DiversityNursing Blog

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We all know and love Nurses, but isn’t it wonderful when a research study validates something you already know? We think you’ll enjoy this article.

If you’ve ever had a loved one in the hospital, you know how important nurses are. Studies show that the amount of time that nurses spend with patients is related to fewer errors. And according to a new study, investing in nursing is key to patient outcomes, including the risk of dying while in the hospital.

The study’s researchers, a team from the University of Pennsylvania, wanted to understand why certain hospitals have better outcomes than others. Specifically, the UPenn team was trying to explain why hospitals in the Kaiser Permanente health care system — an integrated health network in eight states that includes hospitals, insurance, and doctors’ offices all in one system — have such efficient and high-quality care. 

Other organizations have tried to mimic Kaiser Permanente’s organizational structure in order to improve care, but with mixed results. The researchers thought there might be a different X factor that could explain Kaiser’s success: nurses.

In order to find out, the study looked at more than 550 hospitals in California, New Jersey, Pennsylvania, and Florida, including 25 California-based Kaiser Permanente hospitals and 56 Magnet hospitals. Magnet hospitals are recognized by the American Nurses Credentialing Center for being good workplaces for nurses.

Nurses in each hospital answered surveys about their work environment, level of education, job satisfaction, and the number of patients visited during a typical shift. The researchers also pulled data on patient mortality.

“It turns out that, by and large, nursing differences accounted for much of the mortality difference that we saw in Kaiser Permanente hospitals,” says study author Matthew McHugh, PhD, RN, a professor at the University of Pennsylvania School of Nursing.

The results were clear: The odds of dying were about 20 percent lower in Kaiser Permanente and Magnet hospitals, and differences in nursing accounted for “a sizeable portion of the advantage,” according to the study. The analysis adjusted for factors such as hospital size and the severity of patients’ conditions.

“It turns out that these differences we see in nursing, in terms of work environment, staffing levels, investment in nursing around a highly educated workforce, those things translate into better outcomes,” McHugh tells Yahoo Health. 

There were a few specific factors that made Kaiser and Magnet hospitals stand out from the rest, McHugh explains:

1. Better work environments

Happier nurses mean healthier patients, research shows. “We find that places where nurses have a good experience working are places where nurses are better able to do their jobs. They’re more autonomous, they’re supported by management, and they’re integrated into hospital decision-making,” McHugh says.

Empowered nurses have better relationships with physicians, “so when they say ‘something isn’t right,’ they’ll be taken seriously,” McHugh adds. And patients can receive faster and more efficient care when nurses are authorized to make decisions such as when to remove a catheter, for example.

In fact, a study published last year in the Journal of Nursing Administration found that empowered nursing units are more effective and report better patient care compared to units with less authority.

Tangible changes matter, too. In response to the nurse shortage in the early 2000s, Kaiser Permanente made a deliberate, research-based effort to invest in nursing, says Marilyn Chow, PhD, RN, Vice President of National Patient Care Services and Innovation for Kaiser Permanente. 

A study of Kaiser hospitals conducted in 2005 and 2006 found that nurses spent more than 35 percent of their time on documentation. Starting in 2005, the system switched to electronic medical records, which helped streamline paperwork. They also observed that nurses spent a lot of time hunting and gathering equipment and information — checking to see if a medication was ready, for instance. In response, Kaiser Permanente rearranged the work environment to make things more convenient. (Nurses now receive a notification when meds are ready for pickup.)

“We wanted to make sure that we were a place that nurses wanted to work,” Chow tells Yahoo Health. “If you have nurses who are happy and joyful at their work, they will definitely pass that on and be caring and compassionate.”

2. More nurses with Bachelor’s degrees

The role of the nurse is much more complex than it used to be, Chow explains. “The role is not only surveillance, but facilitating and coordinating the care, and not just for one patient, but for four to five patients … there are so many things to take care of,” she says. Patients also arrive sicker and leave the hospital earlier, Chow and McHugh say, which puts an extra demand on nurses to coordinate care and teach patients and family members what to do when they arrive home. 

“Hospitals are very complex, and integrating all of that information requires a certain set of skills and requires you have a pool of knowledge within the overall nursing staff,” McHugh explains. He adds that the study observed a wide variation in nurse education from hospital to hospital, and that variation was associated with adverse events.

3. More nurses, period

Kaiser Permanente hospitals have a 4-to-1 patient-to-nurse ratio, on average, compared to 5-to-1 in non-Magnet hospitals, the UPenn study found.

