Sunday, November 14, 2010

First aid rules that everyone needs to know-KevinMD.com

First aid is defined as the immediate care given to an acutely injured or ill person.  It can literally be life-saving so it behooves all of us to know some basic principles.

What follows are some rules that cover common conditions and general practices:

  1. Don’t panic.  Panic clouds thinking and causes mistakes.  When I was an intern and learning what to do when confronted with an unresponsive patient, a wise resident advised me when entering a “code blue” situation to always “take my own pulse first.”  In other words, I needed to calm myself before attempting to intervene.  It’s far easier to do this when you know what you’re doing, but even if you encounter a situation for which you’re unprepared, there’s usually some good you can do.  Focus on that rather than on allowing yourself an unhelpful emotional response.  You can let yourself feel whatever you need to feel later when you’re no longer needed.
  2. First, do no harm.  This doesn’t mean do nothing.  It means make sure that if you’re going to do something you’re confident it won’t make matters worse.  If you’re not sure about the risk of harm of a particular intervention, don’t do it.  So don’t move a trauma victim, especially an unconscious one, unless not moving them puts them at great risk (and by the way, cars rarely explode).  Don’t remove an embedded object (like a knife or nail) as you may precipitate more harm (e.g., increased bleeding).  And if there’s nothing you can think to do yourself, you can always call for help.  In fact, if you’re alone and your only means to do that is to leave the victim, then leave the victim.
  3. CPR can be life-sustaining.  But most people do it wrong.  First, studies suggest no survival advantage when bystanders deliver breaths to victims compared to when they only do chest compressions.  Second, most people don’t compress deeply enough or perform compressions quickly enough.  You really need to indent the chest and should aim for 100 compressions per minute.  That’s more than 1 compression per second.  If you’re doing it right, CPR should wear you out.  Also, know that CPR doesn’t reverse ventricular fibrillation, the most common cause of unconsciousness in a patient suffering from a heart attack.  Either electricity (meaning defibrillation) or medication is required for that.  But CPR is a bridge that keeps vital organs oxygenated until paramedics arrive.  Which is why…

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Facing doctor shortage, 28 states may expand nurses' role - USATODAY.com

A nurse may soon be your doctor. With a looming shortage of primary care doctors, 28 states are considering expanding the authority of nurse practitioners. These nurses with advanced degrees want the right to practice without a doctor's watchful eye and to prescribe narcotics. And if they hold a doctorate, they want to be called "Doctor."

For years, nurse practitioners have been playing a bigger role in the nation's health care, especially in regions with few doctors. With 32 million more Americans gaining health insurance within a few years, the health care overhaul is putting more money into nurse-managed clinics.

Those newly insured patients will be looking for doctors and may find nurses instead.

The medical establishment is fighting to protect turf. In some statehouses, doctors have shown up in white coats to testify against nurse practitioner bills. The American Medical Association, which supported the national health care overhaul, says a doctor shortage is no reason to put nurses in charge and endanger patients.

Nurse practitioners argue there's no danger. They say they're highly trained and as skilled as doctors at diagnosing illness during office visits. They know when to refer the sickest patients to doctor specialists. Plus, they spend more time with patients and charge less.

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Doctors' house calls making a comeback - USATODAY.com

Dr. Ina Li walked down the seventh-floor hallway of a local apartment building recently, pausing at each door to check the number.

She finally found the one of her patient, Katherine Talmo.

It's easier for Talmo if Li, a geriatrician, comes to her. The 90-year-old doesn't get out nearly as much since she stopped driving nine years ago. But she is determined to stay in her home.

"If I was in a nursing home, I'd only live for one more year," she said. "But if I live at home, I'll live to be 100."

The notion of doctors making house calls harkens back to an era before HMOs, medical centers and outpatient surgery centers.

Those visits offer insights not available during a 15-minute office visit. Doctors learn more about a patient's lifestyle, eating habits, their ability to take medicine and exercise.

