P. Stimpson, director of the Center for Health Policy at the University of Nebraska, referring to the shortage.

Groups representing doctors, including the American Medical Association, are fighting the laws. They say nurses lack the knowledge and skills to diagnose complex illnesses by themselves. Dr. Robert M. Wah, the president of the A.M.A., said nurses practicing independently would “further compartmentalize and fragment health care,” which he argued should be collaborative, with “the physician at the head of the team.”

Dr. Richard Blatny, the president of the Nebraska Medical Association, which opposed the state legislation, said nurse practitioners have just 4 percent of the total clinical hours that doctors do when they start out. They are more likely than doctors, he said, to refer patients to specialists and to order diagnostic imaging like X-rays, a pattern that could increase costs.

Nurses say their aim is not to go it alone, which is rarely feasible in the modern age of complex medical care, but to have more freedom to perform the tasks that their licenses allow without getting a permission slip from a doctor — a rule that they argue is more about competition than safety. They say advanced-practice nurses deliver primary care that is as good as that of doctors, and cite research that they say proves it.

What is more, nurses say, they are far less costly to employ and train than doctors and can help provide primary care for the millions of Americans who have become newly insured under the Affordable Care Act in an era of shrinking budgets and shortages of primary care doctors. Three to 14 nurse practitioners can be educated for the same cost as one physician, according to a 2011 report by the Institute of Medicine, a prestigious panel of scientists and other experts that is part of the National Academy of Sciences.

In all, nurse practitioners are about a quarter of the primary care work force, according to the institute, which called on states to lift barriers to their full practice.

There is evidence that the legal tide is turning. Not only are more states passing laws, but a February decision by the Supreme Court found that North Carolina’s dental board did not have the authority to stop dental technicians from whitening teeth in nonclinical settings like shopping malls. The ruling tilted the balance toward more independence for professionals with less training.

“The doctors are fighting a losing battle,” said Uwe E. Reinhardt, a health economist at Princeton University. “The nurses are like insurgents. They are occasionally beaten back, but they’ll win in the long run. They have economics and common sense on their side.”

Nurses acknowledge they need help. Elizabeth Nelson, a nurse practitioner in northern Nebraska, said she was on her own last year when an obese woman with a dislocated hip showed up in the emergency room of her small-town hospital. The hospital’s only doctor came from South Dakota once a month to sign paperwork and see patients.

“I was thinking, ‘I’m not ready for this,’ ” said Ms. Nelson, 35, who has been practicing for three years. “It was such a lonely feeling.”

Ms. Osburn, 55, has been on the plains her whole life, first on a sugar beet farm in eastern Montana and more recently in the Sandhills region of Nebraska, a haunting, lonely landscape of yellow grasses dotted with Black Angus cattle. She has been a nurse since 1982, working in nursing homes, hospitals and a state-run psychiatric facility.

As farming has advanced and required fewer workers, the population has shrunk. In the 1960s, the school in Wood Lake had high school graduating classes. Now it has only four students. Ms. Osburn and her family are the only ones still living on a 14-mile road. Three other farmhouses along it are vacant.

The isolation takes a toll on people with mental illness. And the culture on the plains — self-reliance and fiercely guarded privacy — makes it hard to seek help. Ms. Osburn’s aunt had schizophrenia, and her best friend, a victim of domestic abuse, committed suicide in 2009. She herself suffered through a deep depression after her son died in a farm accident in the late 1990s, with no psychiatrist within hundreds of miles to help her through it.

“The need here is so great,” she said, sitting in her kitchen with windows that look out over the plains. She sometimes uses binoculars to see whether her husband is coming home. “Just finding someone who can listen. That’s what we are missing.”

That conviction drove her to apply to a psychiatric nursing program at the University of Nebraska, which she completed in December 2012. She received her national certification in 2013, giving her the right to act as a therapist, and to diagnose and prescribe medication for patients with mental illness. The new state law still requires some supervision at first, but it can be provided by another psychiatric nurse — help Ms. Osburn said she would gladly accept.

Ms. Nelson, the nurse who treated the obese patient, now works in a different hospital. These days when she is alone on a shift, she has backup. A television monitor beams an emergency medicine doctor and staff into her workstation from an office in Sioux Falls, S.D. They recently helped her insert a breathing tube in a patient.

The doctor shortage remains. The hospital, Brown County Hospital in Ainsworth, Neb., has been searching for a doctor since the spring of 2012. “We have no malls and no Walmart,” Ms. Nelson said. “Recruitment is nearly impossible.”

Ms. Osburn is looking for office space. The law will take effect in September, and she wants to be ready. She has already picked a name: Sandhill Behavioral Services. Three nursing homes have requested her services, and there have been inquiries from a prison.

“I’m planning on getting in this little car and driving everywhere,” she said, smiling, behind the wheel of her 2004 Ford Taurus. “I’m going to drive the wheels off this thing.”

By Darius Tahir

www.modernhealthcare.com 

In 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.

Written by David McNamee

www.medicalnewstoday.com 

A 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."

BY MAGGIE FOX

www.nbcnews.com 

Hospital workers wash their hands hundreds of times a day. Nurses are constantly using alcohol gels, chemical wipes and iodine washes on themselves and on patients.

Now that there's a hand sanitizer dispenser at every hospital room door, it's time to check that they actually do work as well as everyone assumes and that they are safe, the Food and Drug Administration says.

So FDA issued a proposed plan Thursday for reclassifying some of the products, and for requiring makers to show they are safe and effective.

"We're not asking for any of these products to come off the market at this time."

In the meantime. FDA says, there's nothing for consumers to worry about and hospitals should continue using the products as they have been.

"What it seems they are doing is good due diligence," says Dr. Susan Dolan of Children's Hospital Colorado and the Association of Professionals in Infection Control.

"They are trying to look at the products, look at how they are being used today, how things have changed," she added.

The FDA proposes new rules making companies submit new studies looking at safety issues such as whether heavy, chronic use of the some of the products may cause them to soak in through the skin, or cause resistant bacteria to evolve.

Products that are not shown to be safe and effective by 2018 would have to be reformulated or taken off the market.

"We're not asking for any of these products to come off the market at this time. We're just asking for additional data," Theresa Michele, a director in FDA's drug center, said in an interview with The Associated Press. "And we're likewise not suggesting that people stop using these products."

Alcohol, iodine benzalkonium chloride and other germ-killers have been used for decades. But not to the degree that they are now.

"Twenty years ago you didn't find people using antiseptic gels 100 times a day. It just didn't happen," Michele said.

FDA points to studies that show some of the products might be absorbed into the body at higher levels than previously thought, showing up in blood and urine. Dolan says not all the studies show this, but it's worthwhile doing more checks.

"It's timely and it makes sense," Dolan said. "I do think consumers should not be worried. These are very effective products."

The FDA last updated its review of health care hand cleaners in 1994.

"They are trying to look at the products, look at how they are being used today, how things have changed."

"We emphasize that our proposal for more safety and effectiveness data for health care antiseptic active ingredients does not mean that we believe that health care antiseptic products containing these ingredients are ineffective or unsafe, or that their use should be discontinued," FDA said in its announcement.

The agency agreed to complete its review after a three-year legal battle with the Natural Resources Defense Council, an environmental group that accused the FDA of delaying action on potentially dangerous chemicals. In 2013 the FDA agreed to a legal settlement that included timetables for completing the review of various chemicals, including health care cleaners.

Environmentalists are mainly concerned about an ingredient called triclosan, which is used in most antibacterial soaps marketed to consumers. The agency issued a separate review of triclosan-containing consumer products in late 2013, saying more data are needed to establish their safety and effectiveness.