DiversityNursing Blog

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

Tutu Tuesday Brings Smiles to Florida Children's Hospital

Posted by Erica Bettencourt

Mon, May 04, 2015 @ 12:39 PM

By FREIDA FRISARO

http://abcnews.go.com 

WireAP 81568d5fb53a4d3cb4394b05626b814e 16x9 992 resized 600One morning last summer, Tony Smith slipped a multicolor tutu over his scrubs in the pre-op ward of a South Florida hospital to grant the wish of a young patient heading to surgery.

A photo of the tutu-clad Smith quickly became a hit online and within weeks, Tutu Tuesday was born at Joe DiMaggio Children's Hospital.

"That day, it was all about making a patient feel comfortable. Having me put on the tutu made her feel better," said Smith, an operating room assistant who has worked at the Hollywood, Florida, hospital for almost five years. "I never knew I would have that much impact. I didn't expect it to go viral."

But it did. Once employees saw the shot, they started asking Lotsy Dotsy — resident clown and unofficial keeper of the tutu — for their own frilly skirts to wear. Department by department, hospital staff adopted Tutu Tuesday.

It begins outside the hospital named for a baseball legend, where visitors are greeted by a valet whose tutu clashes with his normal uniform — shorts and a baseball jersey.

"People laugh and ask why I'm wearing a skirt," said John Aristizabal, who takes good-natured kidding as he parks cars. "It's all for the kids, to catch a smile."

On Tutu Tuesday, smiles are contagious.

Inside the hospital, tutus are everywhere. Doctors, nurses, technicians and receptionists don the colorful layers of tulle, decorated with polka dots and fancy bows as they go about the business of tending to patients. Even Nutmeg, the in-house therapy dog, has a specially designed pink tutu. Hospital administrators also play along, wearing tutus over their business suits.

Smith said he could have never imagined that such a simple act would catch on.

"It's for the patients," Smith said. "Just seeing you in a tutu brightens their day, and it can keep them from thinking about what's really going on."

That's exactly what pediatric anesthesiologist Dr. Bob Kaye has been doing for years. He's worn a variety of funny hats and wigs to help ease the fears of his young patients. Now he's added a tutu to his routine and has found that his patients and their parents like the distraction.

"If you can dress in a way that it not threatening and silly, maybe, and make the medical professional look not like the last person who gave them a shot in the doctor's office, then it's a lot easier to feel comfortable with them," he said. "I think it's an ice breaker."

On a Tuesday morning in March, Laurel Barnett and her 13-year-old daughter Julia arrived about 5:45 a.m. for surgery.

"Of course, not having any coffee and then coming in and seeing everyone in tutus is quite amusing," Barnett said. "It's not what you expected to see. It does give children a sense of relief that these people are not only here to help them, but there to have fun as well. It kind of takes their mind off of things."

Smith says he's not bothered at all by the stares and giggles as he makes his way through the hospital's corridors every Tuesday. He even offered his tutu to 12-year-old Brayden Wilmsmeyer, who along with his 10-year twin sisters Leah and Lexi spent spring break getting respiratory treatment at Joe DiMaggio.

The twins had borrowed tutus from two nurses for an impromptu photo session.

"Remember, you are a real man," Smith told Brayden as he pulled the tutu over his pants. "Don't let anyone tell you otherwise just because you're wearing a tutu."

Topics: health, healthcare, nurses, doctors, children, medical, patients, hospital, treatment, children's hospital, medical staff

Lives Of Three Babies Rescued By 3D-Printed, Growth-Flexible Implants

Posted by Erica Bettencourt

Fri, May 01, 2015 @ 11:46 AM

Written by Markus MacGill

www.medicalnewstoday.com 

kaiba gionfriddo resized 6003D printing has come to the rescue of severe cases of a childhood disease in which the windpipe is softened, leading to collapse of the airway and breathing failure. Previously lacking any adequate intervention, tracheobronchomalacia has found an innovative fix in three babies whose condition presented them with little chance of reaching young childhood.

Researchers at the University of Michigan's C.S. Mott Children's Hospital in Ann Arbor say the three boys have become the "first in the world to benefit from groundbreaking 3D-printed devices" to stent their airways in such a way as to allow the supports to keep up with their growth.

A follow-up of all three patients published in the journal Science Translational Medicine shows the personalized bioresorbable splint implants have worked with "promising results."

Pediatric tracheobronchomalacia (TBM) sees excessive collapse of the airways during breathing that can lead to life-threatening cardiopulmonary arrests (halted heart and breathing).