Having more nurses ensures that there are enough eyes in rooms monitoring patients. It also means that nurses have sufficient time to follow up with patients and communicate effectively. “Nurses are at the bedside and are working with all the other providers. They’re the essential person for monitoring patient condition, and if something bad does happen, intervening and mobilizing the intervention response,” McHugh says.

Source: University of California - Los Angeles

Latinos are the largest ethnic minority group in the United States, and it's expected that by 2050 they will comprise almost 30 percent of the U.S. population. Yet they are also the most underserved by health care and health insurance providers. Latinos' low rates of insurance coverage and poor access to health care strongly suggest a need for better outreach by health care providers and an improvement in insurance coverage. Although the implementation of the Affordable Care Act of 2010 seems to have helped (approximately 25 percent of those eligible for coverage under the ACA are Latino), public health experts expect that, even with the ACA, Latinos will continue to have problems accessing high-quality health care.

Alex Ortega, a professor of public health at the UCLA Fielding School of Public Health, and colleagues conducted an extensive review of published scientific research on Latino health care. Their analysis, published in the March issue of the Annual Review of Public Health, identifies four problem areas related to health care delivery to Latinos under ACA: The consequences of not covering undocumented residents. The growth of the Latino population in states that are not participating in the ACA's Medicaid expansion program. The heavier demand on public and private health care systems serving newly insured Latinos. The need to increase the number of Latino physicians and non-physician health care providers to address language and cultural barriers.

"As the Latino population continues to grow, it should be a national health policy priority to improve their access to care and determine the best way to deliver high-quality care to this population at the local, state and national levels," Ortega said. "Resolving these four key issues would be an important first step."

Insurance for the undocumented

Whether and how to provide insurance for undocumented residents is, at best, a complicated decision, said Ortega, who is also the director of the UCLA Center for Population Health and Health Disparities.

For one thing, the ACA explicitly excludes the estimated 12 million undocumented people in the U.S. from benefiting from either the state insurance exchanges established by the ACA or the ACA's expansion of Medicaid. That rule could create a number of problems for local health care and public health systems.

For example, federal law dictates that anyone can receive treatment at emergency rooms regardless of their citizenship status, so the ACA's exclusion of undocumented immigrants has discouraged them from using primary care providers and instead driven them to visit emergency departments. This is more costly for users and taxpayers, and it results in higher premiums for those who are insured.

In addition, previous research has shown that undocumented people often delay seeking care for medical problems.

"That likely results in more visits to emergency departments when they are sicker, more complications and more deaths, and more costly care relative to insured patients," Ortega said.

Insuring the undocumented would help to minimize these problems and would also have a significant economic benefit.

"Given the relatively young age and healthy profiles of undocumented individuals, insuring them through the ACA and expanding Medicaid could help offset the anticipated high costs of managing other patients, especially those who have insurance but also have chronic health problems," Ortega said.

The growing Latino population in non-ACA Medicaid expansion states

A number of states opted out of ACA Medicaid expansion after the 2012 Supreme Court ruling that made it voluntary for state governments. That trend has had a negative effect on Latinos in these states who would otherwise be eligible for Medicaid benefits, Ortega said.

As of March, 28 states including Washington, D.C., are expanding eligibility for Medicaid under the ACA, and six more are considering expansions. That leaves 16 states who are not participating, many of which have rapidly increasing Latino populations.

"It's estimated that if every state participated in the Medicaid expansion, nearly all uninsured Latinos would be covered except those barred by current law -- the undocumented and those who have been in the U.S. less than five years," Ortega said. "Without full expansion, existing health disparities among Latinos in these areas may worsen over time, and their health will deteriorate."

New demands on community clinics and health centers

Nationally, Latinos account for more than 35 percent of patients at community clinics and federally approved health centers. Many community clinics provide culturally sensitive care and play an important role in eliminating racial and ethnic health care disparities.

But Ortega said there is concern about their financial viability. As the ACA is implemented and more people become insured for the first time, local community clinics will be critical for delivering primary care to those who remain uninsured.

"These services may become increasingly politically tenuous as undocumented populations account for higher proportions of clinic users over time," he said. "So it remains unclear how these clinics will continue to provide care for them."

Need for diversity in health care workforce

Language barriers also can affect the quality of care for people with limited English proficiency, creating a need for more Latino health care workers -- Ortega said the proportion of physicians who are Latino has not significantly changed since the 1980s.

The gap could make Latinos more vulnerable and potentially more expensive to treat than other racial and ethnic groups with better English language skills.

The UCLA study also found recent analyses of states that were among the first to implement their own insurance marketplaces suggesting that reducing the number of people who were uninsured reduced mortality and improved health status among the previously uninsured.

