Category Archives: Nursing Education

‘Obesity can reduce life by up to 8 years’

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Life expectancy can be reduced by up to 8 years by obesity, which can also cause adults to lose as much as 19 years of healthy life if it leads to type 2 diabetes and cardiovascular disease. A study published in The Lancet Diabetes & Endocrinology examines the issue.

 

The researchers behind the study analyzed data from the US National Health and Nutrition Examination Survey (NHANES), creating a disease-simulation model to estimate the risk of adults of different body weightdeveloping diabetes and cardiovascular disease.

From this, the researchers then calculated the extent to which overweight and obesity may contribute to both years of life lost and years of healthy life lost in American adults aged between 20 and 79 years old, in comparison to people of normal weight.

They found that people who were overweight (BMI 25-30 kg/m2) were estimated to lose up to 3 years of life, depending on age and gender. Individuals classed as obese (BMI 30-35 kg/m2) were calculated to lose up to 6 years, and people classed as very obese (BMI 35 kg/m2 or more) could lose up to 8 years of life.

According to the study, excess weight had the greatest impact on lost years of life among the young and dropped with increasing age.

Obesity can cause the loss of up to 19 ‘healthy life-years’

As well as reducing life expectancy, carrying extra weight was also found to reduce “healthy life-years,” which were defined in the study as years free of obesity-linked cardiovascular disease and diabetes.

Young adults aged between 20 and 29 showed the highest losses of healthy life-years, adding up to around 19 lost years for very obese people. Among people who were overweight or obese, the researchers calculated that two to four times as many healthy life-years were lost than total years of life lost.

Dr. Steven Grover, lead author and professor of medicine at McGill University and a clinical epidemiologist at the Research Institute of the McGill University Health Centre in Canada, explains the findings:

“The pattern is clear. The more an individual weighs and the younger their age, the greater the effect on their health, as they have many years ahead of them during which the increased health risks associated with obesity can negatively impact their lives.

These clinically meaningful calculations should prove useful for obese individuals and health professionals to better appreciate the scale of the problem and the substantial benefits of a healthier lifestyle, including changes to diet and regular physical activity.”

This week on Medical News Today, we also looked at a study published in The BMJ that found obesity during early pregnancy is a risk factor for infant mortality.

The researchers behind that study found that infant mortality was “moderately increased” among overweight and mildly obese mothers (BMI 25-35 kg/m2) compared with mothers of a normal weight; but among more obese mothers (BMI over 35 kg/m2), the risk of infant mortality was more than doubled.

We also reported on a study in the journal Preventing Chronic Disease that found women – particularly black women – are more at risk of increased obesity if they work jobs that involve a lot of sitting down.

Written by David McNamee

http://www.medicalnewstoday.com/articles/286518.php

 

 

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80 percent reduction in ‘alarm fatigue’ in hospitals

Nurses

The sound of monitor alarms in hospitals can save patients’ lives, but the frequency with which the monitors go off can also lead to “alarm fatigue,” in which caregivers become densensitized to the ubiquitous beeping.

Researchers at Cincinnati Children’s Hospital Medical Center have tackled this problem and developed a standardized, team-based approach to reducing cardiac monitor alarms. The process reduced the median number of daily cardiac alarms from 180 to 40, and increased caregiver compliance with the process from 38 percent to 95 percent.

“Cardiac monitors constitute the majority of alarms throughout the hospital,” says Christopher Dandoy, MD, a physician in the Cancer and Blood Diseases Institute at Cincinnati Children’s and lead author of the study. “We think our approach to reducing monitor alarms can serve as a model for other hospitals throughout the country.”

The main accrediting body for healthcare organizations and programs, the Joint Commission, reported 80 alarm-related deaths between January 2009 and June 2012.

Dr. Dandoy’s study of this project was published in the eFirst pages of the journal Pediatrics.

The researchers developed a standardized cardiac monitor care process on the 24-bed, pediatric bone marrow transplant unit at Cincinnati Children’s. The project involved a process for initial ordering of monitor parameters based on age-appropriate standards, daily replacement of electrodes in a manner that was pain-free for patients, individualized daily assessment of cardiac monitor parameters and a reliable method for appropriate discontinuation of the monitors.

“With fewer false alarms, the staff can address significant alarms more promptly,” says Dr. Dandoy. “We believe the roles and responsibilities entailed in this process can be applied to most units with cardiac monitor care.”