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Music Therapy to Ease Pain and Emotional Distress in Patients With Hematologic Cancer Who Are Undergoing High-Dose Therapy and Stem Cell Transplantation - Full Text View - ClinicalTrials.gov

DISEASE CHARACTERISTICS:

  • Diagnosis of a hematologic malignancy

    • No leukemia
  • Planned high-dose therapy and autologous stem cell transplantation (HDT/ASCT) at Memorial Sloan-Kettering Cancer Center

PATIENT CHARACTERISTICS:

Age:

  • 18 and over

Performance status:

  • Not specified

Life expectancy:

  • Not specified

Hematopoietic:

  • Not specified

Hepatic:

  • Not specified

Renal:

  • Not specified

PRIOR CONCURRENT THERAPY:

Biologic therapy:

  • See Disease Characteristics
  • No prior HDT/ASCT

Chemotherapy:

  • See Disease Characteristics

Endocrine therapy:

  • Not specified

Radiotherapy:

  • Not specified

Surgery:

  • Not specified

More Like This, http://www.nursefriendly.com/cancer/

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Music Therapy, American Cancer Society

Music Therapy

Other common name(s): none

Scientific/medical name(s): none

Description

Music therapy is the use of music by health care professionals to promote healing and enhance quality of life for their patients. Music therapy may be used to encourage emotional expression, promote social interaction, relieve symptoms, and for other purposes. Music therapists may use active or passive methods with patients, depending on the individual patient’s needs and abilities.

Overview

There is some evidence that, when used with conventional treatment, music therapy can help to reduce pain and relieve chemotherapy-induced nausea and vomiting. It may also relieve stress and provide an overall sense of well-being. Some studies have found that music therapy can lower heart rate, blood pressure, and breathing rate.

How is it promoted for use?

Music therapists work with a variety of physical, emotional, and psychological symptoms. Music therapy is often used in cancer treatment to help reduce pain, anxiety, and nausea caused by chemotherapy. Some people believe music therapy may be a beneficial addition to the health care of children with cancer by promoting social interaction and cooperation.

There is evidence that music therapy can reduce high blood pressure, rapid heart beat, depression, and sleeplessness. There are no claims music therapy can cure cancer or other diseases, but medical experts do believe it can reduce some symptoms, aid healing, improve physical movement, and enrich a patient’s quality of life.

What does it involve?

Music therapists design music sessions for individuals and groups based on their needs and tastes. Some aspects of music therapy include making music, listening to music, writing songs, and talking about lyrics. Music therapy may also involve imagery and learning through music. It can be done in different places such as hospitals, cancer centers, hospices, at home, or anywhere people can benefit from its calming or stimulating effects. The patient does not need to have any musical ability to benefit from music therapy.

A related practice called music thanatology is sometimes used at the end of a patient’s life to ease the person’s passing. It is practiced in homes, hospices, or nursing homes.

What is the history behind it?

Music has been used in medicine for thousands of years. Ancient Greek philosophers believed that music could heal both the body and the soul. Native Americans have used singing and chanting as part of their healing rituals for millennia. The more formal approach to music therapy began in World War II, when U.S. Veterans Administration hospitals began to use music to help treat soldiers suffering from shell shock. In 1944, Michigan State University established the first music therapy degree program in the world.

Today, more than seventy colleges and universities have degree programs that are approved by the American Music Therapy Association. Music therapists must have at least a bachelor’s degree, 1,200 hours of clinical training, and one or more internships before they can be certified. There are thousands of professional music therapists working in health care settings in the United States today. They serve as part of cancer-management teams in many hospitals and cancer centers, helping to plan and evaluate treatment. Some music therapy services are covered by health insurance.

What is the evidence?

Scientific studies have shown the value of music therapy on the body, mind, and spirit of children and adults. Researchers have found that music therapy, when used with anti-nausea drugs for patients receiving high-dose chemotherapy, can help ease nausea and vomiting. A number of clinical trials have shown the benefit of music therapy for short-term pain, including pain from cancer. Some studies have suggested that music may help decrease the overall intensity of the patient’s experience of pain when used with pain-relieving drugs. Music therapy can also result in a decreased need for pain medicine in some patients, although studies on this topic have shown mixed results.

In hospice patients, one study found that music therapy improved comfort, relaxation, and pain control. Another study found that quality of life improved in cancer patients who received music therapy, even as it declined in those who did not. No differences were seen in survival between the 2 groups.

A more recent clinical trial looked at the effects of music during the course of several weeks of radiation treatments. The researchers found that while emotional distress (such as anxiety) seemed to be helped at the beginning of treatment, the patients reported that this effect gradually decreased. Music did not appear to help such symptoms as pain, fatigue, and depression over the long term.