"That, of course, is the goal -- to see improvements in the overall health for everyone," Ortega said.

Honor Whiteman

Dogs are often referred to as "man's best friend," and a new study brings further strength to this term after revealing how a rescue dog called Frankie was able to detect the presence of thyroid cancer in human urine samples with almost 90% accuracy.

According to the research team, from the University of Arkansas for Medical Sciences (UAMS) in Little Rock, Frankie - a male German Shepherd-mix - is the first dog that has been trained to differentiate benign thyroid disease and thyroid cancer by sniffing human urine samples.

Thyroid cancer is a cancer that begins in the thyroid gland, situated just below the thyroid cartilage in the front of the neck. Approximately 62,450 new cases of thyroid cancer will be diagnosed in the US this year, and around 1,950 Americans will die from the disease.

Unlike most other cancers, thyroid cancer is more common among younger adults, with almost 2 in 3 cases diagnosed in people under the age of 55.

Diagnostic techniques for thyroid cancer include fine-needle aspiration biopsy, which involves the patient having a thin needle inserted into the thyroid gland in order to obtain a tissue sample.

Senior investigator Dr. Donald Bodenner, chief of endocrine oncology at UAMS, says the diagnostic accuracy of canine scent detection is almost on par with that of fine-needle aspiration biopsy, but it would be an inexpensive and noninvasive alternative.

What is more, he notes many current methods for diagnosing thyroid cancer can be inaccurate, causing some patients to undergo needless surgery.

"Scent-trained canines could be used by physicians to detect the presence of thyroid cancer at an early stage and to avoid surgery when unwarranted," he adds.

Frankie trained to sniff out cancer in human urine samples

For their study, recently presented at The Endocrine Society's 97th Annual Meeting in San Diego, CA, Dr. Bodenner and colleagues obtained urine samples from 34 patients who attended the UAMS thyroid clinic.

All patients showed abnormalities in their thyroid nodules and went on to have biopsies and diagnostic surgery. Thyroid cancer was identified in 15 patients while 19 had benign thyroid disease.

Frankie - who the researchers say had been previously trained to recognize the smell of cancer in human thyroid tissue - was presented with the urine samples to sniff one at a time by a gloved dog handler.

While humans have around 5 million smell receptors, or olfactory cells, dogs possess around 200 million, making their sense of smell around a thousand times stronger than that of humans. 

Frankie alerted the handler to a cancer-positive urine sample by lying down, while turning away from the urine sample alerted the handler to a benign status. 

The authors note that the cancer status of each urine sample was unknown to both the dog handler and the study coordinator.

The handler also presented Frankie with urine samples with a known cancer status in between the study samples so the dog could be rewarded for achieving a correct answer.

30 out of 34 samples correctly identified with canine scent detection

On comparing Frankie's results with those of the final surgical pathology report for the samples, the team found the dog correctly identified the status of 30 out of 34 samples.

The sensitivity, or true-positive rate, of the canine scent detection came in at 86.7%, while specificity, or true-negative rate, was 89.5%. This means Frankie correctly identified a benign sample almost 9 in every 10 times.

The team notes that canine scent detection led to two false-negative and two false-positive results. The researchers now plan to expand their research by teaming up with Auburn University College of Veterinary Medicine, AL, who have agreed to assign two of its bomb-sniffing dogs to thyroid cancer detection training.

This is not the first time Medical News Today have reported on the cancer-detection talent of dogs. In May 2014, a study by Italian researchers revealed how specially trained dogs were able to detect prostate cancer in urine samples with 98% accuracy.

Source: www.medicalnewstoday.com

DONALD G. McNEIL Jr.

A major study testing whether Americans would take their H.I.V. drugs every day if they were paid to do so has essentially failed, the scientists running it announced Tuesday at an AIDS conference here.

Paying patients in the Bronx and in Washington — where infection rates are high among poor blacks and Hispanics — up to $280 a year to take their pills daily improved overall adherence rates very little, the study’s authors said.

The hope was that the drugs would not only improve the health of the people taking them, but help slow the spread of H.I.V. infections. H.I.V. patients who take their medicine regularly are about 95 percent less likely to infect others than patients who do not. The Centers for Disease Control and Prevention estimates that only a quarter of all 1.1 million Americans with H.I.V. are taking their drugs regularly enough to not be infectious.

Paying patients $25 to take H.I.V. tests, and then $100 to return for the results and meet a doctor, also failed, the study found.

“We did not see a significant effect of financial incentives,” said Dr. Wafaa M. El-Sadr, an AIDS expert at Columbia University and the lead investigator. But, she said, there is “promise for using such incentives in a targeted manner.”