The cartilage supporting the airway can strengthen as children with the condition grow, the study paper goes on to explain, but severe cases of the disease require aggressive treatment - and those children are at "imminent risk of death."

Before this new approach to provide an early treatment option for TBM, the only conventional therapies available also carried life-threatening complications of their own.

Babies needed tracheostomy tube placement with mechanical ventilation, requiring prolonged hospitalization, and complications often led to cardiac and respiratory arrest. For example, the rate of respiratory arrest owing to tube occlusion runs as high as 43% of pediatric tracheostomy procedures a year.

Survivors: Kaiba, Ian and Garrett

But none of the newly developed 3D-printed devices have caused any complications for the three children treated, including Kaiba, who at 3 months old was the first to receive the new technology, 3 years ago. The stents were also inserted into 5-month-old Ian and 16-month-old Garrett.

Designed to accommodate airway growth while preventing external compression over a period of time before bioresorption, the technology allows for the particular problem of radial expansion of the airway over the critical period of growth. "If a child can be supported through the first 24 to 36 months of tracheobronchomalacia, airway growth generally results in a natural resolution of this disease," write the authors.

Senior author Dr. Glenn Green, associate professor of pediatric otolaryngology at C.S. Mott, says: "Before this procedure, babies with severe tracheobronchomalacia had little chance of surviving. Today, our first patient Kaiba is an active, healthy 3-year-old in preschool with a bright future." Dr. Green adds:

 

"The device worked better than we could have ever imagined. We have been able to successfully replicate this procedure and have been watching patients closely to see whether the device is doing what it was intended to do.

We found that this treatment continues to prove to be a promising option for children facing this life-threatening condition that has no cure."

 

Dr. Green describes in the video below how he and his colleagues at the University of Michigan worked on finding the solution.


Dr. Green strives enthusiastically for the lives of babies born with the condition, which he says in a post on the hospital's Hail to the little victors blog is often misdiagnosed as treatment-resistant asthma. He adds that it is a rare congenital condition affecting about 1 in 2,200 births, and the severe cases are even rarer, with most children growing out of the milder cases by 2 or 3 years of age.

"Kaiba's parents, April and Bryan, were left watching helplessly each time he stopped breathing, praying that something would change and doctors' predictions that he would never leave the hospital again weren't true," writes Dr. Green in 2013.

The 3D-printed splints were computational image-based designed to be customizable so that the following parameters could be made bespoke to the individual patient's anatomy on "the submillimeter scale:"

  • Inner diameter, length and wall thickness of the device
  • Number and spacing of suture holes.

Not being a closed cylinder, the design of the tubes gave an opening to allow placement but also expansion of the radius as the airways grew. All the inserts placed around the airways were made of polycaprolactone, a polymer that harmlessly dissolves in the body at a rate to allow the technology time to support the growing cartilage.

For Garrett's bespoke device on his left bronchus, the opening had a spiral shape to it, to allow a device to be fitted concurrently around, and grow with, his right bronchus, too.

Freedom from intensive care treatments

The Michigan team also share findings showing that the success of the devices meant the young children were able to come off of ventilators and no longer needed paralytic, narcotic and sedating drugs.

There were improvements in multiple organ systems and problems that had prevented the babies from absorbing food, so now they could be free of intravenous therapy.

The research doctors had received urgent approval from the US Food and Drug Administration to do the procedures, but it is early days for the strategy to become routine for babies with TBM. The case report published today was not designed to test the safety of the devices - so it may yet be possible that rare complications are found to result from treatment in some cases. Dr. Green says:

"The potential of 3D-printed medical devices to improve outcomes for patients is clear, but we need more data to implement this procedure in medical practice."

The specialist surgeon performing the operations, Dr. Richard Ohye, head of pediatric cardiovascular surgery at C.S. Mott, believes the cases provide the groundwork for a potential clinical trial in children with less-severe forms of TBM.


Topics: 3-D printing, medical technology, health, healthcare, children, medical, patients, hospital, patient, treatment, babies, TBM

Individualized Discharge Planning May be Best for Some Elderly Patients

Posted by Erica Bettencourt

Fri, May 01, 2015 @ 10:10 AM

Alexandra Wilson Pecci

www.healthleadersmedia.com 

315872 resized 600Hospitals have a broader responsibility to elderly trauma patients than just the time spent within their walls, and should consider updating their strategies to ensure the best outcomes for these patients, research suggests.

Elderly trauma patients are increasingly likely to be discharged to skilled nursing facilities, rather than inpatient rehabilitation facilities (IRF), finds a study in The Journal of Trauma and Acute Care Surgery published in the April issue.

