DiversityNursing Blog

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

It’s something each of the nation’s 3.1 million RNs understands intimately: Being a nurse is intense. The hospitals and clinics where they work are often stressful. And patient care and healthcare systems have never been more complex.

Nationally, nurse turnover stands at 20 percent, but nearly 40 percent of nurses are ready to leave their job after a single year. About 14 percent leave the field altogether, and the ‘working wounded’ that remain are at best demoralized and at worst error-prone. And dealing with RN turnover is among the biggest, costliest burdens in healthcare today.

It’s why University of Virginia School of Nursing’s Compassionate Care Initiative has sponsored a new Public Radio documentary series – Resilient Nurses, now available online – which will be heard on many public radio stations starting this month and also on Sunday Feb. 22 on the NPR Channel (#122) of SiriusXM satellite radio at 4pm ET / 1pm PT.  

Hosted by award-winning documentary producer David Freudberg of Humankind, the program takes a no-holds-barred look at what ails American RNs: the stress, the exhaustion, and the pressured environments that often lead to their burnout. 

But beyond sourcing RNs’ biggest challenges, Freudberg offers a promising glimpse into the growing number of nurses hoping to improve their lot by harnessing well-being through resilience. Freudberg also chronicles the growing movement of resilience at a handful of American clinics and hospitals where administrators realize the very real financial and personal stake they have in helping their nurses effectively handle stress. 

And the stories are inspiring. Sharing the voices of these powerful, real nurses may be an important step in healing the profession’s broken hearts, strengthening American RNs’ care and practice through a practitioner-centered approach to well-being. 

The Resilient Nurses audio podcast is now available online. Editors and bloggers may download and publish graphics and a brief program description from http://www.humanmedia.org/nurse/resources.php.

We hope the program will inspire nurses, nursing professors, nursing students and others in healthcare to begin their own resilient practices.

Christine Phelan Kueter, writer

Source: U.Va. School of Nursing

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

JESSICA FIRGER

Scientists have discovered a highly aggressive new strain of HIV in Cuba that develops into full-blown AIDS three times faster than more common strains of the virus. This finding could have serious public health implications for efforts to contain and reduce incidences of the virus worldwide.

Researchers at the University of Leuven in Belgium say the HIV strain CRF19 can progress to full blown AIDS within two to three years of exposure to virus. Typically, HIV takes approximately 10 years to develop into AIDS. Patients with CRF19 may start getting sick before they even know they've been infected, which ultimately means there's a significantly shorter time span to stop the disease's progression. 

The scientists began studying the cases in Cuba when reports began coming in that a growing number of HIV-infected patients were developing AIDS just three years after diagnosis with the virus. The findings of their study were published in the journal EBioMedicine.

Having unprotected sex with multiple partners can expose a person to numerous strains of the HIV virus. Research has found that when this occurs, the different strains can combine and form a new variant of the virus.

When HIV first enters the human body it latches on to anchor points of a certain protein, known as CCR5 on the cell membranes, which then allows it to enter human cells. Eventually the virus then latches onto another protein of the cell membrane, known as CXCR4. This marks the point when asymptomatic HIV becomes AIDS. In CRF19, the virus makes this move much sooner. 

For the study, the researchers analyzed blood samples of 73 recently infected patients. Among the group, 52 already had full-blown AIDS, while the remaining 21 were HIV-positive but the virus had not yet progressed. The researchers compared their findings to blood samples of 22 AIDS patients who had more common strains of the virus. 

The researchers found that patients with CRF19 had higher levels of the virus in their blood compared with those who had more common strains. 

They also had higher levels of the immune response molecules known as RANTES, which bond to CCR5 proteins in early stages of the virus. The abnormally high level of RANTES in patients infected with the new strain indicates that the virus runs out of CCR5 anchor points much earlier and moves directly to CXCR4 anchor points.

Thanks to advances in medical treatment and the development of highly effective antiretroviral drugs, HIV/AIDS is no longer a death sentence. But the researchers caution that patients with the new strain of the virus are more likely to be diagnosed when they already have full-blown AIDS and when damage from the disease has taken a toll.

The researchers suspect that this aggressive form of HIV occurs when fragments of other subsets of the virus cling to each other through an enzyme that makes the virus more powerful and easily replicated in the body.