Cash payments might still work for some patients and some poor-performing clinics, she said.

Other H.I.V.-prevention research released here Tuesday offered good news for gay men but disappointing results for African women.

Two studies — both of gay men, one in Britain and the other in France — confirmed earlier research showing that pills to prevent infection can be extremely effective if taken daily or before and after sex. Both were stopped early because they were working so well that it would have been unethical to let them continue with men in control groups who were not given the medicine.

But a large trial involving African women of a vaginal gel containing an antiviral drug failed — apparently because 87 percent of the women in the trial were unable to use the gel regularly.

The failure of the cash-incentives trial was a surprise and a disappointment to scientists and advocates. It had paid out $2.8 million to 9,000 patients in 39 clinics over three years, but the clinics where money was distributed did only 5 percent better than those that did not — a statistically insignificant difference.

Some small clinics and those where patients had been doing poorly at the start of the study did improve as much as 13 percent, however.

People in other countries have been successfully paid to stop smoking while pregnant and to get their children to school. In Africa, paying poor teenage girls to attend school lowered their H.I.V. rates; scientists concluded that it eased the pressure on them to succumb to “sugar daddies” — older men who gave them money for food, clothes and school fees in return for sex.

One study presented here at the annual Conference on Retroviruses and Opportunistic Infections estimated that every prevented H.I.V. infection saved $230,000 to $338,000. Much of that cost is borne by taxpayers.

Mathematical modeling suggested that paying people up to $5,000 a year could be cost effective, Dr. El-Sadr said, but $280 was settled on after a long, difficult debate.

Paying more than $280 at some clinics was not an option, she said; achieving statistical relevance would have meant signing up even more clinics. The study had already involved almost every H.I.V. patient in the Bronx and Washington.

“I don’t think anyone has an answer to what amount would be sufficient without being excessive,” Dr. El-Sadr said.

One advocate suggested that more money could work — in the right setting.

“In South Africa, $280 is a lot of money,” said Mitchell Warren, the executive director of AVAC, an organization that lobbies for AIDS prevention. “For that much, you’d definitely get some behavior change.”

The two studies among gay men looked at different ways to take pills. A 2010 American study, known as iPrEx, showed that taking Truvada — a combination of two antiretroviral drugs — worked if taken daily.

The British study, known as PROUD, used that dosing schedule, and men who took the pill daily were protected 86 percent of the time.

In the French trial, known as Ipergay, men were advised to take two pills in the two days before they anticipated having sex and two in the 24 hours afterward.

Those who took them correctly also got 86 percent protection.

“The problem,” Dr. Susan P. Buchbinder, director of H.I.V. prevention research for the San Francisco health department, said in a speech here commenting on the study, “is that studies have shown that men are very good at predicting when they will not have sex and not good at predicting when they will.”

The African study, known as FACTS 001, was a follow-up to the smaller trial from 2010, which showed that South African women who used a vaginal gel containing tenofovir, an antiviral drug, before and after sex were 39 percent better protected than women who did not.

But it also found that many women failed to use the gel because it was messy or inconvenient or because partners objected.

In this trial, there was virtually no effect.

One problem, said Dr. Helen Rees, the chief investigator, was that the women were very young — the median age was 23, and most lived with their parents or siblings.

“They had no privacy for sex,” she said. “They had to go outside to use the product.”

Mr. Warren, of AVAC, said: “The women wanted a product they could use. But this particular product didn’t fit into the realities of their daily lives.”

The development means that advocates are hoping even more that other interventions for women now in trials will work. They include long-lasting injections of antiretroviral drugs and vaginal rings that can be inserted once a month and leach the drugs slowly into the vaginal wall.

Another trial in Africa, the Partners Demonstration Project, conducted among couples in which one partner had H.I.V. and the other did not, found it was extremely effective to simultaneously offer treatment to the infected partner and preventive drugs to the uninfected one until the other’s drugs took full effect.

In the group getting the treatment, there were zero infections that could be traced to partners who were in the study.

Source: www.nytimes.com

Type "drunk," "hammered," or "trashed" into YouTube's search bar and some pretty unsavory videos are likely to turn up.

And that can't be good for teenagers and young adults, researchers say. User-generated YouTube videos portraying dangerous drinking get hundreds of millions of views online, according a study published Friday in the journal Alcoholism: Clinical and Experimental Research. 

Do you think dangerous drinking videos harm teens?

These videos often present wild bingeing in a humorous light, the study found, without showing any of the negative consequences, like potentially fatal alcohol poisoning and accidents caused by drunk driving.