Discharge to skilled nursing facilities for trauma patients has, however, been associated with higher mortality compared with discharge to inpatient rehabilitation facilities or home.

Researchers wanted to "better characterize trends in trauma discharges and compare them with a population that is equally dependent on post-discharge rehabilitation." They not only examined trauma discharges, but also discharges of stroke patients, who have been taking up more inpatient rehabilitation facility beds.

Using data from 2003–2009 data from the National Trauma Data Bank and National Inpatient Sample, the retrospective cohort study found that elderly trauma patients were 34% more likely to be discharged to a skilled nursing facility and 36% less likely to be discharged to an inpatient rehabilitation facility. By comparison, stroke patients were 78% more likely to be discharged to an inpatient rehabilitation facility.

This is despite the findings of a 2011  JAMA study of patients in Washington State showing that "Discharge to a skilled nursing facility at any age following trauma admission was associated with a higher risk of subsequent mortality."

The Journal of Trauma and Acute Care Surgery study notes that "elderly trauma patients are the fastest-growing trauma population," which leads to the question: Where should hospitals be investing their money and time to ensure the best outcomes for these patients?

"I think hospitals should be investing in post-acute care discharge planning," says Patricia Ayoung-Chee, MD, MPH, Assistant Professor, Surgery, NYU School of Medicine, and lead author of the study. "What's the best post-acute care facility for patients? And it may end up needing to be individualized."

She says reimbursement and insurance factors have "played more of a role than anybody sort of thought about" in discharges, rather than what is always necessarily best for patients.

For example, to be classified for payment under Medicare's IRF prospective payment system, at least 60% of all cases at inpatient rehab facilities must have at least one of 13 conditions that CMS has determined typically require intensive rehabilitation therapy, such as stroke and hip fracture.

"I think the unintended consequence is that we may be discharging patients to the best post-acute care setting, but we also may not be," Ayoung-Chee said by email, and that question "is only now being looked at in-depth."

She says hospitals should think about truly appropriate discharge planning upfront.

Proactive Hospitals
For instance, at admission, hospitals can find out who the patient lives with, or what their social support system is like. If they have a broken dominant hand after a fall, will they be able to get help with their groceries? Do they live alone? Will they be able to use the bathroom?

Caring for patients also doesn't end when patients leave the hospital, she adds. Hence the study's title: "Beyond the Hospital Doors: Improving Long-term Outcomes for Elderly Trauma Patients."

Ayoung-Chee says the next step in her research is to look at a more longitudinal picture, following individual patients to see what factors play into their function or lack of function.

But hospitals can do some of that work on a smaller scale, with internal audits to determine which facilities have the best post-acute care outcomes. For instance, they could spend time examining which facilities had fewer readmissions compared to others, as well as how long it took patients to get home and their how satisfied they were with their care.

Other research is also trying to determine which facilities are best for elderly trauma patients. For instance, a second study, also published in The Journal of Trauma and Acute Care Surgery, shows that geriatric trauma patients have improved outcomes when they are treated at centers that manage a higher proportion of older patients.

One of the overarching takeaways from Ayoung-Chee's research is the idea that hospitals have a broader responsibility to patients than just the time spent within their walls.

"What we do doesn't just end upon patient discharge. If we truly want to get the biggest bang from our buck, we're going to have to think about the entire continuum," she says.

That could range from working to prevent falls that can cause elderly trauma, to seeing patients through all of the appropriate care needed to expect a good functional outcome. Good healthcare for elderly trauma patients should extend beyond the parameters of morbidity and mortality, and toward returning patients to their original functional status and, ultimately, independence, says Ayoung-Chee.

"Our long-lasting effect as healthcare providers isn't just what we do in the hospital," she says. "And we have to start thinking outside."

Topics: nursing, health, nurse, nurses, data, medical, patients, patient, elderly, seniors, trauma discharges, discharge, trauma patients, inpatient, helthcare, rehabilitation

IdentRx Promises to Prevent Nearly All Medication Errors

Posted by Erica Bettencourt

Wed, Apr 29, 2015 @ 11:08 AM

www.medgadget.com 

describe the imageMedication errors continue to plague the clinical community and even rare cases of mistakes can make a big splash in the news. And for a good reason: we all expect to be treated than harmed when receiving medical care. A new device is currently in the third round of pilot testing, including at major retail pharmacies and Purdue University, that may help avoid prescription errors altogether. The IdentRx system from PerceptiMed, a Mountain View, California firm, optically analyzes every single pill that will be given to a patient to make sure it precisely matches each prescription.