There are currently 35 million people worldwide living with HIV/AIDS, according to the most recent data from the World Health Organization. Scientists have identified more than 60 different strains of the HIV 1 virus, with each type typically found predominantly in a specific region of the world.

Source: www.cbsnews.com

Jana Kasperkevic

Far from offering patients pennies for their thoughts, mental health therapists often end up billing them hundreds of dollars per month.

The cost is a growing burden as depression among US adolescents and adults rises. The US is suffering a mental health crisis, with a San Diego State University study in October finding that one in 10 Americans is depressed – and more report symptoms of depression.

More Americans are seeking help, and that help can come at a financial sacrifice of thousands of dollars a year. Aside from the cost of often-weekly visits to psychologists – which may or may not be defrayed by insurance – there can be additional costs for psychiatrists and any medicine they prescribe.

The cost of therapy is especially acute for young Americans, many of whom are underemployed and burdened with college debt. This year, a record number of college freshmen reported being depressed. And while many campuses provide free mental health care, affordable help is often harder to find after students leave school.

The Guardian interviewed seven young professionals about their experiences to find out how young Americans manage to pay for therapy – and if they think it’s worth it. To protect their identities, we have kept their surnames anonymous.

Click on the titles below to read their stories: 

‘I just can’t afford to go’

– AK, 27

‘Why do I need to pay someone to listen to me?’

– Matt, 23

Therapy was ‘the best chance I had of feeling OK’

– JE, 29

‘I needed someone to help me find courage to leave [my job]’

– Eve, 33

‘At its best, it’s paying for a friend’

- John, 27

‘Therapy is not a magic wand’

-Jenn, 26 

‘I’d rather be sad’

– Alex, 27

Source: www.theguardian.com

By MICHAEL TOMSIC

In Medical Park Hospital in Winston-Salem, N.C., Angela Koons is still a little loopy and uncomfortable after wrist surgery. Nurse Suzanne Cammer gently jokes with her. When Koons says she's itchy under her cast, Cammer warns, "Do not stick anything down there to scratch it!" Koons smiles and says, "I know."

Koons tells me Cammer's kind attention and enthusiasm for nursing has helped make the hospital stay more comfortable.

"They've been really nice, very efficient, gave me plenty of blankets because it's really cold in this place," Koons says. Koons and her stepfather, Raymond Zwack agree they'd give Medical Park a perfect 10 on the satisfaction scale.

My poll of the family is informal, but Medicare's been taking actual surveys of patient satisfaction, and hospitals are paying strict attention. The Affordable Care Act ties a portion of the payments Medicare makes to hospitals to how patients rate the facilities.

Medical Park, for example, recently received a $22,000 bonus from Medicare in part because of its sterling results on patient satisfaction surveys.

Novant Health is Medical Park's parent company, and none of its dozen or so other hospitals even come close to rating that high on patient satisfaction. Figuring out why Medical Park does so well is complicated.

First, says Scott Berger, a staff surgeon, this isn't your typical hospital.

"It kind of feels, almost like a mom-and-pop shop," he says.

Medical Park is really small, only two floors. Doctors just do surgeries, like fixing shoulders and removing prostates, and most of their patients have insurance.

Another key is that no one at Medical Park was rushed to the hospital in an ambulance, or waited a long time in the emergency room. In fact, the hospital doesn't even have an emergency room.

The hospital doesn't tend to do emergency surgeries, says Chief Operating Officer Chad Setliff. These procedures are all elective, scheduled in advance. "So they're choosing to come here," he says. "They're choosing their physician."

These are the built-in advantages that small, specialty hospitals have in terms of patient satisfaction, says Chas Roades, chief research officer with Advisory Board Company, a global health care consulting firm.

"A lot of these metrics that the hospitals are measured on, the game is sort of rigged against [large hospitals]," Roades says.

This is the third year hospitals can get bonuses or pay cuts from Medicare (partly determined by those scores) that can add up to hundreds of thousands of dollars.

More typical hospitals that handle many more patients – often massive, noisy, hectic places – are more likely to get penalized, Roades says.

"In particular, the big teaching hospitals, urban trauma centers — those kind of facilities don't tend to do as well in patient satisfaction," he says. Not only are they busy and crowded, but they have many more caregivers interacting with each patient.

Still, Roades says, although patient surveys aren't perfect, they are fair.