The researchers didn't reveal which videos they looked at, to avoid singling out particular YouTube users.

Our own unscientific search turned up many videos under the words "drunk fails," with people who are publicly intoxicated or completely passed out, as well as sleazier stuff like Best Drunk Girls Compilation, Part 1.

There's been lots of research on paid-for alcohol advertisements and product placement on TV shows, in the movies and in music, says Dr. Brian Primack, an associate professor of medicine and pediatrics at the University of Pittsburgh and the study's lead author. "But we haven't really looked at YouTube before," he tells Shots.

Primack and his colleagues looked at a cross-section of 70 YouTube videos that showed unsafe drinking. Together those videos pulled in over 330 million views. Even though the videos weren't paid for by alcohol companies, nearly half of them referenced specific brands of alcohol.

The researchers weren't able analyze who is watching these videos, Primack says, because YouTube no longer makes that information publicly available. But Primack suspects that many viewers are underage, because of previous research he has done on YouTube demographics..

It's also not clear how watching these videos may influence young people's decisions on alcohol use.

This is just a preliminary study, Primack says, but the findings highlight the fact that the Internet is full of unhealthy messages about alcohol. Researchers should look more carefully at sites like YouTube and Tumblr, as well as apps like Instagram and Snapchat, he says.

"We already know that visuals are influential for teens and peer influence is important," Primack says. "Sites like YouTube combine both. You've got video paired with likes, comments and peer-to-peer dialogue."

We contacted YouTube, but a spokesperson declined to speak on the record. YouTube does have a policy against harmful or dangerous content and viewers can report inappropriate videos for review.

But these videos are still easy to find, Primack says, and there's no way to completely shield children from negative depictions of alcohol use, Still, he adds, "I don't think the right response is to freak out and block kids' Internet use."

Instead, parents and educators should push kids to think critically about the messages they're exposed to on the Internet, says Dr. Michael Siegel, a professor of community health at Boston University who wasn't involved in the study.

"By actually understanding and talking about it, kids become resistant to these messages," Siegel says. "They'll be able to see that these portrayals online aren't realistic."

Public health agencies could also make better use of platforms like YouTube to put out their own messages, Siegel says.

Source: www.npr.org

By PAM BELLUCK

Conventional wisdom has it that hot flashes, which afflict up to 80 percent of middle-aged women, usually persist for just a few years. But hot flashes can continue for as long as 14 years, and the earlier they begin the longer a woman is likely to suffer, a study published on Monday in JAMA Internal Medicine found.

In a racially, ethnically and geographically diverse group of 1,449 women with frequent hot flashes or night sweats — the largest study to date — the median length of time women endured symptoms was 7.4 years. So while half of the women were affected for less than that time, half had symptoms longer — some for 14 years, researchers reported.

“It’s miserable, I’ll tell you what,” said Sharon Brown, 57, of Winston-Salem, N.C., who has endured hot flashes for six years. At her job at a tax and accounting office, she has had to stop wearing silk.

Mary Hairston found that acupuncture helped with her hot flashes. CreditKaren Tam for The New York Times 

Over all, black and Hispanic women experienced hot flashes for significantly longer periods than white or Asian women. And in a particularly unfair hormonal twist, the researchers found that the earlier hot flashes started, the longer they were likely to continue.

Among women who got hot flashes before they stopped menstruating, the hot flashes were likely to continue for years after menopause, longer than for women whose symptoms began only when their periods had stopped.

“That having symptoms earlier in the transition bodes ill for your symptoms during menopause — that part is certainly new to me,” said Dr. C. Neill Epperson, director of the University of Pennsylvania’s Center for Women’s Behavioral Wellness, who was not involved in the study. Perhaps, she and others suggested, early birds are more biologically sensitive to hormonal changes.

And many women fall into the early bird category. In this study, only a fifth of cases started after menopause. One in eight women began getting hot flashes while still having regular periods. For two-thirds of women, they began in perimenopause, when periods play hide and seek but have not completely disappeared.

In numerical terms, women who started getting hot flashes when they were still having regular periods or were in early perimenopause experienced symptoms for a median of 11.8 years. About nine of those years occurred after menopause, nearly three times the median of 3.4 years for women whose hot flashes did not start until their periods stopped.

“If you don’t have hot flashes until you’ve stopped menses, then you won’t have them as long,” said Nancy Avis, a professor of social sciences and health policy at Wake Forest Baptist Medical Center and the study’s first author. “If you start later, it’s a shorter total duration and it’s shorter from the last period on.”