Other clinical trials have revealed a reduction in heart rate, blood pressure, breathing rate, insomnia, depression, and anxiety with music therapy. No one knows all the ways music can benefit the body, but studies have shown that music can affect brain waves, brain circulation, and stress hormones. These effects are usually seen during and shortly after the music therapy.

Studies have shown that students who take music lessons have improved IQ levels, and show improvement in nonmusical abilities as well. Other studies have shown that listening to music composed by Mozart produces a short-term improvement in tasks that use spatial abilities. Studies of brain circulation have shown that people listening to Mozart have more activity in certain areas of the brain. This has been called the “Mozart effect.” Although the reasons for this effect are not completely clear, this kind of information supports the idea that music can be used in many helpful ways.

Some clinical trials that involve listening to music have shown no benefit on anxiety during surgical procedures, although one study that allowed patients to choose their own music showed improved anxiety levels. One recent review of studies looked at the effect of music on all types of pain and found a wide variation in its effects. The study authors observed that the best effects were on short-term pain after surgery. It is important to note that not all studies of music use music therapists, who assess the patient’s needs, circumstances, and preferences, as well as the different effects of certain types of music. This may account for some differences in clinical trial results.

Are there any possible problems or complications?

In general, music therapy done under the care of a professionally trained therapist has a helpful effect and is considered safe when used with standard treatment. Musical intervention by untrained people can be ineffective or can even cause increased stress and discomfort. Relying on this type of treatment alone and avoiding or delaying conventional medical care for cancer may have serious health consequences.

Additional resources

More information from your American Cancer Society

The following information on complementary and alternative therapies may also be helpful to you. These materials may be found on our Web site (www.cancer.org) or ordered from our toll-free number (1-800-ACS-2345).

Guidelines for Using Complementary and Alternative Therapies

Dietary Supplements: How to Know What Is Safe

The ACS Operational Statement on Complementary and Alternative Methods of Cancer Management

Complementary and Alternative Methods for Cancer Management

Placebo Effect

Learning About New Ways to Treat Cancer

Learning About New Ways to Prevent Cancer

References

Bodner M, Muftuler LT, Nalcioglu O, Shaw GL. FMRI study relevant to the Mozart effect: brain areas involved in spatial-temporal reasoning. Neurol Res. 2001;23:683-690.

Cepeda MS, Carr DB, Lau J, Alvarez H. Music for pain relief. Cochrane Database Syst Rev. 2006;(2):CD004843.

Clark M, Isaacks-Downton G, Wells N, et al. Use of preferred music to reduce emotional distress and symptom activity during radiation therapy. J Music Ther. 2006;43:247-265.

Ezzone S, Baker C, Rosselet R, Terepka E. Music as an adjunct to antiemetic therapy. Oncol Nurs Forum. 1998;25:1551-1556.

Hilliard RE. The effects of music therapy on the quality and length of life of people diagnosed with terminal cancer. J Music Ther. 2003;40:113-137.

Jausovec N, Habe K. The “Mozart effect”: an electroencephalographic analysis employing the methods of induced event-related desynchronization/synchronization and event-related coherence. Brain Topogr. 2003;16:73-84.

Krout RE. The effects of single-session music therapy interventions on the observed and self-reported levels of pain control, physical comfort, and relaxation of hospice patients. Am J Hosp Palliat Care. 2001;18:383-390.

Lane D. Music therapy: a gift beyond measure. Oncol Nurs Forum. 1992;19:863-867.

Lane D. Music therapy: gaining an edge in oncology management. J Oncol Manag. 1993;2:42-46.

Pelletier CL. The effect of music on decreasing arousal due to stress: a meta-analysis. J Music Ther. 2004;41:192-214.

Phumdoung S, Good M. Music reduces sensation and distress of labor pain. Pain Manag Nurs. 2003;4:54-61.

Schellenberg EG. Music and nonmusical abilities. Ann N Y Acad Sci. 2001;930:355-371.

Schellenberg EG. Music lessons enhance IQ. Psychol Sci. 2004;15:511-514.

Watkins GR. Music therapy: proposed physiological mechanisms and clinical implications. Clin Nurse Spec. 1997;11:43-50.

What is music therapy? American Music Therapy Association Web site. Accessed at www.musictherapy.org/ on May 23, 2008.