"In any other part of the economy," he points out, "if you and I were getting bad service somewhere – if we weren't happy with our auto mechanic or we weren't happy with where we went to get our haircut – we'd go somewhere else." In health care, though, patients rarely have that choice. So Roades thinks the evaluation of any hospital's quality should include a measurement of what patients think.

Medical Park executives say there are ways big hospitals can seem smaller — and raise their scores. Sometimes it starts with communication – long before the patient shows up for treatment.

On my recent visit, Gennie Tedde, a nurse at Medical Park, is giving Jeremy Silkstone an idea of what to expect after his scheduled surgery – which is still a week or two away. The hospital sees these conversations as a chance to connect with patients, allay fears, and prepare them for what can be a painful process.

"It's very important that you have realistic expectations about pain after surgery," Tedde explains to Silkstone. "It's realistic to expect some versus none."

Medical Park now handles this part of surgery prep for some of the bigger hospitals in its network. Silkstone, for example, will have surgery at the huge hospital right across the street — Forsyth Medical Center.

Carol Smith, the director of Medical Park's nursing staff, says that after she and her colleagues took over these pre-surgical briefings, "Forsyth's outpatient surgical scores increased by 10 percent."

But some doctors and patients who have been to both hospitals agree that the smaller one is destined to have higher scores. It is just warmer and fuzzier, one patient says.

Source: www.npr.org

While debate about recreational marijuana use continues, researchers are investigating the effectiveness of cannabis for treating pain, spasticity, and a host of other medical problems. In a symposium organized by the McGill University Health Centre (MUHC) as part of the 2015 American Association for the Advancement of Science Annual Meeting held this week in San Jose, California,  experts from North America and the U.K. share their perspectives on the therapeutic potential of medical cannabis and explore the emerging science behind it.

"We need to advance our understanding of the role of cannabinoids in health and disease through research and education for patients, physicians and policy-makers," says Dr. Mark Ware, director of clinical research at the Alan Edwards Pain Management Unit at the MUHC, in Canada.

As a pain specialist Dr. Ware regularly sees patients with severe chronic pain at his clinic in Montreal, and for some of them, marijuana appears to be a credible option. "I don't think that every physician should prescribe medical cannabis, or that every patient can benefit but it's time to enhance our scientific knowledge base and have informed discussions with patients."

Increasing numbers of jurisdictions worldwide are allowing access to herbal cannabis, and a range of policy initiatives are emerging to regulate its production, distribution, and authorization. It is widely believed that there is little evidence to support the consideration of cannabis as a therapeutic agent. However, several medicines based on tetrahydrocannabinol (THC), the psychoactive ingredient of cannabis, have been approved as pharmaceutical drugs.

Leading British cannabis researcher Professor Roger Pertwee, who co-discovered the presence of tetrahydrocannabivarin (THCV) in cannabis in the 70's, recently published with collaborators some findings of potential therapeutic relevance in the British Journal of Pharmacology. "We observed that THCV, the non-psychoactive component of cannabis, produces anti-schizophrenic effects in a preclinical model of schizophrenia," says Pertwee, professor of Neuropharmacology at Aberdeen University. "This finding has revealed a new potential therapeutic use for this compound."

Neuropsychiatrist and Director of the Center for Medicinal Cannabis Research (CMCR) at the University of California, San Diego Dr. Igor Grant is interested in the short and long-term neuropsychiatric effects of marijuana use. The CMCR has overseen some of the most extensive research on the therapeutic effects of medical marijuana in the U.S. "Despite a commonly held view that cannabis use results in brain damage, meta analyses of extensive neurocognitive studies fail to demonstrate meaningful cognitive declines among recreational users," says Dr. Grant. "Bain imaging has produced variable results, with the best designed studies showing null findings."

Dr. Grant adds that while it is plausible to hypothesize that cannabis exposure in children and adolescents could impair brain development or predispose to mental illness, data from properly designed prospective studies is lacking.

Source: www.sciencedaily.com

By Jodie Diegel, BSN, MBA, RNC, LNCC

Laura* is severely disabled, but when she spent time with Lunar, her caregivers at Little Angels, a non-profit skilled nursing facility in Elgin, Ill., witnessed something they had never seen. Laura began to move her fingers back and forth. Lunar is not a doctor or a therapist, but a 6-year-old specially trained miniature therapy horse from the Northern Illinois-based non-profit organization Mane in Heaven that I started in 2012. Mane in Heaven specializes in animal-assisted activity and therapy visits. Our horses visit with people with physical, mental and emotional challenges ­— from people with severe disabilities to Alzheimer’s and dementia patients to patients who are undergoing treatment for cancer.