It is the only device that visually inspects each pill, recognizing the manufacturer imprints on them all. The system confirms that the pills themselves, and not only the container bottles, match the issued prescriptions, hopefully preventing errors just before the pills are handed to the patients.

Topics: medical technology, prescription, medication errors, technology, health, healthcare, medication, medical, patients, medicine, patient

Can A Person With Dementia Consent To Sex?

Posted by Erica Bettencourt

Mon, Apr 27, 2015 @ 11:56 AM

INA JAFFE

www.npr.org 

 

hands wide a3025de4d88febec5bad153c15516ab775deac64 s800 c85 resized 600Sexual relationships in long-term care facilities are not uncommon. But the long-term care industry is still grappling with the issue.

CAN A PERSON WITH DEMENTIA CONSENT TO SEX?

There's no greater evidence of that than a criminal case in Iowa. On Wednesday, a jury in Iowa found a 78-year-old man not guilty of raping his wife, who had Alzheimer's disease. Henry Rayhons' wife lived in a nursing home. The staff there told Rayhons that because of her dementia, his wife was no longer capable of consenting to sex. He had been charged with sexual assault for allegedly having sex with her after that.

 

But at the Hebrew Home in Riverdale, N.Y., the fact that some people with dementia still have sex lives isn't news. That facility has had a written policy to help staff manage such relationships for 20 years.

"It was controversial in 1995 and it's controversial today," says Daniel Reingold, the CEO of RiverSpring Health, the nonprofit that runs the Hebrew Home.

"We knew that there was intimacy occurring, and we considered it to be a civil right and a legal right," says Reingold. "We also felt that intimacy was a good thing, that touch is one of the last pleasures we abandon and lose as we age."

Reingold says the policy protects residents from unwanted sexual contact. And he argues that people with dementia are indeed capable of giving consent.

"People who have Alzheimer's disease or dementia are asked on a daily basis to make decisions about their desires," says Reingold, "from what they eat to activities they may want to engage in," including intimacy with another person.

But even with a written policy, it's not that easy for nursing homes to figure out when consent to sex is really valid, says Evelyn Tenenbaum, a professor of law at Albany Law School and bioethics professor at Albany Medical College.

"For example, suppose you have a couple and the woman believes that the man she's seeing is her husband," says Tenenbaum. "Then she consents to a sexual relationship. Is that really consent if she doesn't understand who he is and that she's not married to him?"

Sometimes in such cases, nursing homes will defer to the wishes of the resident's family, says Tenenbaum.

"On the other hand, nursing homes are required to take care of the psychosocial needs of their residents," says Tenenbaum. "Whether psychosocial needs would include sexual relationships is a question."

And it's a question with no commonly accepted answer. The American Health Care Association, a trade group representing the majority of nursing homes, only suggests that its member facilities develop their own policies. Patricia Bach, a geriatric psychologist, says when she started looking into the topic she didn't find much.

"There was very, very little empirical evidence, little data, few research studies and it really was a lower priority issue for long-term care providers," she says.

So with a colleague, Bach surveyed members of the American Medical Directors Association, which represents physicians who work in long-term care facilities.

Bach found that "only 25 to 30 percent actually had formal training in the area of intimacy and sexuality, as it would pertain to older adults. Thirty percent had no training at all." The survey also found that only about 30 percent of nursing homes where the respondents worked had formal policies.

That's something that needs to change, and fast, says Reingold.

"We are dealing with the arrival of my fellow baby boomers," he says. They've "grown up in an environment where sexuality was a much more open conversation and activity."

And there's no reason to think that will change, Reingold says, even when those boomers are in long-term care.

Topics: dementia, patients, elderly, consent, criminal case, medical staff, Alzheimer's disease, sex, sexual relationships, assisted living

Special Screenings Of ‘The American Nurse’ To Be Held May 6

Posted by Erica Bettencourt

Mon, Apr 27, 2015 @ 11:38 AM

http://news.nurse.com 

bilde resized 600The award-winning documentary “The American Nurse” (DigiNext Films) will be shown at special screening engagements May 6 in honor of National Nurses Week. The film highlights the work and lives of five American nurses from diverse specialties and explores topics such as aging, war, poverty and prisons. 

“At some point in our life each of us will encounter a nurse, whether it’s as a patient or as a loved one,” Carolyn Jones, director and executive producer of the film, said in a news release. “And that one encounter can mean the difference between suffering and peace; between chaos and order. Nurses matter.” 