Hot flashes, which can seize women many times a day and night — slathering them in sweat, flushing their faces — are linked to drops in estrogen and appear to be regulated by the hypothalamus in the brain. Studies have found that women with hot flash symptoms also face increased risk of cardiovascular problems and bone loss.

Researchers followed the women in the study, who came from seven American cities, from 1996 to 2013. All of them met the researchers’ definition for having frequent symptoms: hot flashes or night sweats at least six days in the previous two weeks.

None had had a hysterectomy or both ovaries removed, and none were on hormone therapy. (If they started taking hormone therapy during the study period, their data stopped being included, Dr. Avis said.)

Although some smaller studies have also found that symptoms can last many years, the new research drew praise from experts because, among other things, it included a larger and much more diverse group of women. One-third of them were African-Americans in Pittsburgh, Boston, Chicago and Ypsilanti, Mich. It also included women of Japanese descent in Los Angeles; women of Chinese descent in Oakland, Calif.; and Hispanic women in Newark — about 100 in each group.

“It’s such a real-world study of women we are seeing day in and day out,” said Dr. Risa Kagan, an obstetrician-gynecologist at the University of California, San Francisco, and the Sutter East Bay Medical Foundation in Berkeley. “There is no other study like this.”

Researchers found significant differences between ethnic groups. African-Americans reported the longest-lasting symptoms, continuing for a median of 10.1 years — twice the median duration of Asian women’s symptoms. The median for Hispanic women was 8.9 years; for non-Hispanic whites, 6.5 years.

Reasons for ethnic differences are unclear. “It could be genetic, diet, reproductive factors, how many children women have,” Dr. Avis said.

The study also found that women with longer-lasting symptoms tended to have less education, greater perceived stress, and more depression and anxiety.

“I’m not at all suggesting that hot flashes are manifestations of depression, but they’re both brain-related phenomena, and depression is also more common in the same groups,” said Dr. Andrew Kaunitz, an obstetrician-gynecologist at the University of Florida who was not involved in the study. It is unclear if stress and emotional issues help cause hot flashes or result from them.

“Women with more stress in their lives may be more aware of their symptoms and perceive them to be more bothersome,” said Dr. JoAnn E. Manson, chief of preventive medicine at the Harvard-affiliated Brigham and Women’s Hospital and an author of a commentary accompanying the study. “But also having significant night sweats that interrupt sleep can lead to stress.”

Dr. Manson said the new study should help women and doctors anticipate that symptoms may continue longer, and might suggest that some women try different approaches at different times.

Women who are still menstruating, she said, “can become pregnant,” so low-dose contraceptives, which also tame hot flashes, might be recommended until menopause. Hormone therapy might then be prescribed for several years, she said.

But hormone therapy has been linked to increased risk of breast cancer and heart disease for some women. Effective non-hormonal therapies also exist, experts said, including low-dose antidepressants.

Dr. Manson, a past president of the North American Menopause Society, has helped the society develop a free app, MenoPro, to assist women deal with hot flashes, starting with nonmedical approaches like lowering the thermostat and cutting back on spicy foods, caffeine and alcohol.

Ms. Brown and Mary Hairston, 53, tried acupuncture in another study by Dr. Avis and colleagues, and found it helped. Before that, Ms. Hairston said, “every night I would just wake up, dripping wet.”

Now, when she starts sweating at the Italian restaurant where she waitresses, “I go stand in the cooler,” she said. “I used to get cold all the time and I would say I couldn’t wait to have hot flashes. Well, I got over that real quick.”

Source: www.nytimes.com

Nurses’ Health Study recruits “next generation”

Boston, MA - From the dangers of tobacco and trans fats to the benefits of physical activity and whole grains, much of what we know about health today is thanks to the Nurses’ Health Study.

Researchers are recruiting 100,000 nurses and nursing students to join the long-running Nurses’ Health Study and expand its landmark research on health and well-being. And for the very first time, male nurses and students are being invited to join. 

RNs, LPNs, and nursing students between the ages of 19 and 46 who live in the US or Canada are eligible to join the study. More than 38,000 have signed up already, and recruitment will stay open until the goal of 100,000 participants is reached.

Researchers hope to engage a highly diverse group of nurses in the “next generation” of the study. For the first time, nursing students are eligible to enroll.

In order to make participation as convenient as possible for busy nurses, participants can join online and complete the study’s surveys through a secure website, http://www.nhs3.org/.

More than 250,000 nurses have participated in the study since the 1970s. By completing confidential lifestyle surveys, they have helped advance medical knowledge about nutrition, exercise, cancer, heart disease, and many other conditions.

