Monday, February 28, 2011

Rare Fractures Linked To Drugs For Weak Bones : NPR

The study found 716 atypical fractures among more than 200,000 Ontario women over 68. The researchers calculate the risk at one or two atypical fractures for every 1,000 women who took bisphosphonate drugs for more than five years.

An X-ray of Schneider's right femur (thighbone), which broke  suddenly as she was standing on a New York subway train.
Enlarge Courtesy of Dr. Jennifer Schneider

An X-ray of Schneider's right femur (thighbone), which broke suddenly as she was standing on a New York subway train.

An X-ray of Schneider's right femur (thighbone), which broke  suddenly as she was standing on a New York subway train.
Courtesy of Dr. Jennifer Schneider

An X-ray of Schneider's right femur (thighbone), which broke suddenly as she was standing on a New York subway train.

That's fairly rare, and considerably less than the risk of another potential side effect from these drugs, a condition called osteonecrosis of the jaw — the death of part of the jawbone, following a major dental procedure. Still, since tens of millions of women are taking bisphosphonates, the Ontario study suggests thousands of them may suffer devastating atypical fractures every year.

But here's the dilemma: Many women really need these drugs, because they really do work to prevent ordinary hip fractures caused by osteoporosis.

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Governors: Medicaid More A Budget Buster Than Ever : NPR

The federal government and the states have shared the cost of Medicaid, the health insurance program for some 60 million low-income Americans, since it was created in 1965.

They've shared something else almost that long — arguments about who should foot how much of the ever-escalating bill.

"Medicaid cost growth has been a problem for time immemorial," says Alan Weil, executive director of the National Academy for State Health Policy.

But this time, he says, things are different.

For one thing, "the program is bigger, so growth on a larger base is more real dollars that's harder to find."

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Skip Dessert? Christie and Huckabee on First Lady’s Side

In the dessert wars, at least, Chris Christie and Mike Huckabee side with Michelle Obama, not Sarah Palin.

Some conservatives, notably Ms. Palin, have mocked Mrs. Obama’s campaign against obesity, particularly in children. But on separate Sunday morning news programs, Mr. Christie, the New Jersey governor, and Mr. Huckabee, the former Arkansas governor — both Republicans — defended Mrs. Obama, and Mr. Christie put his answer in personal terms.

“I think it’s a really good goal to encourage kids to eat better,” Mr. Christie said on “Face the Nation,” on CBS. “You know, I’ve struggled with my weight for 30 years, and it’s a struggle. And if a kid can avoid that in his adult years or her adult years, more power to them, and I think the first lady’s speaking out well.”

Mrs. Obama has urged parents and food manufacturers to make healthier choices available to children, adding that she tells her daughters, “Dessert is not a right.” She has not called for government mandates on the issue.

Even so, Ms. Palin, the former Alaska governor and 2008 Republican vice-presidential candidate, has called Mrs. Obama’s efforts an example of “government thinking that they need to take over and make decisions for us.” In a December episode of “Sarah Palin’s Alaska,” on TLC, Ms. Palin searched her kitchen for the ingredients to make s’mores, saying it was “in honor of Michelle Obama, who said the other day we should not have dessert.”

Conservatives like Rush Limbaugh and Glenn Beck have taken similar shots at Mrs. Obama.

But appearing on “Fox News Sunday,” Mr. Huckabee, who once shed more than 100 pounds, said that in fact Mrs. Obama was calling attention to a serious problem, not calling for government intrusion.

Asked about the criticism of Mrs. Obama, Mr. Christie said, “I think it’s unnecessary,” and he made a point of saying that he did not want the government telling people what to eat.

“But I think Mrs. Obama being out there,” he said, “encouraging people in a positive way to eat well and to exercise and to be healthy, I don’t have a problem with that.”

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Looking Photos of Loved Ones Gives Relief from Pain | TopNews United States

According to the scientists at Stanford University, looking pictures of loved ones reduces pain.

Their study revealed that watching image of romantic partner dulls the activity in the pain-processing part of the brain, to a same degree as paracetamol or cocaine.