The American Academy of Nursing recognized Jones, an award-winning filmmaker and photographer, as the winner of its annual Johnson & Johnson Excellence in Media Award for the documentary. The award recognizes exemplary healthcare journalism that incorporates accurate inclusion of nurses’ contributions and perspectives. “I intended to make a film that celebrated nursing,” Jones said in the release. “I ended up gaining deeper insights into some of the social issues we face as a country, through the eyes of American nurses. I’ve grown to believe that nurses are a truly untapped and under-appreciated national resource.” 

The documentary also was awarded a Christopher Award in the feature film category, alongside films “Selma” and “St. Vincent.”

The film, which was made possible by a grant from Fresenius Kabi, is being presented locally through sponsorship by the Future of Nursing: Campaign for Action, a joint initiative of the Robert Wood Johnson Foundation and AARP, together with the American Nurses Foundation and Carmike Cinemas. 

The campaign’s state action coalitions and other campaign partners are expected to host at least 50 screenings of the film. Ten percent of the proceeds will go to help local efforts to advance nursing. A portion of all proceeds from the film will benefit the American Nurse Scholarship Fund.

To find a screening near you or to learn how to host a screening, go to http://americannurseproject.com/national-nurses-day-screenings.

Topics: film, diversity, nursing, nurse, nurses, medical, patients, hospital, medicine, May, Nurses Week

They Put Cameras Inside A Retirement Home, But Never Expected To See THIS Happen!

Posted by Erica Bettencourt

Fri, Apr 24, 2015 @ 11:03 AM

By Barbara Diamond

www.littlethings.com 

maxresdefault resized 600Now tell us: Is this a viral-worthy video or what?!

Everyone loves it when seniors prove that you’re never too old to have fun. The video below is brand new on YouTube, but I have no doubt it will soon be seen by millions of people.

I couldn’t stop smiling as I watched this clip, which features the residents of Belvedere of Westlake’s Assisted Living Facility fighting for their right to party. With a hilarious parody of The Beastie Boys’ classic song, “(You Gotta) Fight For Your Right (To Party)” — an anthem in both the rap and rock worlds — the Cleveland, OH nursing home residents are here to prove that age is but a number, and they certainly still know how to rock. From slingin’ back bottles of booze and gambling, to rocking out on the guitar and stripping down to their skivvies, these seniors are certainly doing it their way. LOL!

Not only do they still have a great sense of humor and tons of energy, but it’s clear that these folks are truly young at heart. My favorite part is at the 1:53 mark. I won’t give it away, but I will say this… You go, Granny!

If this video made you smile, please SHARE it with your friends on Facebook!

Topics: nursing home, funny, health, healthcare, video, nurses, patients

New Genetic Tests for Breast Cancer Hold Promise

Posted by Erica Bettencourt

Wed, Apr 22, 2015 @ 02:34 PM

By ANDREW POLLACK

www.nytimes.com 

A Silicon Valley start-up with some big-name backers is threatening to upend genetic screening for breast and ovarian cancer by offering a test on a sample of saliva that is so inexpensiv e that most women could get it.

At the same time, the nation’s two largest clinical laboratories, Quest Diagnostics and LabCorp, normally bitter rivals, are joining with French researchers to pool their data to better interpret mutations in the two main breast cancer risk genes, known as BRCA1 and BRCA2. Other companies and laboratories are being invited to join the effort, called BRCA Share.

The announcements being made on Tuesday, although coincidental in their timing, speak to the surge in competition in genetic risk screening for cancer since 2013, when the Supreme Court invalidated the gene patents that gave Myriad Genetics a monopoly on BRCA testing.

The field has also been propelled by the actress and filmmaker Angelina Jolie, who has a BRCA1 mutation and has written about her own decision to have her breasts, ovaries and fallopian tubes removed to sharply reduce her risk of developing cancer.

But the issue of who should be tested remains controversial. The effort of the start-up, Color Genomics, to “democratize access to genetic testing,” in the words of the chief executive, Elad Gil, is generating concern among some experts.

The company plans to charge $249 for an analysis of BRCA1 and BRCA2, plus 17 other cancer-risk genes. That is one tenth the price of many tests now on the market.

Testing of the BRCA genes has generally been limited by medical guidelines to women who already have cancer or those with a family history of breast or ovarian cancers. Insurers generally have not paid for BRCA tests for other women, and some insurers are not paying at all for a newer type of screening known as a panel test that analyzes from 10 to 40 genes at once.

Dr. Gil of Color said his company’s test would be inexpensive enough for women to pay out of pocket, so that neither the woman nor Color will have to deal with insurance companies. He said the company was starting a program to provide free testing to women who cannot afford its test.