“Nurses were originally recruited for their expertise in accurately reporting health data,” explains Dr. Walter Willett, the study’s lead researcher and Chair of the Nutrition Department at Harvard School of Public Health in Boston, Mass. “Their involvement has been invaluable, and their dedication is remarkable—an astounding 90% of them are still enrolled, decades later! The new group, NHS3, will allow us understand how today’s lifestyle and environment affect a person’s health in the future.”

Nurses enrolled in the earlier studies are encouraging their children and younger colleagues to join. “My mom started filling out surveys when the study began,” one nurse recently commented on the NHS3 Facebook page (www.facebook.com/NHS3.org). “I am so proud to be part of this study and see what it has done.”

###

NURSES’ HEALTH STUDIES
Started in 1976 and expanded in 1989, the Nurses’ Health Studies have led to many important insights on health and well-being, including cancer prevention, cardiovascular disease, and diabetes. Most importantly, these studies showed that diet, physical activity, and other lifestyle factors can powerfully promote better health.

Contact: Michael Keating
617-432-7078

 nhs3@channing.harvard.edu

SOURCE Nurses Health Study 3    www.nhs3.org

By Carolyn Gregoire

Having a family pet can be beneficial for child development in a number of ways, including keeping kids active and promoting empathy, self-esteem and a sense of responsibility. But dogs may be particularly beneficial for kids with autism, acting as a "social lubricant" that helps them build assertiveness and confidence in their interactions with others, according to new research from the University of Missouri. 

The researchers surveyed 70 families with autistic children between the ages of eight and 18, all of whom were patients at the MU Thompson Center for Autism and Neurodevelopmental Disorders. Nearly 70 percent of the participating families had dogs, half had cats, and some owned other pets including fish, rodents, rabbits, reptiles and birds. 

The study's lead author Gretchen Carlisle, a research fellow at the University of Missouri, observed that autistic children are were likely to engage socially in social situations where pets were present. While previous research has focused specially on the ways that dogs benefit the development of autistic children, Carlisle found that pets of any type were beneficial for the childrens' social skills.

"When I compared the social skills of children with autism who lived with dogs to those who did not, the children with dogs appeared to have greater social skills," Carlisle said in a statement. "More significantly, however, the data revealed that children with any kind of pet in the home reported being more likely to engage in behaviors such as introducing themselves, asking for information or responding to other people's questions. These kinds of social skills typically are difficult for kids with autism, but this study showed children's assertiveness was greater if they lived with a pet."

Carlisle observed the strongest attachments between the children and small dogs, although parents also reported strong attachments between their children and other pets, such as cats and rabbits. 

“Dogs are good for some kids with autism but might not be the best option for every child,” Carlisle said. “Kids with autism are highly individual and unique, so some other animals may provide just as much benefit as dogs. Though parents may assume having dogs are best to help their children, my data show greater social skills for children with autism who live in homes with any type of pet.”

Carlisle's research joins a body of work demonstrating the benefits of animal interaction among autistic children. A 2013 review of studies found that specially trained dogs, horses and other animals can facilitate increased social interaction and improved communication among autistic children, as well as decreased stress and problem behavior. 

Source: www.huffingtonpost.com

Jessica Zegre-Hemsey, a cardiac monitoring expert at the University of North Carolina at Chapel Hill, and her colleagues at the University of California San Francisco, revealed more than 2.5 million alarms were triggered on bedside monitors in a single month - the first figure ever reported from a real-world hospital setting.

Alarm fatigue occurs when nurses and other clinicians are exposed to a high number of physiological alarms generated by modern monitoring systems. In turn, alarms are ignored and critical alarms are missed because many alarms are false or non-actionable.

The work, the first of its kind to investigate the frequency and accuracy of alarms, addresses a growing patient safety issue that has gained national attention in recent years when a patient died despite multiple alarms that indicated low heart rate. The issue also addresses hidden downsides to modern monitoring technologies.

"Current technologies have been instrumental in saving lives but they can be improved," said Zègre-Hemsey, who is an assistant professor at the UNC-Chapel Hill School of Nursing. "For example, current monitoring systems do not take into account differences among patients. If alarm settings were tailored more specifically to individuals that could go a long way in reducing the number of alarms health care providers respond to."

Zègre-Hemsey and her colleagues collected alarm data on 461 adults in five intensive care units at the UCSF Medical Center for a period of 31 days. Zègre-Hemsey was one of four scientists who analyzed the alarms and helped to determine if they were true or false.

Investigators analyzed a subset of 12,671 arrhythmia alarms, which are designed to alert providers to abnormal cardiac conditions, and found 88.8 percent were false positives. Most of the false alarms were caused by deficiencies in the computer's algorithms, inappropriate user settings, technical malfunctions, and non-actionable events, such as brief spikes in heart rate, that don't require treatment.