In this study, brains of love struck students were subjected to MRI scan as they were made to focus on their love partners while varying heat pains were given on their skin.

Neuroscientist Jarred Younger found that average pain got reduced by 36 to 44 percent and intense pain got reduced by 13 percent.

In a study published in the U. S. journal Public Library of Science, the post-doctoral scholar said, "The reduction of pain is associated with higher, cortical parts of the brain."

It was found that more primitive aspect of the brain block pain at a spinal level, quite similar to how opoid analgesics work.

Key site for love-induced analgesia is the nucleus accumbens, a key reward addition centre for opoids, and other drugs. This tells us that we do not need to depend on drugs to reduce pain.

Researchers at the University of California found that women showed significant reduction in pain experience while holding their partner’s hand.

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Medical News: AAN: Third Language a Charm in Warding Off Dementia - in Meeting Coverage, AAN from MedPage Today

Speak English? Parlez français? Habla español?

Those who can say yes, oui, or sí to all three questions are significantly more likely to avoid cognitive problems late in life than those who speak only two languages, according to Magali Perquin, PhD, of the Public Research Center for Health in Luxembourg, and colleagues.

Moreover, the effect appears to add up -- more languages equal a lower risk of cognitive impairment, Perquin and colleagues reported in a study to be presented at the American Academy of Neurology meeting in Honolulu in April.

Action Points  
  • Note that this study was to be published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.

  • Note that in this study multilingualism was protective against cognitive impairment in seniors, and the more languages spoken the better.
  • Point out that this study cannot determine causality.
  • "It appears speaking more than two languages has a protective effect on memory in seniors who practice foreign languages over their lifetime or at the time of the study," Perquin said in a statement.

    The findings, from a study of 230 people with an average age of 73, fit into the context of a growing body of literature that suggests a so-called "cognitive reserve" -- developed by intellectual activities -- protects against dementia.

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    Creative Storytelling Intervention Helps Dementia Patients | National Nursing News

    Participation in a creative storytelling intervention improves communications skills and demeanor in people with dementia, according to a study by University of Missouri researchers.

    The program, TimeSlips, encourages participants to use their imaginations to create short stories as a group. Participation does not require factual recall, but rather responses to humorous images presented by facilitators. The facilitators record the responses and read narratives to further develop or conclude the stories.

    “TimeSlips provides rich, engaging opportunities for persons with dementia to interact with others while exercising their individual strengths,” said Lorraine Phillips, RN, PhD, FNP-BC, assistant professor in the Sinclair School of Nursing.

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    Food safety, drug safety, and pregnancy information are among eight new topics included in our survey. | Pew Internet & American Life Project

    Health information remains one of the most important subjects that internet users research online. The Pew Internet Project and California HealthCare Foundation have added eight new topics to our national survey measuring internet users’ interest in health information:

    • 29% of internet users look online for information about food safety or recalls.
    • 24% of internet users look online for information about drug safety or recalls.
    • 19% of internet users look online for information about pregnancy and childbirth.
    • 17% of internet users look online for information about memory loss, dementia, or Alzheimer’s.
    • 16% of internet users look online for information about medical test results.
    • 14% of internet users look online for information about how to manage chronic pain.
    • 12% of internet users look online for information about long-term care for an elderly or disabled person.
    • 7% of internet users look online for information about end-of-life decisions.

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    The internet gives patients and caregivers access not only to information, but also to each other. | Pew Internet & American Life Project

    Many Americans turn to friends and family for support and advice when they have a health problem. This report shows how people’s networks are expanding to include online peers, particularly in the crucible of rare disease. Health professionals remain the central source of information for most Americans, but "peer-to-peer healthcare" is a significant supplement.

    This report is based in part on a national telephone survey of 3,001 adults which captures an estimate of how widespread this activity is in the U.S. All numerical data included in the report is based on the telephone survey. The other part of the analysis is based on an online survey of 2,156 members of the National Organization for Rare Disorders (NORD) who wrote short essays about their use of the internet in caring for themselves or for their loved ones.