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One of the company’s unpaid advisers is Mary-Claire King, the University of Washington geneticist whose work led to the discovery of the BRCA1 gene. Dr. King last year publicly called for testing to be offered to all American women 30 and older.

She said that half the women with dangerous mutations would not qualify for testing under current guidelines, in part because many inherit the mutation from their fathers rather than their mothers and a family history of breast or ovarian cancer might not be evident.

21JP BREAST articleLarge resized 600

But other experts say that fewer women in the expanded group would be found to have dangerous mutations, raising the overall cost of testing per cancer case prevented. Moreover, expanded testing could result in many more women being told they have mutations that cannot be classified as either dangerous or benign, leaving women in a state of limbo as to whether they have an increased risk of cancer.

“We have to be careful that we are not just increasing this group of worried-well who have incomplete information,” said Dr. Kenneth Offit, chief of the clinical genetics service at the Memorial Sloan Kettering Cancer Center.

Dr. Offit said it was contradictory that Color was trying to expand testing to everyone on the same day the two biggest testing companies were joining forces to try to reduce how often they find these so-called variants of uncertain significance.

Color is planning to allow women to order tests through its website. Another Silicon Valley start-up that did that, 23andMe, had its health testing shut down in 2013 by the Food and Drug Administration.

Color executives say that unlike with 23andMe, a doctor will be involved in every order and in the test results. If a consumer orders the test directly from its website, her information will be sent to a doctor hired by the company to evaluate it.

An F.D.A. spokeswoman said that if doctors place orders, testing companies that operate their own laboratories do not need F.D.A. approval to offer their tests.

Some testing experts question whether Color can provide testing as inexpensively as it claims. While the actual sequencing might be done for less than $250, that is only part of the cost, which also involves interpretation and working with patients and doctors, they say. Other companies generally charge at least $1,500 for complete analyses of the BRCA genes or for multigene tests.

But Dr. Gil said Color has highly automated its processes and will even offer genetic counseling to women. He said the company chose the saliva test rather than a blood one because it’s easier for users but still accurate. Women send the saliva sample to Color for testing.

Dr. Gil received a doctoral degree in biology at the Massachusetts Institute of Technology, studying a cancer gene. But he has spent much of his career at Google and Twitter. The company’s president, Othman Laraki, also worked at Google and Twitter.

Color’s backers — it says it has raised about $15 million — are mainly from the world of high tech rather than life sciences. Its lead investors are the venture capital firms Khosla Ventures and Formation 8. Individual investors include Laurene Powell Jobs, the widow of Steve Jobs; Susan L. Wagner, a co-founder of the investment firm BlackRock; Padmasree Warrior, the chief technology and strategy officer at Cisco; and Jerry Yang, co-founder of Yahoo.

Dr. Offit of Sloan Kettering said that even Myriad, which long had a monopoly on BRCA testing and has the most data, has reported having a 2 percent rate of variants of unknown significance, meaning 2 percent of the time it cannot tell if a variant in a gene increases the risk of cancer or is benign. Other companies might have higher rates. And the rates for some other, less-well-studied genes can be 20 or 30 percent, he said.

The entire testing industry is now scrambling to pool data to lower that rate, and in some cases to catch up to Myriad, which has kept much of its data proprietary as a competitive advantage. Various data-sharing efforts are already underway, including by ClinVar and the BRCA Challenge.

Now there is also BRCA Share, which is based on a database of genetic variants maintained by Inserm, a French government health research institute. Quest Diagnostics agreed to provide money to improve that database and pay for experiments on cells that could help determine whether certain mutations raise the risk of cancer.

“We are going to help them make it better,” said Dr. Charles M. Strom, vice president for genomics and genetics at Quest. He said BRCA Share would be open to others, with LabCorp becoming the first to join.

Participants will have to contribute their data to the database. Companies will pay for access to the data on a sliding scale based on their size, while others will have access to the data without paying, he said.

Topics: FDA, genes, health, healthcare, nurses, doctors, medical, cancer, patients, breast cancer, treatment, genetic testing, BRCA genes

City of Hope Is Leading The Way To Create A Talent Pipeline For Hispanics In Healthcare

Posted by Erica Bettencourt

Wed, Apr 22, 2015 @ 10:05 AM

Glenn Llopis

www.huffingtonpost.com

talentpipeline 370x229 resized 600Like many healthcare providers in the Los Angeles area, and well beyond to healthcare organizations throughout the United States, City of Hope has recognized the growing need for clinical professionals and staff that more closely mirror the patients it serves in its catchment area. And with a local population that is nearly half Hispanic, that means recruiting more Hispanics into the industry, as well as providing much needed career development opportunities. But whereas most in the industry are just beginning to acknowledge the need, City of Hope has taken the lead to recruit more Hispanics into the industry and also has started to build a Hispanic talent pipeline for the immediate and not so distant future.