A potential solution the researchers suggested would be to design monitors that could be configured to individual patients. No two bodies are exactly the same, and if the monitors could be adjusted to a patient's unique vital signs, the machines would not mistake a normal condition for an abnormal one. A "gold standard" database of annotated alarms could also help developers create computer algorithms that are less sensitive to artifacts.

According to Zègre-Hemsey, reducing alarm fatigue will ultimately require strong collaborations between clinicians, engineers, and hospital administrators as well as additional research.

"Alarm fatigue is a large and complex problem," she said. "Yet the implications are far-reaching since sentinel events like patient death have been reported. This is a current patient safety crisis."

The study was led by primary investigator Barbara J. Drew at UCSF. Co-authors on the paper include UCSF researchers Patricia Harris, Daniel Schindler, Rebeca Salas-Boni, Yong Bai, Adelita Tinoco, Quan Ding, and Xiao Hu from the UCSF department of physiological nursing and Tina Mammone from the UCSF department of nursing.

Source: www.medicalnewstoday.com

By Maureen Salamon

Talking bystanders through CPR methods for a cardiac emergency during a 911 call can significantly boost survival rates, a new study suggests.

State researchers in Arizona examined the aggressive use of so-called pre-arrival telephone CPR guidelines -- step-by-step dispatcher instructions on administering cardiopulmonary resuscitation before trained rescuers arrive -- and found that it bumped survival of cardiac arrest patients from about 8 percent to more than 11 percent.

Cardiac arrest occurs when the heart's normal rhythm abruptly stops, and the organ can no longer pump blood and oxygen to the body. It can be triggered by a heart attack, but the two conditions are different.

Lead researcher Dr. Ben Bobrow said the type of focused intervention studied in his home state -- not only training telephone dispatchers but measuring bystander CPR outcomes and circling back to 911 centers with feedback -- is not done uniformly on a national basis, despite American Heart Association (AHA) guidelines.

But he hopes the results of his study, scheduled to be presented Saturday at the AHA meeting in Chicago, will promote that ideal.

"We believe strongly that this may be the best, and most efficient, way to improve survival rates across the country," said Bobrow, the medical director of the Bureau of EMS and Trauma System for the Arizona Department of Health Services. "Cardiac arrest is one of the leading causes of death, and as a country, despite tons of efforts ... this has not improved."

About 359,000 people in the United States suffered sudden cardiac arrest outside of a hospital setting in 2013, and more than 90 percent of them died, according to the AHA.

The heart association also has reported that 70 percent of Americans feel helpless to act during a cardiac arrest emergency because they don't know CPR or their training had lapsed.

Bobrow and his colleagues analyzed more than 4,000 audio recordings from 911 calls over three years from eight Arizona dispatch centers. That information, paired with emergency medical services (EMS) and hospital outcome data, showed that providing telephone CPR instructions prompted a jump in the number of bystanders implementing CPR, from 44 percent to 62 percent.

With the guidelines in place, the average amount of time elapsing between a bystander's call to 911 and the first chest compression in CPR dropped by 23 seconds, to 155 seconds.

"This research shows . . . that even the simplest of interventions, like having someone on the other end of a phone guide you [in CPR], can result in a remarkable difference of outcome," said Dr. Vinay Nadkarni, a spokesperson for the AHA, who wasn't involved in the study.

"That change is possible with a cellphone and our own two hands," added Nadkarni, an associate professor of anesthesiology and critical care at the University of Pennsylvania School of Medicine. "It's within our grasp."

Nadkarni said that Bobrow and his team had done an "excellent job" in helping 911 dispatchers in Arizona use certain phrases to prompt quick action among bystanders who witness a cardiac arrest.

For example, before the intervention, dispatchers typically asked 911 callers if anyone was available to perform CPR, or if they would be willing to. After the Web-based and live training, the revised script emphasized the importance of dispatchers directing callers to start CPR, saying something like, "You need to do chest compressions and I'm going to help you. Let's start."

With the apparent success of this approach, Bobrow said he and his team have asked the U.S. Centers for Disease Control and Prevention to consider implementing it on a national scale. Funding for such a program is needed, he said.

"It would be an incredibly inexpensive intervention for how many lives it would save," he said. "We estimate conservatively that it would save several thousand lives per year. It's not complicated stuff . . . and the beauty of the 911 system is that it already exists."

Research presented at scientific conferences typically has not been peer-reviewed or published and results are considered preliminary.

Source: www.medicinenet.com