Note: This information may not cover all possible claims, uses, actions, precautions, side effects or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for consultation with your doctor, who is familiar with your medical situation.

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Consult-A-Nurse - HCA Hospitals, Florida

Consult-a-Nurse is a FREE community service from the HCA hospitals in your area, designed to help you find a physician, obtain health information, or register for an HCA hospital sponsored event in your community.

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Friday, November 12, 2010

Hospitals try high-tech to better inform patients - San Jose Mercury News

Click photo to enlarge
In this photo taken Oct. 29, 2010, Kristen Miller, a colonoscopy... ((AP Photo/Brian Kersey))
CHICAGO—Learning he had prostate cancer floored John Noble. Then came the prospect of surgery and his overpowering fear of being "put under" with anesthesia.

Remarkably, he found comfort in a computer. A soothing woman's voice explained the operation step-by-step, its risks and benefits, and even answered his questions. Noble's phobia vanished. The operation to remove his tumor was uneventful and Noble is doing fine.

The 54-year-old Pennsylvania lawyer was aided by an interactive computer program that is part of a growing trend in health care, helping patients better understand what they are consenting for the doctor to do.

Proponents say this way of getting informed consent makes patients partners in decision-making.

Such a system "sends a message that the decisions are truly owned by the patients," said Dr. Harlan Krumholz, a Yale University heart specialist and advocate of changing informed consent procedures.

Computer-based informed consent programs are also part of a broader push for electronic record-keeping that President Barack Obama's administration has advocated to improve patient safety and curb medical errors.

The Emmi Solutions program that John Noble watched about prostate cancer surgery can be viewed at home, and that's where Noble watched it.

Shortly after his diagnosis last December, while he was still grappling with shock and denial, his doctor e-mailed him the program.

"I put off watching it for a

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while," he said. "Who wants to be filled in on the facts of the surgery? Ultimately I forced myself to review it when I was all alone."

By the time he watched it, he felt better prepared mentally than when his doctor first told him he had cancer.

Noble said his biggest fear "was being knocked out. I was terribly afraid of it."

As the interactive explained the operation, Noble could pause it and ask questions or review the information to make sure he understood it.

"It changed my perspective. It removed my fear," he said.

Traditionally, informed consent has involved a conversation with the doctor and signing medical forms written in tough-to-decipher legalese.

It has a dual purpose: to make sure patients understand risks and benefits, and to protect hospitals from lawsuits in case something goes wrong.

Even for someone with a law degree, like Noble, that process can be dizzying in the emotional aftermath of a scary diagnosis.

Research shows patients often have no clue about what they just signed and may end up totally uninformed about why a procedure is being recommended or how it might help or hurt them.

Chicago-based Emmi Solutions has developed programs used in more than 100 hospitals, including the University of Pittsburgh Medical Center, where Noble had his surgery.

Dialog Medical in Atlanta makes another popular informed consent program, iMedConsent, used by more than 190 U.S. hospitals. It's designed for doctors and patients to go over together. Versions written for patients with a sixth-grade reading level are available.

The Department of Veterans Affairs now requires its doctors to use iMedConsent programs for all procedures needing informed consent. The VA estimates it will receive 2.6 million consent forms this year from patients who used the program.

Dr. Ellen Fox, the VA's chief health care ethics officer, recalls a patient who watched the program with his doctor before having a repeat test to see if his bladder cancer was back. Afterward, the man told his doctor he thought he would be having the same test he had four times before.

It was the same test. "But for the first time, the patient really understood what was going to be done to him," Fox said.

"In order to make informed choices about health care, patients need complete and accurate information," Fox said.

"It is ultimately the patient's choice" whether to have a procedure. It's just that patients may not realize they have a choice. The program helps make that clear, she said.

The University of Chicago Medical Center recently began requiring new patients referred for colonoscopies to watch an Emmi program, with hopes that it will reduce the no-show rate.

Kristen Miller, 29, an online marketer with an intestinal condition called Crohn's disease, watched the Emmi program before she had a recent colonoscopy.

Miller has had previous colon exams and wasn't nervous about the procedure. But for the inexperienced, she believes it would take away "the intimidation factor."

Knowing more about the procedure may make it seem less unpleasant, and better informed patients are more prepared for their treatment, said Dr. Stephen Hanauer, the hospital's gastroenterology chief.