According to Ann Miller, senior director of talent acquisition and workforce development, "Even when people in the industry recognize the need for more Hispanics, or just a more diverse workforce, it can feel overwhelming trying to figure out what actions to take and how to build a strategy around it. But once you see the data laid out in front of you, and see that 46 percent of your primary service area is Hispanic, you realize it would be optimal to figure out how to recruit a workforce that looks more like the population you are serving. Beyond that, it's also important to employ a bilingual staff that can speak the language and understand the culture to best meet the needs of the community being served."

Once you recognize the need, it's time to start asking the questions that will help you fill the gaps:

  • How do you find and appeal to the types of people you need to start building relationships with? Who are the influencers and the connectors?
  • How do you get your recruitment team looking toward the future and building a pipeline, when limited resources are focused on more immediate needs?
  • How do you get buy-in from senior management and enlist other departments throughout the organization?
  • How do you partner with others in the industry who recognize the need but have yet to become active in the pursuit of common goals? 

Here's how City of Hope has started to answer these questions as it takes the lead in addressing these timely industry issues. Stephanie Neuvirth, Chief Human Resources and Diversity Officer, has said that it's not easy to build a diverse healthcare or biomedical pipeline of talent, even when you understand the supply and demand of your primary service area and the business case becomes clearer. "Few in the industry are taking the helicopter perspective that is needed to really see the linkage between the different variables that must be factored in to solve the problem," she says. 

Even in healthcare, it's not simple, and it takes time to develop the paths, the relationships and the pipeline to cause real and sustainable change. It takes linking a workforce talent strategy to the broader mission and strategic goals of the organization. And it takes collaboration with the community, schools, government, parents and everyone who touches the pipeline to help achieve the necessary and vital missing pieces of the puzzle.

Talent Acquisition and Workforce Development

What you first have to realize is that there is an immediate but also a long-term gap to fill, which represent two sides of the same coin: talent acquisition and workforce development. We know we can best serve our community by mirroring the community that we serve, and that doesn't stop with the talent that we attract today; it's an imperative that depends on the talent pipeline that we build for the future.

City of Hope's approach has been to start fast and strong with some immediate steps that can then be built upon and cascaded out into a longer term strategy for the future. The good news is that if your goal is to look like the community you serve, you don't have to look far for the talent you need. It's right in your own backyard. But there's still a lot of work to be done in terms of educating people about potential careers in healthcare -- clinical and otherwise -- developing the workforce skills and knowledge that they will need, and planting the seeds in the next generation. 

It's particularly disheartening to hear about the young people graduating from high school and college who can't get jobs, when there are growing shortages in the healthcare industry - the nation's third largest industry, and projected to be its second largest in just seven years. According to a recent report by The Economist, U.S. businesses are going to depend heavily on Latinos - the country's fastest-growing and what it calls "irreversible" population -- to fill the gaps not just in healthcare but across all industries. 

If you look just at nursing, the single largest profession in California, you can see how far we have to go. Only 7 percent of the 300,000 nurses in the state are Hispanic. The clinical gaps extend to doctors, just 6 percent Latino; pharmacists, less than 6 percent; and the list goes on and on.

Teresa McCormac, nurse recruiter, is one of the people at City of Hope working to build the Hispanic talent pipeline, beginning with the need for Spanish speaking nurses. She is responsible for elevating City of Hope's presence in the community through word of mouth referrals and by getting active in broader outreach online, in publications and at local, college and national events, such as the National Association of Hispanic Nurses (NAHN) annual conference taking place in Anaheim, CA this July.

"It's important to have a passionate champion for the candidates, as well as our hiring managers and the organization. My role is to get the word out into the community about City of Hope and connect with the talent we need to fill our current and future openings," she says.

This requires a multi-prong approach to recruitment efforts, where you must act to attract candidates not only for current needs, but down the road five-ten years, and even further into the future. 

This begs the question: how do you get more Hispanics and other diverse students interested in the sciences and considering careers in healthcare? 

Traditionally, recruiters focus on those currently working in healthcare to fill immediate gaps, as well as those working in other industries with transferable skills, who might be interested in working in healthcare in a non-clinical capacity, such as IT or marketing. They also look at colleges with nursing and other clinical programs -- particularly those with high concentrations of Hispanics and other diverse students -- where they can conduct outreach efforts, build partnerships and establish a presence. 