Laura’s reaction was no surprise to me. We witness this type of reaction all the time when Lunar — with her chestnut brown coat and blonde eyelashes and her gentle demeanor — or one of her fellow mini-horses meet our clients. I recall another visit between a young man who was blind and disabled and Turnabout, a 3-year-old mini-horse. Turnabout is the only boy in the bunch and has the biggest personality. When the young man put his hands on Turnabout’s face, they obviously made a connection because the man laughed exuberantly again and again. 

It brings us joy to see the light, laughter and hope our minis provide to people experiencing profound illnesses or disabilities — not to mention that these visits can lead to improved physical, mental and emotional well-being. 

I remember when the idea of working with mini-horses came to me. I was surfing the Internet one evening in December 2011 after volunteering with my two therapy dogs, Buffet and Dudley, when an advertisement caught my eye. “Mini Therapy Horses for Sale,” it said. I thought, “I have two big horses, so I know horse behavior, and I’ve done a lot of obedience training with my two therapy dogs. I can train mini-horses to do the same thing that Buffet and Dudley do.” 

But I knew I couldn’t do it alone. Two months later, I had established a volunteer board of directors, including founding board member and friend Dina Morgan, RN, and had acquired three mini-horses — Lunar, Turnabout and 3-year-old Mystery, our smallest horse. In 2013, 2-year-old Jenella joined the group. 

Mane in Heaven volunteers and mini-horses began site visits in June 2013, and since then our volunteers and horses have visited with thousands of people in need. We have relationships with numerous providers and non-profit organizations in the region, including Marklund, a home for infants, children, teens and adults with serious developmental disabilities; Gigi’s Playhouse, which cares for children and adults with Down Syndrome; Wings, which advocates for survivors of domestic violence, as well as homeless women and children; JourneyCare, which specializes in palliative medicine and hospice care; and Rush University Medical Center, a premier hospital located in Chicago. 

A site visit usually lasts up to two hours and involves an exchange of unconditional love between the horses and our clients. People watch, pet, brush, hug and take pictures with the minis. Rather than thinking and talking about themselves and their problems, our clients focus on the animals. When our horses visit a care facility, the residents laugh and interact more, are mentally stimulated by the entertainment and are able to recall personal memories more readily. 

When Corin Garcia, 19, from Palos Hills, Ill., met Lunar at a Mane in Heaven visit at Rush University Medical Center, it changed her whole perspective on her pending treatment. Corin told me it was a day she dreaded more than anything — admission day for “four tedious, boring days of chemotherapy,” she said. But Corin’s attitude changed when her she met Lunar. “I was in an awful mood, yet when two miniature horses walked through the door my mind cleared all its negative thoughts and my heart instantly melted. Being around these beautiful creatures made the worse day turn into the best I have ever had in the hospital.”

Mane in Heaven does not charge for visits; we rely on donations and fundraising, so fundraising is important work for our volunteers. Interest is growing in our services, thanks, in part, to media coverage by CNN, the Associated Press, and local media outlets. Having the support of volunteers helps us to maximize donations, but we hope to find others who believe in our mission and will also support us financially. While our horses are tiny, there are still significant expenses associated with running our organization. One day we’d love to open our own therapy center and acquire more horses, so we can serve more people. 

Running a nonprofit business is challenging while also working full time, but I really never feel like this is work for me. While I may have had the vision for Mane in Heaven, our volunteers have made it a reality. We have a group of amazing and generous volunteers who help special horses help special people. Everyone has challenges in their lives, but whether we are with the minis at training sessions or on visits, we always feel happier and joyful after some “mini love.” We are the privileged ones to be on the other end of the rope.

Source: http://news.nurse.com

By DANNY HAKIM

ATHENS — Fotini Katsigianni wears a white nurse’s hat that protrudes prominently from the top of her head. She is head nurse at Evangelismos Hospital, one of the city’s most prominent.

So she was surprised last month when she was approached by a man in the hospital’s hallway. At the time, Ms. Katsigianni’s husband was a patient there. The strange man extended an arm with a business card and averted his face, so she could not identify him. He offered to rent her a cut-rate nurse.