Research has shown that better informing patients about their care also can make them less likely to sue if something goes wrong. Still, it's no guarantee, and computer-based informed consent programs provide an electronic record that gives hospitals extra ammunition against malpractice lawsuits.

When patients watch Emmi programs, stopping and starting them to review information, they create an electronic trail. Hospitals have used that data in court to argue that patients were informed about specific risks because they watched portions of the program where risks were detailed.

Sara Juster, a vice president at Nebraska Methodist Health System, says that feature may have played a role in a patient's recent decision to drop a lawsuit against Methodist Hospital in Omaha.

The patient had sued over a shoulder injury her baby suffered during childbirth, a problem her first child also had encountered. The woman had watched an Emmi program detailing risks for the injury, but claimed she had not been informed, Juster said.

The hospital had electronic documentation, so the woman dropped her suit.

Juster said most of the system's obstetricians give pregnant patients "prescriptions" to watch Emmi programs about labor and delivery. Within the past eight years, obstetrics-related suits against the system's hospitals have dropped by half, from about 12 a year to six.

———

Online:

Emmi Solutions: http://www.emmisolutions.com

Dialog Medical: http://www.dialogmedical.com

Foundation for Informed Medical Decision Making: http://www.informedmedicaldecisions.org/

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Violence in the ER-Emergency Department Nursing

A Maryland man made headlines last week when he shot and wounded a doctor at Johns Hopkins Hospital in Baltimore. But unfortunately, his story is no longer a rarity. Hospital violence is increasing in frequency — and ER nurses bear the brunt of the hostility.

According to the International Association for Healthcare Security and Safety and the Emergency Nurses Association, more than half of all emergency room nurses have been spit on, pushed, scratched and/or verbally assaulted on the job. Almost a quarter of ER nurses say they’ve been assaulted more than 20 times in the past three years.

ER nurses are particularly at risk because they often deal with intoxicated, confused or violent patients. Add to that increasing frustration over ER wait times and the healthcare system, and it’s easy to see why nurses are vulnerable.

While some hospitals are installing metal detectors in an effort in improve safety, many experts say that proper training is key to decreasing ER-based violence. All staff working in the ER should know:

  • Warning signs — If a patient is pacing with clenched fists, watch out. Also pay attention to patients’ speech patterns, history (have had they problems with authority in the past?) and diagnoses. Patients with psychiatric disorders and those under the influence of drugs or alcohol are more likely to lash out.
  • How to get help — Call for help as soon as you sense a threat.
  • De-escalation techniques — ER staff should be trained in special techniques designed to diffuse a potentially volatile situation.
  • What to do if violence occurs — Safety, of course, is number one. But after violent incident, report it! Hospital administration needs to know about each and every incident so that steps can be taken to create a culture of safety.

Have you ever been assaulted at work? Do you feel adequately trained to meet the threat of violence?

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ScienceDaily: Alzheimer's Research News

Hurting a nurse is a felony-New York State Law Passed

Assaulting a nurse is now a Class D felony under New York state law.

The Violence Against Nurses Law passed this week puts nurses into a protected group that includes police officers, firefighters and emergency responders. A physical attack on a registered nurse or licensed practical nurse (or one of the other service workers in the protected category) is considered a felony and is punishable by up to seven years in prison.

Workplace violence against nurses has been in the news a lot lately. A California psychiatric technician was allegedly killed at the hands of a patient. A doctor assaulted an ICU nurse while he was a patient in Intensive Care. According to the Emergency Nurses Association, between 8 percent and 13 percent of emergency department nurses are victims of physical violence each week.

While a number of states have considered or are currently considering increasing the penalty for assaulting a nurse, support for these measures have been limited. Similar bills failed in both North Carolina and Vermont; Virginia simply punted the proposal to the state crime commission. Ohio is still considering a change in the law.

The New York Nurses Association and Emergency Nurses Association both applaud passage of the legislation. However, they note that the new law is just part of the solution. Nurses also need training in communication and de-escalation techniques; they need proper equipment (including panic buttons and silent alarms) as well.

What do you think of the new law? Is your gut reaction, “About time!” or “What good will that do?” Discuss!

Any questions, please drop me a line.

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Sincerely,

Andrew Lopez, RN
Nursefriendly, Inc. A New Jersey Corporation.
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