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    Sponge Count Off, Patient Develops Sepsis, Surgeon Blames Nurse.

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    Summary:  Sponge Counts are a basic and critical safety measure during a surgical operation.  In this case, the standard three counts were not performed.  A sponge was left in the patient that would later lead to infection.  When the issue went to court, the surgeon claimed "it was not his responsibility" to keep track of the sponges.

    The patient was admitted for surgical repair of a hernia.  The operation was performed and the patient returned to the floors without obvious incident.

    "A hernia is a weakness or defect in the abdominal wall. It may be present from birth, or develop over a period of time. If the defect is large enough, abdominal contents such as the bowels, may protrude through the defect causing a lump or bulge felt by the patient. Hernias develop at certain sites which have a natural tendency to be weak; the groin, umbilicus (belly button), and previous surgical incisions."1

    Post-operatively, the patient's incision would not heal.  It would soon after start to display signs of active infection.

    "Postoperative wound infections have an enormous impact on patients' quality of life and contribute substantially to the financial cost of patient care. The potential consequences for patients range from increased pain and care of an open wound to sepsis and even death. Approximately 1 million patients have such wound infections each year in the United States, extending the average hospital stay by one week and increasing the cost of hospitalization by 20 percent."5

    In investigating the situation, it would be found that a sponge had been left in the patient in the Operating Room.  The patient sued both the surgeons and the nurses who had assisted in the procedure.

    "Materials counts are necessary to provide a standard of quality of care for the surgical patient and to provide a method of accounting for items placed on the sterile field for use on a surgical procedure."2

    The patient claimed that substantial negligence on the part of the surgeon and nurses contributed to the sponge being missed and the development of complications.  These complications, the plaintiff asserted, could have been avoided had proper procedure been adhered to.  Specifically, if accurate sponge counts had been maintained and the missing sponge accounted for.

    Questions to be answered:

    1. Who is primarily responsible during an operation to verify sponge counts and prevent one from inadvertently being left in a patient.

    2. What are the explicit responsibilities of the Nurses and Physicians involved.

    For the operation in question, less than a dozen sponges were required.  It was standard policy and procedure for three sponge counts to be performed during the operation.

    Anytime there is a discrepancy, the surgeon is to be notified immediately.  Upon notification, it is his duty to the patient to resolve the discrepancy to the best of his ability.

    "In cases where there is an incorrect sponge count, wound closure absolutely must not be completed (unless the patient is unstable) until the missing sponge is accounted for. The surgeon should not pressure the nursing staff to ignore an incorrect count. If after appropriate steps have been taken to find the missing sponge or instrument and it is unsuccessful, every detail of the search should be documented and the surgery completed."3

    Neither the nurses or the surgeon involved stated that they clearly remember the operation in question.   The nurses' documentation of the event would show that only a single sponge count had been performed.  The hospital policy in effect at the time required three per procedure.

    "The nurses count the unused, sterile sponges and note on a form that sponges were counted.   When the surgeon completes the operation, the nurses do a second count by combining the number of  unused sponges with the number of used sponges that have been removed from the patient.  The total of the unused and used sponges must correspond to the number of sponges originally laid out prior to surgery.

    If the sponge count does not correspond, the surgeon is to be notified by the nurses.  The nurses complete a third count shortly before the surgeon closes the incision.   If nurses fail to account for a sponge, they are to report this directly to the surgeon.  The nurses must note the results of the second and third counts on the same form on which they  noted the initial count."

    The surgeon in his notes would document that a third count had been performed.  He also documented that only after receiving this confirmation from the nurse, did he "close" up the patient.

    Is it plausible that the surgeon simply documented as if by habit, that the third count had been completed?  A nurse documenting her assessment may sometimes by habit write "lungs clear" and "bowel sounds active x 4q."  A moment later it is realized that in fact that was not the case and a correction made.  Could the surgeon have fallen into the same trap?

    Upon discovery of the missed sponge and resulting infection, the surgeon insisted that "counting sponges" was not his responsibility.  He went on to explain how in the body cavities they can become soiled with blood and take on the color of internal viscera.