But building a talent pipeline requires that you reach students well before the college years, when they are still in high school, and even earlier as middle and grade-schoolers. It takes time to get the message out there and have it stick, so the bigger and bolder you can go, the better. That was City of Hope's thinking behind the launch of its Diversity Health Care Career Expo in September 2014, which made quite an impact with the community and opened eyes to the variety of career opportunities within healthcare. It also opened City of Hope's eyes to the level of interest from the community when 1500 people showed up for this first of its kind event. 

What started as an idea for a diversity career fair to fill immediate positions quickly grew to encompass a workforce development component to include students, parents, as well as working professionals interested in transitioning into healthcare. The Career Expo brought a level of awareness never seen before in the community -- and did so very quickly. For example, it allowed healthcare professionals to connect the dots between math and science classes students were taking and how this learning applied in the real world of healthcare -- and the different careers these types of classes are helping to prepare them for if they stick with them. It also allowed parents to understand how to help their children prepare for jobs that are available and will continue to be available in the future. They also gained insights into how growing up with smartphones and other electronic devices has given their children a distinct advantage that previous generations didn't have -- enabling them to leverage their everyday use of technology into transferable skills that could lead towards a career in Information Technology, which offers a very promising career path within the healthcare and biomedicine industries. 

Catching students early on to spark their interest and expose them to healthcare careers and professionals who can encourage and support them along the way requires that you go out into the community as well. Toward that end, City of Hope has partnered with Duarte Unified School District and Citrus College on a program called TEACH (Train, Educate and Accelerate Careers in Healthcare).

According to Tamara Robertson, senior manager of recruitment, the TEACH partnership provides students with the opportunity to gain college credit while still in high school by taking college-level classes at no cost. This puts them on the fast track to higher education and career readiness by giving them essential skills and capabilities to enter the workforce soon after graduating high school, or to continue their education with up to one year of college coursework already completed. Eighteen students were accepted into the program in its first year.

Each partner plays a valuable role in the program. City of Hope provides students with opportunities to gain first-hand exposure to healthcare IT by giving overviews of the various areas within IT, providing summer internships, and offering mentoring and development interactions. Duarte High School is the conduit for the program by selecting the students for the program and facilitating the learning, and Citrus College develops the curriculum that enables students to earn college credits and IT certifications. It's ideal for students who may not have the means to continue on to college, but can work for an organization like City of Hope that offers opportunities to start their IT career as a Helpdesk or Technology Specialist. In addition, they can take advantage of tuition reimbursement should they choose to further their education and development.

In today's world, social media must be in the recruitment mix, especially if you want to engage with Hispanics who index higher on time spent on social media than the general population and any other group. Statistically, 80 percent of Hispanics utilize social media compared to 75 percent of African Americans and 70 percent of non-Hispanic whites. It's also a great way to reach not just active candidates in search of a new position, but passive ones employed elsewhere whose interest may be peaked when a more interesting opportunity presents itself. 

This is where Aggie Cooke, branding and digital specialist, comes in -- leveraging social media as a core component of City of Hope's outreach efforts to potential candidates. She takes a three-legged approach to the use of social media for recruitment:

1.  Branding - offering relevant content that portrays the culture and appeals to a candidate's values and broader career aspirations;

2.  Targeting - identifying potential candidates who have skills and experiences that the organization needs today and in the future; and

3.  Engaging - creating a relationship by inviting candidates to dialog with City of Hope.

You can reach more people through social media -- even if they're not active job seekers -- by posting information that is relevant to their field and interests. For example, oncology nurses will be interested in what you have to say about the latest developments in the world of oncology. 

Though it can seem overwhelming with so many messages out there competing for people's attention, you can break through with content that is authentic, timely and purposeful. You can also make an impact by tailoring your content to the medium you are using. For example, a story about a scientific breakthrough at City of Hope would play well on LinkedIn, while pictures of happy employees taking a Zumba class together would engage potential candidates on Instagram. Social media also enables you to expand the reach and prolong the life of live events. For example, attendees of the Career Expo last year engaged online with live tweets and Instagram pictures from the event and later provided comments and feedback about their experience that will be instrumental in planning this year's event.

Going forward, successful programs and events, like TEACH and the Diversity Health Care Career Expo, will be expanded upon, as City of Hope continues to lead the way in talent acquisition, workforce development and creating a talent pipeline for Hispanics and the future of healthcare.

Topics: diversity, Workforce, nursing, diverse, hispanic, health, healthcare, patients, culture, minority, career, careers, City Of Hope, recruiting, talent acquisition, clinical professionals, talent

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