Dr. Dandoy designed and conducted the study along with colleagues in the Cancer and Blood Diseases Institute and in the James M. Anderson Center for Health Systems Excellence at Cincinnati Children’s.

http://www.medicalnewstoday.com/releases/285215.php

 

 

Tightened guidance for U.S. healthcare workers on personal protective equipment for Ebola

Nurses

The Centers for Disease Control and Prevention is tightening previous infection control guidance for healthcare workers caring for patients with Ebola, to ensure there is no ambiguity. The guidance focuses on specific personal protective equipment (PPE) health care workers should use and offers detailed step by step instructions for how to put the equipment on and take it off safely.

Recent experience from safely treating patients with Ebola at Emory University Hospital, Nebraska Medical Center and National Institutes of Health Clinical Center are reflected in the guidance.

The enhanced guidance is centered on three principles:

  • All healthcare workers undergo rigorous training and are practiced and competent with PPE, including taking it on and off in a systemic manner
  • No skin exposure when PPE is worn
  • All workers are supervised by a trained monitor who watches each worker taking PPE on and off.

All patients treated at Emory University Hospital, Nebraska Medical Center and the NIH Clinical Center have followed the three principles. None of the workers at these facilities have contracted the illness.

Principle #1: Rigorous and repeated training

Focusing only on PPE gives a false sense of security of safe care and worker safety. Training is a critical aspect of ensuring infection control. Facilities need to ensure all healthcare providers practice numerous times to make sure they understand how to appropriately use the equipment, especially in the step by step donning and doffing of PPE. CDC and partners will ramp up training offerings for healthcare personnel across the country to reiterate all the aspects of safe care recommendations.

Principle #2: No skin exposure when PPE is worn

Given the intensive and invasive care that US hospitals provide for Ebola patients, the tightened guidelines are more directive in recommending no skin exposure when PPE is worn.

CDC is recommending all of the same PPE included in the August 1, 2014 guidance, with the addition of coveralls and single-use, disposable hoods. Goggles are no longer recommended as they may not provide complete skin coverage in comparison to a single use disposable full face shield. Additionally, goggles are not disposable, may fog after extended use, and healthcare workers may be tempted to manipulate them with contaminated gloved hands. PPE recommended for U.S. healthcare workers caring for patients with Ebola includes:

  • Double gloves
  • Boot covers that are waterproof and go to at least mid-calf or leg covers
  • Single use fluid resistant or imperable gown that extends to at least mid-calf or coverall without intergraded hood.
  • Respirators, including either N95 respirators or powered air purifying respirator (PAPR)
  • Single-use, full-face shield that is disposable
  • Surgical hoods to ensure complete coverage of the head and neck
  • Apron that is waterproof and covers the torso to the level of the mid-calf should be used if Ebola patients have vomiting or diarrhea

http://www.medicalnewstoday.com/releases/284226.php

 

Mild traumatic brain injury can have lasting effects for families, reports the American Journal of Nursing

Nurses

Families of patients with mild traumatic brain injury (TBI) may expect them to return to normal quickly – after all, it’s “just a concussion.” But mild TBI can have a lasting impact on families as well as patients, according to a review in the November issue of American Journal of Nursing. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

“With the increasing numbers of people with mild TBI in the community, it’s crucial for nurses to make this a part of assessment for early recognition and intervention,” comments Maureen Shawn Kennedy, MA, RN, Editor-in-Chief of American Journal of Nursing. “Nurses may often be the first health professionals who, hearing the complaints of the patient or family member, might recognize that they’re having difficulty adjusting to the family impact of head injury.”

Mild TBI Affects Families, Not Just Patients

The article by Kyong S. Hyatt, PhD, RN, FNP, of Walter Reed National Military Medical Center discusses the ways mild TBI can affect patients and families. Important causes of mild TBI include sports injuries, motor vehicle accidents, and falls. In addition, many veterans are dealing with TBI sustained while serving in Iraq or Afghanistan. Yet so far, patient and family adjustment after mild TBI has received “scant” attention in the medical literature.

Patients with mild TBI may have a range of cognitive, physical, and psychological symptoms. In most patients, these symptoms resolve promptly – but “a subset experience persistent symptoms that create unique treatment challenges,” Hyatt writes. The injured patient may express stress in the form of anger, depression, and anxiety – sometimes perceived by family members as a “personality change.” Without prompt recognition and intervention, mild TBI can have a major impact in terms of reintegration into to the family, changes in family functioning, and disrupted family relationships.

Family members may not understand that the person may have difficulty doing everyday tasks – for example, balancing a checkbook or helping children with homework. The impact may be especially great for families that weren’t functioning well before the injury.