    It was the surgeon's argument that it was the nurses' responsibility, not his that a proper sponge count be maintained.  The surgeon, not the nurse is the person manipulating the sponges inside the patient's body.  Can the surgeon release himself from responsibility for a sponge left in a patient because he relied on an inadequate sponge count given by a nurse?

    "Counting is the legal responsibility of the surgical team. Each institution must develop a policy and procedure for such counts and should include the delineation of materials counted, interval of counts, mechanism for performing the count , and documentation of the count status on the intraoperative record. The responsibility for accurate sponge counts rests with the circulating and scrub nurses. The operating room nurses are charged with the responsibility to ensure that no foreign objects remain in the body at the conclusion of surgery."

    The standards of care clearly state that if a sponge is missing, the nurse must notify the surgeon.  There's little mystery to the fact that objects "left" inside patient's bodies can have catastrophic effects.

    The question remains, will the surgeon blaming the nurses get "off the hook" because a count was incorrectly reported?

    "While the surgeon may rely on the nurses' sponge counts the surgeon is ultimately responsible and liable for any foreign object left in a patient after surgery. Only x-ray detectable sponges should be utilized. A retained sponge occurs almost always in the presence of a normal sponge count."

    The trial court held, and appeals court confirmed that the surgeon shared in the negligence.  The standard of care governing both the nurses and the physicians respectively had been breached.

    It is quite interesting to observe how quickly the physician sought to "dump" the blame on the nurses.

    The nursing staff by poorly documenting the sponge counts (omitting the 2nd and third) left themselves open to scrutiny.  Had a proper count at least been documented, the surgeon would have had less ground to stand on when blaming the nurses for his mistake. Related Link Sections:

    Sponge Counts, Operating Room Links:

    Sources:

    1. Pleatman, MD, Mark A. No date given.  "Questions and Answers about Hernias."   Retrieved May 23, 1999 from the World Wide Web:  http://www.laparoscopy.com/pleatman/hernia.htm

    2. San Antonio Chapter of AORN.  No date given.  "Counts, Sponge, Needle, Instrument."  Retrieved May 23, 1999 from the World Wide Web: http://www.connecti.com/~remmert/p0008.txt

    3. The Standard of Care. August 1998. "Retained Surgical Foreign Body."  Retrieved May 23, 1999 from the World Wide Web: http://www.standardofcare.com/publications/980801.htm

    4. 38 RRNL 2 (July 1997

    5. Woods, Ronald K.  and Dellinger, E. Patchen. June 1998.  "Current Guidelines for Antibiotic Prophylaxis of Surgical Wounds." Retrieved May 23, 1999 from the World Wide Web: http://www.aafp.org/afp/980600ap/woods.html
     

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    Send comments and mail to Andrew Lopez, RN

    Created on Saturday, May 22, 1999

    Last updated by Andrew Lopez, RN on Monday, February 28, 2011

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    DAISY Foundation - Welcome

    DAISY is an acronym for Diseases Attacking the Immune System. The Foundation was formed in January, 2000, by the family of J. Patrick Barnes who died at age 33 of complications of Idiopathic Thrombocytopenic Purpura (ITP).

    Everyone who met Pat even once was touched by his positive spirit and his sense of humor. Twice a survivor of Hodgkin's Disease, Pat was driven by a desire to befriend others and help them in any way he could. His legacy is clear: whenever he came across anyone in need, he never turned his back. He reached out to comfort, to make them feel okay. Pat was a natural mentor, sharing his phenomenally positive outlook on life with a wide network of friends and family around the country with whom he stayed in constant contact. The DAISY Foundation was established to keep his very special spirit alive.

    As we brainstormed what to do in Pat's memory, the one really positive thing we could hold onto from the experience of his eight-week illness was the skillful and amazingly compassionate care he received from his nurses - even when he was totally sedated. So we created The DAISY Award For Extraordinary Nurses to recognize the super-human work nurses do every day all over the country. This program achieves one of the four goals we established for The Foundation, the others being

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