“He told me for 30 euros I could have whatever I want!” Ms. Katsigianni said, laughing at the idea of the head nurse being solicited to buy illegal nursing care.

First the men come to the hospitals of Greece during visiting hours, leaving business cards with pictures of nurses under pillows and in waiting rooms. Then the women come at night, mostly foreigners from countries like Georgia, Romania and Bulgaria. They are the nurses of Greece who aren’t really nurses.

Greece’s dire finances have gutted its health care system. Universal coverage effectively ended under the austerity measures imposed under the terms of the country’s bailout. Budget cuts have also thinned the ranks of hospital staff nurses, who are supposed to handle medical tasks like changing IVs.

Now, when patients come to a hospital in Greece, they increasingly have to hire their own nurses just to receive basic care. While private nurses have long been a feature of Greek health care, the country’s wrenching economic crisis has left many patients with neither the money nor the insurance coverage to hire licensed caregivers.

Instead, patients are turning to illegal nurses, often immigrants with little or no training. One top official said he believed that half of the nursing care came from 18,000 illegal providers.

The situation reflects the grip of the black-market economy on Greece, where even paying skilled workers like mechanics and plumbers under the table to avoid taxes is commonplace. Frustrations among Greeks over the deterioration of living standards helped feed the left-wing Syriza Party, which came to power last month vowing to reject austerity policies.

Illegal nurses typically pose as family members or say they are longtime personal employees of a patient. In reality, temp agencies employing these women send men into the hospitals to distribute business cards advertising 12 hours of nursing care for less than $60. By contrast, a contract nurse at another hospital, Sotiria, costs nearly $70 for 6 hours and 40 minutes, though those who still have insurance can be reimbursed for about a third of the cost.

Thanos Maroukis, a professor at the University of Bath, England, who has studied the problem, said temporary agencies are taking “over control of the hospital’s workplace,” adding, “It’s incredible what’s happening, but it’s true.”

Nurses are just the beginning. Almost anything can be rented.

“We have the same thing with TVs, with ambulances, I would say with bedding,” said Anastasios Grigoropoulos, the chief executive of Evangelismos Hospital. “Or chairs.”

Chairs are carried in by strangers who rent them to groups of visiting relatives. Or they bring televisions.

In many other developed countries, hospital security would simply expel unauthorized visitors. But administrators face staff shortages and impoverished patients. They also say they lack the legal jurisdiction to act without police intervention.

“Because of the crisis, the last three years, we see more and more illegal nurses,” said Mr. Grigoropoulos. “You can’t do anything.”

He has called the police, and a few days earlier, Evangelismos was raided. Several illegal nurses were arrested, but that is a fairly rare event, because the police have had their own cutbacks.

Government agencies, too, have been overwhelmed. An influx of immigrants since the 1990s swelled a pool of cheap labor.

These immigrants “filled the space and found themselves in every clinic and every hospital,” said Dimitrios Papachristou, a senior official at the Social Insurance Institute, a state agency known by its Greek acronym, IKA, which provides insurance and pensions to 2.2 million Greek workers, including nurses. “Why is that? There was a great demand by the patients” for cheaper care, Mr. Papachristou said.

Part of the problem, he said, was that his agency had been given the task of conducting inspections of nursing credentials, a task beyond its typical expertise.

“Let me give you an example,” he said. “I’ll send an inspector to a hospital to inspect contract nurses who work there. So I find at that hospital 15 people who are working there do not have an IKA permit.”

But often he does not have the authority even to issue fines. Instead, his agency reports such incidents to hospital directors, and they decide whether to call the police.

“It’s an extremely illogical thing,” he said.

Because most illegal nurses are immigrants, Golden Dawn, the far-right extremist party, has attempted some of its own “raids” on hospitals, advancing its xenophobic agenda.

But some of the real nurses having trouble getting work are themselves immigrants, like Eleni Souli, a 41-year-old Albanian who married a Greek man and works as a contract nurse. She was sitting among a group of eight other nurses at a cafe outside another Athens hospital recently. All had studied for two to four years to become nurses, and they poured out their frustration over coffee and cigarettes.

“They are not nurses," Ms. Souli said of the illegal workers.

Maria Skiada, 54, has been a nurse for 23 years. She said she recently saw a woman who did not even use gloves when she cleaned up.

“That is how you get bugs all around the hospital,” she said.