Nurses have a critical role to play in recognizing and responding to the impact of mild TBI on family functioning. Hyatt writes, “Finding ways to help the patient and family manage emotional distress and accept enduring changes may be the key to postinjury reintegration.”

Click here to read “Mild Traumatic Brain Injury.”

http://www.medicalnewstoday.com/releases/284054.php

 

 

An ingestible pill with needles could be the new form of injection

Nurses_Immunology

Imagine swallowing a pill with tiny needles instead of getting an injection. Then again, imagine swallowing a pill with tiny needles. It may sound painful, but according to the researchers who developed the novel capsule – which could replace painful injections – there are no harmful side effects.

The researchers, from the Massachusetts Institute of Technology (MIT) and Massachusetts General Hospital (MGH), have published the results of their study – which tested the microneedle pill in the gastrointestinal (GI) tracts of pigs – in the Journal of Pharmaceutical Sciences.

Though most of us would probably prefer swallowing a pill over having an injection, many drugs cannot be given in pill form because they are broken down in the stomach before being absorbed.

Biopharmaceuticals made from large proteins, such as antibodies – known as “biologics” – are used to treatcancer, arthritis and Crohn’s disease, and also include vaccines, recombinant DNA and RNA.

“The large size of these biologic drugs makes them nonabsorbable,” explains lead author MIT graduate student Carl Schoellhammer. “And before they even would be absorbed, they’re degraded in your GI tract by acids and enzymes that just eat up the molecules and make them inactive.”

In an effort to design a capsule that is capable of delivering a wide range of drugs – while preventing degradation and effectively injecting the medicine into the GI tract – Schoellhammer and colleagues constructed the capsule from acrylic, including a reservoir for the drug that is coated with hollow, 5 mm long needles made of stainless steel.

The capsule measures 2 cm long and 1 cm in diameter.

Needle capsule worked safely and effectively in pigs

The team notes that previous studies involving humans who have accidentally swallowed sharp objects have suggested swallowing a capsule coated with short needles could be safe. They explain that there are no pain receptors in the GI tract and that, as a result, patients would not feel any pain.

But to assess whether their capsule could safely and effectively deliver the drugs, the researchers tested the pill in pigs, using insulin in the drug reservoir.

The capsules took more than a week to move through the whole digestive tract, and there were no traces of tissue damage, the researchers say. Additionally, the microneedles effectively injected insulin into the lining of the pigs’ stomachs, small intestines and colons, which resulted in their blood glucose levels dropping.

The video below explains in more detail how the capsule works:

Co-lead author Giovanni Traverso, a research fellow at MIT’s Koch Institute for Integrative Cancer Research and gastroenterologist at MGH, notes that the pigs’ reduction in blood glucose was faster and larger than the drop observed from insulin injection.

“The kinetics are much better and much faster-onset than those seen with traditional under-the-skin administration,” he says. “For molecules that are particularly difficult to absorb, this would be a way of actually administering them at much higher efficiency.”

‘Oral delivery of drugs is a major challenge’

Though they used insulin for their tests in pigs, the researchers say they envision their capsule being used to deliver biologics to humans.

“This could be a way that the patient can circumvent the need to have an infusion or subcutaneous administration of a drug,” says Traverso.

Prof. Samir Mitragotri, a professor at the University of California-Santa Barbara – who was not involved in the research – says:

“This is a very interesting approach. Oral delivery of drugs is a major challenge, especially for protein drugs. There is tremendous motivation on various fronts for finding other ways to deliver drugs without using the standard needle and syringe.”

In terms of future modifications, the team plans to alter the capsule so that contractions of the digestive tract slowly squeeze the drug out of the capsule as it travels through the body, and they also want to make the needles out of degradable polymers and sugar that break off, becoming embedded in the gut lining and slowly disintegrating.

Written by Marie Ellis

Copyright: Medical News Today

http://www.medicalnewstoday.com/articles/283459.php

 

 

Hospital shares effective training program on advance directives and end-of-life care

Nurses

An educational program for nurses can help address knowledge gaps related to advance health care directives (AHCDs) – thus helping to ensure that patients’ wishes for care at the end of life are known and respected, reports a paper in the October/December Journal of Christian Nursing, official journal of the Nurses Christian Fellowship. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Maureen Kroning, EdD, RN, of Nyack (N.Y.) College and Good Samaritan Hospital presents her hospital’s experience with developing an inservice educational program to provide nurses with needed information on advance directives. She writes, “It is vital to recognize and address problems associated with AHCD so nurses can provide competent and compassionate care.”

Program Meets Nurses’ Need for Knowledge on Advance Directives

Research shows that, while most adults want their wishes for end-of-life care response, only about one-third have completed AHCDs. Despite the growing need for advance care planning, many health care professionals lack the knowledge to teach patients about advance directives.

At the study hospital, there was a “recognized problem” with AHCD education. On admission, patients were provided with an AHCD information packet and told to ask a nurse if they had any questions. “However,” Maureen Kroning writes, “nurses expressed not fully understanding AHCDs, feeling incompetent to educate patients, nor did they believe AHCD education was an important part of their role.”

A subsequent survey of 49 nurses found significant deficits in knowledge regarding AHCDs, especially among less-experienced nurses. Nurses “specifically and repeatedly” addressed the need for more AHCD education.

In response, the hospital developed an AHCD inservice education program, specifically addressing the knowledge gaps uncovered by the survey and tailored to the needs of adult learners. The two-hour program included information on AHCDs and living wills, and relevant federal and state laws. In addition to lecture and discussion, the program included role-playing opportunities and questions and answers. The online version of the article includes links to the author’s lecture slides and an AHCD patient booklet.

The educational program led to significant improvements in nurses’ knowledge of AHCDs. The hospital also saw vital changes in several areas related to AHCDs, including increased awareness of the problem by hospital leadership and the desire obtain further AHCD education by nurses.

Other hospitals have been provided with and are implementing the educational intervention. Providing time for nurses to attend the program during regular work hours is a key factor in ensuring access to the inservice program.

The experience highlights the need to provide nurses with practical and relevant information about AHCDs and end-of-life care, Maureen Kroning believes. She writes, “If nurses lack the education to effectively educate, how are patients going to make desired decisions about their wishes at the end of life?” She also highlights some key issues for further research related to AHCDs, including addressing patients’ distress around end-of-life care, issues surrounding healthcare team relationships, and the optimal timing of conversations with patients and families about completing an advance directive.

http://www.medicalnewstoday.com/releases/282625.php

 

 

Tinnitus less common in women who drink more coffee

Otolaryngology_Nursing

A new study finds that women who consume more caffeine are less likely to have tinnitus – a condition where a person perceives noise in one or both ears, or in the head, even though there is no external sound.

 

The researchers, from Brigham and Women’s Hospital (BWH) in Boston, MA, write about their findings in The American Journal of Medicine.

According to the American Tinnitus Association, around 50 million people in the US experience some degree of tinnitus, which is often described as “ringing in the ears” although some people also hear hissing, buzzing, roaring, clicking or chirping. Of these, about 1 million are so badly affected they cannot function normally day to day.

For the study, the researchers analyzed data on over 65,000 women with and without tinnitus from the Nurses’ Health Study II.

The women were aged between 30 and 44 at the start of the study in 1991, when researchers collected a wealth of information on medical history, lifestyle and diet. At this point, the average caffeine intake was 242.3 mg per day – the equivalent of nearly two and a half 8-ounce cups of coffee. Most of the caffeine consumed came from coffee drinking.

In 2009, 18 years after they joined the study, the women were asked questions about tinnitus, including date of onset, where applicable. When a woman reported experiencing symptoms either daily or on a few days per week, the researchers counted it as a case. They identified a total of 5,289 cases of reported incident tinnitus.

Women who consumed more caffeine less likely to be among tinnitus cases

When they analyzed the results, the team found the more caffeine women consumed, the less likely they were to be among the tinnitus cases.

Senior author Gary Curhan, a physician-researcher in BWH’s Channing Division of Network Medicine and professor of Medicine at Harvard Medical School, says:

“We observed a significant inverse association between caffeine intake and the incidence of tinnitus among these women.”

He and his and colleagues found that regardless of age, rates of tinnitus were 15% lower among women who consumed 450-599 mg a day of caffeine, compared with women who drank less than 150 mg a day (about one and a half 8-ounce cups of coffee).

Prof. Curham notes that while the reason behind the finding is unclear, we know that “caffeine stimulates the central nervous system, and previous research has demonstrated that caffeine has a direct effect on the inner ear in both bench science and animal studies.”

The researchers say more evidence is required before we can say whether increased caffeine intake might improve tinnitus symptoms.

Funds from the National Institutes of Health helped finance the study.

Medical News Today recently reported on another study where researchers found tinnitus affects processing of emotions. Writing in the journal Brain Research, they describe how, compared with people not affected by the condition, those with tinnitus process emotions differently in the brain.

Written by Catharine Paddock PhD

http://www.medicalnewstoday.com/articles/280775.php

 

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