Ms. Souli said doctors would sometimes be surprised at how infections spread.

“When they see that in the blood work of a patient, they’ll see something and say, ‘Where did he get that from?’ ”

She counted eight illegal nurses at the clinic where she worked the previous evening. “At night,” she said, “it’s full of them.”

That was clear in another part of town, at Sotiria Hospital, on a recent chilly night.

A young Georgian woman in a striped blue shirt was caring for a patient. She said she had already been working at the patient’s home and came with him to the hospital, a claim administrators say is frequently used. A second woman peeked out of the room next door, then waved away questions, saying she could not speak Greek.

“They take food out of our mouths. That’s how it is,” said Stavroula Antoniou, 46, a licensed nurse who works on temporary contracts at Sotiria. She emphasized that her bitterness was not tinged with racism and that many legitimate nurses were foreign-born.

“We’ve earned this,” she said of her job. “We’ve studied and we’ve sat in classrooms.”

Dr. Miltiadis Papastamatiou, Sotiria’s chief executive, said retired nurses were often not replaced, “and that’s led to the needs of both patients and staff not being adequately met,” though he downplayed the extent of the problem at Sotiria.

But a staff nurse there, who would not give her name for fear of losing her job, acknowledged the severity of the issue.

“We know what’s going on,” she shrugged. “Everybody knows.”

Source: www.nytimes.com

Written by James McIntosh

While many would rather not think about when someone might die, knowing how much longer a seriously ill person has left to live can be very useful for managing how they spend their final days. Researchers have now revealed eight signs in patients with advanced cancer associated with death within 3 days.

Diagnosis of an impending death can help clinicians, patients and their friends and family to make important decisions. Doctors can spare time and resources by stopping daily bloodwork and medication that will not make a short-term difference. Families will know if they still have time to visit their relatives.

"This study shows that simple bedside observations can potentially help us to recognize if a patient has entered the final days of life," says study author Dr. David Hui.

"Upon further confirmation of the usefulness of these 'tell-tale' signs, we will be able to help doctors, nurses, and families to better recognize the dying process, and in turn, to provide better care for the patients in the final days of life."

The study, published in Cancer, follows on from the Investigating the Process of Dying Study - a longitudinal observational study that documented the clinical signs of patients admitted to an acute palliative care unit (APCU). During the study, the researchers identified five signs that were highly predictive of an impending death within 3 days.

For the new study, the researchers again observed the physical changes in cancer patients admitted to two APCUs - at the MD Anderson Cancer Center in Houston, TX, and the Barretos Cancer Hospital in Brazil.

Eight highly-specific physical signs were identified

A total of 357 cancer patients participated in the study. The researchers observed them and documented 52 physical signs every 12 hours following their admission to the APCUs. The patients were observed until they died or were discharged from the hospitals, with 57% dying during the study.

The researchers found eight highly-specific physical signs identifiable at the bedside that strongly suggested that a patient would die within the following 3 days if they were present. The signs identified were:

• Decreased response to verbal stimuli
• Decreased response to visual stimuli
• Drooping of "smile lines"
• Grunting of vocal cords
• Hyperextension of neck
• Inability to close eyelids
• Non-reactive pupils
• Upper gastrointestinal bleeding.

With the exception of upper gastrointestinal bleeding, all of these signs are related to deterioration in neurocognitive and neuromuscular function.

Neurological decline strongly associated with death

"The high specificity suggests that few patients who did not die within 3 days were observed to have these signs," the authors write. "These signs were commonly observed in the last 3 days of life with a frequency in patients between 38% and 78%. Our findings highlight that the progressive decline in neurological function is associated with the dying process."

As the study is limited by only examining cancer patients admitted to APCUs, it is not known whether these findings will apply to patients with different types of illness. The findings are currently being evaluated in other clinical settings such as inpatient hospices.

On account of the relatively small number of patients observed for this study, the authors also suggest that their findings should be regarded as preliminary until validated by further research.

In the meantime, the authors of the study are working to develop a diagnostic tool to assist clinical decision-making and educational materials for both health care professionals and patients' families.

"Upon further validation, the presence of these telltale signs would suggest that patients [...] are actively dying," they conclude. "Taken together with the five physical signs identified earlier, these objective bedside signs may assist clinicians, family members, and researchers in recognizing when the patient has entered the final days of life."

Source: www.medicalnewstoday.com